GBS Health Benefits Compliance
Mental Health Parity:
Enforcement temporarily paused for Mental Health Parity “2024 Final Rule”
Although the federal government announced it will temporarily pause enforcing any new requirements in the Mental Health Parity Act 2024 Final Rule for at least the next 18 months, everything that predates the 2024 rule remains fully enforceable. There are good business reasons an employer may want to continue complying with the 2024 standards.
Background & Context
The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires most group health plans or issuers that offer mental-health or substance-use-disorder (MH/SUD) benefits to provide these benefits “at parity” with medical/surgical (M/S) benefits.
Enforcement authority is shared by the Departments of Labor (DOL), Treasury, and Health and Human Services (HHS) (collectively, the Departments) with parallel state-level oversight for insured products. Penalties can include civil monetary fines and corrective-action mandates, and, under ERISA, fiduciaries face personal liability for non-compliance.
In practical terms, the law prohibits plans from imposing:
Financial requirements, such as copays and deductibles, on MH/SUD that are higher than (or not imposed on) M/S benefits.
Quantitative treatment limitations (QTLs), such as visit or day limits, on MH/SUD benefits that are more restrictive than the “predominant” level applied to substantially all M/S benefits in the same classification.
Non-quantitative treatment limitations (NQTLs), like prior-authorization criteria, network-tiering, or provider-reimbursement methodologies, that are applied more stringently to MH/SUD care than to comparable M/S care.
The Departments’ 2013 final regulations operationalized these three standards by defining six benefit classifications, establishing the “substantially-all/predominant” mathematical test, mandating disclosure of medical-necessity criteria, and clarifying that the same parity principles govern NQTLs. Subsequent 2016/2017 FAQs and a Model Disclosure Request Form provided examples and participant rights, and the Departments’
Self-Compliance Tool helps plan sponsors identify issues through testing. The Consolidated Appropriations Act (CAA) 2021 added teeth by obligating every plan that uses NQTLs to create and keep a written comparative analysis (including factors, evidentiary standards, side-by-side results, and corrective actions) that would be provided to regulators, if requested, within 10 business days. The Departments’ enforcement efforts (and 2022 and 2023 reports to Congress) reveal almost universal compliance issues and gaps.
MHPAEA Update
On September 9, 2024 the Departments issued, in part due to widespread compliance gaps, robust final regulations under MHPAEA, including tightened standards for non-quantitative treatment limitations (NQTLs), new detailed comparative-analysis documentation requirements and additional fiduciary duties. The effective date was for plan years starting on or after January 1, 2025 (2026 for certain individual-market policies)
In January 2025 the ERISA Industry Committee (ERIC), a trade association representing large employers, filed suit in the U.S. District Court for the District of Columbia (ERIC v. DOL, et al.) challenging several provisions of the September 2024 final regulations as arbitrary and beyond the Departments’ statutory authority.
On May 12, 2025 the court granted the parties’ joint request to hold the case in abeyance while the Departments reconsider whether to modify or rescind the rule.
On May 15, 2025 the Departments announced they will temporarily pause enforcing any new requirements within the 2024 Final Rule (as opposed to regulations issued prior to the 2024 Final Rule) for violations occurring before
- a final court decision in the litigation and
- an additional 18-month period thereafter.
What this means for Employers
Requirements in the 2024 Final Rule now on hold include the six-element comparative-analysis format (including the outcomes-data test), the “meaningful-benefits” minimum, the 90-day corrective-action clock, and the named fiduciary to attest to prudent vendor oversight.
Everything that predates the 2024 rule remains fully enforceable including:
- The 2013 parity regulations (financial parity testing, quantitative-limit math, NQTL comparability, and disclosure of medical-necessity criteria/denial reasons)
- The Consolidated Appropriations Act (CAA) 2021 mandate to maintain a written NQTL comparative analysis that can be produced within 10 business days of a DOL, HHS, or IRS request.
Employers that sponsor group health plans should continue to:
- Continue performing 2013-standard parity testing and oversight
- Maintain and update a CAA-compliant NQTL comparative analysis
- Respond promptly to participant information requests
- Document prudent decision-making around NQTL design
Note that employers can, if they wish, continue to follow the provisions contained in the September 2024 File Rule, even though enforcement of the extra data collection, outcomes metrics, and fiduciary attestation introduced in 2024 is deferred until the litigation concludes and the 18-month grace period has elapsed. Some plan sponsors may find this approach a smart investment because it:
- demonstrates proactive fiduciary diligence and positions the plan to “flip the switch” if the rule (or a similar version) is reinstated,
- reduces future disruption and consulting costs by keeping documentation and data-collection processes moving instead of starting from scratch,
- limits enforcement and class-action exposure by showing regulators and plaintiffs that it made a good-faith effort to meet the highest available benchmark, and
- strengthens recruitment, retention, and productivity by signaling to employees—and their families—that their mental-health care is valued as much as their with medical care, a commitment that has shown to consistently correlate with lower absenteeism and higher engagement.
Cheat Sheet of Key MHPAEA Regulations (2013 – 2025)
Year | Issuance | New / Clarified Requirements for Plans & Issuers | Still Currently Fully Enforceable? |
2013 | Tri-agency “Final Rules under MHPAEA” (78 FR 68240) |
| Yes |
2016 – 2017 | FAQs Parts 31, 34, 38, 39; Model Disclosure Request Form; Self‑Compliance Tool updates |
| Yes |
2021 | Consolidated Appropriations Act § 203 & FAQs Part 45 |
| Yes |
2024 | Tri-agency Final Rule (issued Sept 9 2024) |
| No Enforcement for 2024 final regulations is temporarily paused |
May 2025
This document is not intended to be exhaustive, nor should any information be construed as tax or legal advice.
