Departments Will Not Enforce 2024 Final Rule under MHPAEA

The Trump Administration has just announced that it will pause enforcement of the September 2024 final rule (“Final Rule”) under the Mental Health Parity and Addiction Equity Act (“MHPAEA”).

The Final Rule clarified content requirements for the comparative analysis of nonquantitative treatment limitations (“NQTLs”) required of most group health plans since the Consolidated Appropriations Act, 2021 (“CAA 2021”). It also required, for plans subject to the Employee Retirement Income Security Act of 1974 (“ERISA”), a named plan fiduciary to certify that they engaged in a prudent process to select and monitor those performing the comparative analysis.

As of May 15, 2025, the Departments of Labor, Treasury, and Health and Human Services (together, “Departments”) will not enforce the Final Rule for compliance failures that occur prior to 18 months following a final decision in the lawsuit filed on January 17, 2025 by the ERISA Industry Committee against the Departments. On May 12, 2025, this lawsuit was stayed at the Departments’ request while they reconsider the Final Rule, so the nonenforcement policy is likely to be in place for the foreseeable future.

Requirements that Remain in Effect

Group health plans are still required to perform a comparative analysis, which is a statutory obligation that has been in place since the CAA 2021 introduced it effective February 10, 2021. Plans are also still required to provide the comparative analysis, together with a significant amount of information related to NQTLs, to the Departments upon request.

The Departments also remain statutorily obligated to enforce the comparative analysis requirement by requesting a minimum number of analyses per year, and to annually report to Congress on these enforcement efforts.

In addition, the parts of the 2013 final rule (“2013 Final Rule”) that were not changed by the 2024 Final Rule remain in effect. This includes the longstanding distinction between quantitative treatment limitations and NQTLs and the requirement that a plan not impose any NQTL on mental health or substance use disorder (“MH/SUD”) benefits in any classification unless, under the terms of the plan as written and in operation, any processes, strategies, evidentiary standards, or other factors used in applying the NQTL to MH/SUD benefits are comparable to, and are applied no more stringently than, those used in applying the NQTL to medical or surgical (“M/S”) benefits in the same classification.

Requirements that Will Not Be Enforced

Among other things, the Final Rule added an entire section of regulation that addressed the content of a comparative analysis. It also required, for plans providing any MH/SUD benefits, coverage of “meaningful” MH/SUD benefits in every classification in which the plan covers M/S benefits. It required the collection and evaluation of data assessing the impact of NQTLs on access-related outcomes. It specifically prohibited the imposition of any financial requirement or treatment limitation applicable only to MH/SUD benefits. It added numerous clarifying examples and definitions for broad fundamental terms used under MHPAEA (e.g., factors, evidentiary standards, processes, strategies). None of this will be enforced.

In addition, ERISA plans will no longer be required to have a named fiduciary certify that they have engaged in a prudent process to select qualified service providers to perform and document the comparative analysis and satisfied their fiduciary duty to monitor the service providers in the performance and documentation of that comparative analysis.

Next Steps

Plan sponsors of both insured and self-funded group health plans previously subject to the comparative analysis requirement should continue to arrange for a comparative analysis to be performed and updated.

While the new nonenforcement policy brings welcome relief for plan sponsors from the Final Rule’s detailed content requirements, that relief might to some extent be offset by the resurrected lack of detail about how to meet the broad mandate.

Plan sponsors will need to rely on prior guidance from the Departments on how to perform and document the comparative analysis until new guidance is issued. This includes, for now: (a) the FAQs About Mental Health and Substance Use Disorder Parity Implementation and the Consolidated Appropriations Act, 2021 Part 45; (b) the Self-Compliance Tool for MHPAEA; and (c) other subregulatory guidance issued under MHPAEA. As was evident from the Departments’ MHPAEA Comparative Analysis Report to Congress (July 2023), which found that “none of the comparative analyses initially submitted were sufficient to demonstrate compliance,” guidance pre-existing the Final Rule has not—at least under the prior administration’s enforcement approach—been adequate to elucidate the vague and onerous comparative analysis requirement imposed on plan sponsors by statute.

In the meantime, the Departments intend to undertake a broader reexamination of each department’s respective enforcement approach under MHPAEA, including those provisions amended by the CAA 2021. Plan sponsors can expect more guidance in the future.

If you have additional questions related to the final rule under the Mental Health Parity and Addiction Equity Act reach out to your Quarles attorney or:

• Austin Anderson: (312) 715-5144 / austin.anderson@quarles.com

Please visit our Federal Policy Watch: Monitoring White House Developments page for more insight about navigating changes at the federal level.