Insurance carriers and third-party administrators (TPAs) of medical plans have found compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA) exceptionally challenging. To date, the federal government has not found a single plan able to provide a sufficient analysis demonstrating any group health plan in the country operates in parity, despite such parity and analysis being required for over five years now. As a result of widespread and ongoing non-compliance, the DOL issued Field Assistance Bulletin 2026-03, announcing it will narrow its primary enforcement priorities to the mental health parity provisions that cause the most harm to plan participants. They also provided an updated guidance tool to help employers spot red flags and know how to engage with their insurance carrier or TPA to rectify those issues.
Applies To:
Employers with over 50 employees sponsoring a medical/Rx plan that covers mental health and substance use disorders (MH/SUD).
Go Deeper:
Group health plans are required to demonstrate that financial requirements (e.g., deductibles and copays), quantitative treatment limits or QTLs (e.g., visit limits), and non-quantitative treatment limits or NQTLs (e.g., prior authorization, medical necessity, network participation, provider reimbursement rates, step therapy/fail first requirements, etc.) for MH/SUD care are designed in parity – and actually operate in parity – with medical/surgical benefits in each of six major benefit classifications. Additionally, plans are required to maintain an NQTL Comparative analysis.
The federal government will prioritize and focus MHPAEA NQTL comparative analysis enforcement in the following three categories in which there is the highest potential for significant harm to participants and beneficiaries:
- Separate treatment limitations, including exclusions.
- Medical necessity standards and review process.
- Standards for determining network adequacy with a focus on network admission standards and provider reimbursement methodologies.
Naturally, the DOL will also investigate other complaints, but these are the primary areas for enforcement of an NQTL comparative analysis. The new guidance tool provides numerous examples for each of those three focus areas to help employers understand what they typically investigate.
Penalties for Non-Compliance:
There is an emphasis on helping insurance carriers and TPAs come into compliance without jumping to penalties too early in the process. However, the government can hold the plan sponsor ultimately responsible for any MHPAEA compliance failure, which often results in having to retroactively reprocess claims going back many years.
Practical Impact to Employers:
The new guidance tool is extremely valuable in helping employers understand where MHPAEA violations often occur, how to spot them, and how to work with the carrier/TPA in rectifying them.
While newer NQTL comparative analysis requirements added by a 2024 final rule have been paused temporarily, the foundational NQTL comparative analysis is still required and has been since the CAA-21 law took effect in February 2021. Employers with more than 50 employees need to have their plan analyzed for financial and QTL parity and document asking their carrier/TPA for their NQTL comparative analysis. If a sufficient analysis is not provided (noting no carrier/TPA in the country has yet provided a sufficient one to the government), the employer should then use the guidance tool to document asking the carrier/TPA how they can initiate an analysis and begin targeting the key areas of MH/SUD exclusions/limits, medical necessity/review criteria, and network access and reimbursement rates.
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