The Employee Benefits Security Administration (EBSA), a division of the U.S. Department of Labor (DOL), recently issued guidance for employer health plans on compliance with federal mental health and substance use disorder parity laws. However, litigation over the rules remains ongoing in a D.C. federal court, though it has been stayed since May 2025.
EBSA’s new field assistance bulletin provides what it bills as a narrower enforcement framework. The agency notes that it has declined to enforce the 2024 rules, but it will enforce the 2013 final rules. Those rules require employer health plans to analyze treatment limitations that fall within the scope of federal parity laws.
While Congress passed new restrictions on nonquantitative treatment limitations in an appropriations bill for fiscal year 2021, EBSA states that it intends to focus on the following three categories of those limitations in its enforcement efforts:
- Blanket coverage exclusions applying only to mental health and substance use disorder benefits;
- Medical necessity standards; and
- Review processes, with emphasis on prior authorization, concurrent review, and retrospective review.
Additionally, EBSA announced that it would stress network adequacy in enforcing the analysis requirement.
Employer health plans have been seeking guidance from the DOL on parity enforcement because of the pending lawsuit and the agency’s refusal to enforce the 2024 rules. Those rules changed the 2021 appropriations legislation to place stricter limits on how employers could curtail coverage for mental health and substance use disorder treatment compared with medical care coverage.
The ERISA Industry Committee (ERIC), a trade group representing large employers that administer benefit plans under the Employee Retirement Income Security Act (ERISA), filed suit in January 2025 challenging the 2024 rules. ERIC claims the rules are unconstitutional and violate the Administrative Procedure Act (APA). The suit also contains allegations that the three agencies that issued the rules exceeded their authority under the Mental Health Parity and Addiction Equity Act (MHPAEA) and the Consolidated Appropriations Act of 2021.
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