Where MHPAEA NQTL compliance breaks down

Yesterday I covered the federal MHPAEA NQTL enforcement footprint. Today, where it actually breaks down for plan sponsors.

The 2025 MHPAEA Report to Congress flagged two recurring failure modes among the plans that got cited. Both are the default posture of most plan sponsors.

The first is the assumption that the carrier or TPA has it covered.

EBSA noted that some plan sponsors still didn’t know responsibility for MHPAEA compliance lies with the plan, not the service provider. Some service providers refused to produce a comparative analysis when asked. Others couldn’t, because they had never built one.

The second is more uncomfortable. Hiring a third party doesn’t save you if the third party doesn’t know your plan.

EBSA noted that named factors in comparative analyses often changed once investigators started asking questions, frequently because the consultant who drafted the document didn’t actually understand plan operations.

How does that happen? It happens when a templated analysis gets produced across hundreds of clients without being tied to any one plan’s actual operations. It happens when a carrier hands the employer a specimen template “compliance kit” that was never tied to that specific plan’s NQTLs. It happens when the document gets drafted without the operational detail from the TPA or PBM.

A signed report from a vendor is a great start, not a defense. The plan still has to know what’s in it to be able to stand behind it.

Open your comparative analysis. Find the section where the factors are named. Can you explain in your own words how each factor applies to a specific NQTL on your plan? If you can’t, you have the same gap that got those plans cited.

Compliance with MHPAEA isn’t accidental. It never has been.