CMS found zero sufficient MHPAEA comparative analyses on first submission

CMS reviewed every comparative analysis a plan or carrier handed them over the last two years. Zero were sufficient on first submission.

That’s not sensational editorializing. That’s the agency, in writing, in the 2025 MHPAEA Report to Congress.

Enforcement is rare and selective. Over two years, EBSA sent 42 initial letters, CMS sent 43. That’s the entire federal footprint on a law that applies to nearly every group health plan in the country. The odds of any single plan being asked are low.

But selective doesn’t mean small. EBSA targeted national service providers, and the corrections rippled across their entire books of business. One ABA exclusion removed from a single carrier’s template affected 97 plans and over 319,000 participants. A nutritional counseling exclusion removed from another carrier’s templates affected 521 plans and over 289,000 participants. EBSA’s two-year enforcement work resulted in corrections affecting more than 18 million participants across more than 39,000 group health plans.

That’s the leverage point. The federal government doesn’t have to audit your plan to fix your plan. They audit the carrier or TPA that wrote your template, and you inherit the change whether you knew it was coming or not.

The named players in the final determinations include Aetna, Cigna, Medica, and Priority Health. These aren’t fly-by-night operations. They are carriers and administrators thousands of plans rely on to be compliant by default.

So here’s the point. If your plan to comply with MHPAEA is “the carrier takes care of it,” then your compliance is only as good as theirs. And on first submission, none of them passed.

Tomorrow I’ll get into what the report says about plan sponsors who assumed their carrier had this handled, and the ones who hired a consultant to write the analysis and still got cited.

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