On May 15, 2025, the U.S. Departments of Labor, Health and Human Services, and the Treasury issued a statement related to the enforcement of the Mental Health Parity and Addiction Equity Act (“MHPAEA”).1
As a result of litigation filed by the ERISA Industry Committee on January 17, 2025, in the U.S. District Court for the District of Columbia2 and Executive Order 14219 titled “Ensuring Lawful Governance and Implementing the President’s ‘Department of Government Efficiency’ Deregulatory Initiative”,3 the Departments have paused implementation of the 2024 Final Rule, which introduced a number of new enforcement mechanisms. Despite the pause in enforcement, the Departments continue to maintain that mental health parity remains a legal requirement and a top policy priority.
What the Enforcement Update Means
Importantly, this pause in enforcement applies only to new provisions introduced in the 2024 Final Rule and does not affect the underlying statutory obligations of MHPAEA, which remain in full effect.4 Plans and issuers are still obligated to follow the 2013 Final Rule, as well as statutory obligations as amended by the Consolidated Appropriations Act, 2021 (“CAA”). From a practical perspective, many of the same challenges that existed before the passage of the CAA, which included a lack of resources to pursue MHPAEA violations, are once again an area for additional advocacy. The 2024 Final Rule amended the 2013 Final Rule and included provisions such as requiring mandatory comparative analyses of non-quantitative treatment limitations, data collection and evaluation requirements to identify and address material differences in access between mental health/substance use disorder (“MH/SUD”) and medical/surgical benefits, and requiring clearer standards for defining MH/SUD conditions.5 The 2024 Final Rule, which became effective on November 22, 2024, has staggered applicability dates of plan years starting on or after January 1, 2025, and plan years (in the individual market, policy years) starting on or after January 1, 2026.
The Departments’ goal with this pause in enforcement is to encourage states to take on the primary enforcement role of MHPAEA. Looking ahead, the Departments’ plan to undertake a broader reexamination of each department’s enforcement approach under MHPAEA. This may include issuing new rules and issuing new subregulatory guidance such as FAQs.6 Providers and patients should stay informed about these current changes and be prepared for evolving obligations and regulatory landscape in the future.
Implications for Providers
With federal enforcement of the 2024 MHPAEA Final Rule temporarily paused, behavioral health providers may encounter inconsistent application of parity standards across health plans — particularly in how nonquantitative treatment limits (“NQTLs”) like prior authorization or medical necessity reviews are used. This could result in increased denials, delays in care, or reimbursement challenges, especially for complex cases. Providers should stay vigilant by tracking disparities in coverage, engaging in advocacy efforts to support stronger parity enforcement, and reinforcing collaborative care models that demonstrate value. Educating patients about their rights under MHPAEA remains essential, as insurers are still legally required to comply with parity laws despite the enforcement grace period.
Implications for Patients
As patients navigate uncertainty around parity enforcement, providers can play a key role in safeguarding access to care. Providers should encourage patients to appeal coverage denials and request a parity analysis, supported by thorough clinical documentation. Additionally, providers should inform patients that suspected violations can be reported to state insurance departments or the Department of Labor, depending on their coverage. Most importantly, providers should help patients understand that MHPAEA protections remain in effect.
[1] U.S. Dep’t of Labor, Statement of U.S. Departments of Labor, Health and Human Services, and the Treasury Regarding Enforcement of the Final Rule on Requirements Related to the Mental Health Parity and Addiction Equity Act (May 15, 2025), https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/mental-health-parity/statement-regarding-enforcement-of-the-final-rule-on-requirements-related-to-mhpaea.
[2] ERISA Indus. Comm. v. U.S. Dep’t of Health & Hum. Servs., No. 1:25-cv-00136 (D.D.C. Jan. 17, 2025).
[3] 90 FR 10583 (Feb. 25, 2025).
[4] U.S. Dept. of Labor et al., supra note i.
[5] 89 FR 77586 (Sept. 23, 2024).
[6] U.S. Dept. of Labor et al., supra note i.
