DOL Announces New Enforcement Policy For Mental Health Parity Nonquantitative Treatment Limitation Requirements

On September 8, 2026, the US Department of Labor (the “DOL”) issued Field Assistance Bulletin No. 2026-03 (the “Bulletin”), which provides “guiding principles” for the DOL’s enforcement of the nonquantitative treatment limitation (“NQTL”) requirements under the Mental Health Parity and Addiction Equity Act (“MHPAEA”). The Bulletin provides “a streamlined and practical framework” for plan sponsors to comply with MHPAEA’s NQTL requirements, which have been criticized as creating “substantial confusion and unnecessary burden on health plans.” The Bulletin reflects the DOL’s recognition that ERISA is a voluntary benefit system: the DOL seeks to support participant access to mental health and substance use disorder (“MH/SUD”) benefits while not driving up compliance costs or discouraging plan sponsors from offering MH/SUD benefits.

The DOL also issued an enforcement guidance tool designed to help plans and insurers comply with their MHPAEA obligations, including the NQTL comparative analyses requirements.

Background

MHPAEA generally prohibits ERISA-governed group health plans and health insurers from imposing more restrictive requirements and limitations on MH/SUD benefits than on medical or surgical benefits.¹ In September 2024, the Departments of Labor, Health and Human Services, and Treasury (“Tri-Agencies”) issued a new final rule (“2024 Final Rule”), which amended previous regulations (“2013 Final Rule”) implementing MHPAEA and added new NQTL comparative analyses requirements under the Consolidated Appropriations Act, 2021 (“CAA”) intended to evaluate whether requirements to access MH/SUD benefits are generally comparable to those required to access medical and surgical benefits. In response to a legal challenge to the 2024 Final Rule, the Tri-Agencies announced in May 2025 that they would not enforce the 2024 Final Rule nor pursue any enforcement actions for a plan sponsor’s failure to comply with the 2024 Final Rule before the pending legal challenge was resolved, plus an additional 18 months. The Tri-Agencies explained, however, that this enforcement relief would only apply to the portions of the 2024 Final Rule that were “new in relation to the 2013 final rule.”

Summary of New Guidance

Continued Nonenforcement of the 2024 Final Rule: Consistent with the Tri-Agencies’ May 2025 nonenforcement position, the Bulletin reiterates that the DOL will not pursue any enforcement actions with respect to the portions of the 2024 Final Rule that modified the 2013 Final Rule. Specifically, the DOL explained that it will not enforce the following requirements in the 2024 Final Rule: (1) the meaningful benefits standard; (2) the prohibition on discriminatory factors and evidentiary standards; (3) the relevant data evaluation requirements; and (4) the related comparative analysis provisions applicable for plan years beginning on or after January 1, 2026.

Narrowed Enforcement Focus: The Bulletin states that the DOL is narrowing its enforcement focus to the following three priority categories, which it believes have highest potential for significant harm to participants and beneficiaries:

• Separate Treatment Limitations, Including Exclusions: The DOL will focus its enforcement efforts on blanket treatment exclusions that apply only to MH/SUD benefits when similar treatments are covered for medical/surgical conditions. Plans and insurers may impose NQTLs based on medical necessity or set standards for experimental/investigative treatments, but generally cannot apply any blanket MH/SUD-only exclusions.
• Medical Necessity Standards and Review Processes: The DOL will also focus on prior authorization, concurrent review, and retrospective review. Plans and insurers are not specifically prohibited from using proprietary clinical guidelines for medical necessity determinations, provided the processes, strategies, evidentiary standards, and other factors used for MH/SUD benefits are comparable to, and applied no more stringently than, those used for medical/surgical benefits. However, plans and insurers must make these guidelines available upon request from participants and beneficiaries as well as during DOL investigations.
• Network Adequacy Standards: Finally, the DOL will focus on network admission standards and provider reimbursement methodologies. In situations where network adequacy parity issues may exist, the DOL will ensure that plans and insurers consider all available options and assist participants and beneficiaries in obtaining covered MH/SUD treatments without exposing them to out-of-network costs due to a lack of in-network treatment options.

Although the DOL emphasized that it will focus on these three categories, the DOL may investigate other categories of NQTLs as issues arise, particularly in response to participant complaints.

Accompanying DOL MHPAEA Enforcement Guidance

The DOL also issued new MHPAEA Enforcement Guidance on September 8, 2026, to help plans and insurers comply with their MHPAEA obligations, including the NQTL comparative analyses requirements. The DOL emphasized that “MHPAEA requirements, including NQTL compliance, can be complicated, especially since not all limitations on MH/SUD benefits are impermissible.” The DOL thus issued the guidance to “provid[e] clearer and more streamlined expectations to plans and insurers for NQTL compliance,” addressing the following questions and topics:

• What should you look for when you’re reviewing your plan for potential MHPAEA NQTL compliance problems?
• Best Practices for Keeping MHPAEA Compliance in Mind When Selecting Health Plan Service Providers
• Best Practices for Monitoring Operational Compliance for Specific NQTLs
• Examples of How Plans have Addressed Concerns during NQTL Investigations
• Tips for Plans Being Reviewed by DOL for NQTL Compliance

Practical Implications for Plan Sponsors and Insurers

The Bulletin and the DOL’s accompanying guidance suggest that the DOL plans to take a more practical approach to MHPAEA compliance, investigations, and enforcement. While the Tri-Agencies’ nonenforcement of the 2024 Final Rule’s new provisions remains in place pending the outcome of the pending legal challenge, plan sponsors and insurers should keep in mind that MHPAEA’s statutory requirements, including the NQTL comparative analysis obligations added by the CAA, remain in effect and enforceable. In light of the new guidance, plan sponsors and insurers should review their current practices, particularly with respect to the three priority enforcement areas identified by the DOL in the Bulletin (treatment exclusions, medical necessity review processes, and network adequacy standards) to ensure that any NQTLs are applied comparably across MH/SUD and medical/surgical benefits.

¹ MHPAEA was originally enacted in October 2008, and was amended by the Consolidated Appropriations Act, 2021 in December 2020.