Our Take
The compliance gap is real, but DOL's comparative analysis approach has already been deemed ineffective by its own leadership.
Why it matters
Self-insured employers face potential liability from mental health parity violations they don't know exist. New Trump administration regulations may shift enforcement focus but current compliance gaps remain.
Do this week
Benefits teams: audit your mental health carveout arrangements this quarter to document comparable coverage before regulatory changes take effect.
EBSA issued 42 parity violation letters in two years
The Employee Benefits Security Administration found that employers using separate companies to administer mental health and medical benefits rarely verify the coverage is comparable, according to a new congressional report on Mental Health Parity and Addiction Equity Act enforcement.
EBSA issued 42 letters requesting comparative analyses between Aug. 1, 2023, and July 31, 2025 (per the agency report). The violations broke down across specific areas: 14 cases involved network provider rules, eight related to speech or occupational therapy exclusions, eight covered autism therapy limitations beyond applied behavioral analysis, seven involved nutritional counseling exclusions, and six targeted applied behavioral analysis therapy exclusions.
One enforcement case involved a plan administrator that updated claim-processing systems for medical benefits but left mental health systems unchanged, creating a technical parity violation.
EBSA officials noted that many self-insured employers "were surprised to find that responsibility for MHPAEA compliance lies with the plan, not their service provider."
Carveout arrangements create blind spots for employers
The enforcement pattern reveals a structural problem: when employers hire separate vendors for mental health and medical benefits, the vendors don't communicate with each other about coverage standards. Plans with these arrangements "rarely obtained a complete comparative analysis from either service provider," EBSA found.
The timing complicates compliance strategy. Trump administration DOL officials have rescinded Biden-era parity regulations and are drafting replacements. Daniel Aronowitz, EBSA's administrator, has criticized the benefits comparison requirements as ineffective and wants to focus on patient access rather than coverage comparisons.
However, the report covers enforcement through mid-2025, suggesting current parity requirements remain active during the regulatory transition.
Document your carveout compliance now
Self-insured employers should audit their mental health carveout arrangements immediately. The compliance responsibility sits with the plan sponsor, not the third-party administrators, regardless of what vendors may claim.
Focus the audit on the areas where EBSA found the most violations: provider network access rules, therapy exclusions, and autism treatment limitations. Request detailed coverage comparisons from both your medical and behavioral health vendors, specifically asking how their processes and approval standards differ.
While regulatory changes may shift enforcement priorities, documenting current compliance protects against existing violation exposure and provides baseline data for whatever framework replaces current requirements.