MHPAEA NQTL Enforcement Focus:

What Employers Need to Know

On September 8, 2026, the Employee Benefits Security Administration (EBSA) issued FIELD ASSISTANCE BULLETIN NO. 2026-03, outlining a revised enforcement approach for the Mental Health Parity and Addiction Equity Act (MHPAEA) and, specifically, the nonquantitative treatment limitation (NQTL) comparative analysis requirements.

The announcement comes after significant feedback from employers, health plans, insurers, and other stakeholders that enforcement of MHPAEA’s NQTL requirements has become increasingly complex and burdensome. According to EBSA, the agency’s goal is to maintain strong protection for mental health and substance use disorder (MH/SUD) benefits while providing a more practical and streamlined enforcement framework.

While this guidance may reduce some immediate compliance concerns for employers, it is important to understand that MHPAEA remains in effect and plans are still required to comply with the law’s parity requirements, including the obligation to prepare NQTL comparative analyses which we first wrote about here.

What is an NQTL?

A nonquantitative treatment limitation (NQTL) is a non-numerical limitation that affects access to benefits. Unlike annual limits, deductibles, or copayments, NQTLs generally involve plan design features such as:

• Prior authorization requirements
• Medical necessity criteria
• Concurrent review processes
• Provider network admission standards
• Reimbursement methodologies
• Coverage exclusions for certain treatments

Under MHPAEA, plans generally cannot apply NQTLs to mental health or substance use disorder benefits in a manner that is more restrictive than the way comparable limitations are applied to medical and surgical benefits.

Why Did EBSA Issue This Guidance?

The guidance follows ongoing litigation challenging portions of the 2024 MHPAEA Final Rule as well as a 2025 federal non-enforcement policy applicable to certain provisions that were newly added by that rule. As a result, EBSA reviewed its enforcement practices and determined that a more focused approach would better direct enforcement resources toward issues that create the greatest barriers to participant access to care.

Rather than broadly scrutinizing every aspect of NQTL compliance, EBSA will focus its enforcement efforts on areas where participants are most likely to experience significant harm.

What Areas Will EBSA Prioritize?

1. Treatment Exclusions Affecting MH/SUD Benefits

EBSA will focus on situations where a plan imposes separate treatment limitations or exclusions that apply only to mental health (MH) or substance use disorder (SUD) benefits. The agency specifically notes concerns with blanket exclusions of treatments for covered MH/SUD conditions when similar treatments are covered for medical or surgical conditions.

Example: A health plan that covers comparable residential treatment for medical conditions but excludes residential treatment for mental health conditions may raise parity concerns.

2. Medical Necessity and Utilization Management Practices

EBSA will also devote enforcement resources to:

• Prior authorization requirements
• Concurrent review procedures
• Retrospective claim reviews

The agency recognizes that plans may use proprietary clinical guidelines when making medical necessity determinations. However, those standards and processes must be applied comparably to both MH/SUD benefits and medical/surgical benefits. Plans cannot impose more stringent review requirements on mental health treatment than they do for physical health treatment.

EBSA further reminds plans that medical necessity criteria and guidelines must be made available upon request during investigations and to participants and beneficiaries when requested.

3. Network Adequacy

Network adequacy remains a major area of concern for regulators. EBSA notes that participants often struggle to find available in-network mental health providers, forcing them to either seek more expensive out-of-network care or forgo treatment altogether.

As a result, enforcement efforts will focus on:

• Network admission standards
• Provider reimbursement methodologies
• Overall access to in-network MH/SUD providers

Where network adequacy concerns exist, EBSA expects plans and issuers to assist participants in obtaining covered services without exposing them to higher out-of-network costs solely because adequate in-network providers are unavailable.

Which Requirements Are Not Currently a Primary Enforcement Focus?

Consistent with the Departments’ prior non-enforcement policy issued in late 2025, EBSA states it will not pursue enforcement of certain provisions that were newly introduced in the 2024 Final Rule when compared with the 2013 regulations. These include provisions relating to the meaningful benefits standard, discriminatory factors and evidentiary standards, certain data evaluation requirements, and related comparative analysis obligations.

Importantly, this does not eliminate the underlying statutory requirements or the mandatory NQTL comparative analyses testing. Rather, it reflects EBSA’s current enforcement priorities while litigation and broader regulatory review continue.

What Should Employers Do Next?

The guidance provides a useful opportunity to reassess existing comparative analyses against the clearer enforcement framework.

Plan sponsors should review current NQTL documentation, evaluate vendor-provided analyses, consider relevant operational data, and ensure that plan administration aligns with written plan terms. Although FAB 2026-03 refines DOL’s enforcement priorities, it does not eliminate MHPAEA obligations or relieve plan fiduciaries of responsibility for compliance.

Employers should continue to:

• Maintain and update NQTL comparative analyses.
• Review plan exclusions affecting mental health and substance use disorder treatment.
• Evaluate prior authorization and utilization management practices for parity concerns.
• Assess behavioral health network adequacy with carriers and TPAs.
• Confirm that medical necessity criteria can be produced upon request.
• Work with carriers, third-party administrators, and consultants to address participant access concerns.

Summary

EBSA’s new enforcement guidance signals a more focused and practical approach to MHPAEA compliance. Rather than pursuing every potential NQTL issue, the agency will concentrate its efforts on three key areas: treatment exclusions, medical necessity review processes, and network adequacy.

For employers, the takeaway is clear: MHPAEA remains in force, NQTL comparative analyses are still required, and mental health parity continues to be a regulatory priority.