The market for nursing home care and other long-term care services is one of the most heavily regulated sectors in the United States economy. The present quality assurance system boasts an extensive regulatory scheme, with a complex interplay of federal, state, and voluntary rules controlling and monitoring the quality of nursing homes and, to a lesser extent, other home and community-based service providers. This chapter describes the current approach to long-term care regulation in the United States focusing on three key areas: 1) the standards for provider participation; 2) the monitoring and enforcement of compliance; and 3) public reporting and other market-based approaches to improving quality. It focuses primarily on nursing home care, given the predominant focus of regulation and the surrounding literature on this sector. It concludes with a brief discussion of the current state and future of long-term care regulation as well as lessons based on the US experience.