DOL Announces Enforcement Relief Regarding the 2024 Mental Health Parity Final Rule
Published May 16, 2025
(Updated May 15, 2025)
DOL Releases Final Rules on the Mental Health Parity and Addiction Equity Act
The Departments of Health and Human Services (HHS), Labor, and the Treasury (collectively, the Departments) released the final rules implementing the Mental Health Parity and Addiction Equity Act (MHPAEA). The new rules add additional protections against more restrictive, nonquantitative treatment limitations (NQTL) for mental health and substance use disorder (MH/SUD) benefits as compared to medical or surgical (M/S) benefits.
The final rules:
- Make clear that MHPAEA protects plan participants, beneficiaries, and enrollees from facing greater restrictions on access to MH/SUD benefits as compared to M/S benefits.
- Reinforce that health plans and issuers cannot use NQTLs that are more restrictive than the predominant NQTLs applied to substantially all M/S benefits in the same classification. Examples of NQTLs include prior authorization requirements and other medical management techniques, standards related to network composition, and methodologies to determine out-of-network reimbursement rates.
- Require plans and issuers to collect and evaluate data and take reasonable action, as necessary, to address material differences in access to MH/SUD benefits as compared to M/S benefits that result from application of NQTLs, where the relevant data suggest that the NQTL contributes to material differences in access.
- Codify the requirement in MHPAEA, as amended by the Consolidated Appropriations Act, 2021, that health plans and issuers conduct comparative analyses to measure the impact of NQTLs. This includes evaluating standards related to network composition, out-of-network reimbursement rates, and medical management and prior authorization NQTLs.
- Prohibit plans and issuers from using discriminatory information, evidence, sources, or standards that systematically disfavor or are specifically designed to disfavor access to MH/SUD benefits as compared to medical/surgical benefits when designing NQTLs.
- Implement the sunset provision for self-funded non-Federal governmental plan elections to opt out of compliance with MHPAEA.
In addition, the DOL's Employee Benefits Security Administration (EBSA) will hold a compliance
assistance webinar on Thursday, September 19 at 2pm ET and join Treasury and HHS in providing future
guidance on the rules.
The final rules generally apply to group health plans and group health insurance coverage on the first day of the first plan year beginning on or after January 1, 2025. However, the meaningful benefits standard, the prohibition on discriminatory factors and evidentiary standards, the relevant data evaluation requirements, and the related requirements in the provisions for comparative analyses apply on the first day of the first plan year beginning on or after January 1, 2026.
The final rules apply to health insurance issuers offering individual health insurance coverage for policy years beginning on or after January 1, 2026.
The final rules are effective November 22, 2024.
Additional Resources:
(Posted September 09, 2024)