The Department of Labor’s Employee Benefits Security Administration (EBSA) has released new guidance spelling out exactly where it intends to focus its enforcement efforts under the Mental Health Parity and Addiction Equity Act (MHPAEA).
For CHROs overseeing self-insured health plans, this is a signal to act now, rather than wait for an audit letter to arrive.
In Field Assistance Bulletin 2026-03, the Employee Benefits Security Administration (EBSA) identified three types of nonquantitative treatment limitations (NQTLs) it will prioritize in investigations of Mental Health Parity and Addiction Equity Act (MHPAEA) compliance:
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Treatment limits and exclusions. Plans that exclude therapies for mental health or substance use conditions, such as behavioral, speech or occupational therapy for autism, without comparable exclusions for medical or surgical care.
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Medical necessity standards and reviews. Plans that require prior authorization for most mental health or substance use disorder (MH/SUD) services but rarely for medical or surgical care or impose age limits on mental health treatments without similar limits on medical benefits.
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Network adequacy standards. Plans that impose stricter credentialing requirements for behavioral health providers than for medical providers or use different reimbursement methods that may limit access to mental health care.
EBSA also released a companion enforcement guidance to help self-assess plans against these same red flags, along with best practices for vendor oversight. DOL made clear that other NQTL categories remain fair game, especially if a participant complaint triggers a look.
This guidance builds on a history CHROs should remember:
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MHPAEA already prohibits group health plans from applying more restrictive limitations to MH/SUD benefits than to medical/surgical benefits.
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The Consolidated Appropriations Act, 2021 added a requirement that plans prepare a written comparative analysis of their NQTLs—a document plan sponsors must be able to produce on request.
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DOL’s 2024 final rule set new minimum standards for how those comparative analyses must be built. Those rules are suspended until 18 months after a final court ruling on litigation challenging them. However—and this is the part plans sometimes miss—the underlying comparative analysis requirement from the 2021 law is still very much in force. The litigation pause applies only to the additional 2024 rule requirements, not the baseline obligation to have an NQTL comparative analysis on file.
What This Means for Your Plan
DOL’s guidance states that plan fiduciaries (or the designated plan administrator) are responsible for selecting and monitoring third-party administrators, behavioral health vendors, and claims administrators and that they are designing and applying NQTLs in a parity-compliant way—even though they’re the ones running day-to-day operations.
A few practical next steps your team can keep in mind:
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Pressure-test your plan design against the three priority categories above. For instance, are there any MH/SUD-specific exclusions, prior-authorization patterns, or network standards that don’t have a clear medical or surgical parallel?
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Revisit your NQTL comparative analysis. If it’s been sitting untouched since 2022 or 2023, now’s the time to refresh it—particularly around medical necessity criteria and network adequacy, since those are explicitly in DOL’s crosshairs.
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Talk to your vendors. Ask your TPA and behavioral health vendor how they’re addressing these three priority areas, and whether they can produce documentation showing parity in practice, not just on paper.
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Use the DOL’s own tool. EBSA’s enforcement guidance tool, which can be used alongside the bulletin, is designed to help plans self-identify these exact red flags before DOL does.
Taking these proactive steps now, can reduce compliance risks and minimize disruptions to your health plan and employees from a DOL inquiry.
