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The Department of Labor (DOL) issued a Field Assistance Bulletin announcing the agency’s intent to focus enforcement of the non-quantitative treatment limitation (NQTL) requirements under the Mental Health Parity and Addiction Equity Act (MHPAEA) in three areas:
- Separate treatment limitations, including exclusions
- Medical necessity standards and review processes
- Standards for determining network adequacy, with a focus on network admission standards and provider reimbursement methodologies
The details: The guidance outlines:
- Red flags that often signal potential parity compliance problems, including exclusions involving medications for addiction treatment and residential, intensive outpatient, or partial hospitalization programs; requiring prior authorization for mental health and substance use disorder (MH/SUD) benefits when they do not apply to medical/surgical benefits; more burdensome processes for behavioral health providers to join networks; longer wait-time standards; and different provider reimbursement methodologies
- Best practices for keeping parity compliance in mind when selecting health plan service providers
- Best practices for monitoring operational compliance for specific NQTLs (medical necessity, network adequacy, out-of-network reimbursement), as compliance depends not only on written terms, but also on how policies operate in practice
- Examples of how plans have addressed concerns during NQTL investigations
- Tips for plans being reviewed by DOL (e.g., compare MH/SUD benefits with medical/surgical benefits using measures including out-of-network utilization, provider network applications, patient wait times)
Why it’s important: Even though the parity law has been on the books for years, enforcement is severely lacking, resulting in continued insurance barriers to mental health and addiction services.
- Changes in parity regulations may be coming, as the administration has declined to enforce a 2024 rule strengthening parity, stating that it will release its own rules instead.
Published
September 2026