CARF accreditation: the process, the requirements, and how to verify a program

At a glance

Question	Answer
What CARF stands for	Commission on Accreditation of Rehabilitation Facilities, the name it was founded under in 1966. It now goes by CARF International.
Who it accredits	Health and human services programs, including behavioral health programs such as outpatient, intensive outpatient and partial hospitalization.
The standards	A manual you buy from CARF: Section 1 (ASPIRE to Excellence) and Section 2 (general program standards) for every program, then the core program standards for what you offer.
Before the survey	At least six months of services delivered under CARF's standards, and every CARF accreditation condition met.
The application	A survey application in CARF's Customer Connect portal, at least three months before your preferred two-month survey window.
The fee	A survey fee based on the number of surveyors and days; CARF gives an estimate on request.
The survey	Peer surveyors observe, review documents, and interview staff and consenting persons served.
After	A Quality Improvement Plan within 90 days of the decision, then an Annual Conformance to Quality Report each year.
Lookup	CARF's online provider search, linked from carf.org as "Find a provider."

What CARF stands for and what it accredits

CARF was founded in 1966 as the Commission on Accreditation of Rehabilitation Facilities (CARF, About). The name reflects where it started, but the work is much broader: it is one of the two accreditors most behavioral health programs choose, alongside the Joint Commission. CARF's behavioral health standards start with ASPIRE to Excellence (how the organization plans, listens to the people it serves, manages money and risk, keeps people safe, supports staff and measures performance), then the general program standards, then a section for each core program, such as outpatient treatment, intensive outpatient treatment and partial hospitalization (CARF, Our standards).

Accreditation is for programs, not people. CARF accredits the programs and locations you list in the application, so a program that adds a level of care later adds it to its accreditation too.

The requirements before a survey

CARF's requirements are the standards in the manual for your programs. A few things have to be true before a survey makes sense:

• The right standards. Every program follows Sections 1 and 2; then add the core program standards for each level of care you want accredited, and any population standards that fit (for example, children and adolescents). Maryland's behavioral health administration publishes a CARF reference grid that shows how the sections fit together. Buy the current year's manual; section numbers move between editions.
• Six months of services. Before the site survey, each program must have applied CARF's standards and delivered services to persons served for at least six months, as CARF explained in a 2024 presentation to North Dakota providers. The same presentation says an organization must satisfy every CARF accreditation condition to be accredited.
• Your state license. Accreditation doesn't replace it. In Texas, a substance use program needs its HHSC chemical dependency treatment facility license first; see how to get a Texas CDTF license.
• Records that prove the habits. Surveyors look for months of recurring work, not a binder written the week before: safety checks, unannounced tests of emergency procedures with a written analysis, record reviews, training, grievances, outcomes and leadership's review of them. Ohio's behavioral health department, summarizing CARF's standards, describes the emergency-procedure tests (1.H.7) and a quarterly review of current and closed records (2.H) (Ohio MHAS).

The accreditation process, step by step

CARF's own pages describe the process as a year or more of preparation, a survey, and ongoing improvement afterward (CARF, Steps to accreditation). In order:

1. Choose the programs and buy the manual. Decide which levels of care and locations you'll put forward, and buy the standards manual for that year from CARF's bookstore.
2. Self-evaluate. CARF recommends a self-study of your conformance to the standards to decide whether you're ready. Name one person to coordinate it and a small committee to do it. Our accreditation gap assessment guide shows how to rate each standard and turn the gaps into a work plan.
3. Prepare on CARF's calendar. CARF's survey preparation guidance starts 12 months out, does a presurvey self-assessment at about 9 months, and sends the application at least 3 months before the survey window.
4. Submit the survey application. In Customer Connect, CARF's password-protected portal, give the two-month timeframe you'd like for the survey, your leadership, the programs and services you want accredited, and the locations where you provide them.
5. Pay the survey fee. CARF sets the fee by the number of surveyors and days the survey needs and invoices it; scheduling starts from the invoice.
6. Host the survey. Peer surveyors from the field determine conformance from what they observe, the documents they review, and interviews with staff and with consenting current and former persons served, and their families where it applies. Tell staff and clients in advance.
7. Read the report and the decision. The report lists strengths and recommendations, and the decision is one of the outcomes below.
8. Send the Quality Improvement Plan within 90 days of the decision, saying what you've done or will do about each recommendation.
9. Keep it. Submit the Annual Conformance to Quality Report each year, keep the recurring work going, and apply for the next survey before the accreditation runs out.

The month-by-month version, with what to do at each mark, is in Comply's CARF survey preparation guide, and a full rehearsal is in how to run a mock accreditation survey.

A readiness checklist

CARF's checklist is its manual: every standard that applies to you. Before you send the application, these should all be true:

Item	Ready when
Manual	This year's manual bought, and the sections for your programs marked
Coordinator	One person owns the process and is CARF's contact
Self-evaluation	Every applicable standard rated, and every gap has an owner and a date
Six months	Each program has delivered services under the standards for at least six months by the survey window
Policies	They describe what staff actually do, and staff can explain them (see writing the policy and procedure manual)
Recurring records	Safety checks, emergency-procedure tests with written analyses, record reviews and training are on file, on time, for months
Quality data	Outcome and satisfaction measures collected, reviewed by leadership, and acted on
Persons served	Rights and grievance process in place; clients know surveyors may ask to talk with them
Application	Customer Connect account set up; programs, locations and your preferred window decided at least 3 months out

Comply runs the recurring part (drills, safety checks, chart reviews, training) on a schedule and keeps the proof in one binder; see Comply.

What it costs

CARF bills a survey fee based on how many surveyors and days your survey needs, and asks you to contact it for an estimate; it doesn't publish a price list (CARF, Steps to accreditation). Add the manual, staff time and policy work. Our guide to what accreditation costs and how long it takes lays out the full budget.

The outcomes

Outcome	What it means
Three-Year Accreditation	The organization satisfies each CARF accreditation condition, substantially conforms to the standards, and is designed and run to benefit the persons served.
One-Year Accreditation	Conformance to many standards, with significant deficiencies the organization has shown it can and will correct.
Provisional Accreditation	Given after a One-Year Accreditation expires to an organization still at that level, for one year; it must be at the Three-Year level at the next survey or receive Nonaccreditation.
Nonaccreditation	The organization hasn't come into substantial conformance over time, or hasn't satisfied one or more accreditation conditions.

Definitions from CARF, Accreditation decisions. "CARF accreditation types" usually means these outcomes; the program areas you're accredited for (outpatient, IOP, PHP and so on) are listed on the decision.

How to look up or verify CARF accreditation

• CARF's provider search. CARF's consumer guide sends people to its online provider search at carf.org/providersearch (CARF, Choosing services). Search by the organization's name or location and check that the specific program and address you care about are listed, not just the organization.
• Ask for the decision letter or report. An accredited program can show the letter, with the programs, locations and expiration date. Many publish their reports.
• Check the date. Accreditation runs out. A program in its second or third year should also be filing its Annual Conformance to Quality Report.

Payers and referral partners do this check during credentialing, so keep the letter in your credentialing documents and update every plan when a new decision arrives.

What accreditation gets a program

• Payer contracts. TRICARE requires IOPs to be accredited, and names the Joint Commission, CARF and COA (TRICARE Policy Manual, chapter 11). Many commercial plans contract with an IOP or PHP only once it's accredited; see IOP credentialing in Texas.
• A working quality system. CARF's ASPIRE standards push business planning, outcomes and input from persons served, which many programs keep using long after the survey.
• Referral trust. Families, courts and other providers can check the status themselves in CARF's search.

Choosing between the two accreditors? Joint Commission vs. CARF compares payer acceptance, survey style, fees and timing.

Opening a new program? Accreditation for a new program covers the first six months. Or book a free 30-minute call.

Questions

What does CARF stand for?

The Commission on Accreditation of Rehabilitation Facilities, the name CARF was founded under in 1966. It now calls itself CARF International and accredits behavioral health programs, including outpatient, IOP and PHP, as well as other health and human services.

What is the CARF accreditation process?

Buy the standards manual for your programs, self-evaluate, deliver services under the standards for at least six months, submit the survey application in Customer Connect at least three months before your preferred window, pay the survey fee, host the peer surveyors, then send a Quality Improvement Plan within 90 days of the decision and an Annual Conformance to Quality Report each year.

What are the requirements for CARF accreditation?

Conformance to the standards in the manual that apply to your programs (Sections 1 and 2 plus the core program standards), every CARF accreditation condition met, and at least six months of services under the standards before the survey. Your state license comes first; CARF doesn't replace it.

How do I apply for CARF accreditation?

Through Customer Connect, CARF's online portal. The survey application asks for your preferred two-month survey timeframe, your leadership, the programs and services you want accredited and their locations. CARF suggests sending it at least three months before that timeframe.

How long does CARF accreditation take?

CARF's own guidance starts preparing 12 months before the survey. A new program also needs six months of services under the standards first, so a first CARF survey usually lands six months or more after opening.

How do I verify that a program is CARF accredited?

Use CARF's online provider search (carf.org/providersearch), and check that the specific program and location are listed. You can also ask the program for its decision letter, which lists what's accredited and when it expires.

How much does CARF accreditation cost?

CARF bills a survey fee based on the number of surveyors and days and gives an estimate on request; it doesn't publish a price list. See accreditation cost and timeline for the rest of the budget.

Is CARF accreditation required in Texas?

Not for the HHSC license. It's the payers that ask: TRICARE requires accreditation for IOPs and PHPs, and many commercial plans contract with programs only once they're accredited by CARF or the Joint Commission.

Cima Consulting isn't affiliated with or endorsed by CARF. CARF decides every accreditation; we don't guarantee an outcome.

Sources

• CARF, About (founded 1966 as the Commission on Accreditation of Rehabilitation Facilities) and Our standards (ASPIRE to Excellence; program standards)
• CARF, Steps to accreditation (self-study; Customer Connect; survey fee by surveyors and days; Quality Improvement Plan; Annual Conformance to Quality Report) and Preparing for an accreditation survey (12-, 9- and 3-month steps)
• CARF, Accreditation decisions
• CARF, Choosing services (the online provider search)
• CARF presentation to North Dakota providers, November 2024 (six months of services; every accreditation condition)
• Maryland Behavioral Health Administration, CARF reference grid; Ohio Department of Mental Health and Addiction Services, CARF behavioral health standards update
• TRICARE Policy Manual, chapter 11, intensive outpatient programs