FEATURED ARTICLES

DOL Narrows Mental Health Parity Enforcement to Three Priority Areas, Signaling Relief for Plan Sponsors Navigating NQTL Compliance

On September 8, 2026, the Department of Labor’s (DOL) Employee Benefits Security Administration (EBSA) issued guidance in the form of Field Assistance Bulletin No. 2026-03, which outlines a streamlined enforcement framework for the Mental Health Parity and Addiction Equity Act’s (MHPAEA) nonquantitative treatment limitation (NQTL) comparative analysis requirements. The guidance marks an important clarification of the Trump Administration’s approach to parity enforcement. EBSA will concentrate its enforcement resources on three discrete areas “in which there is the highest potential for significant harm to participants and beneficiaries.”

To place the new guidance in context, under the Biden Administration, the DOL, HHS, and Treasury (Departments) implemented a final rule entitled “Requirements Related to the Mental Health Parity and Addiction Equity Act” (2024 Final Rule), which imposed significant new requirements on comparative analyses. In early 2025, the ERISA Industry Committee (ERIC) filed suit, challenging certain provisions of the 2024 Final Rule. Next, under the Trump Administration, an Executive Order, titled “Ensuring Lawful Governance and Implementing the President’s ‘Department of Government Efficiency’ Deregulatory Initiative,” directed federal agencies to review regulations to identify those that could undermine national interest, including by imposing undue burdens on small businesses or significant costs upon private parties that are not outweighed by public benefits. On May 15, 2025, in consideration of the Executive Order, the Departments announced that they would not enforce the 2024 Final Rule or otherwise pursue enforcement actions, and the ERIC lawsuit was stayed on that basis. Now, the DOL has published this long-awaited guidance.

The practical effect for group health plan sponsors and issuers of the new guidance is significant. EBSA is drawing an indication where it intends to enforce. That said, MHPAEA’s statutory obligations remain fully in effect, including the NQTL comparative analysis requirements added by the Consolidated Appropriations Act, 2021 and the 2024 Final Rule. So, this guidance should not be interpreted as a wholesale relaxation of the parity mandate or its implementing regulations, including the 2024 Final Rule.

The guidance reportedly follows input from the regulated community that MHPAEA’s NQTL comparative analyses requirements created confusion and imposed unnecessary burdens on health plans. Many stakeholders asked for clear guidance related to MHPAEA’s NQTL requirements, and the DOL’s guidance provides a partial response.

The DOL’s enforcement priority areas are as follows.

• First, EBSA will target separate treatment limitations, including exclusions. EBSA will target blanket exclusions of treatments for covered mental health or substance use disorder (MH/SUD) conditions “where similar treatments are covered for medical/surgical conditions.”
• Second, EBSA will scrutinize medical necessity standards and review processes. Here, EBSA will focus on prior authorization, concurrent review, and retrospective review. Plans may use proprietary clinical guidelines to inform medical necessity determinations, but the DOL underscores that “the processes, strategies, evidentiary standards, and other factors used to apply such NQTLs to MH/SUD benefits” must be “comparable to, and … applied no more stringently than” those used for medical/surgical benefits. Additionally, plans, issuers, and their health plan service providers “must make these guidelines available upon request” to EBSA.
• Third, EBSA will examine network adequacy, focusing on network admission standards and provider reimbursement methodologies. EBSA recognizes that an inadequate MH/SUD provider network “can be a significant barrier to obtaining MH/SUD treatment,” as participants likely face higher out-of-pocket costs for out-of-network care.

For plan sponsors and issuers, the guidance’s emphasis on “advance and reasonable notice to interested parties” before enforcement actions coupled with the release of an accompanying enforcement guidance tool suggests that EBSA is signaling a collaborative, rather than adversarial, compliance posture. Specifically, the DOL stated it is trying to strike the “right balance to ensure that its enforcement is fair and even-handed,” by “enforcing compliance in a practical and meaningful way that does not unnecessarily drive up compliance costs or discourage sponsors of group health plans from offering MH/SUD benefits.”

Ultimately, plan sponsors, insurers, and other relevant stakeholders should review their NQTL practices in EBSA’s three priority categories and should ensure that their third-party administrators and managed behavioral health organizations are prepared to produce compliant documentation upon request. A copy of the DOL’s Field Assistance Bulletin No. 2026-03 is available here.

Reporter, Colleen Pert, Houston, +1 713 276 7331, [email protected]

CLIENT ALERT 

DOJ’s National Fraud Enforcement Division Is Open for Business

On August 13, the Department of Justice’s new National Fraud Enforcement Division (the “Fraud Division”) issued a memorandum publicly setting out the Fraud Division’s structure and enforcement priorities. The following week, the Department formally published a final rule that outlined the scope of the Fraud Division’s new authority and specified which work would remain with previously existing DOJ divisions. On August 24, the Division then debuted its new multi-agency National Fraud Detection Center, which will lean on data-sharing to identify and prosecute fraud on government programs. King & Spalding’s Client Alert on this topic is available here.

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