EBSA names three mental health parity enforcement priorities even with the 2024 rule paused
EBSA's Bulletin 2026-03 names three parity enforcement priorities for group health plans while the 2024 rule stays on hold. The statute's comparative-analysis duties still apply, so sponsors setting 2027 benefits cannot treat the pause as cover.
The Board Room · Leadership desk
18 months: the 2024 rule's new provisions go unenforced until a final ruling in the ERISA Industry Committee lawsuit, plus 18 months. Three areas: EBSA's parity enforcement priorities. 59 percent of employers expect cost-reduction changes to health benefits, per Marsh.
| Figure | Value | Note | Claim |
|---|---|---|---|
| Added to 2024 rule pause after final lawsuit ruling | 18 months | 3 | |
| EBSA priority areas | 3 areas | 14 | |
| Employers expecting cost-reduction changes | 59% | Marsh finding, health benefits | 11 |
What happened
- The Labor, Health and Human Services and Treasury departments said on May 15, 2025 they would not enforce the 2024 rule's new provisions until a final ruling in the ERISA Industry Committee's lawsuit, plus 18 months.
- The bulletin is an internal memorandum to EBSA enforcement staff, and the Labor Department said it creates no rights enforceable by any party.
- The three areas are separate treatment limitations including exclusions, medical necessity standards and review processes, and network adequacy.
- EBSA released an enforcement guidance tool the same day, and Becker's Behavioral Health reported it flags autism therapy exclusions, longer behavioral health prior authorization timelines and visit limits with no medical equivalent.
Why it matters
- Who has to decide decision Sponsors planning 2027 cost cuts are deciding on exclusions, authorization rules and networks, the same areas EBSA named, so the parity review has to come before the design is locked.
- What it limits constraint Documenting a response to a red flag creates no safe harbor and no protection from private litigation, so documentation alone does not close a plan's exposure.
- Who's exposed exposure A participant complaint about a limitation outside the three areas can still draw an investigation, because EBSA kept that option open.
The bulletin tightens where EBSA will look and aims to ease the compliance load on plans, yet the underlying law is unchanged [13]. The first priority is the easiest to test. EBSA's focus will be blanket exclusions limited to mental health and substance use benefits, though the agency said narrower exclusions could also draw its attention, particularly when complaints come in [5].
The second priority puts a document obligation on the sponsor and its vendors. Plans may use proprietary clinical guidelines for prior authorization, concurrent review and retrospective review, the bulletin says, provided the standards for mental health and substance use benefits are comparable to those for medical and surgical benefits and no stricter [6]. When asked, plans and their service providers have to hand the guidelines over, to investigators and to participants alike [6]. In our view, that puts service-provider contracts inside the sponsor's review.
Network adequacy is the priority where participants notice a gap first. Participants unable to get treatment in network end up paying out-of-network costs or going without care, the bulletin notes [15]. EBSA named admission standards and provider reimbursement methodologies as the focus [7].
The case for waiting is that the ground may move. The bulletin says the assistant secretary may update it periodically [10], and Epstein Becker Green said the departments have signaled a replacement proposed rule by year-end [16]. According to the HCA article, that leaves any compliance work based on the bulletin resting on a framework that holds for now but is not settled [17]. Some of a review done this quarter may therefore need redoing next quarter.
Against that, the statute's obligations apply now. They include the comparative analyses of nonquantitative treatment limitations, and the bulletin says so [4]. The tradeoff is rework later against exposure today. We'd expect a sponsor that has already mapped its plan documents against the three areas to need only a comparison once a proposal appears.
The article does not say when the ERISA Industry Committee litigation will reach a final decision, so the length of the pause cannot be calculated [3].
What to watch
- Whether the departments publish the replacement proposed rule by year-end, as Epstein Becker Green said they have signaled.
- Any update to the bulletin by the assistant secretary, which the bulletin allows periodically.
- A final decision in the ERISA Industry Committee litigation, which starts the 18-month clock on the enforcement pause.
Clarity's read
What the record supports and how the coverage leans. The claims behind it follow.
Reality
- Evidence55
- Adoption
- Insufficient
- Hype gap+15
- Incentives
- Insufficient
- Confidence50
Claim ledger
Ranked by verification strength, evidence, and original report placement.
- [1]
The Department of Labor's Employee Benefits Security Administration issued Field Assistance Bulletin No. 2026-03 on September 8, 2026, naming three areas where it will focus enforcement of the Mental Health Parity and Addiction Equity Act.
- [2]
The bulletin is an internal memorandum to EBSA enforcement staff, and the DOL said it creates no rights enforceable by any party.
- [3]
On May 15, 2025, the DOL, HHS and the Treasury Department said they would not enforce the new provisions of the 2024 final rule until a final decision in litigation brought by the ERISA Industry Committee, plus an additional 18 months.
- [4]
The May 2025 notice said the statute's obligations, as amended by the Consolidated Appropriations Act, 2021, continue to apply, and the bulletin adds that this includes the requirements for comparative analyses of nonquantitative treatment limitations.
- [5]
On exclusions, EBSA said it will concentrate on blanket exclusions that apply only to mental health and substance use benefits, and that it may also look at narrower exclusions, especially after complaints.
- [6]
On medical necessity standards and review processes (prior authorization, concurrent review, retrospective review), plans may use proprietary clinical guidelines if the standards applied to mental health and substance use benefits are comparable to, and no more stringent than, those applied to medical and surgical benefits; plans and their service providers must provide the guidelines on request, both during investigations and to participants.
- [7]
The third priority is network adequacy, specifically admission standards and provider reimbursement methodologies.
- [8]
EBSA released an enforcement guidance tool the same day; Becker's Behavioral Health reported it flags exclusions of applied behavior analysis and speech or occupational therapy for autism, longer prior authorization timelines for behavioral health than for medical care, and visit limits that do not apply to medical services.
- [9]
Epstein Becker Green attorneys said EBSA treats the red flags as warning signs and not automatic findings of noncompliance, and that documenting a response to a red flag does not create a safe harbor under the parity law or protect a plan from private litigation.
- [10]
The bulletin says the assistant secretary may update it periodically.
- [11]
Marsh found that 59 percent of employers expect to make cost-reduction changes to their health benefits; changes to exclusions, authorization rules or networks are the kind of decisions the three priority areas cover.
- [12]
EBSA said it may also investigate other limitations as issues arise, particularly when participants complain.
- [13]
The bulletin narrows EBSA's enforcement focus and is meant to reduce compliance burdens for plans, but it leaves the law in place.
- [14]
The three enforcement areas are separate treatment limitations including exclusions, medical necessity standards and review processes, and network adequacy.
- [15]
When participants cannot find in-network treatment, the bulletin notes, they either pay out-of-network costs or go without care.
- [16]
Epstein Becker Green said the departments have signaled a replacement proposed rule by year-end.
- [17]
The signaled replacement rule makes any compliance work built on the bulletin a current framework and not a settled one.
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Sources
1 independent publisher whose own reporting we read for this story.
- hcamag.comMental health parity enforcement is live: what HR should review
1 article · October 15, 2026
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