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FIELD ASSISTANCE BULLETIN NO. 202 6 - 03
D ATE : SEPTEMBER 8, 2026 M EMORANDUM F OR : C OLLEE N M C K EE, D IRECTOR OF E NFORCEMENT R EGIONAL D IRECTORS E MPLOYEE B ENEFIT S S ECURITY A DMINISTR ATI ON (EBSA) F ROM : D ANIEL A RONOWITZ , A SSIS TANT S ECRE TARY S UBJECT : G UI DING P RINCIPLES FOR EBS A ’ S E NFORCEMENT OF THE M EN T AL H EA L TH P ARITY AND A DDICTION E QUITY A CT ’ S N ONQUANTIT ATIVE T RE A TMENT L IMITATION R EQUIREMENT S On January 15, 2026, the Department
of Labor’s (the Department’s) Employee Benefits Security Administration (EBSA)
announced its updated national enforcement priorities for
fiscal year 2026 , which includes
addressing
barriers to mental health and substance use disorder (MH/SUD) benefits. 1
As part of this national enforcement priority, t his Field Assistance Bulletin announces
the Department ’ s
enforcement policy regarding
t he Mental Health Parity and Addiction Equity Act (MHPAEA) , as amended by the Consolidated Appropriations Act, 2021 (CAA, 2021), and the final rule en titled “Requirements Related to the Mental Health Parity and Addiction Equity Act” (2024 Final Rule) . 2
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 MH/SUD benefits than on medical/surgical benefits.
The Department has received significant input from the regulated community that
prior enforcement of MHPAEA’s
nonquantitative treatment limitation (NQTL) comparative analyses
requirements created substantial confusion and unnecessary burdens on health plans.
Many stakeholders have asked
for clear guidance related to MHPAEA’s NQTL requirements .
The Department is issuing this Field Assistance Bulletin to provide
additional
clarity on
the Department’s approach to enforcing the statutory and regulatory NQTL requirements. In its enforcement of these critical protections ,
the Department seeks
to achieve the right balance
to ensure that its enforcement is fair and even - hande d , with advance and reasonable notice to interested parties : supporting access to comp rehensive MH/SUD benefits
but
enforcing compliance
in a practical and meaningful way that does not unnecessarily drive up compliance costs or discourage sponsors of group health plans from offering MH/SUD benefits. In sum, this updated enforcement guidance is designed to provide a streamlined and practical framework for compl iance
with
MHPAEA’s NQTL requirements .
B ACKGROUND
On September 9, 2024, the Departments of Labor, Health and Human Services (HHS), and the Treasury (the Departments) issued the 2024 Final Rule . The 2024 Final Rule amended previous 1 US Department of Labor’s Employee Benefits Security Administration Updates National Enforcement Projects for Employee Benefit Plans (Jan. 15, 2026), available at https://www.dol.gov/newsroom/releases/ebsa/ebsa20260115 .
2 89 FR 77586 (Sept. 23, 2024).
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regulations ( 2013 F inal R ule 3 )
implementing MHPAEA and added new rules implementing the NQTL comparative analyses
requirements under MHPAEA, as amended by the CAA, 2021 . The 2024 Final Rule, which became effective on November 22, 2024, ha s
staggered applicability dates , with certain amendments to
the 2013 Final Rule
applicable to
plan years starting on or after January 1, 2025, and all of the amendments
applicable to plan years (in the individual market, policy years) starting on or after January 1, 2026.
On January 17, 2025, the ERISA Industry Committee (ERIC) filed suit in the U.S. District Court for the District of Columbia challenging certain provisions of the 2024 Final Rule on multiple grounds, including on the grounds that they are arbitrary and capr icious and contrary to law. 4
Additionally, Executive Order 14219, titled “Ensuring Lawful Governance and Implementing the President’s ‘Department of Government Efficiency’ Deregulatory Initiative,” 5
directs federal agencies to review regulations to identify those that may undermine the national interest, including by imposing undue burdens on small businesses or significant costs upon private parties that are not outweighed by public benefits. In suc h cases, federal agencies must exercise enforcement discretion to ensure lawful governance.
O n May 15, 2025, the Departments issued a nonenforcement policy, stating that :
T he Departments will not enforce the 2024 Final Rule or otherwise pursue enforcement actions, based on a failure to comply that occurs prior to a final decision in the
[ERIC]
litigation,
plus an additional 18 months. This enforcement relief applies only with respect to those portions of the 2024 Final Rule that are new in relation to the 2013 final rule. The Departments note that MHPAEA’s statutory obligations, as amended by the CAA, 2021,
continue to have effect. HHS encourages states that are the primary enforcers of MHPAEA with respect to issuers to adopt a similar approach to enforcement. HHS will not consider a state to be failing to substantially enforce MHPAEA, as amended, because th e state adopts such an approach. 6 The Departments further indicated that
they
would
undertake a broader reexamination of each D epartment’s respective enforcement approach under MHPAEA , including those provisions amended by the CAA, 2021 . 7 EBSA reviewed its enforcement approach under MHPAEA .
To preserve enforcement resources and accord with the Departments’ May 2025 nonenforcement policy, EBSA
will not pursue enforcement actions of those portions of the 2024 Final Rule that are new in relation to the 2013
3 78 FR 68240 (Nov. 13, 2013).
4 Complaint, ERISA Indus. Comm. v. Dep’t of Health & Hum. Servs. , No. 1:25 - CV - 00136 (D.D.C. Jan. 17, 2025).
5 90 FR 10583 (Feb. 25, 2025).
6 Statement of U.S. Departments of Labor, Health and Human Services, and the Treasury regarding enforcement of the final rule on requirements related to the Mental Health Parity and Addiction Equity Act (May 15, 2025),
https://www.dol.gov/agencies/ebsa/laws - and - regulations/laws/mental - health - parity/statement - regarding - enforcement - of - the - final - rule - on - requirements - related - to - mhpaea .
7 Id.
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F inal R ule . 8
Nevertheless, because MHPAEA’s statutory obligations continue to apply, including the requirements added by the CAA, 2021 related to NQTL comparative analyses, EBSA
will narrow its enforcement focus
areas
relating to requests for NQTL comparative analyses under the statute .
This
approach to enforcement
is designed to reduce compliance burdens and to provide clarity for plans and issuers on how to meet the NQTL requirements in a balanced and even - handed manner.
G UIDING P RINCIPLES FOR EBSA’ S E NFORCEMENT OF
MH PAEA ’ S
NQTL
R EQUIREMENT S
EBSA will prioritize and focus MHPAEA
NQTL
comparative analysis
enforcement
u nder MHPAEA, as amended by the
CAA , 2021 ,
in
the following
three categories in which there is the highest potential for significant harm
to participants and beneficiaries 9 :
1. S eparate treatment limitations , including e xclusions .
While plans and issuers can impose NQTLs
based on medical necessity
or set standards for experimental /investigative
treatments , in general they cannot apply blanket exclusions of
treatments
for covered MH/SUD conditions, where
similar treatments are covered for medical/surgical conditions . 10
EBSA will focus its resources on cases involving
blanket
treatment
exclusions
applicable only to
MH/SUD benefits , but may
also
address more limited exclusions, especially in response to complaints .
2. Medical necessity standards and review process .
In this category, EBSA will focus its resources on prior authorization, concurrent review, and retrospective review. Under MHPAEA, nothing specifically prohibits
plans and issuers from us ing
proprietary clinical guidelines
to help make medical necessity determinations , as long as the processes, strategies, evidentiary standards, and other factors used to apply such NQTLs to MH/SUD benefits
are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, and other factors used to apply the NQTLs to medical / surgical benefits .
However, plans ,
issuers , and their health plan service providers
must make these guidelines available upon request during EBSA’s NQTL investigations and to participants and beneficiaries upon request . 11 3. Standards for determining n etwork adequacy with a focus on network admission standards
and
provider reimbursement
methodologies .
When participants and beneficiaries cannot find MH/SUD treatment
in - network, they must choose
to either go out - of - network for MH/SUD care
or forgo MH/SUD treatment
altogether. Because out - of - network care typically comes with higher out - of - pocket costs for participants and beneficiarie s ,
an inadequate network
can be a significant barrier to
obtaining
MH/SUD treatment . Where there are
network adequacy
parity issues , EBSA will ensure that plans
8 Specifically, the meaningful benefits standard, prohibition on discriminatory factors and evidentiary standards, relevant data evaluation requirements, and the related requirements in the provisions for comparative analyses that apply on the first day of the first plan year beginning on or after January 1, 2026.
9 The 2025 MHPAEA Report to Congress noted that EBSA continues to focus on limitations that impact access to care. Examples of EBSA’s enforcement results included in the Report are consistent with these three categories. See 2025 MHPAEA Report to Congress
(February 20, 2026), available at https://beta.dol.gov/research - data/surveys - reports - publications/2025 - mhpaea - report - congress .
10 See
ERISA section 712(a)(3)(A)(ii), which generally requires a plan or coverage to ensure that no separate treatment limitations are applicable only with respect to mental health or substance use disorder benefits.
11 See ERISA section
712(a)(4), which generally requires a plan administrator or health insurance issuer to make available the criteria for medical necessity determinations upon request.
and issuers consider all available options
and assist
participants and beneficiaries seeking covered MH/SUD
treatment s
without exposing such participants and beneficiaries to out - of - network costs due to the lack of availability of a covered MH/SUD
service in - network .
While EBSA will focus enforcement in these three areas, EBS A remains committed to protecting MH/SUD benefits for all plan participants and beneficiaries through its MHPAEA enforcement and therefore may need to investigate other categories of NQTL s as issues arise, particularly when responding to participant complaints. To
further increase regu latory and enforcement clarity and implement our guiding enforcement principle of providing advance notice to the regulated community prior to enforcement actions, on September 8 , 2026, EBSA issued an enforcement guidance tool to help plans and issuers comply with their obligations under MHPAEA, including the NQTL comparative analys es requirements. Given the
complexity of EBSA’s national enforcement priority of addressing barriers to MH/SUD benefits, EBSA will strive to provide additional clarity and guidance as warranted. EBSA also continues to welcome input from all interested entities as to what additional guidance from the Department would help plans and issuers meet the statutory and regulatory requirements. ***
Page 4 of 4 This memorandum is an internal Department policy directed at EBSA and its employees. As such, it is not intended to, does not, and may not be relied upon to create any rights, substantive or procedural, enforceable by law by any party in any matter, civil or criminal. Adhering to the principles and priorities discussed above and focusing on matters evidencing the most harm to participants and beneficiaries, EBSA remains committed to protecting the mental health and substance use disorder benefits of plan participants and beneficiaries. Therefore, the Assistant Secretary (or his designee) may update this document periodically.