BENEFITS DIGEST

A plan’s mental health rules can look evenhanded on paper and still make treatment harder to obtain. Proskauer highlights that tension in Labor’s enforcement guidance, which points to problems such as longer authorization times and reimbursement practices that make it difficult to retain mental health providers. Although enforcement of parts of the 2024 rule is on hold, the statutory obligation to compare treatment restrictions remains. Sponsors should know what operational data their vendors can produce, rather than relying only on a written assurance that the plan complies.

Labor’s mental health parity investigations will focus on three areas. First are separate restrictions on mental health and substance-use treatment, including exclusions. Second are medical-necessity standards and review processes. Third is network adequacy, including how providers are admitted and reimbursed. M3 Insurance explains what employers should check against those priorities. Prior authorization and other reviews must be comparable to, and no more stringent than, those used for medical and surgical benefits. The focus areas help organize a compliance review, but they don’t eliminate other enforcement or the requirement to produce the plan’s comparative analyses.

Proskauer reads the Labor Department’s parity red flags as a practical checklist, with the examples running to plan exclusions, medical-necessity review, and network practices that treat mental health or substance-use care more restrictively than medical care, plus the vendor-oversight questions a sponsor should be asking its administrator. The authors also read the guidance as a preview of rulemaking priorities. The document is guidance rather than a new final regulation, and the prediction about future outcome requirements is the authors’ inference.

Hall Benefits Law reminds employers that parity obligations did not pause with the 2024 regulations’ nonenforcement. The statute and the 2013 rules still apply, comparative analyses required since the 2021 appropriations act remain mandatory, and EBSA’s current enforcement guidance signals attention to exclusions, medical-necessity review practices and network adequacy. ERIC’s challenge to the 2024 rules has been stayed since May 2025, which leaves the older framework as the operative one for now.

A narrower federal enforcement agenda doesn’t eliminate mental-health parity duties. This National Law Review analysis discusses the Labor Department’s focus on coverage exclusions, medical-necessity standards and access to in-network care. The [enforcement bulletin](https://beta.dol.gov/policy-regulations/reference-materials/guidance-searches/ebsa-field-assistance-bulletin-no-2026-03) preserves statutory duties, including comparative analyses of treatment limits that aren’t expressed as dollar or visit caps. Labor, Treasury and HHS have jointly announced nonenforcement of newer provisions of the 2024 rule, but that policy doesn’t erase the underlying law. The replacement-rule timetable also needs care. In their [September 30 court filing](https://litigationtracker.law.georgetown.edu/wp-content/uploads/2025/01/ERISA-INDUSTRY-COMMITTEE-v.-DEPARTMENT-OF-HEALTH-AND-HUMAN-SERVICES-et-al_2026.09.30_JOINT-STATUS-REPORT.pdf), the agencies said they intend to submit a proposal for White House regulatory review by December 18, 2026. That’s a submission target, not a public-release deadline. ERIC objects that the agencies have retreated from their earlier December 31 publication target.

CBIZ’s October update flags three dates for employers. Medicare Part D creditable coverage notices, which tell employees whether their drug coverage is at least as good as standard Medicare coverage, are due before October 15. Extended Form 5500s for calendar-year plans are due October 15, and Massachusetts HIRD filings open November 15. The Labor Department’s benefits agency, in new Field Assistance Bulletin 2026-03, is focusing mental health parity enforcement on blanket exclusions of mental health treatment, the review practices plans use to decide whether care is necessary, and inadequate provider networks. Its updated red-flags checklist helps plans spot potential problems in their own designs while new regulations are drafted. The issue also covers the Trump Accounts temporary regulations, with IRS automatic enrollment reaching more than 60 million children and comments open through November 29, San Francisco’s 2027 health care expenditure rates, New York and New Jersey paid leave figures for 2027, and the District of Columbia’s October 1 reductions in paid family leave durations and maximum benefits.

All Points North, a Colorado addiction and mental health treatment provider, is now pressing its claim-denial fight with Aetna in as many as 29 separate federal cases. In an October 6 [order](https://digest.theinnerfirm.com/docs/csmn-v-aetna-severance-order-2026-10-06.pdf), Judge Nina Y. Wang severed the provider’s 2024 suit over allegedly widespread claim denials into individual benefits cases, one per patient, each pairing Aetna with that patient’s employer health plan, and waived the filing fees. The first new dockets include the [Boston Consulting Group](https://digest.theinnerfirm.com/docs/csmn-v-aetna-bcg-complaint-2026-10-06.pdf) and [Alaska Electrical](https://digest.theinnerfirm.com/docs/csmn-v-aetna-alaska-electrical-complaint-2026-10-06.pdf) plans. Each new case opens with the same 118-page complaint from the original action, which named more than two dozen employer plans, including those of Amazon, Apple and CVS. In it, the provider and eleven named patients allege that since 2022 Aetna denied hundreds of claims for residential and outpatient mental health and addiction treatment using boilerplate requests for records that had already been sent, with representatives conceding the records arrived but were never attached to the claims, and a portal that often offered no way to appeal. The complaint says Aetna placed the provider on a special review status and told it the status would lift only after six months of what Aetna called clean claims, without saying what was wrong with the claims it had. A demand letter from the provider’s counsel put the disputed benefits for the 42 patients above $5.5 million. The mental health parity claims stay behind in the original case, where the eleven patients will press them against Aetna and six employer plans, and the court set an October 21 conference to build a master schedule for all of the severed cases. No defendant has responded to the new cases yet.

Employers shouldn’t assume their health plan administrator’s standard coverage complies with mental health parity requirements, or that someone else is preparing the required comparison of restrictions on mental health and medical benefits. The International Foundation distills new Labor Department guidance recommending that plan fiduciaries build parity into how they select and monitor service providers. When different companies administer medical and mental health benefits, employers need to make sure someone brings both sets of information together; the Department’s enforcement reports say plans with split arrangements rarely get a complete comparison from either vendor, and reconciling the two administrators’ information is the plan’s job. The piece reprints the Department’s sample questions for current and prospective vendors, from whether the comparison comes with the contract or at extra cost to how mental health network access is measured against medical, then lays out monitoring steps for medical necessity reviews and network adequacy. It closes by flagging a deregulatory parity proposal on the agenda for December.

Mercer’s practitioner read of the Labor Department’s parity enforcement bulletin organizes FAB 2026-03 into three enforcement priorities and a red-flag list worth running against your own plan, age limits on applied behavior analysis therapy, exclusions of medication-assisted treatment for addiction, exclusions of residential treatment or intensive outpatient care, different telehealth restrictions for mental health and medical care, and network admission and payment methods that treat behavioral providers differently. It also catalogs which portions of the 2024 parity rule the agencies will not enforce for now, and notes the promise of a new proposed mental health parity rule by the end of 2026.

Peter Sessions’ weekly survey leads with the Anderson argument, reading it as a good day for plan administrators. Two mental health decisions stand out in the rest of the issue. In the Northern District of California, the court in the long-running Wit reprocessing litigation against United Behavioral Health granted most of the class’s summary judgment motion, giving binding effect to earlier findings that the company’s coverage guidelines were improperly restrictive and excusing further administrative appeals as pointless, which keeps the largest behavioral health claims administration case in the country moving. And an Illinois court allowed a mental health parity claim over round-the-clock nursing coverage at a residential treatment center to proceed against a plan sponsored by insurance brokerage Arthur J. Gallagher. The survey also collects the week’s decisions on late appeals, discretionary clause bans, a pension calculator error that produced no remedy, and a $497,500 preliminary settlement approval.

Trevor Colhoun, who runs the behavioral health network TPN.health, argues that coverage only counts when an employee actually reaches an appropriate provider instead of getting lost in disconnected directories and referrals. Brokers and advisers write the RFPs, evaluate the networks, negotiate the pricing and review vendor performance, so he’d point the incentives at them: tie part of vendor compensation to measurable standards such as response times and the rate at which members accept their first provider match.

For World Mental Health Day on October 10, the International Foundation offers a practical guide for managers on helping employees who may be struggling. It covers how to recognize when something is wrong, how to approach the conversation and refer to resources rather than counsel, and how to plan accommodations and a return to work that stick, including managing co-worker reactions. The underlying material comes from Canada's Workplace Strategies for Mental Health, so its legal-duty references track Canadian law, but the management guidance travels well. The Foundation also flags its free virtual conference on workplace mental health, October 7.

Judge William Orrick allowed claims over denied benefits and failures to protect plan participants to proceed against both Blue Shield and its mental health subcontractor, Magellan. Blue Shield also faces a claim that its mental health network offered worse access than its medical network. For employees in plans outside ERISA, the court allowed claims to enforce their employers' contracts with Blue Shield. Magellan won dismissal of several state-law claims on different grounds, including that participants couldn't enforce its contract with Blue Shield. The plaintiffs can revise the dismissed claims. The ruling allows the surviving claims to move forward; it doesn't establish that either company broke the law.

Mental health parity enforcement has narrowed but not stopped. With the 2024 parity rule shelved during litigation, the Labor Department enforces the 2013 regulations, and its September guidance concentrates on three targets, exclusions that apply only to mental health and substance use benefits, medical necessity and utilization review processes, and network adequacy, meaning whether enough providers are actually available. Employers should check whether their plans exclude autism therapies or addiction medications while covering comparable medical care, use an employee assistance program as a gatekeeper to care, let actual claims practice diverge from written terms, or discount behavioral providers more deeply than medical ones in reimbursement formulas. They should also confirm vendors can produce medical necessity criteria promptly on request.

The Labor Department has identified three priorities for mental health parity investigations. In [Field Assistance Bulletin 2026-03](https://digest.theinnerfirm.com/docs/ebsa-fab-2026-03-2026-09-08.pdf), issued September 8, investigators are told to focus on plans that exclude mental health treatments while covering comparable medical care, on how plans decide whether treatment is medically necessary, and on whether patients can actually get care through the plan's provider network, the areas EBSA says carry "the highest potential for significant harm." Plans must still maintain a written analysis comparing their restrictions on mental health and substance use treatment with those on medical and surgical care, and provide it to the Department on request. Participant complaints can prompt investigations beyond the three priorities. Epstein Becker notes the agencies have committed to proposing replacement parity regulations by December 31.

Health plans still need a written comparison of how they apply certain restrictions to mental health care and to medical care, even though the 2024 parity regulations aren't being enforced. Holland & Hart explains that the requirement comes from the statute. The firm also warns that failing to provide a required document after a participant's request can expose a plan administrator to penalties of up to $110 a day. The 2024 regulatory preamble suggests that the comparative analysis is among the documents participants can request. DOL's enforcement priorities include exclusions of mental health services, stricter medical-necessity standards than those used for medical care, and inadequate provider networks.

An important reminder about the parity guidance we covered Monday: EBSA's narrowed enforcement focus doesn't shrink the comparative analysis itself. Employers must still maintain a complete NQTL analysis covering all nonquantitative treatment limits, because participants can demand the full document with 30 days to produce it, private plaintiffs don't follow the agency's priorities, and participant complaints can still trigger investigations of any category.

Roberts Disability Law's summary of Doe v. The Signature Benefits Plan, the decision that led yesterday's Court section, adds a point our writeup didn't reach: the court reviewed the entire administrative record, including documents from the independent external review, because the plan itself made external review final and binding. Here, the court treated the external review as part of the claims process, so it considered those documents too. The full findings of fact are in yesterday's issue.

The enforcement pause on parts of the 2024 rule doesn't remove the underlying duties, and Ogletree Deakins notes that violations can expose self-insured employers to an excise tax of $100 per day for each affected person. Eversheds Sutherland turns the bulletin's red flags into questions to ask when selecting a vendor, IFEBP highlights practices such as requiring an employee assistance program referral for mental health treatment when medical care has no comparable requirement, or applying reimbursement discounts only to master's-level mental health providers, and Proskauer cautions that the relief is temporary, conditional on pending litigation, and no shield against complaint-driven review of any category of comparative analysis.

In Jane Doe v. The Signature Benefits Plan, No. 8:24-cv-02230 (C.D. Cal. Sept. 17, 2026), Chief Judge Dolly M. Gee ordered the plan, self-funded by The Walt Disney Company, to cover a teenager's five-week residential mental health stay at an out-of-network facility. The plan gave the company “full discretion” to decide claims, but the court found no basis to give the same leeway to Evernorth Behavioral Health, the utilization reviewer that made the denial decisions and is “not mentioned anywhere in the Plan,” so it reviewed the record fresh. The court found that the denials used the wrong standards. The initial letter said the boy was not at “imminent risk” of serious self-harm, a test the applicable guidelines don't contain. They ask instead about persistent thoughts of suicide or self-harm that lower levels of care can't manage, which the court found the record supported. The independent external reviewer applied a definition of medical necessity “found nowhere in the Administrative Record.” The mother won benefits and interest and may seek attorney fees, and the parties must work out the amount owed. For sponsors, the case raises two questions. Has the actual decision maker been given discretion, and do denial letters apply the right criteria?

Thursday's issue carried the government documents themselves, the enforcement bulletin and EBSA's red-flag checklist. Today we turn to the client briefing, which earned a slot of its own. Submitted by Aon's U.S. Health Solutions Compliance & Policy Consulting team, the four-page bulletin by Rebecca Sooter and Kristen Boorman explains EBSA's decision to concentrate parity enforcement on the three treatment-limitation categories it says carry the “highest potential for significant harm to plan participants.” Those are exclusions and separate limitations, medical-necessity review processes, and network adequacy, with authority reserved to investigate anything else “particularly in the context of participant complaints.” Aon's recommendation is the practical place to start. Get the comparative analyses from your vendors now and test them against the three priorities, using the red-flag page as the checklist.

One more word on parity this week, for what it adds to the calendar. Sheppard Mullin's team reads the new enforcement bulletin as “a reprioritization, not a reprieve,” and keeps the timeline in view. The agencies have committed to a replacement proposed rule by December 31, the industry challenge to the 2024 rule is still pending, and whether outcomes-based access standards survive remains an open question, so the landscape could shift again before year-end. Their caution is worth adopting now. Document the reasoning behind outcomes-data decisions, because the self-compliance tool alone will not carry a plan through whatever comes next.

The Field Assistance Bulletin got the headlines last week; this page is the working document. EBSA has posted a plain-language catalog of the warning signs it looks for in mental health parity investigations, organized around the three treatment restrictions the Department said on September 8 it will focus on: separate treatment limitations including exclusions, medical-necessity standards and review processes, and network adequacy. The page flags problem language in plan documents and problem patterns in operations, gives fiduciaries questions for selecting and monitoring service providers, and describes seven examples of voluntary fixes following DOL investigations. Two examples of what draws attention: a plan that excludes addiction-treatment medications such as methadone, naltrexone or buprenorphine while covering comparable medications for medical conditions, and a plan requiring burdensome manual paperwork to approve mental health treatment while running automated approvals for medical care. It closes with advice for plans facing a DOL review, starting with having the comparative analyses ready. Our thanks to the reader who sent along [Aon's client bulletin](https://img.response.aonunited.com/Web/AonUnited/%7Bf7d62089-816c-4d0d-9788-d5c2e1616625%7D_DOL_Issues_Guidance_on_Mental_Health_Parity.pdf) flagging the page; [Foley's compliance-traps alert](https://www.foley.com/insights/publications/2026/09/mental-health-parity-compliance-traps-dol-guidance-warns-what-to-watch-out-for) covers the same ground from the plan sponsor's chair.

The second-day read on Field Assistance Bulletin 2026-03, built on practitioner interviews. The critique is that the bulletin names its targets, blanket exclusions, utilization management, and network adequacy, without defining a violation. KFF's Kaye Pestaina says the Department outlined the areas it will focus on “but don't really give specifics about what is a violation in those areas.” Segal's Elena Lynett hears sponsors asking for “a clear path forward and clear boundaries,” and Morgan Lewis's Sage Fattahian calls the guidance a step in the right direction that leaves the original question open, what exactly the Department wants to see in a comparative analysis. The statutory comparative analysis obligation remains fully enforceable, the 2024 rule's additions sit in a nonenforcement window, and new proposed regulations are expected by December.

The compliance-alert read on the same bulletin, from a usefully different angle. Vorys traces the FAB's origin to Executive Order 14219's deregulatory review, which sent EBSA back to re-evaluate its MHPAEA enforcement approach, and notes the bulletin is by its terms internal policy directed at EBSA staff that plans can nonetheless use to guide compliance. The most useful detail is the example of what counts as a blanket exclusion. A plan that excludes residential treatment for mental health and substance use disorder conditions while covering comparable inpatient or post-acute care on the medical side, skilled nursing included, is the kind of exclusion EBSA will pursue. Plans relying on proprietary clinical guidelines for medical necessity must make them available on request, under ERISA section 712(a)(4). The advice to employers is to confirm their plans have documentation showing compliance with the three priorities, since EBSA will still investigate other limitations as participant complaints surface them.

Three firms read [Field Assistance Bulletin 2026-03](https://beta.dol.gov/system/files/media/policy-regulations/guidance-search/ebsa-field-assistance-bulletin-no-2026-03.pdf) within a day of each other, and together the readings cover the ground. Mayer Brown inventories the nonenforcement box, which holds the 2024 rule's meaningful benefits standard, its discriminatory-factors prohibition, its relevant data requirements, and the 2026 comparative analysis provisions, all suspended until the pending litigation resolves plus 18 months. Segal turns the bulletin into a sponsor worklist, with red flags running from ABA age limits to EAPs functioning as gatekeepers and 14 questions to put to vendors. Proskauer walks the procedure, where comparative analyses remain due within 10 days of a request, EBSA reserves every other NQTL category when participant complaints arrive, and new proposed regulations may come as early as this year.

The DOL released Field Assistance Bulletin 2026-03 this week with a companion web page that reads like an examiner's checklist, and Seyfarth turns both into a working roadmap. Enforcement will concentrate on three areas: blanket treatment exclusions, where residential eating disorder care and ABA therapy for autism are the named examples; medical necessity and utilization management; and network adequacy and provider reimbursement. Worth underlining: the nonenforcement relief for contested pieces of the 2024 final rule, which the agency is reworking through new rulemaking, changes nothing about the statutory comparative analysis obligation for NQTLs. Since vendors hold most of the data these reviews require, the guidance doubles as leverage for negotiating that support into service agreements.

Field Assistance Bulletin 2026-03, addressed by Assistant Secretary Daniel Aronowitz to the agency's enforcement staff, sets out how EBSA will enforce the mental health parity law's nonquantitative treatment limitation requirements while the 2024 final rule remains in nonenforcement status. The bulletin identifies three priority areas. Blanket exclusions applied only to mental health and substance use disorder benefits, medical necessity standards including prior authorization and concurrent and retrospective review, and network adequacy with attention to provider admission standards and reimbursement methodologies. Proprietary clinical guidelines may be used but must be produced on request to investigators and participants.

Differences between physical and mental health services mean ensuring equal care 'in spaces that can be quite different.'

Today's complex stressors require clearer access pathways and a company-wide commitment to mental health support.

Despite repeated warnings from the US Departments of Labor, Health and Human Services, and the Treasury (collectively, the departments) that they prioritize mental health parity compliance, employer