By: Christopher Parrella, Esq., CPC, CHC, CPCO

Parrella Health Law, Boston, MA

A Health Care Provider Defense and Compliance Firm

The Department of Labor has issued new guidance explaining how it intends to enforce the Mental Health Parity and Addiction Equity Act while litigation over the 2024 parity regulations remains pending. The message is important for behavioral health and substance use disorder providers: the newest portions of the 2024 rule may not currently be enforced, but the underlying statutory parity obligations remain very much alive.

In Field Assistance Bulletin 2026-03, the Employee Benefits Security Administration said it will continue enforcing MHPAEA’s nonquantitative treatment limitation requirements under the 2013 regulations and the Consolidated Appropriations Act of 2021. The agency described its new approach as narrower and more practical, with enforcement concentrated in areas where participants face the greatest risk of losing access to mental health or SUD treatment.

That distinction matters. In May 2025, the Departments of Labor, HHS, and Treasury announced that they would not enforce portions of the 2024 final rule that were new compared with the 2013 regulations, while litigation challenging the rule remains unresolved, plus an additional 18 months after a final decision. EBSA now confirms that this non-enforcement position continues. However, Congress’s requirement that plans conduct comparative analyses of nonquantitative treatment limitations remains in effect.

EBSA identified 3 enforcement priorities.

First, the agency will scrutinize separate treatment limitations and exclusions that apply only to mental health or SUD benefits. Plans generally cannot impose blanket exclusions on treatment for covered behavioral health conditions when comparable treatment remains available for medical or surgical conditions.

Second, EBSA will focus heavily on medical necessity criteria and utilization review. That includes prior authorization, concurrent review and retrospective review. Plans may use proprietary clinical guidelines but the processes and standards applied to behavioral health benefits must be comparable to those used for medical and surgical benefits and cannot be applied more stringently. Importantly, plans and their service providers must make those clinical guidelines available during EBSA investigations and upon request by participants and beneficiaries.

This should get the attention of behavioral health providers. Many payer disputes involving residential treatment, PHP, IOP and SUD services already center on proprietary medical necessity standards. DOL is effectively telling plans that these standards are not beyond scrutiny simply because they are proprietary.

Third, EBSA will target network adequacy, particularly network admission standards and provider reimbursement methodologies. The agency specifically recognized that inadequate behavioral health networks can force patients either to pay out-of-network costs or abandon treatment entirely. Where parity problems exist, EBSA expects plans to consider alternatives that allow beneficiaries to obtain covered behavioral health treatment without bearing higher costs simply because the network is inadequate.

For providers, this guidance creates a clearer roadmap for challenging problematic payer practices. When a payer repeatedly denies behavioral health services, requires more aggressive utilization review than it uses for comparable medical care or maintains an inadequate network while refusing reasonable out-of-network reimbursement, those facts should be documented carefully.

The call to action is straightforward. Behavioral health and SUD providers should begin identifying recurring payer patterns involving exclusions, medical necessity criteria, prior authorization, concurrent review, retrospective denials and network inadequacy. Preserve denial letters, clinical criteria, appeal decisions and evidence of unsuccessful attempts to locate in-network alternatives. These records may support not only individual appeals but broader parity complaints and regulatory scrutiny.

Mental health parity enforcement has not gone away. DOL has simply told the industry where it intends to look first. Providers should pay attention.  If you have questions about mental health parity, payer denials or behavioral health reimbursement disputes, please contact Parrella Health Law at 857.328.0382 or Chris directly at cparrella@parrellahealthlaw.com.