"[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 >>
"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 >>
BenefitsLink note: DOL initially released this Regulatory Agenda in error on Aug. 15, 2025. See BenefitsLink summary of final Agenda publicly released on Sep. 4, 2025. MORE >>
"[EBSA and CMS] issued over 120 enforcement letters during the reporting period ... Plans frequently failed to prepare analyses, omitted benefit classifications, and relied on vague or unsupported assertions, ultimately hindering their ability to demonstrate MHPAEA compliance." MORE >>
"The 2024 Rule is not currently enforced due to litigation and agency reconsideration. Employers must comply with the 2013 Rule and the CAA. Enhanced requirements from the 2024 Rule are on hold but may return in future rulemaking. State enforcement may vary; fully insured plans must monitor both federal and state requirements. Continue to perform and document NQTL comparative analyses and prepare for further regulatory updates." MORE >>
"The main impact of the nonenforcement action is on portions of the 2024 final rule that went into effect in 2025 and were scheduled to take effect in 2026. These were not specified in CAA, 2021 but were interpretations of how to implement the law.... Those include ... [1] Fiduciary certification process ... [2] Definitions for mental health and substance use disorder diagnosis and treatment ... [3] Meaningful benefit standard ... [4] Prohibition on discriminatory factors." MORE >>
"Over the last several decades, Congress has, on a bipartisan basis, sought to given federal officials the authority and the tools to ensure mental health parity, which requires health plans that cover mental health and substance use care benefits do so at the same level as physical health care benefits.... [R]ecently the Trump Administration has taken specific steps that will most certainly undermine mental health parity. This should be troubling for anyone who has a family member or friend with mental illness -- an illness that occurs in more than 1 in 5 U.S. adults." MORE >>
24 pages. Topics include: Health benefits litigation update. [1] H.R.1 -- One Big Beautiful Bill Act ICHRA/HSA provisions; [2] MHPAEA enforcement developments; [3] PBM reporting and state issues; [4] Health benefits litigation update. MORE >>
"This may come as welcome news for employers throughout the country who have struggled to understand, and ultimately comply with, the highly technical mental health parity laws, particularly the requirement to provide a detailed non-quantitative treatment limitation (NQTL) comparative analysis. However, until the Departments re-examine their MHPAEA enforcement program more broadly, the non-enforcement policy provides limited relief[.]" MORE >>
"Despite the pause in litigation, the halting of any noncompliance enforcement, and the Departments’ reconsideration of the 2024 Final Rule, sponsors are not relieved from their current obligations under the 2013 final rule, including the obligation to perform a comparative analysis." MORE >>
"[T]he nonenforcement policy ... does not apply to the 2013 regulations or the MHPAEA statutory requirements, including the nonquantitative treatment limitation comparative analysis report requirement added by the Consolidated Appropriations Act, 2021.... [P]lan sponsors should still ensure that they have obtained a thorough comparative analysis report, and that the plan complies with the mental health parity requirements specified in the statute and the 2013 regulations, including the quantitative treatment limitation and financial requirements." MORE >>
"MHPAEA is still very much in force -- only the new provisions of the 2024 Final Rule are on hold. Plan sponsors must: [1] Continue complying with the MHPAEA requirements in the 2013 Final Rule. [2] Perform and document the NQTL comparative analysis. [3] Monitor further developments as the Departments reconsider the 2024 Final Rule." MORE >>
"The Departments' nonenforcement policy does not mean an employer (even one under a current MHPAEA examination) is relieved of compliance with MPHAEA. However, ... such compliance can be less burdensome (and, in particular, the NQTL comparative analysis can be less detailed without fear of reprisal) during the nonenforcement period, which is likely to last until at least 2027 and likely 2028 or beyond." MORE >>
"The May 15, 2025 announcement ... does not clearly indicate, however, which provisions are considered 'new' relative to the 2013 Final Rule and the MHPAEA amendments in the CAA 2021.... [A] chart provides an assessment of key MHPAEA compliance obligations that are likely paused and those that are likely still in effect." MORE >>
"Group health plans are [still] required to conduct parity testing under the MHPAEA and CAA for both quantitative and nonquantitative limitations ... The NQTL analysis must demonstrate that the processes, strategies, evidentiary standards and other factors the plan uses in applying an NQTL to MH/SUD benefits are comparable to and applied no more stringently than those used with respect to M/S benefits." MORE >>
"Plan sponsors and issuers are advised to make good faith efforts to comply with the comparative analysis requirements under the CAA and all other applicable requirements under MHPAEA. Failure to conduct the comparative analysis in accordance with the 2024 Final Rule will not, at this point, result in adverse action from the Departments." MORE >>
"[T]he purpose of the comparative analysis is to provide further visibility into whether plans are compliant with MHPAEA. Whether the analysis is determined to be sufficient or not, if an agency audit determines that any financial requirements or treatment limitations do not comply with the parity requirements, the plan may be required to take corrective action (e.g., reprocess claims and refund participants when applicable). In addition, non-compliant plans could be subject to a penalty[.]" MORE >>
"Employers should be prepared to turn over an NQTL comparative analysis to the government upon request. Employers with fully insured plans should contact the insurance company (if they have not already done so) to request a copy of the insurance company's NQTL comparative analysis. Employers with self-funded plans who have not yet conducted or arranged for an NQTL comparative analysis should begin the process of locating a vendor and should contact benefits counsel." MORE >>
"Employers with fully insured plans subject to MHPAEA should continue to communicate with their carriers to ensure the carrier is performing the NQTL analyses Employers with self-insured plans subject to MHPAEA ... should ensure their contract with their third party administrator (TPA) requires that the TPA complete and/or provide all of the data necessary for another party to complete the NQTL analyses ... Employers who have any carved-out coverages subject to MHPAEA should ensure the TPA for those benefits is assisting with and/or completing NQTL analyses relative to the specific benefits involved." MORE >>
"The upside of this announcement for health plan sponsors is ... [that] words, plan sponsors will not be found non-compliant with MHPAEA under affected aspects of the 2024 Regulations until late 2026, at the earliest.... So, what does this mean for plan sponsors who have either completed their comparative analyses or are working on coming into compliance with the 2024 Regulations? In short, not much. " MORE >>
