News Archive

"Despite several years of enforcement, CMS has seen little overall improvement in the quality of initial analyses, though some plans are providing more robust data and explanations after feedback. As in prior years, many analyses were incomplete or insufficient at the outset. CMS reported that none were adequate on first submission ... EBSA and CMS generally gave plans and issuers multiple chances to correct issues before issuing a formal noncompliance determination."  MORE >>

"Removing barriers to behavioral health benefits is a national enforcement priority.... 2025 MHPAEA report to Congress describes continuing comparative analysis enforcement.... Agencies intend to propose new MHPAEA rule, and cease defending Biden-era rule.... The agencies anticipate 'significant revisions' to the provisions of the 2024 final rule challenged by ERIC."  MORE >>

"The memorandum, which has no legal effect, was issued by Daniel Aronowitz, Assistant Secretary for EBSA.... The fact that he issued it to the Director of Enforcement of field staff, as well as the field staff, underscores its importance, because the Director of Enforcement issued all prior Field Assistance Bulletins.... The emphasis on not making law by litigation and reducing participant litigation that results only in big payouts for plaintiff class-action lawyers is something the Assistant Secretary wrote about even before being appointed to lead EBSA."  MORE >>

"During the reporting period, EBSA requested comparative analyses for 77 NQTLs and CMS requested comparative analyses for 43 NQTLs.... EBSA appears to be emphasizing network standards and exclusions or limits on key MH/SUD treatments, while CMS emphasizes prior authorization/precertification, medical necessity, and other utilization management controls."  MORE >>

"As the line of cases emphasizing disparate limitations continues to grow, the emphasis is not just on the availability of other types of mental health care. As a result, courts nationwide have found potential MHPAEA violations in several cases involving wilderness programs." [Allison B. v. BlueCross BlueShield of Ill., No. 24-6162 (N.D. Ill. Feb. 20, 2026)]  MORE >>

"Employers rate mental health support among the highest impact benefits they can offer, and employees increasingly see mental and emotional well-being as fundamental to how they show up at work and engage with their benefits.... [O]ff-exchange plans and [ICHRAs] have effectively standardized mental health coverage. Parity has moved from intent to execution. Employers are being asked to show that mental health support is meaningfully accessible -- not just technically covered."  MORE >>

"The DOL engaged in less correspondence with health plans and issuers about the NQTLs at issue, but also issued more initial determination letters in the same time period. This indicates that the DOL proceeded with citing MHPAEA violations while asking fewer questions.... CMS issued far more insufficiency letters ... CMS noted there were many times where there was no comparative analysis, and that additional information was still needed even after reviewing the comparative analyses. Both the DOL and CMS issued more final determination letters in 2025 than in prior years showing that they are increasingly willing to cite a plan or issuer ... for providing deficient comparative analyses."  MORE >>

32 pages. "During the Reporting Period [August 1, 2023, through July 31, 2025], [EBSA] enforcement work on NQTLs resulted in corrections under MHPAEA affecting more than 18 million participants across more than 39,000 group health plans.... These results come from EBSA's enforcement activity during the Reporting Period, in which the agency issued: 42 initial letters requesting comparative analyses for 77 NQTLs; 14 insufficiency letters covering 32 NQTLs; 25 initial determination letters findings plans/issuers had violated MHPAEA for 43 NQTLs; and 5 final determinations of noncompliance finding MHPAEA violations for 7 NQTLs."  MORE >>

"The statutory language in the CAA requires plans to conduct the NQTL comparative analysis.... [S]elf-funded plans must be able to produce a written NQTL comparative analysis demonstrating parity between mental health/substance use disorder benefits and medical/surgical benefits, upon request by regulators or participants. Litigation related to the 2024 MHPAEA final rules hasn't eliminated or paused this requirement."  MORE >>

"The new Mental Health Parity Index identifies disparities in 43 states in terms of access to in-network mental health and substance abuse treatment in comparison to physical health. The analysis found that patients in seven out of 10 counties face challenges in accessing in-network mental healthcare. The index ... [is] based on data from the four largest commercial insurers."  MORE >>

"A recent settlement by the Trump administration has made it clear that it intends to enforce parity compliance when it comes to proper access to mental health and substance use disorder services.... In addition to paying a $32 million settlement, Kaiser has agreed to improve monitoring of its behavioral health network for adequacy. According to EBSA, Kaiser violated parity regulations by failing to have sufficient mental healthcare and substance abuse treatment providers in its network."  MORE >>

"Applying arbitrary-and-capricious review, the Sixth Circuit emphasized that ERISA requires reasoned decisionmaking, which has both procedural and substantive components. The court focused on procedural deficiencies and concluded that Anthem's decision failed at that threshold level.... The plaintiff alleged that Anthem mishandled mental health claims more restrictively than medical or surgical claims but failed to identify record evidence demonstrating how Anthem applied treatment limitations to medical or surgical benefits in practice." [T.E. v. Anthem Blue Cross & Blue Shield, No. 25-5407 (6th Cir. Jan. 22, 2026)]  MORE >>

"EBSA intends to prioritize investigations in the following health plan areas: [1] Cybersecurity and data protection ... [2] Mental health and substance use disorder parity ... [3] Surprise billing compliance ... [4] Protections of employee contributions ... EBSA reaffirmed its ongoing efforts to identify abusive or fraudulent Multiple Employer Welfare Arrangements (MEWAs)."  MORE >>

"EBSA stated that its investigations will continue to evaluate how plans and service providers protect against cybersecurity threats.... [T]he Mental Health Parity and Addiction Equity Act and its 2013 regulations, as well as the Consolidated Appropriations Act, 2021, remain ... an enforcement priority.... EBSA will be focusing enforcement efforts on the implementation of the No Surprises Act ... EBSA will be reviewing pension plan practices to notify participants who are approaching normal retirement age and required minimum distribution age[.]"  MORE >>

"Both [OMB] and the Spring DOL Regulatory Agenda have teased an upcoming requirement for [PBMs] to disclose fees and rebates to ERISA health plan fiduciaries.... The 2025 new trend extending into 2026 is making prescription drugs available directly to consumers at lower costs,.... New electronic disclosure rules for health plans ... This year should bring additional transparency rules."  MORE >>

"What happened at the end of 2025: [1] Trump Accounts ... [2] Expansion of HSAs ... [3] Reduced Hepatitis B vaccination recommendations ...

"What's expected in 2026: [1] Pharmacy Benefit Manager transparency ... [2] Direct-to-consumer Rx programs ... [3] New HIPAA Security Rules ... [4] New electronic disclosure rules for health plans ... [5] Mental health parity ... [6] Transparency ... [7] Surprise billing adjustments."  MORE >>

"[1] Health legislation in congress ... [2] Transparency regulations ... [3] OBBB act guidance ... [4] NSA guidance ... [5] Mental Health Parity and Addiction Equity Act (MHPAEA) ... [6] Expansion of fertility benefits ... [7] Direct-to-consumer prescription drug programs ... [8] ERISA preemption of state PBM laws ... [9] Fiduciary breach litigation ... 10. HIPAA wellness/tobacco surcharge litigation."  MORE >>

"Although [this checklist identifies] many action items below, through the end of 2025 and in 2026, ... employers will focus their compliance efforts on: [1] potentially implementing design changes under the One Big Beautiful Bill Act (OBBBA); [2] potentially offering an excepted benefit that includes fertility benefits; [3] solidifying fiduciary and cybersecurity practices for health and welfare plans to reduce litigation risk; and [4] ensuring compliance with the recently scaled back requirements under the [MHPAEA] and [HIPAA]"  MORE >>

"The One Big Beautiful Bill Act has agencies working to create new guidance and regulations for telehealth, health savings accounts, and dependent care assistance programs. Ongoing litigation has paused enforcement of Mental Health Parity and Addiction Equity Act rules. Litigation impacts other aspects of health plan administration and design."  MORE >>

"[H]aving a vendor partner complete the analysis is somewhat like asking a fox to guard the henhouse. A third-party review gives an unbiased, objective perspective to provide accurate evaluations of a carrier's adherence to regulations and standards. This independence improves credibility with stakeholders, identifying potential risks by providing a more comprehensive review of industry practices, and is often necessary for demonstrating compliance to external parties like the [DOL] or plaintiff's attorneys."  MORE >>

"To replace QTL/NQTL regulations finalized in 2013, the Departments of the Treasury, Labor, and Health and Human Services proposed regulations in 2023 that solicited 9,503 comments. After review, the Departments issued final regulations on September 10, 2024. The 2024 rules shift the focus of the regulations from the process of applying NQTLs to the outcomes of that application. The key changes are addressed [in this article]."  MORE >>

"The court concluded that the participant had plausibly alleged an 'as written' MHPAEA violation in that the 24-hour nursing requirement was imposed only on residential mental health treatment facilities -- not on comparable medical/surgical analogs. While the administrator argued that it effectively imposed the same requirement on medical/surgical facilities because it required them to meet state licensing or federal Medicare/Medicaid requirements (which in turn required 24-hour nursing), the court ruled that a requirement that is expressly written into the plan is facially different than the incorporation of extrinsic licensing standards, even if those standards impose the same requirement in practice." [Brady K. v. Health Care Serv. Corp., No. 25-0759 (N.D. Ill. Sep. 25, 2025)]  MORE >>

Published Sep. 4, 2025.  Changes from the Fall 2024 IRS Regulatory Agenda:

Added to Proposed Rule stage:

• Indian Tribal Governmental Plans [1545-BI19]
• Minimum Vesting Standards [1545-BN49]
• Electronic Furnishing of Payee Statements Regarding Digital Asset Sales by Brokers [1545-BR47]
• Modification to Section 415(c) Compensation Definition Relating to Back Pay [1545-BR49]
• Determination of Target Normal Cost and Funding Target for Single-Employer Defined Benefit Pension Plans [1545-BR50]
• Transparency in Coverage (CMS-9882) [1545-BR51]

Moved from Proposed Rule stage to Final Rule stage:

• Regulations Governing Practice Before the Internal Revenue Service [1545-BQ12]
• Automatic Enrollment Requirements under Section 414A [1545-BR08]
• SECURE 2.0 Act Updates to Catch-up Contribution Rules Under Section 414(v) [1545-BR11]

MORE >>

"In light of the litigation challenging the 2024 Final Rule, the Departments announced a non-enforcement policy ... while they reconsider the 2024 Final Rule, including whether to issue a notice of proposed rulemaking rescinding or modifying the regulation.... [P]lans and issuers are still required to develop and maintain MHPAEA NQTL comparative analyses and provide them to regulators upon request."  MORE >>

"[F]ederal employees, policy experts and front-line workers warn that suspending the rules and cutting enforcement funding ... could mean longer waits for help when patients challenge insurance decisions, fewer investigations of insurers and employer health plans over possible violations of federal mental health protections, and more people going without care they're legally entitled to."  MORE >>