In May 2025, the Departments of Labor, Health and Human Services, and the Treasury announced a temporary pause in enforcement of the 2024 final rule under the Mental Health Parity and Addiction Equity Act (MHPAEA), following a legal challenge brought by an employer coalition. This enforcement pause gives the agencies time to reexamine certain provisions and consider future revisions through the regulatory process.

Importantly, this pause applies only to the new rule—not to the longstanding obligations that have governed group health plans for years. Nearly all existing MHPAEA requirements remain in effect, including those established in the 2013 final rule, subsequent federal guidance, and the Consolidated Appropriations Act of 2021 (CAA 2021), which introduced the requirement to prepare a written comparative analysis of non-quantitative treatment limitations (NQTLs).

NQTLs refer to plan restrictions that limit the scope or duration of benefits without imposing a dollar or numerical cap. Examples include prior authorization protocols, step therapy, and network adequacy standards. These restrictions must be applied to mental health and substance use disorder (MH/SUD) benefits in a manner that is no more restrictive than how they are applied to medical and surgical benefits—both in design and in operation.

The 2024 final rule, now on hold, would have introduced new requirements, including fiduciary certification of NQTL analyses, mandatory data collection and reporting, and a clarified standard for determining whether MH/SUD benefits are “meaningful.” With enforcement suspended until at least 18 months after a final court decision, these provisions are not currently in effect.

Employer-sponsored group health plans that offer MH/SUD coverage must continue to comply with all existing parity rules. This includes ensuring that financial requirements (such as deductibles and copays) and treatment limitations are not more restrictive than those imposed on medical/surgical benefits. NQTLs must be carefully evaluated and applied in parity.

Plans are also required to maintain a written comparative analysis describing how each NQTL is developed and administered for MH/SUD benefits compared to medical/surgical benefits. Although this analysis does not need to be submitted on a routine basis, it must be made available upon request—within 10 days for federal agencies or within 30 days for plan participants under ERISA. Given the level of detail required, employers should not wait until a request is received to begin preparing this documentation.

Despite the temporary enforcement pause, MHPAEA compliance remains a top enforcement priority for the Department of Labor. Employers found out of compliance may be required to reprocess claims, issue participant refunds, and could face penalties of up to $100 per day per affected individual. Federal audits are expected to continue under the existing regulatory framework.

Given the complexity of these rules, employers are encouraged to coordinate with insurance carriers, third-party administrators, and pharmacy benefit managers to confirm compliance with parity standards. This includes thoroughly documenting how NQTLs are applied and monitored—particularly in self-funded and level-funded arrangements.

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This is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel or an insurance professional for appropriate advice.