MHPAEA 29 CFR 2590.712

Every parity analysis submitted to the Department of Labor has been insufficient.

Equipoise — a state of balance. The law calls it: no more restrictive than.

Not a single NQTL comparative analysis has been found sufficient on initial DOL review — across four consecutive Reports to Congress. Equipoise automates the NQTL comparative analysis that health plans are required to maintain. You bring your plan data. The tool runs the federal framework, identifies the gaps, and generates the documentation.

Start Your First Analysis → Why this exists ↓

MH / SUD

Mental health & substance use

Prior auth · denial rates · network

M / S

Medical & surgical

The benchmark, side by side

No more restrictive than — measured

Analyses sufficient on
first DOL review

Up to 54

Comparison points per plan
(9 NQTLs × 6 classifications)

$150–500K

Estimated cost per
consulting engagement

$100/day

Penalty per affected individual
(IRC §4980D)

Why This Exists

The compliance obligation every plan has.
The tool no one has built.

Federal law requires every health plan to prove that their mental health and addiction benefits are no more restrictive than their medical and surgical benefits. Not just on paper — in practice. How long does approval take? How often are claims denied? What clinical criteria are used? Who makes the decisions?

These comparisons must be documented across every non-quantitative treatment limitation, in every benefit classification. The DOL's illustrative list includes up to 21 NQTL categories. Equipoise currently analyzes the 9 most commonly enforced, with more in development — generating up to 54 comparison points per plan. Plans must maintain this documentation at all times and produce it on demand for regulators.

The problem is that nobody can do it correctly. The Department of Labor has reviewed these analyses for years. Every single one has been insufficient on first submission. Plans hire consulting firms at an estimated $150–500K per engagement to spend months producing binders that still fail review. There is no software that automates the analysis itself.

Equipoise does. Think of it like TurboTax for parity compliance. You bring your plan's data — your prior authorization rules, your denial rates, your network standards, your clinical criteria. Equipoise runs the federal comparison framework automatically, tells you where you're compliant and where you're not, cites the specific regulation, and tells you exactly how to fix the gaps.

TurboTax doesn't pull your W-2s from your employer's payroll system. You enter them. But the analysis, the cross-referencing, the identification of gaps, and the documentation — that's what the software does. That's what Equipoise does for the most consequential compliance obligation in healthcare.

Compliance is half of it. Private MHPAEA suits and DOL audits run on the statutory requirement that never paused. Class action settlements are running into eight figures. The question isn't whether your plan will be audited. It's whether your analysis will survive review when it is. Equipoise produces the documented, citation-backed analysis that holds up under scrutiny — from regulators, plaintiffs' counsel, or both.

The Enforcement Pause Is Not a Pardon

In May 2025, the tri-Departments announced they will no longer enforce or defend the 2024 Final Rule. Replacement regulations are targeted for late 2026. The underlying statutory obligations under MHPAEA and the 2013 rule remain fully in effect. Plans must still maintain and produce NQTL comparative analyses on demand. Private suits and DOL audits run on the statutory requirement that never paused. State enforcement is accelerating independently — Georgia alone imposed $25 million in fines in 2025. Equipoise resolves the confusion.

Recent Enforcement

Georgia: $25M+ in parity fines (2025)

Major national payer: $12.9M class action settlement

Delaware: $450K UnitedHealthcare fine

New York: $2.5M EmblemHealth settlement

The Problem

The analysis is required. The tools don't exist.

Four structural failures explain why every plan in America is exposed.

The compliance rate is nearly zero

Four consecutive Department of Labor Reports to Congress (2022–2025) confirm: not a single NQTL comparative analysis submitted was found sufficient on initial review. Over 199 request letters sent. Over 180 insufficiency letters issued. The manual approach does not work.

DOL EBSA Reports to Congress, 2022–2024

The analysis is massive

The DOL's illustrative list runs to 21 NQTL categories; Equipoise analyzes the 9 most commonly enforced across 6 benefit classifications. That's 54 comparison points, each requiring documentation of factors, evidentiary standards, and operational outcomes — for both MH/SUD and M/S.

MHPAEA 2013 Rule + CAA 2021 §203

Consulting doesn't scale

Plans hire Milliman, Mercer, or Manatt at an estimated $150–500K per engagement. The work takes months. The output is a binder that still fails review. And it needs to be repeated every time a benefit design changes.

No software alternative exists

Enforcement is real and growing

$100/day per affected individual under IRC §4980D. State attorneys general are filing independently — Georgia imposed $25 million in fines in 2025 alone. A major national payer settled a $12.9M class action for MH/SUD criteria more restrictive than M/S.

IRC §4980D; Georgia OCI; State AG enforcement actions

How It Works

You know your plan. Equipoise knows the regulation.

You bring the inputs — PA rules, denial rates, network standards. The tool runs the Department of Labor's six-element framework, identifies the gaps, cites the law, and generates the documentation.

Select & Configure

Choose the NQTL category and benefit classification. Enter your plan's MH/SUD criteria and M/S criteria for the same limitation. Each category has its own comparison factors — prior auth asks different questions than network composition.

Analyze & Compare

The engine runs the six-element comparative analysis server-side: identifies factors, evaluates stringency as written and in operation, and flags where MH/SUD is more restrictive. Every finding cites the specific regulatory provision.

Document & Remediate

Results appear with pass/fail/warning for each element, a gap narrative, the regulatory citation, and specific remediation recommendations. Export as a compliance-ready report formatted for DOL documentation standards.

See It In Action

Walk through a complete MHPAEA analysis.
No login required.

Five stages. From NQTL selection to fiduciary attestation. This is what the tool does.

Equipoise — New Analysis

Select Your NQTL

Choose the non-quantitative treatment limitation and benefit classification to analyze.

NQTL Category

Prior Authorization

▾

Benefit Classification

Inpatient Outpatient Emergency Rx

Plan Type

Commercial Medicaid MCO FEHB

Select Your NQTL

Choose from 9 NQTL categories and 6 benefit classifications. Each combination generates a category-specific analysis with tailored comparison factors. The tool knows that prior auth asks different questions than network composition.

Equipoise — Required Elements

DOL Required Elements

Prior Authorization · Inpatient · Commercial

NQTL & Plan Terms

The NQTL, the specific plan language defining it, and the benefits affected

Factors

Variables used to determine application of the NQTL

Evidentiary Standards & Sources

The evidence and sources supporting each factor

Comparative Analysis

MH/SUD vs. Med/Surg, as written and in operation

Findings & Conclusions

Whether the NQTL complies, with the reasoning

Remediation Plan

Corrective actions if the analysis finds non-compliance

The Six Required Elements

CAA 2021 requires every NQTL comparative analysis to contain six specific elements. Equipoise structures your inputs around this framework automatically, so nothing gets missed. Each element maps to a specific regulatory citation.

Equipoise — Comparative Analysis

Factor-by-Factor Comparison

Prior Authorization · Inpatient · 8 factors analyzed

Factor

MH/SUD

Med/Surg

Result

PA Required

Yes — all

Select only

FAIL

Turnaround Time

72 hrs

48 hrs

REVIEW

Clinical Criteria

MCG + internal

MCG

PASS

Denial Rate

18.2%

6.1%

FAIL

Peer-to-Peer

By request

Automatic

REVIEW

Reviewer Credentials

Board-cert

PASS

Appeal Process

2-level + ext

PASS

Scope of Services

All IP stays

High-cost only

FAIL

Factor-by-Factor Comparison

The engine compares MH/SUD and Med/Surg side by side across every relevant factor. Red means MH/SUD is more restrictive. Amber means it needs review. Every cell links to the specific data you entered and the regulation that governs it.

Equipoise — Findings

Findings

3 FAILURES

2 WARNINGS

PA scope more restrictive for MH/SUDFAIL

MH/SUD requires prior authorization for all inpatient stays. Med/Surg applies PA only to high-cost procedures. This constitutes a more restrictive application of the NQTL to MH/SUD benefits.

29 CFR 2590.712(c)(4)(iii)(A)

Denial rate disparity exceeds thresholdFAIL

MH/SUD denial rate (18.2%) is 2.98x the Med/Surg rate (6.1%). Outcome data suggests the NQTL is applied more stringently in operation.

CAA 2021 §203(a)(8)(B)

Turnaround time differentialREVIEW

MH/SUD turnaround (72 hrs) exceeds Med/Surg (48 hrs). While both meet regulatory minimums, the disparity may warrant corrective action.

29 CFR 2590.712(c)(4)(ii)

Corrective Action Plan

ActionOwnerDeadlineStatus

Reduce PA scope to match M/SVP UMQ3 2026Open

Audit denial rate criteriaCMOQ2 2026In Progress

Align turnaround SLAsOps DirQ2 2026Open

Findings & Corrective Action

Every finding includes the specific disparity, the regulatory citation, and a recommended corrective action. The tool generates a remediation plan with owners, deadlines, and status tracking. No ambiguity about what to fix or why.

Equipoise — Export Report

Export Compliance Report

Prior Authorization · Inpatient · 8 findings documented

NQTL Comparative Analysis Report

Prior Authorization · Inpatient In-Network · Commercial

Comparative Analysis Summary

Findings & Remediation

I attest that the data entered reflects current plan operations and that this analysis will be reviewed by qualified ERISA counsel before submission to regulators.

Generate Compliance Report →

Export & Attest

Generate a documentation-ready PDF formatted for DOL review standards. Includes the fiduciary attestation checkbox required for formal submissions. The output is what plans actually need to produce on demand.

Request Early Access →

What Equipoise Analyzes

9 NQTL categories. 6 benefit classifications.
Category-specific analysis for each.

Every NQTL has its own comparison factors. Prior authorization requires different inputs than network composition. Equipoise knows the difference.

Prior Authorization

Scope, turnaround, denial rates, criteria source, appeal process, peer-to-peer availability

Concurrent Review

Review frequency, reviewer qualifications, clinical criteria, continued stay standards

Step Therapy

Required steps, duration per step, exception process, advancement criteria

Medical Necessity

Criteria source, update frequency, level-of-care standards, peer review, reviewer credentials

Network Composition

Provider ratios, geographic access, reimbursement rates, credentialing, wait times, directory accuracy

Reimbursement Rates

Rate comparison vs. Medicare, methodology, OON payment standards, rate trends

Formulary Design

Tier placement, step therapy on Rx, quantity limits, refill PA, exception process, mail order access

Retrospective Review

Lookback period, turnaround, recoupment policies, criteria source, denial rates

Emergency Services

Screening criteria, prudent layperson standard, post-stabilization PA, OON coverage parity

The Landscape

What exists today. And what doesn't.

The market has consulting firms and document organizers. Nobody has built the analytical engine.

Approach	Time	Cost	Automated Analysis	Continuous	DOL-Aligned
Consulting (Milliman, Mercer, Manatt)	3–6 months	$150–500K	×	×	After iterations
URAC ParityManager	Ongoing	Undisclosed	× (workflow only)	✓	—
Internal spreadsheets	Months	Staff time	×	×	×
Equipoise	Minutes per NQTL	Fraction of consulting	✓	✓	Designed to

Equipoise automates the comparative analysis. It does not replace ERISA counsel review for binding compliance determinations.

Parity is one compliance surface. If your plan also needs structured governance for specialty pharmacy continuation, billing verification, or women's health, we build bundled packages. Ask about bundled governance →

Who It's For

Four roles. One compliance obligation.

Chief Compliance Officer

"I need to prove compliance across every NQTL. I can't produce the documentation."

VP Behavioral Health

"I know our MH/SUD criteria are different. I can't quantify where or how much."

General Counsel

"The DOL can request our analysis at any time. Plaintiffs' counsel already has. We don't have documentation that survives either."

Benefits Consultant

"My clients ask if they're parity-compliant. I have no tool to give them a real answer."

About

Built by someone who knows this world.

Joe Nalley built a 13-location integrated health system from the ground up — behavioral health, SUD/MAT, primary care, urgent care, lab, imaging, surgical center, and a community hospital — and ran it as CEO through acquisition. He founded and sold ClearBill, a billing-integrity platform that returned $9.2M to payers in its first six months of full deployment. Today he is Staff Vice President of Carelon Growth (Elevance Health's specialty health-services arm), where he owns six high-acuity clinical risk books — MSK, Oncology, CHF, Maternity, Autoimmune, and Dementia — across $50B+ in specialty medical spend. Across the lifetime of the companies he has led, more than 200,000 patients have been served.

The analytical engine implements the DOL's six-element comparative analysis framework as defined in 29 CFR 2590.712(c)(4). Every threshold, every citation, and every finding has been verified against the regulatory text, DOL enforcement actions, and the Reports to Congress.

For the full methodology, read the Equipoise white paper.

Questions? Get in touch or reach us at joe.nalley@showyourwork.health.

The Outcome

What month 12 looks like

Your ERISA counsel presents the completed NQTL comparative analysis to the DOL examiner. All 9 NQTL categories assessed. 6 benefit classifications compared. Every finding documented with the six-element framework the DOL actually requires. When the examiner asks for your analysis, you hand them a methodology that was built on the same framework they use to evaluate it. That is what Equipoise is designed to produce.

The analysis your plan is required to maintain.
Automated.

9 NQTL categories. 6 benefit classifications. Category-specific inputs. Regulatory citations. Remediation recommendations. Documentation-ready output.

Start Your First Analysis →

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