2024 MHPAEA Rule: Enforcement Halted, Parity in Limbo

Establishing Equal Footing: The Mental Health Parity and Addiction Equity Act

Enacted in 2008, the Mental Health Parity and Addiction Equity Act (“MHPAEA” or the “Act”) aims to ensure that coverage for mental health or substance use disorders (“MH/SUD”) isn’t more restrictive than coverage for medical or surgical care. Simply put, it requires that MH/SUD benefits are on equal footing with other medical treatments.

The MHPAEA applies to all employer-sponsored group health plans except those sponsored by employers with fewer than 50 employees. The Act does not require covered plans to offer MH/SUD benefits. Instead, it mandates that if MH/SUD benefits are provided, such benefits cannot have more restrictive barriers, such as different financial requirements or treatment limits, than benefits for medical or surgical care.

Staying in Compliance

In 2020, the Consolidated Appropriations Act, 2021 (CAA) amended the MHPAEA to require group health plans and health insurers to perform and record comparative analyses to show how non-quantitative treatment limitations (“NQTLs”) are designed and applied to MH/SUD benefits as compared to medical or surgical care benefits. The Department of Health and Human Services, the Department of Labor, and the U.S. Treasury (the “Departments”) may request a comparative analysis from employers in the event of a potential violation of MHPAEA or in any instance they deem appropriate.

In 2024, new regulations jointly issued by the Departments (the “2024 Rule”) clarified and further expanded the MHPAEA. These updates require plans to:

Offer meaningful MH/SUD benefits, if provided by the plan, wherever meaningful medical and surgical benefits exist;
Collect and analyze outcome data to identify any MH/SUD disparities through a complex comparative analysis;
Ensure plan fiduciaries certify they used a prudent process to select and monitor vendors conducting the mandated comparative analyses; and
Safeguard the plan by prohibiting the use of factors or evidentiary standards that systematically disadvantage MH/SUD benefits.

Halt! Trump Administration Not Enforcing 2024 Rule

On May 15^th, 2025, the Departments announced they will not enforce the 2024 Rule, in response to a motion filed by the Departments in the ERISA Industry Committee (ERIC) v. U.S. Dept. of H.H.S. et. al. lawsuit, in which ERIC challenged the 2024 Rule. The “non-enforcement period” is set to last 18 months after a final decision is reached in the ongoing ERIC lawsuit. In essence, the more stringent requirements introduced by the 2024 Rule are temporarily on hold while the legal challenge proceeds and the Departments reconsider the 2024 Rule.

Where Do We Go from Here?

Despite the nonenforcement of the 2024 Rule, employers and plan sponsors must continue to comply with MHPAEA, including the following:

The CAA: The statutory requirement that plans complete a comparative analysis is not halted by the ERIC lawsuit, meaning employers and plan sponsors must continue to perform comparative analyses for any group health plan that offers MH/SUD benefits.
2013 Rule: Further, the final regulations published in 2013 (the “2013 Rule”) are still in effect and enforceable. The 2013 Rule mandates that plans and insurers offering MH/SUD benefits have parity in the financial requirements, qualitative treatment limitations, and non-qualitative treatment limitations of MH/SUD benefits as compared to any medical or surgical benefits, across all benefit classifications. Benefit classifications include (i) inpatient, in-network; (ii) inpatient, out-of-network; (iii) outpatient, in-network; (iv) outpatient, out-of-network; (v) emergency care; and (vi) prescription drugs.
State Parity Laws: Employers must remain vigilant about state-specific parity laws. It’s crucial to verify if your state has independently adopted any provisions from the 2024 Rule, as such state-level mandates would still require compliance. For example, Nebraska has not adopted the 2024 Rule. Therefore, group health plans and insurers operating in Nebraska should continue to adhere to the 2013 Regulations and the requirements of the CAA.

Please contact our benefits team if you have more questions about how to ensure compliance under the ever-evolving MHPAEA landscape.

Carrie E. Schwab
Linnea N. Jorgenson, Summer Associate