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On May 15, 2025, the U.S. Departments of Labor, Health and Human Services, and the Treasury (Departments) announced a pause on enforcing the 2024 Mental Health Parity and Addiction Equity Act’s (MHPAEA) final rule due to a lawsuit challenging its validity. The rule is under review for potential changes or rescission.
The Departments have announced they will delay enforcing the 2024 final rule until a litigation decision is reached, plus an additional 18 months, while also reviewing their MHPAEA enforcement program.
2024 Final Rule
On September 9, 2024, a final rule was issued to enhance MHPAEA, ensuring equal coverage for medical/surgical (M/S) and mental health/substance use disorder (MH/SUD) benefits in group health plans.
The final rule introduces significant changes, focusing on nonquantitative treatment limitations (NQTLs) like prior authorization requirements. It mandates health plans and insurers to:
- Provide essential benefits for each covered mental health or substance use disorder condition in every category where medical/surgical benefits are offered;
- Avoid using discriminatory factors in designing NQTLs for MH and SUDs;
- Gather and assess outcomes data to address disparities in MH/SUD and M/S benefits access.
- Include key elements in NQTL comparative analyses and provide them to relevant authorities or individuals upon request.
The final rule takes effect for plan years starting January 1, 2025, with NQTL data evaluation requirements beginning January 1, 2026.
Employer Impact
Employer-sponsored health plans must adhere to MHPAEA requirements, referencing the 2013 final rule, and stay informed on any 2024 updates. Download the bulletin for more details.
National Insurance Services is not a law firm and no opinion, suggestion, or recommendation of the firm or its employees shall constitute legal advice. Readers are advised to consult with their own attorney for a determination of their legal rights, responsibilities and liabilities, including the interpretation of any statute or regulation, or its application to the readers’ business activities.
