DOL Refocuses Mental Health Parity Enforcement: What Group Health Plan Sponsors Need to Know
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Article Summary
The DOL's EBSA recently signaled a more targeted enforcement approach to Mental Health Parity Act (MHPAEA) compliance, zeroing in on treatment limitations, medical necessity review processes, and network adequacy standards as its top priorities. While this doesn't change existing legal requirements, plan sponsors should treat it as a roadmap and take the opportunity to audit their current compliance posture.
On September 8, 2026, the U.S. Department of Labor Employee Benefits Security Administration (EBSA) issued Field Assistance Bulletin (FAB) 2026-03, providing new guidance on how EBSA intends to enforce the Mental Health Parity and Addiction Equity Act (MHPAEA) nonquantitative treatment limitations (NQTLs) requirements.
The bulletin does not change MHPAEA's legal requirements or eliminate compliance obligations. Instead, it describes EBSA's internal enforcement priorities and signals a more targeted, risk-based approach to NQTL enforcement. EBSA states that it will focus its investigation on areas it views as presenting the greatest potential harm to participants and beneficiaries seeking mental health and substance use disorder (MH/SUD) treatment.
For employers sponsoring group health plans, the guidance may provide helpful insight into where EBSA is most likely to focus its attention. At the same time, plan sponsors should continue to maintain robust MHPAEA compliance processes, including current NQTL comparative analyses.
What Is Changing?
EBSA indicates that it will focus investigative resources on NQTLs that may create the greatest barriers to mental health and substance use disorder care, particularly:
- Separate treatment limitations, including exclusions that apply to MH/SUD benefits but not to comparable medical/surgical benefits;
- Medical necessity standards and review process (e.g., prior authorization, concurrent review, and retrospective review); and
- Network adequacy standards, including network admission standards and provider reimbursement methodologies.
Practical takeaway for plan sponsors
While the guidance may be viewed as a narrowing of enforcement priorities, employers should not interpret the bulletin as a relaxation of MHPAEA obligations. Instead, employers should view the bulletin as a roadmap for where EBSA may focus its enforcement efforts, not as a reduction in compliance expectations.
As mental health remains a national enforcement priority, now is an opportune time for employers to evaluate their compliance posture. This includes confirming that any mental health or substance use disorder (MH/SUD) exclusions are parity-compliant, ensuring medical necessity criteria and utilization management practices are applied comparably to behavioral health and medical/surgical benefits, and assessing whether behavioral health network access challenges are being identified, tracked, and addressed.
Employers should continue working closely with their carriers, third-party administrators, pharmacy benefit managers, and legal advisors to identify potential parity risks, document compliance efforts, and strengthen overall readiness. Revisiting behavior health access, network adequacy, and utilization management practices can help ensure employees have access needed care while reducing potential compliance exposure.