Enforcement Paused on 2024 MHPAEA Final Rules — But Compliance Still Matters
In a notable development, the Departments of Labor, Health and Human Services, and Treasury have announced they will not enforce the 2024 final rules under the Mental Health Parity and Addiction Equity Act (MHPAEA) — at least for now. This follows a legal challenge filed by the ERISA Industry Committee (ERIC), which argued the Departments overstepped their authority and that the January 1, 2025, compliance deadline was unrealistic.
The 2024 rules focused heavily on non-quantitative treatment limitations (NQTLs) — such as prior authorization and step therapy — and set stricter standards for comparative analysis documentation, originally mandated by the Consolidated Appropriations Act of 2021. These requirements posed significant challenges for plan sponsors and insurers.
Under the new non-enforcement policy, the Departments will not enforce the 2024 rules for violations occurring before a final decision in the ERIC case, plus 18 months. However, the policy only applies to the new provisions — it does not impact existing MHPAEA regulations or the CAA’s 2021 statutory requirements.
As a reminder for plan sponsors, the MHPAEA promotes equal access to treatment for mental health and addiction issues by eliminating any discriminatory policies. This applies to all group health plans and while it does not require plans to offer mental health and substance use disorder benefits, it does require that if a plan does offer such benefits, the coverage must be equal to that for other services such as medical and surgical care.
Health plans cannot impose more restrictive limits on mental health or substance use disorder benefits than on medical/surgical benefits. This includes:
- Financial requirements, such as copays, deductibles, and coinsurance.
- Treatment limits, such as the number of visits or days of coverage.
- Non-quantitative treatment limits (NQTLs), such as prior authorization, medical necessity standards, or provider network standards.
Despite the temporary reprieve, plan sponsors should not assume they’re off the hook. The comparative analysis requirement still stands, and ERISA §712 allows for private causes of action by plan participants. Employers and insurers must continue evaluating their mental health and substance use disorder benefits to ensure compliance with longstanding parity obligations.
About the author
Samantha Bradley is Senior Vice President, Employee Benefits at leading global insurance brokerage HUB International Oregon. With over 10 years of experience in the employee benefits industry, she facilitates and manages complex benefit program initiatives for various clients in multiple industries.
