Skip to main content

Practice & Policy · 13 min read · Field Notes

The MHPAEA Rule Is Being Rewritten: What Therapists Should Document Right Now Before the Reset

2026-07-11 Matthew Sexton, LCSW, NATC All Field Notes

Quick answer On March 30, 2026, the Departments of Labor, Health and Human Services, and Treasury told a federal court they will not defend the 2024 mental-health-parity final rule and will instead write a new one, due as a proposed rule by December 31, 2026 (Becker's Behavioral Health, April 2026). Nothing has moved since. The next checkpoint is a joint status report due September 30, 2026. That gap is not a reason to stop documenting parity violations. The underlying statute, including the comparative-analysis requirement, was never paused. It's the reason to start now, while the record is easy to build and before a new rule resets the ground again. — Matthew Sexton, LCSW, NATC

If you bill commercial insurance in New York, New Jersey, or Connecticut, you've probably heard some version of "the parity rule is getting rewritten" without a clear sense of what that means for your Tuesday. Fair. The honest answer is: less than you'd think, and more than you'd want. Less, because the law that actually governs your claims hasn't changed. More, because a rulemaking vacuum is exactly the moment when a clean paper trail stops being optional and starts being your best leverage.

What the agencies told the court on March 30, 2026

They told the court they're conceding, not defending. In a joint status report filed in ERISA Industry Committee v. HHS et al. (D.D.C.), the Department of Labor, HHS, and Treasury said they will not defend the September 2024 MHPAEA final rule against the industry lawsuit challenging it, and will instead pursue a new proposed rule with "significant revisions" to the provisions ERIC contested (Becker's Behavioral Health; Mercer; Groom Law Group, reported April 1 to 3, 2026).

The agencies committed to a deadline: a Notice of Proposed Rulemaking by December 31, 2026. That's a proposal, not a finished rule. Public comment, revision, and a final rule would all come after that, likely stretching into 2027 or later. For a solo practice planning a full calendar year, that's a long runway of uncertainty about which specific standard will eventually govern.

The 2024 rule being abandoned is the one that created the "meaningful benefits" standard and new data-collection duties, requiring plans to track outcomes like prior-authorization denial rates for behavioral health against medical and surgical claims (Federal Register, September 23, 2024; DOL Fact Sheet, 2024). Those specific mechanics are what's getting rewritten. The parity statute they sit on top of is not.

How did we get here? The pause that came before the reset

This wasn't a sudden reversal. It was a second step. On May 9, 2025, the same three agencies filed a Motion for Abeyance and announced a non-enforcement policy: no enforcement action against a plan for failing to comply with the 2024 rule's new provisions, for the duration of the litigation plus an additional 18 months (U.S. Department of Labor, May 9, 2025). That 18-month grace period is still running.

Read the two filings together and the arc is plain. May 2025 was the agencies buying time and signaling they weren't going to fight hard for the rule as written. March 2026 was them saying so directly: they won't defend it, and they're starting over. If you were waiting to see whether the pause was temporary, you have your answer.

ERIC filed the original lawsuit on January 17, 2025, in D.D.C., with former Trump-administration DOL Secretary Eugene Scalia as lead counsel for the industry group (Georgetown Law Health Care Litigation Tracker; PLANSPONSOR). Fourteen months from filed complaint to "we won't defend this" is a fast collapse for a federal rule, and it tells you the specific provisions ERIC targeted (the meaningful-benefits standard, the new data requirements, and how the "predominant/substantially all" test gets applied to non-quantitative limits) were genuinely vulnerable, not just unpopular.

Timeline: how the 2024 MHPAEA rule got scrapped, January 2025 to December 2026 A five-step timeline of the parity rule rewrite. January 17, 2025: ERIC sues to challenge the 2024 rule. May 9, 2025: agencies pause enforcement during litigation. March 30, 2026: agencies tell the court they won't defend the rule and will write a new one. September 30, 2026: a joint status report to the court, a procedural checkpoint, not a rule release. December 31, 2026, highlighted as the key date: the Notice of Proposed Rulemaking is due. The parity rule's timeline: Jan 2025 to Dec 2026 Jan 17, 2025 ERIC sues to challenge the 2024 rule May 9, 2025 Agencies pause enforcement during litigation Mar 30, 2026 Agencies tell the court: won't defend, will rewrite Sep 30, 2026 Joint status report — a procedural checkpoint Dec 31, 2026 NPRM due — the new rule proposal Sources: Becker's, Mercer, Groom Law Group, DOL EBSA (2025–2026 filings).

Does anything about MHPAEA still apply right now?

Yes, and this is the part that gets lost in headlines about a rule being scrapped. The 2024 rule is paused and headed for a rewrite, but the underlying statute is not. Plans and issuers are still required to perform and document a comparative analysis of their non-quantitative treatment limitations (NQTLs) under the Consolidated Appropriations Act, 2021 amendments to MHPAEA, and that requirement is self-implementing. It never depended on the 2024 rule taking effect, so it was never part of the pause (U.S. Department of Labor statement; Groom Law Group analysis).

In plain terms: a plan still has to be able to show, on request, that its prior-authorization rules, medical-necessity criteria, and review procedures for behavioral health are comparably applied to how it treats medical and surgical care. That obligation predates the 2024 rule and will outlive whatever replaces it. The specific test for measuring "comparable" is what's up for revision. The duty to have the analysis on file is not.

That's the practical hinge for a clinician. You don't need to wait for the December NPRM to have standing to ask a plan why it applied a stricter review to a behavioral-health claim than it would to a comparable medical one. That question is available to you today, under the statute that's currently in force, regardless of which version of the implementing rule eventually wins.

What does the enforcement record show while the rule gets rewritten?

Regulators kept working through the pause. The government's 2025 MHPAEA Report to Congress, covering August 1, 2023 through July 31, 2025, shows DOL's Employee Benefits Security Administration issued 14 insufficiency letters and 5 final determination letters of noncompliance in that window, with all four affected plans' violations tied to prior-authorization practices, according to a Crowell & Moring LLP analysis of the government's own report (Crowell & Moring LLP). CMS, covering the plans it oversees, issued 62 insufficiency letters and 10 final determination letters over the same period.

Those numbers are small relative to the scale of the commercial insurance market, and that's the point worth sitting with. Regulatory enforcement, even when it's active, moves at a pace measured in single-digit and low-double-digit determinations per two-year cycle. A rulemaking pause doesn't meaningfully slow that already-slow process down further. But it also means an individual clinician's own documented pattern of denials is often more current and more specific than what shows up in a federal report two years later.

The through-line across every insufficiency and determination letter is the same category the statute has always used: how a plan's review process treats behavioral health compared to medical care. That's the NQTL question. A new rule can change how strictly that comparison gets measured. It can't change that prior authorization, medical-necessity criteria, and review frequency are the terrain the fight happens on.

What should you document before the September 30 checkpoint?

Build the record now, while nothing procedural is due from you and the categories are stable. The next official checkpoint is September 30, 2026, when DOL, HHS, Treasury, and ERIC jointly report back to the court on rulemaking status (Groom Law Group; NFP). Nothing requires action from a clinician by that date. That's exactly why it's the right window: quiet, no deadline pressure, and the standard you're documenting against isn't about to shift out from under you before December.

Three things worth tracking starting this week, mapped to the NQTL categories that survive the rewrite regardless of what the new rule says:

  • Prior-authorization turnaround and denial reasons, by payer. Note the date submitted, the date decided, and the stated reason for every behavioral-health prior auth. This is the exact category DOL's determination letters keep citing, and it's the easiest pattern to spot once you have three or four months of it side by side.
  • Medical-necessity criteria language, verbatim. When a denial cites "does not meet criteria," get the specific criterion in writing. A vague denial is hard to compare to anything. A named criterion is something you can eventually hold up against how the same plan reviews a comparable medical claim.
  • Reimbursement rate by CPT code, over time. If a plan pays a behavioral-health code at a rate that looks out of step with what it pays for medical/surgical work, dated documentation of that pattern is the raw material a parity complaint runs on later (Mental Health Parity Denials: What to Document to Win goes deeper on building this file into an actual appeal).

None of this depends on which version of the rule eventually lands. The categories are statutory. What changes with the rewrite is the technical test regulators use to measure compliance, and you don't control that timeline anyway. What you control is whether, when the NPRM drops in December and everyone else is reading it cold, you already have eight months of your own dated record showing exactly where a plan's review process treats your claims differently than it treats a physician's. That's also the record that makes an external appeal faster to write when a denial lands in the meantime, and the same discipline that keeps defensible documentation from turning into an evening of reconstruction.

Worth naming plainly: this quiet window is also when enforcement, however slow, is still landing. Connecticut fined all five of its major commercial insurers for parity violations in May 2026, and the pay-rate disparities regulators cited there are the same NQTL category this documentation habit tracks (CT Mirror, May 2026). The rule being rewritten in Washington doesn't touch state-level enforcement, and it doesn't touch the file you're building on your own claims.

FAQ

Is the 2024 MHPAEA final rule still in effect?

It's in a non-enforcement posture. The tri-agencies announced in May 2025 they would not enforce the 2024 rule's new provisions during litigation plus an additional 18 months, and in March 2026 said they will not defend the rule at all and are writing a new one instead.

When will the new MHPAEA rule be finalized?

No final date exists yet. The agencies committed to a proposed rule (NPRM) by December 31, 2026. A final rule would follow public comment and revision, likely pushing into 2027 or later.

Does the rewrite mean parity protections went away?

No. The Mental Health Parity and Addiction Equity Act itself, including the Consolidated Appropriations Act, 2021 requirement that plans document a comparative analysis of their treatment limitations, is a statute and was never paused. Only the 2024 implementing rule's specific mechanics are being rewritten.

What happens on September 30, 2026?

The court requires DOL, HHS, Treasury, and ERIC to jointly report on the status of the new rulemaking. It's a procedural check-in, not a rule release. No new standard takes effect that day.

Should I wait for the new rule before documenting parity issues?

No. The categories regulators use to evaluate parity, prior authorization, medical-necessity criteria, and comparative reimbursement, are set by the statute, not the rule being rewritten. Documentation built now on those categories stays useful under whatever version of the rule eventually finalizes.

---

Sources

  1. Becker's Behavioral Health, Mercer, and Groom Law Group, reporting on the DOL/HHS/Treasury joint status report filed March 30, 2026 in ERISA Industry Committee v. HHS et al. (D.D.C.), April 1 to 3, 2026.
  2. Groom Law Group / NFP, analysis of the court-ordered September 30, 2026 joint status-report deadline for DOL, HHS, Treasury, and ERIC.
  3. U.S. Department of Labor, official statement on the May 9, 2025 Motion for Abeyance and non-enforcement policy. dol.gov
  4. U.S. Department of Labor / Groom Law Group, on the self-implementing status of the Consolidated Appropriations Act, 2021 NQTL comparative-analysis requirement under MHPAEA.
  5. Crowell & Moring LLP, analysis of the 2025 MHPAEA Report to Congress (August 1, 2023 to July 31, 2025), covering DOL/EBSA and CMS insufficiency and final determination letters. crowell.com
  6. Federal Register and U.S. Department of Labor Fact Sheet, on the September 23, 2024 MHPAEA final rule and its "meaningful benefits" and data-collection standards. federalregister.gov · dol.gov
  7. Georgetown Law Health Care Litigation Tracker and PLANSPONSOR, on the January 17, 2025 filing of ERISA Industry Committee v. HHS et al.
  8. The Connecticut Mirror, on Connecticut's May 2026 parity fines against five major commercial insurers. ctmirror.org
  9. VibeCheck blog, Mental Health Parity Denials: What to Document to Win, and Appeal a Mental Health Claim Denial & Win: 53% Overturned, for the New York external-appeal overturn rate.

Sources current as of July 2026. The underlying court filings and agency statements are the primary record; trade-press dates reflect first reporting.

About the author

Matthew Sexton, LCSW, NATC, is a practicing psychotherapist in private practice. He built VibeCheck, a HIPAA-eligible clinical support tool, for his own caseload — by a clinician who does this paperwork, for the clinician who's tired of it. It is not an AI therapist and not a replacement for the clinician.

Disclaimer

This article is for educational and informational purposes only. It does not constitute medical, clinical, legal, or therapeutic advice, and reading it does not create a therapist-client relationship with Matthew Sexton, LCSW or Mental Wealth Solutions PLLC. Although the author is a licensed clinical social worker, the content in this article is not clinical assessment, diagnosis, or treatment.

The status of MHPAEA rulemaking, the non-enforcement policy, and related court filings described here reflect the public record as of July 2026 and are subject to change as the litigation and rulemaking proceed. Nothing here is a substitute for confirming a specific compliance question with the payer, your billing or compliance team, or qualified legal counsel. Plans, states, and circumstances differ, and what is described here may not match your situation.

If you are in immediate emotional crisis, you can reach the 988 Suicide & Crisis Lifeline by calling or texting 988 (US). If you are experiencing domestic violence or are in physical danger, contact the National Domestic Violence Hotline at 1-800-799-7233 or visit thehotline.org. In a life-threatening emergency, call 911.

Built by a clinician who does this work too.

See VibeCheck → See pricing — $77.77/mo per seat →