On September 8, 2026, the Department of Labor’s (DOL) Employee Benefits Security Administration (EBSA) released its Field Assistance Bulletin No. 2026-03 (FAB 2026-03), which explains its enforcement priorities for the nonquantitative treatment limitation (NQTL) rules under the Mental Health Parity and Addiction Equity Act (MHPAEA). The DOL will focus on the following three areas: (1) separate treatment limitations, including exclusions, (2) medical necessity standards and review processes and (3) standards for determining network adequacy. The DOL also issued a companion enforcement guidance tool to help plans evaluate their own compliance. FAB 2026-03 does not create any new requirements but does offer a reasonable roadmap for employers and plan sponsors to focus their MHPAEA compliance.
MHPAEA generally prohibits group health plans and issuers from imposing more restrictive requirements or limits on mental health and substance use disorder (MH/SUD) benefits than on medical/surgical (M/S) benefits. This rule of parity applies to both “quantitative treatment limitations” (QTLs), such as dollar limits and numerical limits, and to “nonquantitative treatment limitations” (NQTLs), such as prior authorization, medical necessity criteria and provider network standards, that may restrict access to care. The Consolidated Appropriations Act, 2021 (CAA-21) added a requirement that plans and issuers prepare certain comparative analyses that demonstrate that each NQTL applied to a MH/SUD benefit was comparable to, and did not apply more strictly than, an NQTL applied to a M/S benefit. In 2024, the DOL, Health and Human Services and Treasury issued final rules related to MHPAEA. These new rules became subject to litigation and enforcement relief in 2025. Generally, however, MHPAEA’s statutory requirements, including the CAA-21’s comparative analysis requirement and other 2013 regulations, remain in effect and enforceable. The DOL announced further guidance would be provided soon and indicated that it would undertake a broader re-examination of its enforcement approach under MHPAEA.
The DOL’s FAB 2026-03 bulletin explains that the DOL will prioritize and focus MHPAEA NQTL comparative analysis enforcement in the following three areas in which there is the highest potential for significant harm to participants and beneficiaries:
Additionally, the DOL and EBSA released an enforcement guidance tool to help plans and issuers comply with MHPAEA obligations, including the NQTL comparative analysis requirements. It includes information about what employers should look for (1) when reviewing their plans for MHPAEA NQTL compliance problems, (2) best practices to keep in mind when selecting health plan service providers and (3) best practices for monitoring operational compliance for specific NQTLs. Additionally, the tool provides examples of how plans have dealt with certain issues raised during NQTL investigations, as well as tips for plans that have been identified by the DOL for an NQTL compliance review.
The DOL acknowledges that enforcement of MHPAEA’s NQTL comparative analysis requirements has created substantial confusion and unnecessary burdens on employer health plans. Stakeholders have asked for clear guidance about these requirements. In their FAB 2026-03 bulletin the DOL identifies where they will focus its enforcement of MHPAEA. As such, employers and plan sponsors should use this as a roadmap for where to focus their MHPAEA compliance efforts. Additionally, employers and plan sponsors should also review the DOL’s new enforcement guidance tool for a list of warning signs of common problems, as well as best practices, examples and tips for MHPAEA compliance.
Employers and plan sponsors should use the DOL’s new enforcement priorities as an opportunity to promptly review their MHPAEA compliance efforts rather than wait for a DOL inquiry. In particular, plan sponsors should work with their carriers, TPAs and other service providers to confirm that required NQTL comparative analyses are current and adequately address the three areas the DOL has identified for heightened scrutiny: separate treatment limitations and exclusions, medical necessity and utilization review processes and network adequacy standards. Employers should also consider using the DOL’s new enforcement guidance tool to identify potential compliance gaps and document the steps being taken to address them. While FAB 2026-03 does not impose new requirements, it provides employers with a clear roadmap of where DOL enforcement attention will be focused and, therefore, where compliance efforts should be prioritized now.
We will provide updates as any future guidance is issued. Should you have questions in the meantime, please contact your Conner Strong & Buckelew account representative. For a complete list of Legislative Updates issued by Conner Strong & Buckelew, visit our online Resource Center.
