DOL Clarifies MHPAEA Enforcement Priorities for Health Plans
A new Department of Labor bulletin directs EBSA enforcement of mental health parity rules toward three high-risk areas: separate exclusions, medical-necessity review, and network adequacy standards.
The US Department of Labor’s Employee Benefits Security Administration (EBSA) issued a Field Assistance Bulletin outlining its immediate enforcement priorities for the Mental Health Parity and Addiction Equity Act (MHPAEA). The guidance gives group health plan sponsors a clear view of where regulators will focus scrutiny of nonquantitative treatment limitations (NQTLs), despite ongoing litigation and a partial nonenforcement policy related to a separate 2024 rule.
Sophisticated counsel care because the bulletin targets three areas with high potential for participant harm: (1) blanket exclusions or separate limitations for mental health or substance use disorder (MH/SUD) benefits not comparably applied to medical/surgical benefits; (2) medical necessity standards and utilization review processes, such as prior authorization; and (3) standards for network adequacy, including provider admission criteria and reimbursement rates that may limit access to in-network care. Plan sponsors should use this guidance to focus their compliance efforts, working with third-party administrators to review plan terms, audit utilization management practices, assess MH/SUD provider network adequacy, and update NQTL comparative analyses to address these specific high-risk areas. EBSA also released an online tool to help plans identify potential compliance gaps.