Departments announce nonenforcement of 2024 Mental Health Parity Rule

In an announcement on May 15, 2025, the agencies that enforce the federal mental health parity law—the U.S. Departments of Labor, Health and Human Services, and the Treasury (the Departments)—declared that they will not enforce the final rule “Requirements Related to the Mental Health Parity and Addiction Equity Act (MHPAEA)” (2024 Final Rule) and will likely make other changes to parity enforcement. This law ensures that insurance plans cover mental health and substance use disorder care just 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. In the immediate week following notification of this decision, APA Services has been actively engaged in advocacy efforts, including collaborating with other stakeholders on a joint statement expressing concerns regarding the Departments’ decision, and 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 to press the Biden administration to issue 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. (See APA Services urges that the proposed rule can be a bold step toward achieving true parity, October 24, 2023.)

The 2024 Final Rule, issued on September 9, 2024, under the Biden administration, represented a significant update to the regulations implementing MHPAEA. (See APA Services pushed for new rule strengthening mental health care access, September 10, 2024). 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, it introduced key changes pertaining to nonquantitative treatment limitation (NQTL) comparative analyses, as mandated by the Consolidated Appropriations Act, 2021 (CAA, 2021). The rule also addressed the concept of “meaningful benefits,” intending to ensure that if a plan provides any benefits for a mental health condition or substance use disorder in a particular classification, it must provide meaningful benefits in all classifications in which it provides medical/surgical benefits. Finally, 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 2024 Final Rule became effective on November 22, 2024, and was set to be implemented in phases, with applicability dates beginning on or after January 1, 2025, and January 1, 2026.

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). For more information about the lawsuit, see APA Service’s article ERIC lawsuit challenges mental health parity law, published earlier this year. 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.

Additionally, the Departments cited Executive Order 14219opens in new window, which directs federal agencies to review regulations that undermine the national interest, such as those imposing undue burdens on small businesses or significant costs on private parties that are not outweighed by public benefits. APA Services, however, believes that the significant public benefits of strong parity rules, in terms of improved public health and access to care, demonstrably outweigh any associated burdens.

It is crucial to remember that MHPAEA’s statutory obligations, as amended by the CAA, 2021, 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. Important, the administration’s current action is a decision of nonenforcement, 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 subregulatory guidance issued prior to the 2024 Final Rule.

The Departments’ May 15 statement also indicated that they will reconsider the 2024 Final Rule, which may involve issuing a notice of proposed rulemaking to rescind or modify the regulation. This means that the 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. APA Services is particularly disappointed by these developments, as the 2024 rule’s publication is the fruit of long years of advocacy led by APA Services staff in close coordination with other national behavioral health consumer and provider organizations. 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.