Labor & Employment Law Daily Wrap Up, DOL NEWS—EBSA prioritizes three areas for Mental Health Parity enforcement focus, (Sep 9, 2026)

By Brandi O. Brown, J.D.

The Labor Department said it will concentrate mental health parity enforcement on treatment exclusions, medical-necessity reviews, and provider network adequacy, while providing health plans and insurers with greater clarity on compliance expectations.

The Labor Department's Employee Benefits Security Administration said this week that it is narrowing and clarifying its enforcement approach to the Mental Health Parity and Addiction Equity Act's nonquantitative treatment limitation requirements, focusing its resources on areas it believes pose the greatest risk of harm to participants seeking mental health and substance use disorder treatment.

In Field Assistance Bulletin No. 2026-03, EBSA outlined an enforcement framework that agency officials said is intended to reduce compliance burdens, provide greater regulatory certainty for health plans and insurers, and ensure that mental health parity requirements are enforced "in a practical and meaningful way" that does not “unnecessarily drive up compliance costs” or “discourage” group health plan sponsors from offering mental health and substance use disorder benefits.

The bulletin addresses enforcement of the Mental Health Parity and Addiction Equity Act, or MHPAEA, as amended by the Consolidated Appropriations Act of 2021, and the final rule entitled “Requirements Related to the Mental Health Parity and Addiction Equity Act” (2024 MHPAEA final rule). The statute generally prohibits group health plans and insurers from imposing more restrictive limitations on mental health and substance use disorder benefits than on comparable medical and surgical benefits.

Complaints received. According to EBSA, employers, insurers, and other stakeholders have told the Labor Department that prior enforcement of the law's nonquantitative treatment limitation, or NQTL, comparative-analysis requirements generated confusion and significant compliance burdens. The agency said the new guidance is intended to provide clearer expectations while continuing to support access to mental health and substance use disorder care.

The guidance comes against the backdrop of ongoing litigation over the 2024 MHPAEA final rule and a broader federal review of regulatory requirements. The bulletin notes that the 2024 rule expanded requirements governing NQTL comparative analyses and became effective in late 2024, with some provisions applicable beginning in 2025 and the remainder applying for plan years beginning in 2026.

Partial pause announced in 2025. However, the Departments of Labor, Health and Human Services, and the Treasury announced in May 2025 that they would not enforce portions of the 2024 rule that were new compared with earlier regulations until the resolution of litigation brought by the ERISA Industry Committee, plus an additional 18 months. The agencies said at the time that MHPAEA's statutory requirements, including comparative-analysis obligations added by the 2021 appropriations law, remained in effect.

Reviewed its enforcement approach. Consistent with that policy, EBSA explained, it reviewed its enforcement approach under MHPAEA. To preserve enforcement resources and accord with the Departments' May 2025 nonenforcement policy, EBSA states that it will not pursue enforcement actions of those portions of the 2024 Final Rule that are new in relation to the 2013 Final Rule.

Nevertheless, because MHPAEA's statutory obligations continue to apply, including the requirements added by the CAA of 2021 related to NQTL comparative analyses, EBSA will narrow its enforcement focus areas relating to requests for NQTL comparative analyses under the statute. This approach to enforcement, it explained, is designed to reduce compliance burdens and to provide clarity for plans and issuers on how to meet the NQTL requirements in a balanced and even-handed manner.

Categories with highest potential for harm. Rather than broadly examining all types of nonquantitative treatment limitations, EBSA said it will concentrate enforcement efforts on three categories that it believes present the highest potential for significant harm to plan participants and beneficiaries.

The first category involves separate treatment limitations and exclusions. The agency said health plans generally may not impose blanket exclusions on treatments for covered mental health or substance use disorder conditions when comparable treatments are covered for medical or surgical conditions. EBSA said it will focus particularly on cases involving broad exclusions that apply only to mental health or substance use disorder benefits, while reserving the ability to review narrower exclusions when complaints or other concerns arise.

The second enforcement priority concerns medical necessity standards and review procedures, including prior authorization, concurrent review, and retrospective review practices. The bulletin states that plans may use proprietary clinical guidelines when making medical-necessity determinations, provided that the processes and evidentiary standards applied to mental health and substance use disorder benefits are comparable to and no more stringent than those used for medical and surgical benefits. EBSA also emphasized that plans, insurers, and service providers must make those guidelines available during agency investigations and to participants and beneficiaries who request them.

The third focus area concerns network adequacy, particularly standards governing provider participation and reimbursement methodologies. EBSA said inadequate provider networks can create significant barriers to obtaining mental health and substance use disorder treatment because participants may be forced either to seek out-of-network care at higher cost or to forgo treatment altogether. Where parity-related network issues are identified, the agency said it will seek to ensure that plans and insurers explore available options and assist participants seeking covered mental health and substance use disorder services without requiring them to bear out-of-network costs because in-network care is unavailable.

Authority over other categories. Although the bulletin identifies those three areas as enforcement priorities, EBSA said it retains authority to investigate other categories of nonquantitative treatment limitations, particularly in response to participant complaints. The agency said it remains committed to protecting mental health and substance use disorder benefits and may pursue additional reviews when circumstances warrant.

Advance notice and transparency. The guidance also reflects a broader emphasis on advance notice and regulatory transparency. EBSA said it is seeking to provide plans and insurers with greater clarity regarding its expectations before taking enforcement action. In conjunction with the bulletin, the agency released an enforcement guidance tool intended to help plans and issuers comply with MHPAEA requirements, including obligations related to NQTL comparative analyses.

Looking ahead, EBSA said it may issue additional guidance as needed and will continue soliciting feedback from interested stakeholders regarding areas where further clarification would be helpful. While the agency's approach narrows the immediate scope of enforcement activity, the bulletin underscores that mental health parity remains a national enforcement priority and that EBSA intends to continue targeting practices it believes create meaningful barriers to accessing mental health and substance use disorder treatment.

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