DOL has not enforced the 2024 parity rule since May 15, 2025 — the statute behind it still applies

The Departments of Labor, Health and Human Services and the Treasury stopped enforcing the 2024 MHPAEA final rule on May 15, 2025.1 dol.gov The rule is still codified, at 29 CFR 2590.712 and 2590.712-1.4 ecfr.gov The statute underneath it never paused.

That three-way split — live statute, codified-but-unenforced regulation, pending litigation — is why parity reads as confusing right now, and it is the first thing a billing team needs straight before it argues anything.

What MHPAEA actually requires

Parity is a comparison, not a floor. The law sets no rate and mandates no benefit. It requires that whatever a plan does to mental health and substance use disorder benefits be no more restrictive than what it does to medical/surgical benefits in the same classification.

There are six classifications and only six: inpatient in-network, inpatient out-of-network, outpatient in-network, outpatient out-of-network, emergency care, and prescription drugs.4 ecfr.gov An outpatient behavioral health rule is measured against outpatient medical/surgical rules, never against inpatient anything.

Limits split into two kinds. Quantitative treatment limitations are countable — visit caps, day limits, copays, coinsurance. Non-quantitative treatment limitations are the rest: prior authorization, concurrent review, medical necessity criteria, step therapy, network admission standards, provider reimbursement methodology, blanket exclusions. NQTLs are where behavioral health revenue actually dies, and they are the entire subject of the 2024 rule.

The NQTL standard: a plan may not impose an NQTL on MH/SUD benefits in a classification that is more restrictive, as written or in operation, than the predominant NQTL applied to substantially all medical/surgical benefits in that same classification.4 ecfr.gov “In operation” is the phrase that does the work. A policy that reads identically on paper can still fail if the denial rate behind it does not.

What an NQTL comparative analysis is

The Consolidated Appropriations Act, 2021 amended MHPAEA to require plans and issuers to perform, document, and hand over a written comparative analysis for every NQTL they impose on MH/SUD benefits.3 federalregister.gov That statutory obligation took effect in early 2021 and is the one the Departments say still binds.1 dol.gov

The 2024 rule spells out what the document must contain. Six content elements, per NQTL:

Source: 29 CFR 2590.712-1(c).5 ecfr.gov

On request from the Secretary, the plan has 10 business days to produce it. If the submission is deemed insufficient, another 10 business days for the additional information. After an initial determination of noncompliance, 45 calendar days to respond with a corrective plan. After a final determination, 7 business days to notify every participant — in a standalone notice, in no less than 14-point type, opening with the words “Attention! The Department of Labor has determined…“5 ecfr.gov

What is in force, and what is not

The non-enforcement policy is not a repeal and not a stay. The Departments said they will not pursue enforcement for failures occurring before a final decision in the ERIC litigation, plus an additional 18 months, and only as to the parts of the 2024 rule that are new relative to 2013. HHS also told states it will not treat them as failing to substantially enforce MHPAEA if they take the same approach.1 dol.gov

The litigation is ERISA Industry Committee v. HHS, No. 1:25-cv-00136 (D.D.C.), filed January 17, 2025. It is being held while the Departments decide whether to propose rescinding or modifying the rule. The most recent docket activity is an April 2, 2026 minute order from Judge Timothy J. Kelly directing a further joint status report by September 30, 2026 on the status of any proposed rulemaking.6 courtlistener.com No rescission or replacement had been published in the Federal Register as of this writing.

The enforcement record

The Departments’ 2025 Report to Congress, dated February 20, 2026, covers August 1, 2023 through July 31, 2025 — a window that straddles the policy change.2 dol.gov

Reporting period 1 Aug 2023 – 31 Jul 2025. Source: 2025 MHPAEA Report to Congress.2 dol.gov

CMS reported “a continued trend of zero comparative analyses that were sufficient at first submission.” EBSA closed 89 NQTL investigations without a determination because the plan fixed the problem first — usually by deleting an exclusion.2 dol.gov

The subject matter is the useful part. Of EBSA’s 77 requested analyses, the largest category was provider network admission standards (14), then exclusions of speech or occupational therapy (8), autism service limits short of an outright ABA ban (8), nutritional counseling exclusions (7), ABA exclusions (6), and residential or partial hospitalization exclusions (5). Among the 43 NQTLs that drew an initial determination of noncompliance, preauthorization and network admission standards tied at 10 each.2 dol.gov

One national service provider removed prior authorization, utilization management, concurrent review, reimbursement and exclusion limits running on legacy systems, then paid more than $3 million in claims and $540,000 in interest to participants and their providers.

Two caveats sit on those numbers. The report attributes EBSA’s drop in insufficiency letters partly to resource redeployment, and says the CAA supplemental funding for NQTL enforcement ended in December 2024 with no funds available beyond 2025.2 dol.gov Several insufficiency letters went to plan sponsors who assumed their TPA held a comparative analysis. Compliance sits with the plan.

Using parity when a payer’s behavioral rules are visibly stricter

The disclosure hooks that survive the non-enforcement policy are the older ones.

Under 29 CFR 2590.712(d)(1) — text carried forward from the 2013 rule — the medical necessity criteria a plan uses for MH/SUD benefits must be made available by the plan administrator or issuer to any current or potential participant, beneficiary, or contracting provider upon request. Paragraph (d)(2) requires the reason for any MH/SUD payment denial to be made available to the participant or beneficiary.4 ecfr.gov Neither is new in 2024.

Medicaid managed care carries a near-identical provision at 42 CFR 438.915, running to any enrollee, potential enrollee, or contracting provider of an MCO, PIHP or PAHP.7 ecfr.gov That subpart came from a separate 2016 rulemaking8 federalregister.gov and is not covered by the May 2025 policy.

The comparative analysis itself is a different matter. The provision letting a participant — or a provider acting as authorized representative — request it after an adverse MH/SUD determination is at § 2590.712-1(e)(2), and it is new in 2024.5 ecfr.gov It is codified. Federal regulators have said they will not enforce it.

The enforcement record shows where pressure works. Blanket exclusions get removed fastest, because a limit applied to MH/SUD benefits with no medical/surgical analogue in the same classification is the easiest failure to see. Network admission standards and out-of-network reimbursement methodology drew the most federal questions; prior authorization and concurrent review drew the most findings. A parity argument that names the classification and the medical/surgical comparator is a different document from one that says behavioral health is treated worse.

The next date on the calendar is September 30, 2026, when the Departments must tell Judge Kelly whether they intend to propose a new rule.