Challenges to mental health parity law leave uncertainty for mental health and substance use treatment

In a recent announcement on May 15, 2025opens in new window, the agencies that enforce the federal mental health parity law—the U.S. Departments of Labor, Health and Human Services, and the Treasury—declared that they will not enforce the final rule ‶Requirements Related to the Mental Health Parity and Addiction Equity Act (MHPAEA)opens in new window″ and will likely make other changes to parity enforcement. This law ensures that insurance plans cover mental health and substance use disorder care as fully as they cover physical health treatment, preventing discriminatory practices and making sure patients have equitable access to care through their insurance plans.

While the parity regulations and guidance that were in effect before the 2024 final rule will remain in place for now, the departments’ decision has significant implications for the implementation of mental health parity and, therefore, the provision and coverage of mental health and substance use disorder services. 

Following notification of this decision, APA Services actively engaged in advocacy efforts, including collaborating with other stakeholders on a joint statement expressing concerns regarding the departments’ decision, and ongoing outreach to Congress. APA Services will continue to advocate for effective enforcement of parity at the federal and state levels.

APA Services engaged in extensive advocacy for stronger parity regulations to address remaining parity problems like inadequate mental health networks, driven by inequitable reimbursement and treatment of psychologists and other mental health professionals. 

The 2024 final rule, issued on September 9, 2024, represented a significant update to the regulations implementing MHPAEA. It amended the 2013 final rule and introduced new requirements aimed at strengthening parity protections for mental health and substance use disorder benefits. For example, the rule would have required plans to collect key outcomes data and take corrective action if that data showed material differences in access to mental health and substance use disorder care compared to medical/surgical care.

The decision by the departments to not enforce the 2024 final rule comes in response to a lawsuit filed on January 17, 2025, by the ERISA Industry Committee (eric). In this suit, eric challenged certain provisions of the rule, arguing that they were arbitrary, capricious, and contrary to law. Rather than defend the lawsuit, the administration offered not to enforce the rule and consider other changes regarding parity noted below.

It is crucial to remember that MHPAEA’s statutory obligations, as amended by the Consolidated Appropriations Act (CAA), 2021opens in new window, remain in effect. The core principle of parity—requiring that mental health and substance use disorder benefits be no more restrictive than medical/surgical benefits—is still the law. Importantly, the administration’s current action is a decision of non-enforcement, not a rescission of the 2024 final rule itself. Rescinding or revising that rule would necessitate the Administrative Procedure Act’s notice and comment process, a formal rulemaking procedure. Consequently, despite the departments’ decision not to enforce the 2024 final rule, several key aspects of mental health parity persist currently. These include MHPAEA’s statutory obligations, the 2013 final regulations implementing MHPAEA, the CAA, 2021’s requirement to maintain and provide NQTL comparative analyses upon request, and all sub-regulatory guidance issued prior to the 2024 final rule.

The departments’ May 15 statement also indicated that they would reconsider the 2024 final rule, which may involve issuing a notice of proposed rulemaking to rescind or modify the regulation. This means that specific regulations governing parity could change in the future. APA Services will be prepared to comment on any such changes. The departments also intend to more broadly reexamine their enforcement approaches under MHPAEA. 

The departments’ decision to not enforce the 2024 final rule and potential future changes in parity regulations and enforcement reflects a complex interplay of legal challenges and administrative review, and their full impact remains to be seen. The association is particularly disappointed by these developments, as the 2024 rule's publication is the fruit of years of advocacy led by APA Services staff in close coordination with other national behavioral health consumer and provider organizations. As a result, the CEO Alliance on Mental Healthopens in new window, a group of the chief executive officers of 15 of our country’s leading mental health organizations including APA, sent a letter to Congress outlining their vision for a mental health system that focuses on whole person health. 

These current and future changes introduce significant uncertainty regarding the specific requirements that health plans and insurers must adhere to regarding mental health and substance use disorder parity. APA Services will closely monitor further developments related to the 2024 final rule and will continue to advocate for strong enforcement of parity to protect equitable access to care.

For more information, contact Julio C Abreu.