Trump Administration Won’t Enforce Portions of Final Rule on Mental Health Parity

On May 15, 2025, the U.S. Departments of Labor, Health and Human Services, and the Treasury (Departments) released a statement regarding the nonenforcement of the 2024 final rule under the Mental Health Parity and Addiction Equity Act (MHPAEA). The statement relates to a lawsuit brought by an employer trade group seeking to invalidate the final rule. Critics have called the rule's requirements “unworkable,” warning they could lead employers to drop mental health and substance use disorder coverage altogether. The litigation has been put on hold while the Departments reconsider the final rule, including whether to modify or rescind it altogether.

According to the Departments’ statement, they will not enforce the 2024 final rule (or otherwise pursue enforcement actions) based on a failure to comply that occurs prior to a final decision in the litigation, plus an additional 18 months. This enforcement relief applies only with respect to those portions of the 2024 final rule that are new in relation to the 2013 final rule. The Departments are also reexamining their MHPAEA enforcement program more broadly.

2024 Final Rule

On September 9, 2024, the Departments released a final rule to strengthen MHPAEA’s requirements. MHPAEA requires parity between a group health plan’s medical/surgical (M/S) benefits and mental health/substance use disorder (MH/SUD) benefits.

The final rule’s changes are extensive and primarily focus on nonquantitative treatment limitations (NQTLs). NQTLs include a variety of strategies that generally limit the scope or duration of benefits, such as prior authorization requirements. Among other changes, the final rule requires health plans and health insurance issuers to:

• offer meaningful benefits (including a core treatment) for each covered MH condition or SUD in every classification in which M/S benefits (a core treatment) are offered;
• not use factors and evidentiary standards to design NQTLs that discriminate against MH conditions and SUDs;
• collect and evaluate relevant outcomes data and take reasonable action, as necessary, to address material differences in access to MH/SUD benefits as compared to M/S benefits; and
• include specific elements in documented comparative analyses of NQTLs and make them available to the Departments, an applicable state authority or individuals upon request.

The final rule generally applies for plan years beginning on or after January 1, 2025; however, certain key requirements, such as NQTL data evaluation requirements, apply for plan years beginning on or after January 1, 2026.

Impact on Employers

Despite the nonenforcement policy, the Mental Health Parity and Addiction Equity Act (MHPAEA) remains in effect. This includes the original statutory requirements and the 2013 final rule, both of which continue to apply. The nonenforcement policy applies only to those portions of the 2024 final rule that go beyond the 2013 rule.

MHPAEA was later amended by the Consolidated Appropriations Act, 2021 (CAA 2021), which added a requirement for group health plans to prepare and make available written comparative analyses for nonquantitative treatment limitations (NQTLs). To implement this mandate, the Departments issued FAQs About Mental Health and Substance Use Disorder Parity Implementation and the Consolidated Appropriations Act, 2021 Part 45 (FAQ Part 45). While FAQ Part 45 is not subject to the current nonenforcement policy, the Departments have announced they are reevaluating this guidance as part of a broader review of MHPAEA enforcement.

Given the significant compliance challenges posed by FAQ Part 45—and the government’s indication that revisions may be forthcoming—employers and plans may want to pause before making substantial investments in implementing its more complex requirements.

In the meantime, plans should:

• maintain compliance with the 2013 final rule and MHPAEA’s core statutory provisions;
• preserve documentation and analyses prepared to date in connection with the CAA amendments; and
• monitor developments from the Departments, particularly any changes to FAQ Part 45 or future enforcement priorities.

Reach out to your Hylant representative for further information. Don’t have one? Contact us here.

The above information does not constitute advice. Always contact your employee benefits broker or trusted advisor for insurance-related questions.