We are confused by recent litigation and government statements regarding mental health parity testing requirements. Does our company still need to test our group health plan’s mental health (MH) and substance use disorder (SUD) benefits for parity and conduct nonquantitative treatment limitation (NQTL) comparative analysis under the Mental Health Parity and Addiction Equity Act (MHPAEA) and the Consolidated Appropriations Act, 2021 (CAA)?
Yes. Testing for both quantitative and nonquantitative parity between a group health plan’s MH/SUD benefits and medical/surgical (M/S) benefits and conducting NQTL comparative analyses continues to be required under MHPAEA and CAA.
Under MHPAEA, group health plans may not impose less favorable financial requirements (e.g., deductibles, copayments and coinsurance), quantitative treatment limitations (e.g., day or visit limits) and NQTLs (e.g., prior authorization, standards related to network composition and other medical management techniques) on MH/SUD benefits than on M/S benefits. The 2013 MHPAEA final regulation issued by the Departments of Labor, Health and Human Services, and the Treasury remains in effect.
CAA added a requirement for group health plans to conduct comparative analyses of the design and application of NQTLs used for MH/SUD benefits compared with M/S benefits and provide them to the Departments upon request. The Departments have been actively auditing group health plans since the CAA provisions took effect in February 2021.
Last fall, the Departments published a final regulation amending certain provisions of the 2013 MHPAEA final regulation and adding new provisions on the design and application of NQTLs, data collection and evaluation, content requirements and time frames for responding to requests for NQTL comparative analyses.[1] The final regulation establishes minimum standards for developing comparative analyses to assess whether each NQTL complies with MHPAEA’s parity requirements. Generally, the final regulation applied for plan years beginning on or after January 1, 2025; however, some key requirements were delayed until plan years beginning on or after January 1, 2026.
In January 2025, the ERISA Industry Committee (ERIC) filed a lawsuit challenging the 2024 MHPAEA final regulation. Among other things, ERIC claimed that the Departments exceeded their statutory authority by including the following allegedly unlawful provisions in the final regulation:
Earlier this month, at the request of the Departments, the United States District Court for the District of Columbia paused the ERIC lawsuit until further order of the court. The court also ordered that the parties file a joint status report on August 7, 2025, and every 90 days thereafter, to report on the progress of the Departments’ reconsideration of the 2024 MHPAEA final regulation.[2]
In a non-enforcement statement, the Departments confirm that they will not enforce any new requirements imposed by the 2024 rule until a final court ruling on the ERIC lawsuit challenging certain provisions of the 2024 rule — plus an additional 18 months.
The Departments clarified that the provisions of the 2013 MHPAEA final regulation remain in effect, and plan sponsors still have an obligation to produce NQTL comparative analyses as required by the CAA. While this non-enforcement statement provides some relief for group health plan sponsors, the Departments note that they remain committed to ensuring individuals receive the protections provided under the MHPAEA. To that end, plan sponsors should continue reviewing their plan design to ensure compliance under the 2013 MHPAEA final regulation. This includes analyzing NQTLs and drafting comparative analyses that reflect the CAA statutory requirements.
