The Employee Benefits Security Administration (EBSA), a division of the U.S. Department of Labor (DOL), is reportedly focusing its enforcement efforts on ensuring that employees have access to behavioral health and substance use disorder care. Although the Trump administration has largely rejected the 2024 mental health parity regulations, the 2013 regulations and the Mental Health Parity and Addiction Equity Act (MHPAEA) remain in effect. As a result, employers should seriously consider employee complaints about access to care, particularly when it comes to mental health and substance abuse disorder care.
EBSA previously announced its focus on parity issues in its January 2026 enforcement priorities statement and another bulletin released in April. As a result, the agency has been focusing inquiries into various aspects of health plans, including claims processes, treatment exclusions, inaccurate provider lists, and limitations on behavioral health and addiction care. Issues such as prior authorization, medical necessity criteria, and exclusions for experimental treatment could also arise in these inquiries.
For its part, EBSA has stated its intention to focus on informal resolution efforts rather than on formal investigations and enforcement actions. However, at least one former EBSA employee has warned of potential EBSA action concerning No Surprises Act claim disputes and MHPAEA complaints. Extensive violations of the law or a failure to cooperate with an investigation could lead to formal action by EBSA, including a request to the Internal Revenue Service (IRS) to impose excise taxes.
The MHPAEA requires health plans to provide parity between medical and behavioral health non-quantitative treatment limitations (NQTLs). As a result, employers should examine their plans’ NQTLs to ensure they provide behavioral health benefits comparable to medical and surgical benefits. Performing this comparative analysis can help employers prepare for a potential EBSA audit.
The DOL and other federal agencies continue to work on regulations to replace the 2024 parity regulations. New regulations could provide more information about EBSA’s expected compliance with NQTLs.
HBL has experience in all areas of benefits and employment law, offering a comprehensive solution to all your business benefits and HR/employment needs. We help ensure you are in compliance with the complex requirements of ERISA and the IRS code, as well as those laws that impact you and your employees. Together, we reduce your exposure to potential legal or financial penalties. Learn more by calling 470-571-1007.
