What Remains of the Mental Health Parity and Addiction Equity Act After Federal Agencies Applaud Its Purpose But Criticize Its Implementation

Follow us on LinkedIn to see future News.

Helena I. Poch Ciechanowski

December 16, 2025

For nearly six years after U.S. Senator Paul Wellstone perished in a plane crash on October 25, 2002, his son David, now the co-founder and CEO of Pathfinder Solutions PBC, along with former First Lady Rosalynn Carter, fiercely advocated for new legislation to promote mental health parity.  These efforts culminated in 2008 with the passage of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA).  Named after Senator Wellstone and former Senator Pete Domenici, both of whom became mental health policy advocates after experiencing the effects of mental illness in their immediate families, the MHPAEA provides, generally, that if an employment-based group health plan or health insurance issuer offers coverage for mental health or substance use disorders (a “Covered Plan”), the mental health/substance use disorder benefits cannot be subject to “less favorable limitations” compared to similar coverage for medical or surgical benefits.

Over a decade and a half later, achievement of health insurance parity for mental health afflictions and substance use addictions—David Wellstone’s mission to honor his father’s legacy—is still a work in progress.
Final Regulations for the implementation of the MHPAEA were published in November 2013 and became effective January 13, 2014 (“Original Final Rules”).   For nearly a decade, health insurance coverage trudged along, offering some options for coverage of treatment for mental health and substance use disorders, but less than the full parity contemplated by the 2008 legislation.

The 13^th Anniversary of the MHPAEA brought the dawn of a new day, or did it?
To enhance compliance, Congress amended the MHPAEA through passage of Section 203 of Title II of Division BB of the Consolidated Appropriations Act of 2021 (the CAA Amendment).  The CAA Amendment was followed by a new set of final rules issued by the U.S. Department of Health and Human Services, the U.S. Department of Labor, and the U.S. Department of Treasury (U.S. Departments) on September 9, 2024 (“New Final Rules”).

The New Final Rules contain effective dates of January 1, 2025 and (for the individual market) January 1, 2026, and their salient points are as follows:

• Covered Plans that impose greater restrictions on access to mental health/substance use disorder benefits (compared to comparable medical surgical benefits) violate the MHPAEA.
• Covered Plans cannot impose more restrictive “non-quantitative treatment limitations” (NQTLs), such as prior authorization requirements, other medical management techniques, standards related to network composition, or methodologies to determine out-of-network reimbursement rate, compared to the “predominant” NQTLs applied to medical/surgical benefits “in the same classification.”
• Covered plans are prohibited from using discriminatory information, evidence, sources, or standards that systematically disfavor or are specifically designed to disfavor access to mental health or substance use disorder benefits as compared to medical/surgical benefits when designing NQTLs.
• Covered Plans must collect and comparatively evaluate data about the effects of NQTLs and make the reporting available to state and federal agencies.
• If data compilations reveal discrepancies between the effect of NQTLs on benefits for mental health/substance use disorders, compared to medical/surgical benefits, then the Covered Plan must take reasonable action to address any material differences in access to benefits.
• The New Final Rules implement a “sunset provision” for self-funded, non-Federal governmental health plans to opt out of compliance with MHPAEA.

One step forward, two steps back.
On January 17, 2025, while the New Final Rules were still in their nascent stage of applicability, the ERISA Industry Committee filed suit in the D.C. District Court, contending that the New Final Rules are arbitrary, capricious, and inconsistent with the law.  Contemporaneously, the U.S. Departments began reconsidering the New Final Rules pursuant to Executive Order 14219.[1]  In connection with their reconsideration, the U.S. Departments requested a stay of the ERISA Industry Committee litigation, and on May 15, the U.S. Departments publicly confirmed that—for a minimum of 18 months after the pending litigation is resolved—they will not enforce the New Final Rules and will not take action for failing to adhere to them.  See Statement here.  Notwithstanding the status of the New Final Rules, the U.S. Departments recognized that “MHPAEA provides critical protections for workers, individuals, and their families who need treatment for mental health conditions and substance use disorders” and reiterated that Covered Plans must comply with the Original Final Rules.

As of this writing, the litigation is still pending, and therefore the New Final Rules will not be implemented in 2026.  For now, Covered Plans, including employers with self-funded healthcare plans, should remain mindful of the Original Final Rules, as well as the U.S. Departments’ stated commitment to protecting accessibility to mental health and substance use disorder benefits.

This article is designed to provide one perspective regarding recent legal developments, and is not intended to serve as legal advice.  Always consult an attorney with specific legal issues.

[1] “Ensuring Lawful Governance and Implementing the President’s ‘Department of Government Efficiency’ Deregulatory Initiative.”