The 2024 rules were the strongest parity requirements ever written. They are currently not being enforced, and the statute underneath them still is.
On September 9, 2024, the Departments of Labor, Health and Human Services, and the Treasury “released new final rules implementing MHPAEA.” They were the most substantive parity requirements ever issued. What has happened since is a case study in the difference between a rule and an enforced rule.
What the 2024 rules required
The rules were designed to move parity from a design test to an access test. Among other things they:
- Made clear “that MHPAEA protects plan participants, beneficiaries, and enrollees from facing greater restrictions on access to MH/SUD benefits as compared to medical/surgical benefits.”
- Reinforced that plans “cannot use NQTLs applicable to MH/SUD benefits that are more restrictive than the predominant NQTLs applied to substantially all medical/surgical benefits in the same classification.”
- Required plans “to collect and evaluate data and take reasonable action, as necessary, to address material differences in access to MH/SUD benefits as compared to medical/surgical benefits that result from application of NQTLs, where the relevant data suggest that the NQTL contributes to material differences in access.”
- Codified the comparative analysis requirement, “including evaluating standards related to network composition, out-of-network reimbursement rates.”
The third item was the significant one. It made a plan’s own access data the test, rather than the reasonableness of its written policies.
The rules “became effective on November 22, 2024,” with “staggered applicability dates of plan years starting on or after January 1, 2025, and plan years (in the individual market, policy years) starting on or after January 1, 2026.”
What happened next
On January 17, 2025, an employer trade association “filed suit in the U.S. District Court for the District of Columbia challenging certain provisions of the 2024 Final Rule on multiple grounds, including on the grounds that they are arbitrary and capricious and contrary to law.”
Citing that litigation and a deregulatory executive order, the Departments “requested that the ERIC litigation be held in abeyance while the Departments reconsider the 2024 Final Rule, including whether to issue a notice of proposed rulemaking rescinding or modifying the regulation through notice and comment rulemaking.”
Then, on May 15, 2025: “The Departments 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.”
Two qualifications matter and are easy to miss. The relief “applies only with respect to those portions of the 2024 Final Rule that are new in relation to the 2013 final rule.” And “MHPAEA’s statutory obligations, as amended by the CAA, 2021, continue to have effect.”
Reading this correctly
| What changed | What did not |
|---|---|
| The new 2024 requirements are unenforced pending litigation and possible rescission | The 2008 statute and the 2013 rule remain in force |
| The data-driven access test is in abeyance | The CAA, 2021 comparative analysis requirement still applies |
| Federal enforcement is paused, and HHS encouraged states to follow | States retain primary enforcement authority over issuers and may choose otherwise |
Worth remembering: this is what the rulemaking course meant when it said a model or rule is not settled until it has survived litigation and a change of administration. A plan reading only the 2024 rule would conclude that behavioral access data must be collected and acted on. A plan reading only the news of non-enforcement might conclude parity obligations lapsed, which is wrong: the statute, the 2013 rule, and the comparative analysis requirement all still bind. Getting this right requires reading the enforcement statement alongside the rule, and it is a reminder that citing a regulation without checking its current status is how confident errors get made.
Key takeaways
- The 2024 rules would have made a plan’s own access data the parity test.
- Litigation and an executive order led the Departments to reconsider the rule.
- Since May 15, 2025 the Departments will not enforce provisions new relative to 2013, pending final decision plus 18 months.
- Statutory MHPAEA obligations, including the CAA, 2021 comparative analysis requirement, remain in effect.
Sources
Check your understanding
What is the enforcement status of the 2024 MHPAEA final rule?
The rule was challenged in litigation, the Departments requested abeyance while reconsidering it, and enforcement relief applies only to what is new relative to 2013. MHPAEA's statutory obligations as amended by the CAA, 2021 remain in force.