Mental Health Parity Final Rule Enforcement Paused

The Mental Health Parity and Addiction Equity Act (MHPAEA) requires group health plans to provide mental health and substance use disorder (MH/SUD) benefits equal to medical/surgical benefits. In September 2024, federal agencies issued the 2024 MHPAEA Final Rule, introducing new compliance requirements with effective dates beginning January 1, 2025.

However, on May 15, 2025, the Departments of Labor, HHS, and Treasury issued a joint statement pausing enforcement of the 2024 Final Rule’s new provisions. The now-paused rule required plans to:

Ensure that for each mental health or substance use disorder condition, at least one primary treatment is covered in every benefit category where comparable medical treatments are offered.
Perform data-driven analyses to detect and rectify any differences in how mental health and substance use disorder benefits are accessed or utilized compared to medical/surgical benefits.
Require plan fiduciaries to formally confirm that they have thoroughly reviewed the plan’s comparative analysis to ensure compliance.

These requirements were intended to take effect beginning in 2025, and many employers had already begun preparations. However, recent developments have put these requirements on hold for two central reasons. The first stems from a legal challenge brought by a national industry group arguing the new rules exceed agency authority, which led to the agencies requesting the case be paused to allow reconsideration of the 2024 Final Rule. The second derives from the recent Executive Order directing agencies to reassess regulations imposing excessive costs. The 2024 Final Rule requirements, which industry groups have argued will discourage mental health benefit offerings, fall under this Executive Order scrutiny.

What Employers Must Still Do

It is important to note that this enforcement pause only affects the 2024 Final Rule. All prior MHPAEA requirements remain in effect, including those added by the 2021 Consolidated Appropriations Act (CAA). As such, employer sponsored plans must continue to meet these long-standing obligations:

Maintain Parity in Plan Terms and Administration: Ensure that limitations such as copayments, visit caps, or prior authorization requirements for mental health and substance use disorder services are no more stringent than those applied to medical or surgical services. Review plan design, utilization management, and network access for compliance.
Prepare NQTL Comparative Analyses: As mandated by the Consolidated Appropriations Act, plans are required to analyze and document how nonquantitative treatment limitations are applied, ensuring they are not more restrictive for mental health and substance use disorder services than for medical services. This documentation must be available upon request by regulators or participants.
Follow Existing Guidance: Without the 2024 Rule in effect, plans should continue to follow the 2013 MHPAEA regulations along with existing agency guidance and FAQs. Resources such as DOL FAQ Part 45 (2021) provide direction on conducting NQTL analyses and demonstrating compliance.

In short, the pause on enforcing new requirements is not a free pass to ignore parity rules altogether. Rather, employers should continue their compliance programs under the pre-2024 framework. Regulators retain the authority to investigate parity complaints or request an employer’s health plan NQTL analysis and take action if a plan is not providing parity in coverage.

For questions about compliance strategy or preparing for future rule changes, consult a member of the McGrath North Employee Benefits Practice Group today.