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    Mental health parity law (MHPAEA)

    Also known as MHPAEA, Mental Health Parity and Addiction Equity Act, Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, mental health parity, parity law

    The Mental Health Parity and Addiction Equity Act (MHPAEA) bars many US health plans from limiting mental health and substance use benefits more than medical/surgical benefits.[1] A stricter rule issued in September 2024 is not being enforced in its new parts: in May 2025 the Departments paused enforcement while they reconsider it.[2] The statute, and the 2013 rule, still apply.[3][4]

    Editor reviewedStrict sourcingUpdated WikiMental health, Health and medicine, Tech policy
    Key facts

    The Mental Health Parity and Addiction Equity Act (MHPAEA), formally the Paul Wellstone and Pete Domenici Act of 2008, is the main US federal law requiring “parity” between mental health or substance use coverage and medical/surgical coverage in the health plans it covers.[1] As of 11 October 2026, the law is in force. A stricter 2024 rule is partly unenforced, and the government is writing a new one.[2][4] This page is general information, not legal or medical advice. Plan rules vary, so check your plan documents or the Labor Department.

    What the law requires

    Parity means a plan cannot make mental health care harder to get than comparable medical care. The 2024 final rule restated this for non-quantitative treatment limitations (NQTLs), the non-numeric rules such as prior authorisation, medical-necessity criteria and network standards. It barred plans from using NQTLs that restrict mental health and substance use benefits more than medical/surgical ones.[1] Since the Consolidated Appropriations Act of 2021, plans must also document NQTL “comparative analyses”. The 2024 rule set out what those analyses must contain and who can see them.[5]

    The 2024 rule and the 2025 pause

    The Departments of Labor, Health and Human Services and the Treasury issued the final rule on 9 September 2024. It was published in the Federal Register on 23 September 2024. Beyond the stricter NQTL standard, it required plans to collect and evaluate data on access to care and to act on material differences.[1]

    The ERISA Industry Committee (ERIC), which represents large employers’ plans, challenged the rule in court.[6] On 15 May 2025 the Departments said they would not enforce the parts of the 2024 rule that are new relative to the 2013 rule. The pause covers failures occurring before a final decision in that litigation, plus 18 months. They asked for the case to be paused while they reconsider the rule, including whether to rescind or modify it.[2] They also said the statute’s obligations, as amended in 2021, continue to apply.[3]

    Enforcement in 2026

    On 8 September 2026 the Labor Department’s Employee Benefits Security Administration (EBSA) issued Field Assistance Bulletin 2026-03. It sets out how EBSA will enforce the NQTL rules, focusing on three areas: exclusions that apply only to mental health or substance use benefits, medical-necessity and prior-authorisation processes, and network adequacy.[7] According to the law firm Crowell & Moring, EBSA is working on a new MHPAEA rule, and plans are being enforced against under the 2013 rule in the meantime.[4]

    In practice, people with job-based or marketplace coverage still have parity protections from the 2008 law. The extra requirements added in 2024 are on hold.[3][2] The paying for therapy guide explains how this fits with other coverage.

    Open questions as of October 2026: the content and timing of a proposed rule, which Crowell & Moring expected to lead to a final rule by the end of 2026; how the ERIC case is resolved; and whether the 18-month tail after a final decision will matter in practice if the rule is rescinded or modified first.[4][2]

    Why it matters for access

    Parity law concerns coverage on paper. Getting care also depends on finding a provider who takes your plan. In 2009–2010, only 55.3% of psychiatrists accepted new privately insured patients, compared with 88.7% of other physicians.[8] As of 30 September 2026, about 154.6 million people lived in federally designated mental health shortage areas.[9] Track rule changes in the mental health care access tracker.

    Next in the crash course

    Questions readers ask

    What does the mental health parity law require?

    It bars group health plans and insurers it covers from imposing treatment limitations on mental health and substance use benefits that are more restrictive than those on medical/surgical benefits.[1]

    Is the 2024 parity rule in effect?

    It was finalised, but on 15 May 2025 the Departments said they would not enforce its new provisions for failures before a final court decision in the ERIC lawsuit plus 18 months, while they reconsider the rule.[2]

    Does that mean parity is not enforced at all?

    No. The Departments said MHPAEA's statutory obligations, as amended in 2021, still apply, and the Labor Department issued enforcement guidance in September 2026.[3][7]

    What is a non-quantitative treatment limitation (NQTL)?

    A coverage rule that is not a number, such as prior authorisation, medical-necessity criteria or network standards. The Labor Department's 2026 bulletin prioritises mental-health-only exclusions, medical necessity and prior authorisation, and network adequacy.[7]

    Will there be a new parity rule?

    As of September 2026 the Labor Department was working on a new rule. A law firm analysis said a final rule was expected by the end of 2026, which is a forecast, not a confirmed date.[4]

    Sources

    · 9 claims from 5 publishers

    Each numbered claim is a statement we checked against the sources listed with it. Tap a number in the text to see its sources in place.

    1. [1]

      On 9 September 2024 the Departments of Labor, HHS and the Treasury issued final MHPAEA rules, published on 23 September 2024, that bar plans from using non-quantitative treatment limitations that restrict mental health and substance use benefits more than medical/surgical benefits and require plans to collect and act on access data. confirmedas of 2024-09-23

    2. [2]

      On 15 May 2025 the three Departments said they would not enforce the parts of the 2024 rule that are new relative to the 2013 rule, for failures occurring before a final decision in the ERIC lawsuit plus 18 months, while they reconsider the rule, including possible rescission. confirmedas of 2025-05-15

    3. [3]

      The Departments said MHPAEA's statutory obligations, as amended by the Consolidated Appropriations Act, 2021, continue to apply during the non-enforcement period. confirmedas of 2025-05-15

    4. [4]

      As of mid-September 2026 EBSA was working on a new MHPAEA rule, and plans were being enforced against under the 2013 rule; Crowell & Moring said a new final rule was expected by the end of 2026. reportedas of 2026-09-14

    5. [5]

      The 2024 rule also set content requirements for the NQTL comparative analyses that plans must provide to regulators and, on request, to participants, as required by the 2021 Consolidated Appropriations Act. confirmedas of 2024-09-23

    6. [6]

      The 2024 parity rule is being challenged in a lawsuit brought by the ERISA Industry Committee (ERIC), which represents large employers' benefit plans. confirmedas of 2026-09-14

    7. [7]

      On 8 September 2026 the Labor Department's EBSA issued Field Assistance Bulletin 2026-03 on enforcing MHPAEA's treatment-limitation rules, focusing on mental-health-only exclusions, medical necessity and prior authorisation, and network adequacy. confirmedas of 2026-09-08

    8. [8]

      In a national survey for 2009–2010, 55.3% of psychiatrists accepted new patients with private insurance, compared with 88.7% of other physicians; acceptance of Medicare (54.8%) and Medicaid (43.1%) was also lower. confirmedas of 2014-02-01

    9. [9]

      As of 30 September 2026, HRSA counted 7,127 mental health Health Professional Shortage Area designations covering about 154.6 million people, with 26.24% of need met and 7,796 more practitioners needed to remove every designation. confirmedas of 2026-09-30

    Revision history (1)
    1. Page created.

    Created Oct 11, 2026. Last reviewed by an editor on Oct 11, 2026. Next scheduled review: Dec 31, 2026.

    Cite this page

    "Mental health parity law (MHPAEA)." ContentLora, updated Oct 11, 2026. https://contentlora.com/wiki/mental-health-parity-law

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