Few employers that hire separate companies to administer mental health benefits and medical benefits check whether the mental health benefits are really comparable to the medical benefits, according to officials at the federal Employee Benefits Security Administration.
“Plans with these carveout arrangements rarely obtained a complete comparative analysis from either service provider, especially where the service providers were not communicating with each other or aware of the processes, strategies, evidentiary standards or other factors used by the other,” EBSA officials say in a new report to Congress on Mental Health Parity and Addiction Equity Act enforcement efforts.
“Plans with carveout arrangements should closely review the information provided by their service providers to ensure there is a meaningful comparison of information provided by each service provider,” officials say.
See also: EBSA enforcement efforts yield $1.4 billion in recoveries
EBSA officials say they also see a need for more employer education about how the parity requirements work.
Some employers with self-insured health plans “were surprised to find that responsibility for MHPAEA compliance lies with the plan, not their service provider,” officials say.
EBSA is the U.S. Department of Labor agency that oversees benefit plans.
Federal law requires EBSA and the Centers for Medicare and Medicaid Services, the U.S. Department of Health and Human Services agency that enforces federal requirements for health insurance companies, to send Congress an MHPAEA enforcement report every year.
EBSA noted in the report that it issued 42 letters asking plans for “comparative analyses” of behavioral health benefits and medical benefits from Aug. 1, 2023, through July 31, 2025.
Fourteen related to the rules governing what kinds of providers can participate in a plan’s network, eight related to exclusions for speech or occupational therapy and eight related to limitations on therapy for people with autism other than exclusions for applied behavioral analysis.
Seven related to exclusions for nutritional counseling, and six related to exclusions for applied behavioral analysis therapy.
When EBSA asked plans and plan administrators for analyses comparing the behavioral health and medical benefits, many were weak, officials said.
One of the enforcement cases involved a plan administrator that had parity problems because it updated the claim-processing systems for self-insured employer plans’ medical benefits but not for the employer plans’ mental health benefits.
Labor officials have promised to focus on compliance education
DOL officials in the administration of President Donald Trump have promised to focus more on educating employers about benefits law compliance and less on suing and prosecuting employers.
The new approach to compliance does not mean the DOL is happy with employers’ mental health benefits parity compliance.
The backdrop: Trump administration DOL officials have rescinded parity regulations approved while President Joe Biden was in office and are now drafting replacement regulations.
Daniel Aronowitz, the assistant Labor secretary who serves as administrator of EBSA, has said the benefits comparison requirements have worked poorly and that he would rather focus more on patients’ ability to get care and less on benefits comparisons.
But the review period for the new report ended in mid-2025, while Trump had been in office for six months.
The report suggests that, for now, at least, EBSA may still want to see employers and their plan administrators making an effort to check whether the behavioral health benefits they offer are comparable to the medical benefits.
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