DOL Signals Continued MHPAEA Enforcement Amid Rulemaking Reset

The DOL has issued new guidance outlining the EBSA’s enforcement priorities, alongside the 2025 MHPAEA report to Congress, which was jointly filed by DOL, the Department of Health and Human Services, and the Department of the Treasury (collectively, the “Departments”). Together, these materials signal a reset in regulatory approach, but not a retreat from MHPAEA enforcement.

Regulatory Reset, Not Retreat

The 2024 final MHPAEA rule imposed significant new compliance obligations and is currently being challenged in litigation by the ERISA Industry Committee (“ERIC”). In a March 30, 2026, joint status report in ERISA Indus. Comm. v. U.S. Dep’t of Health & Hum. Servs., No. 25-cv-136-TJK (D.D.C.), the Departments advised the court that, rather than defend the 2024 rule in that proceeding, they intend to issue a new proposed rule with anticipated significant revisions to the provisions challenged by ERIC, include the rulemaking on the 2026 Spring Regulatory Agenda, and issue a notice of proposed rulemaking no later than December 31, 2026.

The 2025 MHPAEA report to Congress (the “2025 report”) confirms, however, that MHPAEA’s statutory framework remains very much in force. The Departments have adopted a nonenforcement policy for the new portions of the 2024 final rule while ERIC’s litigation proceeds and for an additional period thereafter, but they emphasize that MHPAEA’s statutory obligations — including the Consolidated Appropriations Act requirement that plans and issuers prepare and document comparative analyses for NQTLs — remain in effect. The result is a regulatory reset focused on revising the contested rule, not a pullback from parity enforcement.

EBSA’s New Enforcement Priorities

DOL’s separate enforcement-priorities memorandum provides important context for how EBSA plans to exercise its authority going forward. In Field Assistance Bulletin 2026-01, EBSA directs that enforcement efforts should prioritize the most egregious conduct and significant harm, avoid “regulating by enforcement” where possible, require senior-level review of significant enforcement initiatives, and proceed in a timely and responsive manner.

Most notably for health benefit disputes, EBSA states that civil enforcement should focus on breaches of the duty of loyalty, impermissible conflicts of interest, and conduct designed to enrich plan fiduciaries, administrators, or other entities, or to advance goals unrelated to participants’ best interests. That conflicts-focused emphasis is particularly relevant to disputes involving mental health and substance use disorder (“MH/SUD”) care, where cost-containment incentives, network savings arrangements, reimbursement reductions, and administrative convenience can affect access to covered behavioral health treatment.

Conflicts, Loyalty, and MH/SUD Practices

Many parity disputes arise from practices that are framed as neutral utilization-management or plan-design tools but that may operate in practice to reduce access to MH/SUD care. When those practices are driven by financial incentives or administrative efficiency rather than participant outcomes, they can implicate not only MHPAEA’s parity requirements but also broader ERISA concerns regarding fiduciary loyalty and conflicts of interest.

Practices presented as neutral network, reimbursement, or claims-administration tools may receive closer scrutiny where they appear to advance cost-containment or reimbursement-reduction objectives at the expense of participants’ ability to obtain covered behavioral health treatment.

Comparative-Analysis Enforcement Continues

The 2025 report describes MHPAEA NQTL enforcement activity from August 1, 2023, through July 31, 2025. During that period, EBSA reports that its NQTL enforcement efforts resulted in corrections affecting more than 18 million participants across more than 39,000 group health plans. EBSA also reports issuing 42 initial letters requesting comparative analyses for 77 NQTLs, 14 insufficiency letters covering 32 NQTLs, 25 initial determination letters finding MHPAEA violations for 43 NQTLs, and five final determinations of noncompliance.

CMS, which reviews comparative analyses from nonfederal governmental plans and health insurance issuers, also remained active during the reporting period. CMS issued 43 initial letters requesting comparative analyses and 10 final determinations of noncompliance. While the 2025 report adopts a more measured tone than some prior reports and acknowledges implementation challenges for employers and plan sponsors, it does not suggest that comparative-analysis enforcement is waning.

Access-to-Care Remains Central

The 2025 report confirms that access-to-care issues remain central to MHPAEA enforcement. EBSA identifies recurring NQTL categories that directly affect access to MH/SUD treatment, including provider network admission standards, network adequacy and composition, out-of-network reimbursement methodologies, prior authorization, concurrent review, medical-necessity standards, and exclusions or limitations affecting residential treatment, partial hospitalization, medication-assisted treatment, autism-related services, and eating-disorder treatment.

These categories reflect familiar pressure points for MH/SUD providers and patients. Network design and reimbursement methodologies can determine whether meaningful in-network MH/SUD care exists at all, while prior authorization and concurrent review can delay or interrupt treatment. Medical-necessity criteria and internal claims systems can generate denials that appear neutral on paper but operate more restrictively for behavioral health care in practice, and categorical exclusions or legacy plan-design limitations can block coverage for services central to treating mental health and substance use disorders.

The Role of Vendors and NQTL Design

The 2025 report also highlights the practical role that third-party vendors and service providers may play in the administration of NQTLs. Many MH/SUD access disputes do not arise from a single written exclusion but from the “machinery” of claims administration: network-participation standards, reimbursement methodologies, utilization-review protocols, claims-processing systems, and other vendor-supported processes that determine whether care is meaningfully accessible and how much of a claim will be paid.

These vendors may not always act as ERISA fiduciaries, but their methodologies may still be central to the plan’s MHPAEA compliance. When a plan or issuer relies on a third-party process to price, reduce, steer, review, or otherwise limit MH/SUD claims, that process may be part of the NQTL’s design or application, and the plan or issuer must still be able to identify the factors, evidentiary standards, processes, and strategies used for MH/SUD benefits and show that they are comparable to, and applied no more stringently than, those used for medical/surgical benefits.

This is also where EBSA’s conflicts-focused enforcement guidance and MH/SUD practices intersect. A plan’s reliance on vendor methodologies may warrant closer scrutiny where those methodologies appear to serve cost-containment, reimbursement-reduction, or administrative objectives at the expense of participants’ access to covered behavioral health treatment, regardless of whether the vendor is formally acting as an ERISA fiduciary.

Practical Takeaways

For plans and issuers, the key takeaway is that MHPAEA compliance remains an active enforcement concern even as the Departments move away from defending the 2024 final rule as written. Plans should continue to maintain operationally accurate comparative analyses, confirm that vendors can supply the information needed to support those analyses, and ensure that NQTLs affecting MH/SUD benefits can be justified as comparable to, and no more stringently applied than, limitations on medical/surgical benefits.

For MH/SUD providers and participants, the 2025 report remains a roadmap for identifying and challenging access barriers. The most compelling issues are likely to be those tied to concrete participant harm, conflicted plan administration, inadequate networks, restrictive reimbursement methodologies, utilization-management barriers, and exclusions or limitations that apply more stringently to behavioral health care than to medical/surgical care.

In short, the federal government may be stepping back from defending the 2024 final rule in its current form, but it is not abandoning MHPAEA. The enforcement emphasis appears to be shifting toward clearer legal grounding, targeted investigations, conflicts of interest, and concrete access barriers — areas that will remain central to MH/SUD coverage disputes.