New England Biz Law Update
Three federal agencies have announced a pause on enforcing new regulations under the Mental Health Parity and Addiction Equity Act (MHPAEA).
These rules, initially finalized in September 2024, aimed to strengthen protections for mental health and substance use disorder (MH/SUD) benefits.
Under MHPAEA, benefits for MH/SUD must align with those for medical/surgical care in terms of coverage limits, copayments and treatment access. The 2024 rules were intended to strengthen this mandate by ensuring coverage for core treatments in all categories, requiring additional analysis criteria for potential disparities and requiring fiduciaries to certify compliance processes.
However, challenges from industry groups argued the regulations were arbitrary and capricious and could actually lead to a reduction in healthcare benefits. In a statement, the ERISA Industry Committee (ERIC) called the new requirements “wholly unworkable” saying “litigation became the only path to protecting employees and their access to quality, affordable benefits.”
ERIC filed its lawsuit in January of this year. A judge agreed to stay the case after federal agencies told the court they were considering rescinding or modifying the 2024 rules.
The Departments of Labor, Health and Human Services, and Treasury issued a joint statement on May 15, 2025, confirming they will not enforce certain new provisions of the 2024 MHPAEA Final Rule.
That statement referenced both the ERIC lawsuit and Executive Order 14219 scrutinizing regulations that may impose excessive costs.
Requirements on hold
The now-paused requirements include the following provisions:
- Meaningful benefits standard – Ensure at least one “core treatment” for each MH/SUD condition was covered in every benefit category where comparable medical treatments are offered.
- NQTLs revised standards – Required additional content and evidentiary standards, including outcomes data, related to a plan’s nonquantitative treatment limitations (NQTL) comparative analysis. (NQTL’s are non-numerical limits on benefits such as prior authorization requirements, medical necessity criteria, fail-first policies, and network adequacy.)
- Fiduciary certification – Required plan fiduciaries to formally certify they had reviewed the plan’s comparative analysis for compliance
Requirements were slated to take effect January 1, 2025 or 2026 (depending on plan year cycles).
Obligations remain
Despite the enforcement pause, health plans are advised to adhere to existing parity obligations. MHPAEA standards, enhanced by the 2021 Consolidated Appropriations Act, remain enforceable. Employers must maintain balance in plan limitations and document NQTL analyses, ensuring MH/SUD benefits remain fair compared to medical benefits.
