DOL Identifies Three Mental Health Parity Enforcement Priorities for 2026

Key Takeaways

• DOL has identified three MHPAEA enforcement priorities for 2026: blanket treatment exclusions, medical necessity and utilization review, and network adequacy. Behavioral health and addiction treatment providers should assess whether recurring coverage barriers involving these areas may present federal mental health parity concerns.
• Statutory NQTL comparative-analysis requirements remain in effect. Although DOL is not enforcing portions of the 2024 Final Rule that are new relative to the 2013 regulations, health plans and insurers remain subject to the comparative-analysis requirements added by Congress in 2021.
• Provider documentation may help identify patterns that trigger EBSA scrutiny. Repeated denials, restrictive medical necessity standards, and inadequate behavioral health networks should be tracked because participant complaints can prompt DOL investigations.

On September 8, 2026, the Department of Labor’s (“DOL”) Employee Benefits Security Administration (“EBSA”) issued Field Assistance Bulletin (“FAB”) 2026-03, describing how it will prioritize enforcement of the Mental Health Parity and Addiction Equity Act (“MHPAEA”).¹ After more than a year of regulatory uncertainty that left many stakeholders unsure about the direction of enforcement, the DOL has adapted its approach: rather than pursuing enforcement based on provisions of the 2024 Final Rule that are new relative to the 2013 regulations, the agency will focus on three priority areas under the existing statute: blanket treatment exclusions, medical necessity review processes, and network adequacy.

Mental health parity requires health plans to treat mental health and substance use disorder (“SUD”) benefits on equal footing with medical and surgical benefits. In 2024, the DOL, the Department of Health and Human Services (“HHS”), and the Treasury Department issued a Final Rule that substantially strengthened the regulatory framework implementing MHPAEA, including nonquantitative treatment limitation (“NQTL”) comparative-analysis requirements under the Consolidated Appropriations Act, 2021.² That rule was challenged in court by the ERISA Industry Committee (“ERIC”), a trade group representing large employers. In May 2025, the federal agencies announced they would not enforce the provisions of the rule that are new relative to the 2013 regulations while the litigation played out.³

The result was a period of uncertainty for stakeholders across the healthcare industry, including providers, plans, and patient advocates. Many were left wondering what the government would actually enforce and where the boundaries of compliance stood. The new guidance attempts to answer that question.

EBSA acknowledged the confusion that prior enforcement had created and said it received significant feedback that its approach had been burdensome and unclear. In response, the agency adopted a streamlined framework. While it will not enforce the provisions of the 2024 Final Rule that are new relative to the 2013 regulations, MHPAEA’s core statutory protections were never suspended, including the requirement that plans analyze whether their NQTLs treat behavioral health services fairly. EBSA’s guidance prioritizes enforcement resources in three categories of restrictions that the agency identifies as presenting substantial risks of barriers to care.

EBSA’s Three NQTL Enforcement Priorities

Blanket Treatment Exclusions

Plans may not impose blanket exclusions applicable only to covered mental health and SUD treatments where similar treatments are covered for medical or surgical conditions. EBSA will prioritize those exclusions and may also investigate more limited treatment exclusions, particularly in response to complaints. Providers who have seen insurers refuse entire categories of addiction treatment should take note.

Medical Necessity and Utilization Review

Prior authorization, concurrent review, and retrospective review are squarely in the agency’s focus. Plans and issuers can use proprietary clinical guidelines, but those guidelines must be comparable to, and applied no more stringently than, the processes and standards applied to medical and surgical benefits. Plans, issuers, and their service providers must make medical-necessity criteria available to participants and beneficiaries upon request and must provide relevant materials during EBSA NQTL investigations. For providers and participants concerned about whether utilization-management practices are applied comparably, the FAB indicates that EBSA will scrutinize medical-necessity standards and review processes across MH/SUD and medical/surgical benefits.

Network Adequacy

EBSA will focus on network-admission standards and provider-reimbursement methodologies used to determine network adequacy. When participants cannot find an available in-network behavioral-health provider and therefore face higher out-of-network costs or forgo care, EBSA will examine whether the standards used to assess network adequacy comply with MHPAEA’s NQTL requirements. The FAB’s emphasis on provider-reimbursement methodologies is notable, although it does not create a freestanding reimbursement-rate mandate or prescribe a particular network-adequacy metric. This focus may be particularly relevant where reimbursement methodologies or network-admission standards contribute to materially different access to in-network MH/SUD providers, although each parity assessment remains fact-specific.

EBSA noted it may also investigate other types of restrictions, particularly in response to participant complaints.

What DOL’s MHPAEA Priorities Mean for Behavioral Health Providers

The period since the May 2025 non-enforcement announcement understandably left many providers and patient advocates concerned that parity enforcement might lose momentum. This guidance may address those concerns. While the DOL has listened to industry feedback about compliance burdens and adjusted its approach accordingly, the agency also made clear that the core parity obligations remain in effect. EBSA will be looking at the areas where it believes that patients are most likely to face barriers to care.

For behavioral health and addiction treatment providers, the three priority areas map closely to the issues that drive many coverage disputes: blanket denials of entire treatment modalities, aggressive utilization review processes, and networks that do not include enough behavioral health providers to meet patient demand. Providers experiencing these issues may find a clearer basis for identifying and raising potential parity concerns under the federal enforcement framework.

The emphasis on participant and beneficiary complaints as an enforcement trigger is also worth noting. Providers who help patients understand their MHPAEA rights and identify potential parity concerns may help bring those issues to the attention of the appropriate regulator, subject to applicable privacy, authorization, and ethical requirements.

We expect EBSA to refine its approach over time, and the ongoing litigation over the 2024 Final Rule will continue to impact the regulatory environment. The central point, however, is clear: MHPAEA’s underlying statutory requirements remain in effect, and EBSA has identified the NQTL categories on which it will concentrate enforcement resources.

AGG represents behavioral health and addiction treatment providers in parity enforcement actions, coverage disputes, and reimbursement litigation involving health plans, issuers, and administrators. For guidance on these issues, please contact a member of AGG’s Healthcare Litigation team.

[1] Field Assistance Bulletin No. 2026-03, U.S. Department of Labor, Employee Benefits Security Administration, September 8, 2026. Available at https://beta.dol.gov/system/files/media/policy-regulations/guidance-search/ebsa-field-assistance-bulletin-no-2026-03.pdf.

[2] Requirements Related to the Mental Health Parity and Addiction Equity Act, 89 Fed. Reg. 77,586, September 23, 2024.

[3] U.S. Departments of Labor, Health & Human Services & Treasury, Statement Regarding Enforcement of the Final Rule on Requirements Related to the Mental Health Parity and Addiction Equity Act, May 15, 2025. Available at https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/mental-health-parity/statement-regarding-enforcement-of-the-final-rule-on-requirements-related-to-mhpaea.