Mental health benefits aren’t just expected, they’re essential. And as the need grows, so does the focus on Mental Health Parity and Addiction Equity Act (MHPAEA) compliance. The Department of Labor (DOL) has made clear that mental health parity enforcement is a top priority, and big changes are arriving for the 2025 plan year.
At Paragon Partners, we’re here to help brokers and employer clients navigate these shifting requirements with clarity, confidence, and compliance. Here’s what you need to know about the latest MHPAEA updates and how to help your clients stay ahead.
DOL Enforcement Is Ramping Up
The DOL isn’t just watching, it’s taking action. Employers and health plans have been receiving insufficiency letters after failing to provide adequate documentation for mental health parity compliance. These letters are more than just a warning; they can trigger follow-up investigations, required corrective action, and even public disclosure.
Key takeaway: Mental health parity enforcement is no longer theoretical. It’s here, and it’s real.
Comparative Analyses: No Longer Optional
Under the Consolidated Appropriations Act (CAA) of 2021, group health plans must be able to provide comparative analyses of non-quantitative treatment limitations (NQTLs), things like prior authorization, step therapy, provider reimbursement, or medical necessity criteria.
These analyses are used to determine whether mental health and substance use disorder (MH/SUD) benefits are being managed in parity with medical/surgical benefits.
For brokers: Help your clients understand that this is a documentation issue, not just a plan design issue. Even if the benefits look good on paper, if the processes behind them aren’t documented and justified, it could still mean noncompliance.
What’s New for 2025: The Final Rule
Starting with plan years beginning on or after January 1, 2025, a new Final Rule brings even more accountability:
- Fiduciary certification will now be required, confirming that a prudent process was used to select qualified service providers who performed and documented the NQTL comparative analyses.
- Employers must be prepared to demonstrate active oversight—not just outsource responsibility to a carrier or vendor.
- Regulators expect ongoing review and updates to ensure continued parity.
Best Practices for Brokers and Employers
This isn’t just a compliance box to check once, it’s a living process. Here’s how brokers can support their clients now:
- Request comparative analyses from carriers and TPAs early in the plan year.
- Review plan documents and summary plan descriptions (SPDs) for any red flags in how mental health benefits are administered.
- Encourage ongoing audits and updates to ensure continued compliance—especially if any plan changes occur.
- Ask carriers and vendors about their NQTL methodology and documentation processes.
- Ensure fiduciary roles are clearly defined, especially in self-funded arrangements.
How Paragon Partners Supports You
Mental health parity compliance is a moving target, but you don’t have to go it alone. At Paragon, we equip our broker partners with the insights and tools they need to guide clients confidently, including:
- Carrier vetting to ensure they meet current and upcoming MHPAEA standards.
- Support for plan design review during quoting and renewals.
- Guidance on documentation needs and fiduciary responsibilities.
- Education on trends in mental health and employee expectations.
We’re your behind-the-scenes partner—staying ahead of regulation so you can stay focused on client service and growth.
Compliance with MHPAEA
As mental health becomes an essential part of every benefits conversation, compliance with MHPAEA must follow suit. The 2025 Final Rule raises the bar, but it also opens the door to better, more thoughtful benefits.
Let’s help your clients meet that bar—and build stronger plans in the process.
