Mental Health Parity 2024 Final Rules Update: Non-Enforcement Statement Published

MHPAEA Background

MHPAEA prevents group health plans providing mental health/substance abuse disorder (MH/SUD) benefits from imposing limits on those benefits that are more stringent than limits imposed on medical/surgical (M/S) benefits. This generally means that any of the following requirements imposed on a plan’s MH/SUD benefits cannot be more restrictive than those applied to the plan’s M/S benefits:

• Financial requirements — such as deductibles, co-payments, coinsurance, and out-of-pocket maximums
• Quantitative treatment limitations — such as number of treatments, visits, or days of coverage
• Non-quantitative treatment limitations (NQTLs) — such as prior authorization requirements, step therapy, and standards for provider admission to participate in a network, including methodologies for determining reimbursement rates. NQTLs are generally non-numerical requirements that limit the scope or duration of benefits.

Plans Subject to MHPAEA

MHPAEA requirements generally apply to self-funded, fully insured, grandfathered, and non-grandfathered plans that offer MH/SUD benefits. Some group health plans are exempt from MHPAEA requirements, including:

• Self-funded plans sponsored by employers with 50 or fewer employees;
• Plans offering only excepted benefits (e.g., vision-only or dental-only coverage); and
• Retiree-only plans.

Fully insured plans with 50 or fewer employers are generally required to comply with MHPAEA by satisfying the essential health benefit (also known as “EHB”) requirements of the Affordable Care Act.

CAA, 2021

The CAA, 2021, amended MHPAEA to expressly require group health plans (subject to it) to conduct and document comparative analyses of the design and application of NQTLs, and provide this analysis to the Departments (or an applicable state authority) and participants upon request. This NQTL comparative analysis requirement went into effect on February 10, 2021 and continues to remain in effect for group health plans.

MHPAEA Timeline

MHPAEA Non-Enforcement Statement Context

This non-enforcement statement was published by the Departments in response to a high-profile lawsuit filed by a prominent employer advocacy group challenging the 2024 Final Rules in January 2025. The Departments, in conjunction with the Department of Justice, filed a motion on May 9, 2025, to hold this case “in abeyance” (meaning to temporarily pause the lawsuit) pending the Departments’ “reconsideration” of the 2024 Final Rules. The District of Columbia district court granted the Departments’ motion to pause the lawsuit on May 12, 2025.

According to the motion filed, the Departments intend to reconsider the 2024 Final Rules, including potentially rescinding or modifying them. Additionally, the Departments stated that they intend to issue a “non-enforcement policy in the near future” for “portions” of the 2024 Final Rules applicable to the 2025 and 2026 plan years, and “reexamine the Department’s current MHPAEA enforcement program more broadly.” As anticipated, this non-enforcement statement was published by the Departments on May 15, 2025, a few days after the district court granted the Departments’ motion to temporarily pause the lawsuit.

MHPAEA Non-Enforcement Statement Details

The Departments’ non-enforcement statement reiterates the Departments’ intention to reconsider the 2024 Final Rules, including potentially rescinding or modifying them through notice and comment rulemaking.

The statement declares that the Departments “will not enforce the 2024 Final Rules or otherwise pursue enforcement action, based on a failure to comply that occurs prior to a final decision in the litigation, plus an additional 18 months.”

Notably, this enforcement relief applies to those sections of the 2024 Final Rules that are “new in relation to the 2013 final rule,” including the new fiduciary certification for ERISA group health plans, effective for plan years beginning on or after January 1, 2025, and the following provisions, effective for plan years beginning on or after January 1, 2026:

• meaningful benefits standard,
• the prohibition on discriminatory factors and evidentiary standards,
• the relevant data evaluation requirements, and
• the revised NQTL comparative analyses requirements.

This express delay in enforcement provides welcome relief and breathing room for employers plan sponsors who have struggled to comply with the dense and complex requirements of the 2024 Final Rules.

However, the Departments emphasize that plans (and issuers) are still required to comply with the statutory obligations under MHPAEA, including the NQTL comparative analysis requirement (in accordance with the CAA, 2021 outlined above here). Additionally, the Departments direct plans (and issuers) to continue to refer to the 2013 MHPAEA final rule as well as other related subregulatory guidance, particularly the MHPAEA/CAA, 2021 FAQs Part 45 (found here)^[1] for compliance guidance.

Employer Plan Sponsor Considerations

While this statement of non-enforcement by the Departments is certainly welcome news for many employers plan sponsors, they must still comply with the current CAA, 2021 requirement to conduct and document their NQTL comparative analyses. As such, employer plan sponsors are advised to continue working with their plan service providers (e.g., insurance carriers, third-party administrators (TPAs), pharmacy benefit managers (PBMs), and/or managed behavioral health organizations) to ensure that they:

• identify and remove any problematic plan features or other plan design concerns that might run afoul of MHPAEA generally, and
• conduct and document the required NQTL comparative analyses.

The Departments wrap up this non-enforcement statement with a vital reminder to employer plan sponsors that “MHPAEA provides critical protections for workers, individuals, and their families who need treatment for mental health conditions and substance use disorders,” and they “remain committed to ensuring that individuals receive protections under the law in a way that is not unduly burdensome for plans and issuers.”

Risk Strategies continues to closely monitor developments related to the 2024 Final Rules and MHPAEA generally, and will provide updates when available. In the meantime, contact your Risk Strategies account team with any questions or email us directly here.

[1] The Departments do state that they may make updates to this and other guidance in the process of reconsidering the 2024 Final Rules.