The Mental Health Parity and Addiction Equity Act (MHPAEA) generally prohibits group health plans and health insurance insurers from more restrictive limitations on mental health and substance use disorder benefits than on medical and surgical benefits. Some of these limitations include nonquantitative treatment limitations, or NQTLs, such as prior authorization requirements, medical necessity reviews and provider network standards.
Under the Consolidated Appropriations Act, 2021, group health plans and health insurance insurers must demonstrate compliance with MHPAEA through a comparative analysis of their NQTLs. Preparing a compliant comparative analysis can be challenging, particularly for plan sponsors that must obtain and evaluate information from third-party administrators and other service providers. The U.S. Department of Labor (DOL) has repeatedly identified significant deficiencies in the plans’ comparative analyses.
On Sept. 8, recognizing these challenges, DOL issued Field Assistance Bulletin No. 2026-03. The bulletin responds to concerns that previous enforcement of MHPAEA’s NQTL comparative-analysis requirements created confusion and unnecessary burdens. The bulletin confirms DOL’s nonenforcement position with respect to the 2024 final regulations (see our previous eAlert on the topic here) The bulletin also identifies three areas that DOL believes presents the greatest potential harm to participants, and, accordingly, as enforcement priorities:
- Treatment limitations and exclusions: DOL will prioritize blanket exclusions that apply only to mental health or substance use disorder treatment when similar medical or surgical treatment is covered.
- Medical necessity standards and review processes: Plans and insurers may use proprietary clinical guidelines when making medical necessity decisions. However, the processes, standards and other factors used for mental health and substance use disorder benefits must be comparable to — and applied no more strictly than — those used for medical and surgical benefits.
- Network adequacy standards: When an inadequate network prevents participants from finding covered mental health or substance use disorder treatment in-network, DOL expects plans and insurers to consider available options and help participants obtain care without incurring higher out-of-network costs solely because an in-network provider is unavailable.
Importantly, the bulletin does not create new legal requirements or eliminate existing MHPAEA obligations. Instead, it explains how DOL will prioritize enforcement of existing requirements. Although DOL will concentrate on these three areas, it may investigate other NQTLs when concerns arise, particularly in response to participant complaints.
A New Compliance Tool
Along with the bulletin, EBSA released a compliance tool identifying plan language and practices that may signal MHPAEA compliance concerns. The tool is intended to help plans and issuers review both their written terms and how coverage operates in practice.
Practical Takeaways for Employers
The bulletin narrows EBSA’s immediate enforcement focus but does not relieve plan sponsors of existing MHPAEA compliance responsibilities. Plan sponsors should continue to prepare and maintain required NQTL comparative analyses and work with insurers, third-party administrators and other service providers to:
- Review treatment exclusions, medical necessity procedures and provider network standards;
- Confirm that restrictions on mental health and substance use disorder benefits are not applied more stringently than comparable restrictions on medical and surgical benefits; and
- Ensure that supporting clinical guidelines and other information can be provided promptly when requested.
Warner Has You Covered
If you would like assistance reviewing your plan’s NQTL comparative analysis or evaluating its treatment limitations, medical necessity procedures or network standards, please contact Stephanie Grant or your Warner attorney.
