The Department of Labor is sharpening its enforcement focus on health plans’ compliance with federal mental health parity requirements, including restrictions that could affect access to behavioral healthcare.
The department’s Employee Benefits Security Administration issued updated enforcement guidance Sept. 8 identifying potential compliance red flags, monitoring practices and corrective actions involving mental health and substance use disorder benefits. The guidance accompanies Field Assistance Bulletin 2026-03, which prioritizes enforcement of nonquantitative treatment limitation requirements under the Mental Health Parity and Addiction Equity Act in three areas: treatment limitations and exclusions, medical necessity standards and review processes, and network adequacy standards.
Here are seven things to know:
1. Certain behavioral health treatment exclusions could draw scrutiny. The agency identified exclusions involving applied behavior analysis, speech therapy or occupational therapy for autism spectrum disorder as potential red flags when comparable exclusions do not apply to medical or surgical care. It also flagged exclusions involving medications for addiction treatment, nutritional counseling for eating disorders, and residential, intensive outpatient or partial hospitalization programs.
2. Prior authorization and medical necessity processes are a key enforcement area. Potential compliance problems include requiring prior authorization or concurrent review for all or almost all mental health and substance use disorder benefits when those requirements apply to few or no medical or surgical benefits in the same classification. Extra review requirements and certain treatment criteria can also raise concerns.
3. The agency is looking closely at behavioral health networks. More burdensome processes for behavioral health providers to join networks, longer wait-time standards and different provider reimbursement methodologies can signal potential parity problems. The agency also flagged situations in which plans offer procedures for patients unable to find an in-network medical provider but do not provide comparable assistance for behavioral healthcare.
4. Compliance depends on how policies operate in practice. Written plan terms are not the only focus. The agency identified longer prior authorization timelines, manual behavioral health authorization processes when medical authorizations are automated, and shorter authorization periods for behavioral health services as potential red flags.
5. Telehealth, cost-sharing and visit limits can also raise compliance concerns. The guidance identifies lack of telehealth coverage for behavioral healthcare when telehealth is covered for medical care, higher copays or coinsurance for mental health and substance use disorder services, and visit or episodic limits that do not apply to medical or surgical services as potential red flags.
6. Plans are expected to use monitoring mechanisms to identify disparities. The agency recommends comparing mental health and substance use disorder benefits with medical and surgical benefits using measures including out-of-network utilization, provider network applications and patient wait times. Plans should also monitor participant complaints and take action when data indicate disparities or other compliance concerns.
7. Corrective actions can require changes to coverage and plan operations. The guidance points to actions taken during previous department investigations, including expanding behavioral health telehealth and network recruitment, reducing behavioral health services subject to preauthorization, extending automated preauthorization systems to behavioral health services, and removing certain exclusions. These examples show how identified parity concerns can translate into changes in benefit design and administrative processes.
View the full PDF here.
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