DOL Announces Enforcement Priorities for Mental Health Parity
The Department of Labor (DOL) recently released Field Assistance Bulletin 2026-03 (FAB) detailing their enforcement priorities regarding the Mental Health Parity and Addiction Equity Act (MHPAEA). Mental health parity has been a hot topic in recent years, particularly regarding non-quantitative treatment limitations (NQTL) and the required comparative analysis to demonstrate parity between NQTLs applied to mental health and substance use disorder (MH/SUD) benefits compared to medical/surgical (M/S) benefits.
While the FAB is not a statute or regulation, it indicates where the DOL will focus its enforcement efforts. This is important for employers who, as plan sponsors, are responsible for their plan’s MHPAEA compliance.
The FAB continues the DOL’s nonenforcement policy regarding portions[1] of the Fall MHPAEA 2024 regulations but reiterates that the overall NQTL comparative analysis requirement still applies. The DOL indicates they will “prioritize and focus” NQTL comparative analysis enforcement on:
- Separate treatment limitations, including exclusions
- Enforcement will focus on blanket exclusions applicable only to MH/SUD benefits, though more limited exclusions may be addressed.
- Medical necessity standards and review process
- Enforcement will focus on prior authorization, concurrent review, and retrospective review. Plans must be prepared to demonstrate that the guidelines used to apply these to MH/SUD benefits are comparable to and not applied more stringently than when applied to M/S benefits.
- Network adequacy with a focus on network admission standards and provider reimbursement
- When MH/SUD and M/S network parity issues exist, enforcement will focus on ensuring plans consider all options and provide assistance with seeking out MH/SUD treatments without exposing participants to out-of-network costs due to lack of in-network MH/SUD service providers.
While the above will be DOL priorities, it does not mean the DOL will not take enforcement action for other mental health parity related issues, especially in response to complaints. The DOL has also made an enforcement guidance tool available to help plans understand their obligations under the MHPAEA.
Key Takeaway: Employers, as plan sponsors, should review the enforcement priorities announced by the DOL to understand where MHPAEA enforcement actions will be focused. Employers would be well served to ensure their NQTL comparative analysis documentation addresses these priorities.
[1] Specifically, the meaningful benefits standard, prohibition on discriminatory factors and evidentiary standards, relevant data evaluation requirements, and the related requirements for comparative analyses.
The information provided is a summary of laws and regulations relating to employee benefit plan compliance. This information should not be construed as legal advice. In all cases, employers should consult with their own legal counsel.
