The ERISA Industry Committee v. United States Department of Health and Human Services et al.
Brief Summary: On January 17, 2025, the ERISA Industry Committee (ERIC) filed a lawsuit against the U.S. Departments of Health and Human Services (HHS), Labor (DOL), and the Treasury, seeking to invalidate the the Final Parity Rule implementing the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). ERIC argues the Final Parity Rule exceeds the agencies’ authority under and the Consolidated Appropriations Act of 2021 (CAA) and violates the Administrative Procedure Act (APA) and the Fifth Amendment’s Due Process Clause.
Background: MHPAEA prohibits group health plans and insurers that provide mental health or substance use disorder (MH/SUD) benefits from imposing less favorable benefit limitations on MH/SUD treatments than on medical/surgical (M/S) benefits. On September 9, 2024, HHS, DOL, and the Treasury issued the Final Parity Rule aimed at strengthening MHPAEA’s parity enforcement. The rule requires plans to address “material differences” in access to MH/SUD benefits, as demonstrated by outcomes data, and mandates “meaningful benefits” for MH/SUD treatment in all classifications where M/S benefits are offered.
Overview of the Lawsuit: ERIC, which represents large employers offering ERISA-governed health benefits, challenges the Final Parity Rule on several grounds. ERIC argues that the rule imposes burdensome and ambiguous requirements, particularly the “meaningful benefits” standard, which creates a benefits mandate that exceeds the Departments’ regulatory authority. Specifically, they contend that the rule allows the agencies to determine the adequacy of inpatient MH/SUD benefits and dictates the scope of MH/SUD coverage based on third-party clinical standards, rather than comparing it to the plan’s inpatient M/S coverage. Additionally, the rule imposes a “material differences in access” standard, which ERIC alleges improperly expands the Department’s authority to regulate outcomes, not just plan terms. ERIC further asserts that the rule will significantly increase administrative costs, diverting resources from providing MH/SUD benefits, and potentially causing employers to reevaluate their coverage levels, which could lead to patients losing access to or being unable to use their current behavioral health benefits. Read the complaint here.
Current Status: The agencies have until April 18, 2025, to respond.
Potential Impact: Millions of Americans continue to face barriers to mental health and substance use disorder (MH/SUD) treatment, and inadequate parity laws may further exacerbate these disparities. If the Court holds in favor of ERIC, consumers with MH/SUD treatments may experiences reduced access to MH/SUD benefits.
Last Updated on March 14, 2025 by Aimed Alliance
