The U.S. Departments of Labor, Health and Human Services, and the Treasury recently submitted a report to Congress summarizing their review of comparative analyses of nonquantitative treatment limitations (NQTLs) under the Mental Health Parity and Addiction Equity Act (MHPAEA). Covering the Departments’ work over the two-year period ending July 31, 2025, the report stresses the need for health plans to prepare complete comparative analyses of their NQTLs.
MHPAEA generally prohibits health plans and health insurance issuers from imposing barriers on access to mental health or substance use disorder (MH/SUD) benefits that do not apply to medical and surgical (M/S) benefits. MHPAEA’s parity requirements apply to financial requirements, quantitative treatment limitations and NQTLs, which generally limit the scope or duration of benefits. MHPAEA requires health plans and issuers to perform and document comparative analyses of the design and application of NQTLs used for MH/SUD benefits compared to M/S benefits. Health plans and issuers must make their comparative analyses available upon request to the Departments, as well as applicable state authorities. The Departments must report to Congress annually on the results of their NQTL comparative analyses reviews.
MHPAEA Compliance Report
The Department of Labor’s Employee Benefits Security Administration (EBSA) oversees MHPAEA compliance of health plans maintained by private-sector employers. During the reporting period ending in 2025, EBSA issued 42 initial letters requesting comparative analyses for 77 NQTLs (30 letters to health plans and 12 letters to issuers). According to EBSA, while many comparative analyses were deficient when initially produced, most health plans and issuers worked with EBSA to correct deficiencies and remove problematic NQTLs. Consequently, EBSA only issued five final determinations of noncompliance during the reporting period. Key points from the report include the following:
- EBSA prioritizes NQTLs with the most significant impact on access to care, especially limitations related to network adequacy and composition and impermissible exclusions of MH/SUD treatment, such as exclusions of applied behavioral analysis for autism or methadone treatment for opioid use disorder;
- When health plans and issuers proactively consider MHPAEA compliance and have prepared complete comparative analyses, EBSA’s investigations are resolved more quickly and have better outcomes; and
- Sponsors of self-insured health plans have frequently been surprised to learn that the health plan itself (and not a service provider) is responsible for MHPAEA compliance . In addition, many sponsors mistakenly believed their service provider already had a comparative
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