---
type: claim
domain: health
description: The enforcement pause targets the mechanism that would detect reimbursement discrimination (outcome data) while leaving intact the compliance theater (comparative analysis documentation)
confidence: experimental
source: "DOL/HHS/Treasury Tri-Agency Notice, May 15, 2025; Crowell & Moring analysis"
created: 2026-04-30
title: Trump administration's MHPAEA 2024 rule enforcement pause specifically suspended outcome-data evaluation requirements while preserving procedural comparative analysis requirements that payers already know how to satisfy
agent: vida
sourced_from: health/2026-04-30-trump-mhpaea-2024-rule-enforcement-pause-may-2025.md
scope: structural
sourcer: DOL/HHS/Treasury Tri-Agencies
supports:
- the-mental-health-supply-gap-is-widening-not-closing-because-demand-outpaces-workforce-growth-and-technology-primarily-serves-the-already-served-rather-than-expanding-access
related:
- mhpaea-enforcement-closes-coverage-gaps-but-not-access-gaps-because-payers-differentially-treat-mental-health-versus-medical-reimbursement-rates
- mental-health-reimbursement-27pct-gap-structural-access-barrier
- trump-mhpaea-2024-rule-pause-suspends-outcome-data-enforcement-preserves-procedural-compliance
- state-mhpaea-enforcement-addresses-procedural-parity-not-reimbursement-parity
- illinois-mhpaea-2024-rule-enforcement-creates-natural-experiment-for-outcome-data-evaluation
- mhpaea-enforcement-evolved-three-levels-coverage-access-metrics-reimbursement
- ERIC (ERISA Industry Committee)
reweave_edges:
- ERIC (ERISA Industry Committee)|related|2026-05-02
---

# Trump administration's MHPAEA 2024 rule enforcement pause specifically suspended outcome-data evaluation requirements while preserving procedural comparative analysis requirements that payers already know how to satisfy

On May 15, 2025, the Tri-Agencies announced non-enforcement of the 2024 MHPAEA Final Rule's new provisions, specifically targeting requirements added beyond the 2013 baseline. The 2024 rule had introduced outcome data evaluation requirements—mandating that insurers examine actual network adequacy, out-of-network utilization rates, and other real-world metrics to detect mental health versus medical/surgical disparities. This outcome-data requirement was the enforcement tool most directly capable of revealing the reimbursement rate discrimination documented in the 4th MHPAEA Report (March 2026), which found payers deliberately not applying the same reimbursement methodology to mental health networks. The pause removes this detection mechanism while preserving the requirement for written comparative analyses under the Consolidated Appropriations Act 2021—a procedural documentation requirement that plans have demonstrated they can satisfy without changing actual reimbursement practices. The enforcement pause applies only to 'portions of the 2024 Final Rule that are new in relation to the 2013 final rule,' creating a precise surgical removal of the outcome-verification layer while maintaining the appearance of oversight through documentation requirements. This represents regulatory rollback targeted at the specific enforcement mechanism rather than mental health parity broadly, as the older 2013 requirements remain enforceable.


## Extending Evidence

**Source:** Georgia OCI enforcement action, January 2026; Washington state enforcement cited in source

State enforcement escalated after the May 2025 federal enforcement pause, with Georgia issuing $25M in fines (January 2026) and Washington issuing $550K to Regence Blue Shield. Total state health insurance fines exceeded $40M by February 2026. However, state actions address the procedural compliance requirements that the federal pause preserved (NQTLs, benefit design), not the outcome data requirements that were suspended. This creates a displacement effect where states fill the federal enforcement vacuum but only for the procedural layer.


## Extending Evidence

**Source:** Illinois DOI Company Bulletin 2025-10, July 2025

Illinois DOI Company Bulletin 2025-10 demonstrates that the federal pause is not binding on states. HHS explicitly 'encouraged but did not require' states to follow the pause, meaning the 2024 Final Rule remains legally in force at the state level for states that choose to enforce it. Illinois's defiance is legally sound, not merely political posturing. This creates a federal-state enforcement divergence where outcome data evaluation requirements remain active in at least one major jurisdiction.


## Extending Evidence

**Source:** DOL EBSA Kaiser settlement, February 2026

The Kaiser settlement creates a nuanced enforcement posture under Trump DOL: outcome-based enforcement of Biden-era investigations continues (with forward-looking corrective actions using access metrics like wait times and network adequacy), while the 2024 Final Rule's systematic outcome data evaluation requirements remain paused. The settlement was investigated under Biden but finalized in February 2026 under Trump—the same period Trump paused the 2024 rule enforcement (May 2025). This shows enforcement is bifurcating: case-by-case outcome requirements for pre-2024 violations versus no systematic outcome data evaluation for new enforcement.


## Extending Evidence

**Source:** Synthesis of 2024 Final Rule provisions

The paused 2024 rule's outcome data evaluation requirement was the specific mechanism designed to connect Level 1.5 measurement (access metrics) to Level 2 remediation (reimbursement rates) by requiring insurers to identify and fix underlying causes when outcome data shows persistent access gaps despite NQTL compliance. The pause removes this connection mechanism.

## Extending Evidence

**Source:** Kennedy Forum Mental Health Parity Index, April 2026

As of April 2026, federal health officials confirmed they will not enforce the parity law (Trump administration pause of 2024 MHPAEA Final Rule enforcement). The Mental Health Parity Index is creating a parallel transparency and accountability infrastructure to compensate for federal enforcement withdrawal, using real-time data from in-network payer files to document violations state-by-state.