Mental health parity is still the law, even with the new rule on hold.
The newest requirements in the 2024 parity rule are not being enforced, and on September 8, 2026 the Department of Labor said where it will focus instead. What has not changed is the statute: your plan cannot manage mental health and substance use benefits more tightly than medical ones, and it has to be able to show that when asked.
Four kinds of limits, one standard.
The Mental Health Parity and Addiction Equity Act compares how a plan treats mental health and substance use benefits against how it treats medical and surgical benefits in the same classification.
Financial Requirements
Deductibles, copays and coinsurance for mental health and substance use care cannot be more restrictive than those applied to substantially all medical and surgical benefits. The comparison runs within each classification, such as inpatient, outpatient, emergency care and prescription drugs, so a therapy copay above the usual office visit copay is the kind of difference to check. A separate deductible that applies only to mental health care is not allowed.
Quantitative Limits
Visit caps and day limits are held to the same test. These are easy to see in a plan summary, which is why they are rarely where plans fail now. Where they still turn up is in older plan language carried forward, or in a rider or carve-out program with its own rules. A read of the full plan document, not only the summary, closes that question.
Nonquantitative Limits
Prior authorization, medical necessity criteria, network standards and provider reimbursement. These are where most parity problems sit, because they are applied in operation rather than printed in the plan. Step therapy, fail-first requirements and exclusions for residential treatment are other forms. Proving parity means showing the process and the evidence behind each limit, and how it is applied in practice, not just that a written policy exists.
Comparative Analyses
Since the Consolidated Appropriations Act of 2021, plans must document how each nonquantitative limit is designed and applied, and produce that analysis on request. The analysis has to name the limit, the factors used to design it, the evidence behind those factors, and how their application compares on both sides. The regulators can request it at any time, and a plan participant may request it as well.
What the Department of Labor said in September 2026.
Field Assistance Bulletin 2026-03 kept the pause on the 2024 rule’s new provisions and named three priorities.
Blanket Exclusions
Plans that exclude a mental health or substance use treatment outright while covering comparable medical treatment. Examples to look for are residential treatment, applied behavior analysis or medication for opioid use disorder excluded while comparable medical care is covered. The check is a line-by-line read of the plan’s exclusions against what it covers on the medical side.
Medical Necessity Review
How prior authorization and concurrent or retrospective review are applied to mental health and substance use care compared with medical care. The question is whether therapy or an inpatient stay faces review more often, with shorter approvals or stricter criteria, than a comparable medical service. The answer lives in the administrator’s review policies and denial data, which is why the employer needs access to both.
Networks and Reimbursement
Whether the network actually has mental health providers available and whether reimbursement rates are set on comparable terms. A directory listing therapists who are not taking new patients is the gap employees notice first. Reimbursement matters because rates set below those for comparable medical providers keep clinicians out of network, which pushes employees into out-of-network bills.
What Is Paused
The 2024 rule’s meaningful benefits standard, its discriminatory-factor prohibitions, its outcome data requirements and its new comparative analysis content. The underlying statute and the 2021 analysis requirement still apply. For employers the practical effect is small: the work that was always required, a documented analysis of each nonquantitative limit, is still the work that has to be done. Waiting for the reconsideration to finish is not a reason to leave that file empty.
Insured or self-funded, the employer is still on the hook.
On a fully insured plan the carrier writes the analysis, but the employer sponsors the plan and should have a copy. On a self-funded plan the employer owns the analysis outright and needs the third-party administrator and pharmacy benefit manager to supply the data behind it. Either way, the useful question is not whether a document exists but whether it answers the three enforcement priorities for your plan.
What employers ask about mental health parity.
Does mental health parity apply to small employers?
The federal parity law applies to group health plans of employers with more than 50 employees. Small-group insured plans are held to parity through the ACA essential health benefit rules. A small employer on a self-funded or level-funded plan can fall outside both routes, so parity there depends on what the plan document and the vendor’s design actually say. That is worth reading before assuming the plan is covered.
Our plan is fully insured. Is this our problem?
Partly. The carrier builds and maintains the analysis, but the employer sponsors the plan. Ask the carrier for its nonquantitative limit comparative analysis and keep it with your plan records. When you ask, check that the analysis covers the limits in your specific plan rather than a generic template, and note when it was prepared, since it should be refreshed whenever the plan design changes.
What is a nonquantitative treatment limitation?
Any limit that is not a number: prior authorization, step therapy, medical necessity criteria, network admission standards and how providers are paid. The test is comparative: a limit is allowed if it is designed and applied to mental health care no more strictly than to medical care in the same classification. That is why the documentation asks why a limit exists, not only whether it does.
Was the 2024 parity rule repealed?
No. The Departments announced in May 2025 that they would not enforce its new provisions while they reconsider it, and the September 2026 bulletin kept that position. The statute and the 2021 comparative analysis requirement remain in force. The rules can change again when the reconsideration finishes, so we track the Departments’ guidance and flag anything that affects your plan year.
What should we have on file?
The comparative analyses for each nonquantitative limit, the plan documents, and written confirmation from each vendor of how they apply prior authorization and medical necessity review. Add a record of any changes made after a review, since showing that a problem was found and corrected carries weight if the plan is questioned. Refresh the file whenever the plan design, the administrator or the pharmacy benefit manager changes.
How does this affect self-funded plans?
The employer owns the analysis. The data comes from the administrator and pharmacy benefit manager, so their contracts should require them to provide it. At renewal or a contract change, that means a clause requiring the vendor to produce the data and cooperate with a regulator’s request on a set timeline. Without it, the sponsor of a self-funded plan is responsible for an analysis it cannot complete.
General information, not legal advice. Parity rules are complex and applied plan by plan.
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