The document was released in December 2017 by the Centers for Medicare & Medicaid Services (CMS). It outlines CMS activities to identify health plan violations of the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) during fiscal years 2016 and 2017. CMS has primary enforcement authority with respect to MHPAEA when a state elects not to enforce—or fails to substantially enforce—MHPAEA in plans issued in the individual and fully-insured group markets. CMS is enforcing MHPAEA with respect to issuers in four states: Missouri, Oklahoma, Texas, and Wyoming. CMS also conducts market conduct examinations of issuers . . .