The Departments of Health and Human Services, Labor and the Treasury (“the Departments”) have announced they will not enforce the 2024 Final Rule (“Final Rule”) under the Mental Health Parity and Addiction Equity Act (“MHPAEA”) while they consider whether to modify or rescind the Final Rule. The Departments also recently requested, and the U.S. District Court for the District of Columbia agreed, to defer any action on a current lawsuit challenging the Final Rule, pending the Departments’ decision.
As discussed in our November 5, 2024 Benefits Update, the Final Rule, among other things, appeared to impose additional coverage requirements for mental health and substance use conditions, and required the plan’s named fiduciary to certify that it engaged in a prudent process to review, document and compare the plan’s nonquantitative treatment limitations (“NQTLs”). In January 2025, the Final Rule was challenged in U.S. federal district court for the District of Columbia, by the ERISA Industry Committee (“ERIC”), a large employer lobbying group, on the grounds that it exceeded the Departments’ legal authority under MHPAEA and violated the Administrative Procedure Act.
In their recent announcement, the Departments advised that they will not enforce any new requirements first introduced in the Final Rule until 18 months after the court reaches a final decision in the ERIC lawsuit—or earlier, if the Departments rescind or modify the Final Rule. This delay in enforcement applies only to requirements that were added by the Final Rule; plans still must comply with the preexisting requirements of MHPAEA, including the requirement to perform and document the plan’s comparative analysis of its NQTLs. Consequently, while plans may hold off on making any benefit changes under the Final Rule or obtaining named fiduciary certifications, the obligation to document the plan’s comparative analysis of NQTLs remains in effect.
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