Mental Health Parity Enforcement in Practice: Understanding DOL Investigations and Preparing Your Plan
Insider Insights for Multiemployer Plans | | Webinar #4 | February 10, 2026 | 5-minute read
Featuring Lisa Gomez, former Assistant Secretary of Labor, Employee Benefits Security Administration (EBSA)
Key Takeaways
The Department of Labor (DOL) has named mental health parity a national enforcement priority for 2026, even though enforcement of the 2024 final regulations is currently paused.
Regulatory uncertainty doesn’t suspend your compliance obligations.
Investigators look at how your plan operates day to day, not just what your documents say.
A current, plan-specific NQTL comparative analysis with documented fiduciary review is your best defense.
Vendors can help, but fiduciaries remain responsible for oversight.
Why This Matters Now
Mental health parity is one of the most closely watched compliance issues for multiemployer health plans, and scrutiny is expected to increase, not decrease. Although enforcement of the 2024 Mental Health Parity and Addiction Equity Act (MHPAEA) final regulations is currently paused, the DOL has elevated parity to a national enforcement priority for 2026.
In the Zenith American Solutions webinar “Mental Health Parity Enforcement in Practice: Understanding DOL Investigations and Preparing Your Plan,” Lisa Gomez explained why plans should prepare now for heightened oversight and what fiduciaries can do to reduce risk. [Link to replay.]
Plans that assume litigation or regulatory delays will slow enforcement may be taking on unnecessary risk.
What Is MHPAEA?
MHPAEA requires group health plans to provide mental health and substance use disorder benefits in a manner comparable to medical and surgical benefits.
Most plan sponsors understand the concept. What’s changing is that regulators are examining how plans operate in practice, not just how benefits are described in plan documents. Plans must be able to show that mental health benefits aren’t subject to more restrictive limitations than medical benefits, particularly in these areas:
This means plans must be able to demonstrate that mental health benefits are not subject to more restrictive treatment limitations than medical benefits, particularly when it comes to:
Prior authorization requirements
Medical necessity determinations
Provider network access
Claims administration practices
Other non-quantitative treatment limitations (NQTLs)
What Triggers a DOL Investigation?
Many fiduciaries assume investigations only follow major violations. In reality, reviews can start from:
Participant complaints
Provider concerns
Data anomalies
Routine enforcement initiatives
Regulatory audits
Once an investigation begins, regulators typically evaluate both documentation and operational practices to determine whether mental health benefits are administered comparably to medical and surgical benefits.
The NQTL Comparative Analysis: Your Core Document
One of the most common questions fiduciaries ask is what an NQTL comparative analysis must include. It’s a documented review showing that the NQTLs applied to mental health benefits are comparable to those applied to medical and surgical benefits.
Regulators expect analyses to be:
Plan-specific
Detailed and well-documented
Regularly reviewed and updated
Supported by operational evidence
Reviewed through a fiduciary oversight process
Common pitfalls:
Relying exclusively on vendors for compliance
Failing to update analyses as plan operations evolve
Being unable to demonstrate fiduciary review
Lacking documentation that connects policies to actual administration practices
In a DOL investigation, having an analysis isn’t enough. Regulators want evidence that it reflects how the plan actually operates.
Fiduciary Oversight: An Ongoing Responsibility
Parity compliance is a governance responsibility, not a one-time project. Strong plans build continuous oversight that includes:
Regular vendor monitoring. Third-party administrators, behavioral health vendors, pharmacy benefit managers, and other providers shape how benefits are administered. Fiduciaries should understand those practices and whether they support parity.
Documented review activities. Meeting minutes, committee discussions, compliance reviews, and vendor reporting help demonstrate prudent oversight.
Alignment between documents and operations. Investigators compare written plan provisions to actual practice, and any gap can raise concerns.
Recurring compliance reviews. Schedule them rather than treating parity as a one-time exercise.
Your Action Checklist
Review and update your NQTL comparative analyses regularly.
Establish a documented fiduciary review process.
Monitor vendor performance and compliance practices.
Confirm that plan operations match written documentation.
Maintain records that demonstrate ongoing oversight.
Frequently Asked Questions
Are plans still at risk if the 2024 regulations aren’t currently being enforced?
Yes. Enforcement of certain provisions may be delayed or challenged, but parity remains a national enforcement priority. Keep your compliance processes in place, update your analyses, and document fiduciary oversight.
What’s the biggest MHPAEA compliance risk for multiemployer plans?
Failing to maintain a current, defensible NQTL comparative analysis supported by documented fiduciary review and operational evidence.
Can vendors handle MHPAEA compliance for us?
Vendors can provide valuable support, but fiduciaries retain responsibility for oversight. Regulators expect you to understand, review, and document the compliance work performed on your behalf.
How often should plans review parity compliance?
Treat it as an ongoing governance process, with periodic reviews of plan operations, vendor activities, and compliance documentation.
The Bottom Line
Enforcement is evolving, but regulators’ message is consistent: compliance takes more than documentation. Plans must show that mental health and substance use disorder benefits are administered fairly, consistently, and comparably to medical benefits. The strongest defense is a proactive governance process, and plans that invest in it now will be better positioned if scrutiny increases.
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About Insider Insights for Multiemployer Plans
Zenith American Solutions’ Insider Insights webinar series delivers timely perspectives on regulatory developments, fiduciary responsibilities, operational best practices, and emerging trends affecting Taft-Hartley and multiemployer plans. Each session helps trustees, fund offices, and industry professionals make confident decisions in an evolving benefits landscape.
