Dol Attempts to Clarify Mental Health Parity for EmployersIn an attempt to clarify the ambiguous status of current Mental Health Parity enforcement and employer plan sponsors’ obligation, the DOL published Field Assistance Bulletin No. 2026-03. While we like to give an ‘A’ for effort, it’s difficult to grade to content of this FAB above a ‘C’.
The DOL reminds us that at its core, the Mental Health Parity and Addiction Equity Act (MHPAEA) generally prohibits group health plans and health insurance issuers offering group or individual health insurance coverage from offering health coverage that imposes more restrictive requirements and limitations on Mental Health or Substance Use Disorder benefits than on medical or surgical benefits. The Consolidated Appropriations Act of 2021 added several components to the law, including the requirement for plans to obtain a comparative analysis of any non-quantitative treatment limitations (NQTLs) within the mental health benefits under the plan. Next, we received a ‘Final Rule’ in 2024 containing a myriad of substantive changes and enhancements to the rule. Following the confusion generated by this 2024 update, the EBSA sued to block enforcement of this update, and subsequently, the Departments announced a period of non-enforcement of the 2024 final rule, as it changed the 2013 rule. Super clear, right?
So what does any of this mean for employers? According to the recent FAB, the DOL clarifies that plans are still required to maintain a current analysis of any NQTLs applicable to mental health and substance use treatment under their group health plans, and they have provided a (mildly) helpful guide for just how to do this. The areas of targeted enforcement will focus on:
- Medical necessity review standards
- Plan exclusions and treatment limitations
- Network adequacy standards and provider reimbursement calculations
At this time, self-insured employers should work with their TPAs to ensure plan standards comply with the focus of the DOL’s enforcement priorities, especially as they look toward their 2027 renewals and potential plans changes.
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