On September 8, 2026, the Department of Labor issued new enforcement guidance regarding the Mental Health Parity and Addiction Equity Act (MHPAEA) and its nonquantitative treatment limitation (NQTL) requirements.
Under MHPAEA, group health plans must ensure that any nonquantitative treatment limitations (NQTLs) affecting mental health and substance use disorder (MH/SUD) benefits are designed and applied in a manner comparable to, and no more restrictive than, those applied to medical/surgical benefits.
Common NQTLs include prior authorization requirements, utilization management protocols, provider network standards, reimbursement methodologies, and certain benefit exclusions.
Under the new guidance, the DOL will focus NQTL enforcement on three categories:
- Separate treatment limitations, including exclusions
- Medical necessity standards and review process
- Network adequacy standards, with a focus on provider admission criteria and reimbursement methodologies
As a result, employers sponsoring self-insured health plans should:
- Review plan documents and SPDs for benefit exclusions or limitations that may affect MH/SUD benefits
- Consul with ERISA counsel regarding the preparation or completion of any plan-specific comparative analysis
- Finalize or update their latest comparative analysis documentation to ensure compliance with the law
Please contact your Davis+Gilbert benefits attorney to discuss the latest issues affecting self-insured health plans.