The Patient Protection and Affordable Care Act included a mandate that skilled nursing facilities and nursing homes adopt and implement an effective compliance and ethics program as a condition of participation in the Medicare and Medicaid programs. The governing regulation was issued by the Centers for Medicare & Medicaid Services (CMS) on October 4, 2016 and gives facilities until November 28, 2019 to meet the compliance program requirements. At that time, state survey agencies will begin assessing facility compliance with implementation of an effective compliance and ethics program as a condition for nursing facility participation in the Medicare and Medicaid programs. They will follow the CMS State Operation Manual “Guidance to Surveyors for Long Term Care Facilities.” Survey protocols and guides for state survey agencies have also been posted by CMS and can be reviewed by nursing homes in preparation for the reviews.