Compliance News | September 11, 2026
The DOL has published a Field Assistance Bulletin (FAB) that gives an overview of its current approach to enforcing the Mental Health Parity and Addiction Equity Act (MHPAEA). The DOL is prioritizing enforcement around areas where it views participants and beneficiaries are at the greatest risk of significant harm.
Along with the FAB, the DOL issued an enforcement guidance tool to help plans comply with its updated approach to MHPAEA enforcement.
Under amendments made to MHPAEA as part of the Consolidated Appropriations Act of 2021, group health plans that cover medical/surgical (M/S) and mental health and substance use disorder (MH/SUD) benefits are required to maintain documented comparative analysis related to nonquantitative treatment limitations (NQTLs). (We discussed this in our January 14, 2021 insight, “New Law Strengthens Parity for Mental Health and SUD.”)
In 2024 the DOL and the Departments of Health and Human Services (HHS) and the Treasury (collectively, the Departments) issued final rules related to MHPAEA. (We summarized the final rules in our September 11, 2024 insight, “Final Mental Health Parity Rules Issued,” and discussed them in a November 19, 2024 webinar, “New Standards for Mental Health Parity Under the Final MHPAEA Rules.”)
While new requirements under the 2024 regulations remain subject to litigation and enforcement relief, the statutory requirements, along with the existing MHPAEA 2013 regulations, are applicable and enforceable. (See our January 24, 2025 insight, “MHPAEA Lawsuit Filed Same Day Report to Congress Released” and our May 20, 2025 insight, “MHPAEA Litigation and Enforcement News.”)
While plan sponsors await additional regulatory guidance, the DOL and HHS continue to actively enforce MHPAEA.
DOL Field Assistance Bulletin No. 2026-03 was issued by Daniel Aronowitz, Assistant Secretary of Labor for the Employee Benefits Security Administration (EBSA) to the agency’s director of enforcement. The FAB provides direction to the enforcement division regarding MHPAEA enforcement, particularly related to the more recent NQTL documented comparative analysis standards. The FAB announces that DOL MHPAEA enforcement will prioritize:
Although EBSA will prioritize enforcement in these three areas, the FAB notes that the agency remains committed to protecting MH/SUD benefits for all plan participants and beneficiaries through its MHPAEA enforcement efforts. As a result, EBSA may also investigate other categories of NQTLs as issues arise, particularly in response to participant complaints.
The enforcement guidance tool, “Identifying Potential Problems: If You See the Following in Written Plan Provisions or Plan Operations, Think Twice about Possible MHPAEA Compliance Problems,” was released as a companion to the FAB to help plans comply with the agency’s updated approach to MHPAEA NQTL enforcement.
The enforcement guidance tool includes examples and tips, including identifying “red flag” terms in plan documents or applicable policies. Plans should determine if written or procedural changes are needed to better support compliance given the new guidance. The tool warns plans to review, in particular, plan exclusions related to applied behavior analysis (ABA) therapy, residential treatment, medication assistance treatment and nutrition counseling for eating disorders as compared to medical exclusions. The DOL also encourages plans to carefully review medical necessity standards that are more restrictive for MH/SUD, including age limits related to ABA therapy.
The enforcement guidance tool provides additional examples of plan terms that may raise MHPAEA compliance concerns, including the lack of availability of telehealth for MH/SUD conditions when it is available for medical conditions. The Departments’ additional examples also underscore the importance of continued compliance with long-standing MHPAEA parity rules related to financial requirements, such as copayments and coinsurance, and quantitative treatment limitations, such as visit limits.
The tool also highlights operational “red flags” plan sponsors should look for. The DOL warns that standards that are more restrictive for MH/SUD in practice than as described in plan terms are problematic. The agency highlights particular practices, such as care-management practices that apply more stringently to MH/SUD and employee assistance programs operating as a gatekeeper to MH/SUD benefits.
The DOL highlights operational differences in prior authorization and concurrent review that warrant closer scrutiny, including longer timelines or more stringent processes for obtaining prior authorization for MH/SUD, as well as shorter approval periods for MH/SUD treatment compared to M/S benefits. Additionally, the tool provides best practices for monitoring operational compliance with respect to the medical necessity and review standards as well as for assessing and determining network adequacy and reviewing out-of-network reimbursement methodologies.
DOL provides tips for working with plan service providers, including 14 questions that plan sponsors can ask prospective or existing service providers to better monitor their compliance with MHPAEA. Finally, the tool provides examples of how plans have been able to resolve compliance concerns in the context of DOL investigations.
Plan sponsors should carefully review the new DOL guidance and evaluate their plan documents and operational practices in light of the “red flag” examples to address any potential compliance concerns.
Plans should also assess the best practice guidance and determine whether further discussions with service providers are warranted to support ongoing MHPAEA compliance.
In addition, plan sponsors should consider providing feedback to the DOL regarding any questions or concerns about the best practice guidance and should continue to monitor for forthcoming MHPAEA guidance.
This page is for informational purposes only and does not constitute legal, tax or investment advice. You are encouraged to discuss the issues raised here with your legal, tax and other advisors before determining how the issues apply to your specific situations.