Enforcement of the 2024 Final Rule Issued for the Mental Health Party and Addiction Equity Act of 2008 (MHPAEA) is Paused

***Key takeaways following the enforcement pause of the 2024 Final Rule***

Group health plans and plan sponsors are no longer subject to the new compliance requirements scheduled to begin on 1/1/2025 and 1/1/2026. 

On May 15, 2025, the U.S. Departments of Labor, Treasury, and Health and Human Services announced and released a Non-Enforcement Policy regarding the MHPAEA’s Final Rule issued on September 9, 2024. The 2024 Final Rule included two noteworthy impacts to the MHPAEA. First, it amended specific aspects of the previously issued 2013 Final Rule. Second, it introduced new regulations for content requirements and mandatory response time limits for requests of Non-qualitative Treatment Limitations (NQTL) comparative analysis introduced by the Consolidated Appropriations Act of 2021 (CAA of 2021).

What does the Non-Enforcement Policy specifically address?

The Non-Enforcement Policy was enacted to inform the public that the enforcement of the MHPAEA 2024 Final Rule will not take place.  Group health plans and plan sponsors are to continue following the 2013 Final Rule requirements.

Until further notice, the following 2024 Final Rule requirements shall not be enforced:

“Meaningful Benefits” Standard

Group health plans offering any benefits for a mental health and substance use disorder (MD/SUD) condition in any classification is required to provide meaningful benefits for this MD/SUD condition in all classification’s that the medical/surgical benefits provide under the plan. This was to start for plan years beginning on or after 1/1/2026.

NQTL Content Requirement

Group health plans will be required to prepare and then maintain availability of comparative analysis reporting. This content is to outline the design and application of NQTLs for the MD/SUD plan coverages and is to include six minimum content elements. The content requirement was to begin with plan years beginning on or after 1/1/2025. While the enforcement of the content elements was to begin with plan years beginning on or after 1/1/2026.

Updated Definitions of MD/SUD and Medical/Surgical Conditions

Group health plans were scheduled to be required to apply MD/SUD condition definitions that follow the updated definitions used by the World Health Organization’s International Classification of Diseases (ICD) as adopted by HHS, and/or the definitions utilized by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM). This requirement was to start for plan years beginning on or after 1/1/2025.

Revised Standards for NQTLs

Group health plans were to be prohibited from applying a NQTL on any MD/SUD benefit for any condition classification that is written or applied in a more restrictive manner than the NQTL that is predominantly applied to the Medical/Surgical benefits in the same classification. This was to start for plan years beginning on or after 1/1/2026.

New Plan Fiduciary Certification

Plan fiduciaries of ERISA covered plans were to certify that, in completing the NQTL comparative analysis: 1. a prudent process was used to hire a qualified service provider to complete and document the analysis, and 2. the plan fiduciaries properly monitored the performance and documentation of the service provider.  This was to start for plan years beginning on or after 1/1/2025.

Why The Need for a Pause?

There are two basic motivations for implementing the Non-Enforcement Policy.

1. On January 17, 2025, the ERISA Industry Committee (ERIC) filed a lawsuit against the federal government in the U.S. District Court for the District of Columbia.  In the lawsuit, ERIC claims that the 2024 Final Rule provisions are arbitrary and capricious and contrary to law.
2. The decision not to enforce the 2024 Final Rule is supported by Executive Order 14219. Executive Order 14219 introduced the Department of Government Efficiency (DOGE) and its directive to re-examine existing regulations and enforcement discretion.

In response to the lawsuit, the Departments advised the court that enforcement of the 2024 Final Rule has been suspended.  Additionally, the Departments requested the court to halt the legal proceedings while the 2024 Final Rule is re-assessed under the Non-Enforcement Policy and DOGE initiatives.

What MHPAEA Rules And Guidance Are Group Health Plans To Follow? 

Group health plans and plan sponsors shall continue to use and rely on the MHPAEA requirements and guidance that were in place during the 2024 plan year.  Therefore, Plan sponsors will continue to rely on the 2013 Final Rule requirements and the subsequent additional regulatory 2013 Final Rule guidance offered through agency FAQs.  Additionally, the use and reliance of the CAA of 2021’s requirement for group health plans to complete NQTL comparative analysis of MH/SUD benefits and to provide this content to the Departments upon their request will continue.

The Fedeli Group will continue to examine the Departments’ actions, the ERIC lawsuit, and the impacts that these may have on group health plans. We will provide updates as additional information becomes available.

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DISCLAIMER

The information provided by The Fedeli Group’s Compliance Alert is not intended to be, nor should it be, interpreted as conferring legal advice to the reader of the Compliance Alert. The Fedeli Group Compliance Alerts are designed specifically and solely for informational purposes. Should the reader have any legal questions or concerns after reading this Compliance Alert, it is recommended that the reader seek counsel for a formal opinion.