Story 1
The parity pause: what the May 2025 statement does and does not do.
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The Mental Health Operator · Issue 1 · November 2026
The parity enforcement pause: what still applies to your claims
Issue 1. The Departments stopped enforcing the 2024 parity rule in May 2025. The statute, the comparative analysis duty and the prior authorization clocks did not stop. Three stories, one thirty-minute task.
2024 rule · not enforced
2013 rule · statute · CAA, 2021
90834 · 90837 · 99214
Edition
1 · Nov 2026
Focus
Parity pause
Audience
MH groups · CMHCs
Codes
90834 · 90837 · 99214
Clocks
72 h / 7 days
Length
4 min
Three stories
Story 2
The comparative analysis plans still owe, and how to use it.
Story 3
Authorization clocks and public metrics already yours to cite.
The parity pause: what still applies
On May 15, 2025 Labor, HHS and the Treasury said they will not enforce the 2024 MHPAEA rule for failures before a final ERIC decision plus 18 months, for the new portions only. Statutory obligations under the CAA, 2021 continue; plans may rely on the 2013 rule and FAQs Part 45; HHS encourages, without requiring, states to follow [1].
- 1Nov 13, 2013Original parity rule, still in effect
- 2CAA, 2021Comparative analysis duty on plans, in effect
- 3Sep 9, 20242024 final rule issued
- 4May 15, 2025Nonenforcement statement [1]
- 5Decision + 18 monthsEarliest end of the pause; no decision yet
| Item | Status | Source |
|---|---|---|
| Meaningful benefits standard (plan years from Jan 1, 2026) | Not enforced by the Departments | DOL fact sheet [2] |
| Data evaluation and six-element analysis format | Not enforced by the Departments | May 2025 statement [1] |
| Statutory parity requirement | In effect | May 2025 statement [1] |
| CAA, 2021 comparative analysis duty | In effect | May 2025 statement [1] |
| 2013 final rule | In effect | May 2025 statement [1] |
| State parity enforcement against issuers | State by state | May 2025 statement [1] |
Takeaway
Your underpayment claim never depended on the 2024 rule. It depends on your contract and your 835s, and both are exactly where they were.
The comparative analysis plans still owe
The CAA, 2021 requires plans applying NQTLs to mental health and SUD benefits to prepare comparative analyses and produce them on request. When a plan's authorization or medical necessity rule stops therapy claims and spares comparable medical visits, ask for that NQTL's analysis and attach the remittance record. The parity claims playbook has the exhibits and letter outline; the enforcement timeline has the dates.
Parity clocks on the plan, authorization clocks on the payer
Produce the comparative analysisplan
10 business days22%
Respond to an initial noncompliance findingplan
45 calendar days100%
Notify participants after a final findingplan
7 business days16%
Standard authorization decisionpayer
7 calendar days168 hours
Expedited authorization decisionpayer
72 hours3 days
01045 days
Parity clocks on the planAuthorization clocks on the payer
Clocks you can already cite
Since January 1, 2026, Medicare Advantage and Medicaid and CHIP managed care plans must decide expedited requests in 72 hours and standard in seven calendar days, with a specific denial reason, and each posted its own metrics by March 31, 2026 [3]. Time-stamp every request; keep the payer's metrics in the appeal folder. Our API explainer covers scope.
ASP update
New: a 2027 buyer's guide for mental health billing services: the three clocks as vendor questions and nine contractable KPIs. The behavioral health payer matrix now carries the state Medicaid and payer notices we track, each cell linked to its source.
Allowed versus contract, three codes
Pull last month's 835s for your two largest commercial payersZero-pay files included.
List allowed versus contract for 90834, 90837 and 99214One line per code per payer.
Compare the gapsTherapy codes further below contract than the E/M code: the first exhibit in a parity file. If not: proof your contracts are honored. Either answer is worth having.
Or have it run monthlyOur mental health billing services team runs it for clients; behavioral health billing services shows how it fits the revenue cycle.
Frequently asked questions
Is parity law suspended for 2026?
No. The May 15, 2025 statement pauses federal enforcement of the new portions of the 2024 rule only. It confirms that MHPAEA's statutory obligations, as amended by the CAA, 2021, continue to have effect.
Can my practice ask a plan for its comparative analysis?
Participants and their authorized representatives can request it, and regulators can require production within 10 business days. Attach your operational record from the 835s when you ask.
Do the 72-hour and 7-day prior authorization clocks apply to commercial plans?
Not under CMS-0057-F. They apply to Medicare Advantage and Medicaid and CHIP managed care plans (not QHP issuers on the FFEs). Commercial plans follow their contracts and state law.
How often will The Mental Health Operator publish?
Monthly; a second late-November issue covers the telehealth POS and modifier map for 2027.
- Departments of Labor, HHS and the Treasury: Statement Regarding Enforcement of the Final Rule on Requirements Related to MHPAEA (May 15, 2025)
- DOL EBSA fact sheet: Final Rules under the Mental Health Parity and Addiction Equity Act (September 2024)
- CMS fact sheet: Interoperability and Prior Authorization Final Rule, CMS-0057-F (January 17, 2024)
Checked October 25, 2026. Confirm against the source; items marked proposed may change in the final rule.
Want the thirty-minute check done for you?
Send last month's 835s for your two largest payers. We return the allowed-versus-contract lines for therapy and E/M codes, and whether there is a parity file to build.