McDermott Will & Schulte, a global law firm

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 health plans continue to not fully comply, as reported in the departments’ 2025 MHPAEA Report to Congress, issued on February 20, 2026. The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) requires the secretaries of the departments to report annually to Congress on the results of their reviews of nonquantitative treatment limitations (NQTLs) comparative analyses conducted by health plans and insurance issuers. The 2025 report fulfills the departments’ obligation to report on the NQTL comparative analysis review activities between August 1, 2023, and July 31, 2025 (the reporting period).

Department of Labor Employee Benefit Security Administration (EBSA) review by the numbers

• Forty-two letters (30 to plans, 12 to insurance issuers) requesting comparative analyses, for a total of 77 NQTLs across 28 investigations
• Fourteen insufficiency letters covering 32 NQTLs
• Twenty-five initial determination letters citing MHPAEA violations in connection with 43 NQTLs
• Five final determinations of noncompliance finding MHPAEA violations for seven NQTLs

EBSA notes that it continues to see many deficient initial comparative analyses, with similar issues to those identified in prior reports, but that many deficiencies were cured through the exchange of additional questions and information. Plans and insurance issuers have been motivated to come into compliance after an issue is identified, which EBSA identifies as the reason why final noncompliance determinations are low compared to the total number of corrections.

During the reporting period, the departments requested, most frequently, comparative analyses for the following NQTLs:

• Provider network admission standards
• Exclusion of speech or occupational therapy
• Limits on autism services (age limit, parental participation requirement, diagnostic confirmation by specific specialist, other limit on applied behavioral analysis (ABA) therapy or intensive behavioral therapies, etc.), but not an ABA therapy exclusion
• Exclusion of nutritional counseling
• Exclusion of ABA therapy

CMS by the numbers

• Forty-three initial letters (33 to plans, 10 to insurance issuers) requesting comparative analyses for a total of 43 NQTLs across 43 investigations
• Sixty-two insufficiency letters covering 43 NQTLs
• Nine initial determination letters citing MHPAEA violations in connection with nine NQTLs
• Ten final determinations of noncompliance finding MHPAEA violations for 10 NQTLs

CMS identified a trend of zero comparative analyses that were sufficient at first submission, and provided up to two opportunities for the submission of additional information before making an initial compliance determination. In 2024 and 2025, CMS did not see a significant improvement in the sufficiency of initial NQTL comparative analyses, although a few plans and insurance issuers provided more detailed comparative analyses upon request. Deficiencies and trends observed by CMS during this reporting period are consistent with prior reports.

During the reporting period, CMS requested, most frequently, comparative analyses for the following NQTLs:

• Prior authorization
• Medical necessity
• Precertification
• Concurrent review
• Medical management standards for experimental/investigational treatments

Conclusion

The 32-page 2025 report is markedly shorter than prior reports (119 pages in 2023 and 142 pages in 2024) and does not include detailed discussions of MHPAEA enforcement priorities that were addressed in prior reports. Although this may represent a departure from the structure of past reports, the report is clear that MHPAEA enforcement remains a priority and that plans and insurance issuers should continue to work internally and with their service providers to ensure compliance with the MHPAEA NQTL comparative analysis requirements.

As highlighted in the report, to avoid compliance concerns, plan sponsors should also ensure that any third party or consultant drafting comparative analyses on behalf of the plan is familiar with plan operations, design, and application of NQTLs.

If you have any questions regarding mental health parity, please reach out to your regular McDermott Will & Schulte lawyer or one of the listed authors.