The Departments have issued a statement regarding their enforcement of the MHPAEA final regulations indicating that they will not enforce certain provisions of the 2024 Final Rule.

Although the litigation is on hold, sponsors of group health plans are reminded that MHPAEA’s statutory requirements and the 2013 regulations implementing the law are still in effect. Moreover, continued enforcement is anticipated.

Background

On December 27, 2020, Congress enacted the Consolidated Appropriations Act, 2021 (CAA), which amended MHPAEA, in part, to require group health plans and health insurers that offer both medical/surgical benefits and mental health/substance use disorder (MH/SUD) benefits and impose nonquantitative treatment limitations (NQTLs) on MH/SUD benefits to perform and document comparative analyses of the design and application of their NQTLs. (We discussed these requirements in our January 14, 2021 insight, which includes examples of NQTLs.)

Final MHPAEA rules were published on September 23, 2024, amending the longstanding 2013 final MHPAEA rules and establishing new standards for NQTLs, including implementing the additional documented comparative analyses requirements that were added through the CAA of 2020. We discussed the 2024 final rules in our September 26, 2024 insight. They include staggered applicability dates, with some provisions taking effect for plan years beginning on or after January 1, 2025, and others for plan years beginning on or after January 1, 2026.

ERIC filed suit against the MHPAEA regulations on January 17, 2025. The case asserts that the regulations are unlawful because they violate the Administrative Procedure Act, exceed the Departments’ statutory authority under MHPAEA, including the amendments enacted through the CAA, violate the Fifth Amendment’s due process clause and are “arbitrary and capricious.” The suit also alleges that the 2024 final regulations “threaten the ability of plan sponsors to offer quality, affordable benefits in compliance with the law.” (We discussed the litigation in our January 24, 2025 insight.)

MHPAEA litigation on hold

In the federal government’s response to the MHPAEA litigation, filed on May 9, 2025, the Department of Justice requested an abeyance (a suspension of the case) and indicated that the Departments intend to reconsider the final regulations, including potentially issuing a proposed rulemaking rescinding or modifying the current regulations. Further, the Departments informed the court of their intent to issue a non-enforcement policy covering the portions of the new regulations that are applicable in 2025 and 2026. The Departments also said they will reexamine the MHPAEA enforcement program more broadly.

 On May 12, 2025, the court granted a stay, pausing the litigation while Departments undertake their review. Meanwhile, ERIC can ask the court to resume the litigation at any time during the stay. The Departments must provide the court with status updates every 90 days.

Enforcement considerations

On May 15, 2025, two days after the court agreed to suspend the MHPAEA litigation, the Departments issued a statement formally announcing nonenforcement of the 2024 MHPAEA regulatory provisions that are newly applicable in 2025 and 2026. The Departments say they will not otherwise pursue enforcement actions, based on a failure to comply with those provisions that occurs prior to a final decision in the litigation, plus an additional 18 months.

This means that the Departments will not take enforcement action against plan sponsors with respect to portions of the 2024 Final Rule that are new in relation to the 2013 final rule. However, generally, requirements with respect to quantitative treatment limits (QTLs) and nonquantitative treatment limitations (NQTLs), including those that require a comparative analysis, under the statute and 2013 final regulations, remain in effect.

Action items for plan sponsors

Sponsors of group health plans should monitor upcoming federal MHPAEA guidance and this litigation. Meanwhile, the statutory requirements and the 2013 regulations implementing MHPAEA regulations remain applicable and continued enforcement is anticipated.

Plan sponsors should continue to work with their service providers to maintain a current version of documented comparative analysis. If they have not already done so, sponsors should ensure their plan has been reviewed for compliance with provisions of MHPAEA that are not in flux, such as the quantitative treatment limitation rules and certain NQTL concepts that have remained consistent.

Meanwhile, plan sponsors seeking to prioritize MH/SUD benefits can continue to do so despite debates around MHPAEA compliance considerations. Reviewing MH/SUD benefits and updating them with modern designs, adding benefits that may be valuable and/or removing unnecessary restrictions are positive steps plan sponsors can take.