Background: The Comparative Analysis Requirement
Under the Mental Health Parity and Addiction Equity Act (MHPAEA), as amended by the Consolidated Appropriations Act (CAA), 2021, group health plans and health insurance issuers must conduct comparative analyses to show that nonquantitative treatment limitations (NQTL), such as prior authorization, standards related to network composition and methodologies to determine out-of-network reimbursement rates, are applied to mental health (MH) and substance use disorder (SUD) benefits no more stringently than to medical and surgical benefits. These analyses must demonstrate that the underlying processes, evidentiary standards and decision-making criteria used for MH and SUD benefits are comparable to those used for medical care.
In September 2024, the Departments of Labor, Health and Human Services, and the Treasury (the “Departments”) finalized rules to further implement and clarify the comparative analysis requirements under MHPAEA. The 2024 Final Rule outlines what constitutes a sufficient comparative analysis and sets deadlines for producing it upon request, with staggered effective dates beginning in 2025. Among other things, the Final Rule (1) introduces a “meaningful benefits” standard that may require plans to cover MH or SUD treatments in every classification where medical and surgical benefits are offered, (2) adopts a “material differences in access” test that uses outcome data as presumptive evidence of a violation even where plan terms are facially neutral and (3) requires ERISA plan fiduciaries to certify they have engaged in a prudent process to select and monitor service providers performing the comparative analysis.
Recent Developments: Enforcement Delay of the 2024 Final Rule
On May 15, 2025, the Departments issued a joint enforcement statement announcing that they will not enforce the new requirements under the 2024 Final Rule pending further review and reconsideration of the regulation. This action was prompted by two key developments:
- Litigation: In January 2025, the ERISA Industry Committee (ERIC) filed suit challenging provisions of the 2024 Final Rule as arbitrary and capricious and contrary to law.
- Executive Order 14219: Directs agencies to suspend enforcement of regulations that may impose undue burdens or costs not justified by public benefits.
As a result, the Departments will not take enforcement action for failures to comply with the new provisions of the 2024 Final Rule that occur before the conclusion of the litigation plus an additional 18 months. This non-enforcement policy does not apply to obligations that predated the 2024 Final Rule, such as those under MHPAEA as amended by the CAA 2021.
What This Means for Employers and Plan Sponsors
- Comparative Analysis Requirement Remains in Effect: The underlying statutory requirement to conduct and maintain comparative analyses for NQTLs has not been repealed. Plans must still demonstrate MH and SUD parity in accordance with existing law and guidance.
- No Need to Comply with New Requirements — For Now: Provisions introduced for the first time in the 2024 Final Rule — like those mentioned above — will not be enforced at this time. However, these may be revised or reissued in the future following additional rulemaking.
Action Items for Employers and Plan Fiduciaries
- Continue to maintain and update NQTL comparative analyses as required under current law.
- Monitor for further guidance as the Departments reassess the 2024 Final Rule.
- Consider reviewing current plan practices and comparative analysis documentation to ensure compliance.
