CARF vs. Joint Commission (JCAHO): Which Accreditation to Pursue?

Why Accreditation Matters in 2025
CARF Accreditation: A Closer Look
Joint Commission Accreditation: A Closer Look
CARF vs. Joint Commission Accreditation: Head-to-Head Comparison
What to Consider When Making the Final Decision
Is It Worth Pursuing Double Accreditation?
References & Sources

In 2025, accreditation is a lever for survival, growth, and long-term viability. But with two dominant accrediting bodies in behavioral healthcare—CARF vs. The Joint Commission (JCAHO)—choosing the right path isn’t always straightforward. This guide breaks down what you actually need to know: costs, prep timelines, documentation requirements, differences in philosophy, and what it all means for your specific type of program. Whether you’re running an outpatient clinic, a residential treatment center, or something in between, this comparison will help you move forward with clarity and confidence.

Why Accreditation Matters in 2025

For behavioral health providers, accreditation is more than an endorsement. It’s often a prerequisite for payer contracts, regulatory compliance, and operational performance.

1. Quality of Care and Patient Safety

A 2025 meta-analysis found that accredited facilities see 20% lower mortality and 15% fewer 30-day readmissions in chronic care population. (1)
CARF-accredited organizations report a 26% increase in service volume and a 37% rise in quality conformance within the first 12–18 months. (2)
Both CARF and Joint Commission now require use of Measurement-Informed Care (MIC)—real-time patient outcome tracking—to maintain accreditation status in 2025. (3)

2. Competitive Advantage and Market Credibility

Many big-name insurers, and even some state Medicaid programs—won’t put you in their network unless you’re accredited by groups like CARF or The Joint Commission. That stamp of approval can also boost how patients and referral partners see you, helping build a stronger reputation and trust.

3. Regulatory Compliance and Legal Protection

For many behavioral health providers, accreditation is a gatekeeper for reimbursement. Most state Medicaid programs and commercial insurers require either CARF or Joint Commission accreditation for network participation. Beyond access to funding, accreditation also supports compliance with evolving national safety standards. In 2025, The Joint Commission updated its National Patient Safety Goals to include stricter expectations around infection control and medication management (4). In the event of audits or legal scrutiny, the structured documentation and quality assurance protocols mandated by accreditation can offer crucial protection.

CARF Accreditation: A Closer Look

CARF (Commission on Accreditation of Rehabilitation Facilities) is an independent, nonprofit accreditor specializing in health and human services, including behavioral health, addiction treatment, residential care, and community-based programs.

The accreditation is modular and depth-driven—ideal if you want a focused approach on select services while embedding a rigorous clinical, quality, and outcome-based framework. The structured process encourages both intellectual and operational dedication, backed by a transparent timeline and peer-based support every step of the way.

CARF Standards: Core vs. Specific Program Requirements

CARF standards are organized around two layers:

Core (Section One “Aspire to Excellence”): Broad requirements on leadership, organizational management, human resources, financial practices, health/safety, and rights of persons served.
Program-specific standards: Tailored criteria depending on service type—e.g., outpatient treatment, inpatient, residential, CCBHCs, integrated primary care, crisis services, and others, as detailed in CARF’s 2025 Behavioral Health Standards Manual.

Organizations can seek accreditation for specific programs without accrediting the entire agency—an advantage over more all-encompassing accreditors.

Outcome Measurement & Performance Improvement

CARF’s 2025 standards require comprehensive MIC protocols, including:

Standardized tools selection (PHQ‑9, GAD‑7, DAST‑10, etc.)
Defined frequency and procedures for collecting data
Regular analysis and use of outcome data to adjust care, support clinical oversight, meet value-based care needs, and satisfy funder reporting.

Documentation & Policy Requirements

Manuals and written policies for every standard area
Sample organizational charts, code-of-conduct, risk management, emergency preparedness, privacy, and finance controls.
Competency-based staff training, e.g., trauma-informed care, crisis intervention, medication safety.
Ongoing self-audits and submission of annual conformance reports, ensuring continuous alignment with standards.

CARF Accreditation Process & Timeline

The CARF accreditation cycle includes (5):

Initial Preparation (12–15 months): Gap analysis, Self-study, Document and policy alignment.
Application & Survey Scheduling. Online submission via CARF Portal, Invoice (Including an application fee (~US$995) and survey fee (based on size)—followed by survey scheduling within six months.
On-site Survey. Conducted by a customized team of peer surveyors over 1–3 days. Includes interviews, observations, file reviews, and recommendations.
Credentialing Decision & Quality Improvement Plan (QIP). Cycle commitment results in three-year accreditation (optimal), with alternatives including one-year, provisional, preliminary, or non-accreditation statuses. Within 90 days, organizations must submit a QIP addressing any areas requiring corrective actions.
Ongoing Compliance. Annual Conformance to Quality Reports (ACQR) required at year 1 and 2. Continuous quality improvement essential for maintaining accredited status.

Joint Commission Accreditation: A Closer Look

The Joint Commission (TJC), formerly known as JCAHO, is the longstanding accreditor for U.S. healthcare facilities. As of June 2025, TJC has begun rolling out “Accreditation 360,” a modernized accreditation model simplifying requirements—reducing standards by over 700 to better align with CMS Conditions of Participation and support continuous performance improvement (6).

What TJC Evaluates: Four Critical Areas for Behavioral Health Accreditation

TJC accreditation focuses on core domains essential for safe, effective care:

1. Performance Improvement & Patient Safety

In 2025, TJC tightened its National Patient Safety Goals (NPSGs) for behavioral health. Facilities must ensure accurate patient identification (using two identifiers), safe medication practices, infection prevention, suicide risk assessment, and equity.

2. Environment of Care & Life Safety

The 2025 updates include a full overhaul of emergency management standards for behavioral health facilities—requiring better hazard assessments, response protocols, and continuity planning. These changes reflect lessons from the COVID‑19 era and evolving environmental risks.

3. HR & Competency

Staff must demonstrate role-based competencies, from suicide risk screening to opioid treatment protocols—driven by both TJC standards and SAMHSA/CMS crosswalks implemented in July 2025.

4. Information Management & Technology

TJC assesses data integrity and privacy systems, including electronic health records, medication reconciliation processes, and timely communications—especially during transitions of care and treatment planning.

Accreditation Process & Timeline

Preparation & Readiness Assessment (6–12 months). Conduct a gap analysis aligned with TJC standards. Form implementation teams, update policies, and run mock tracers to embed readiness practices.
Application & Deposit. Apply via TJC’s extranet and submit a non-refundable deposit (typically ~$1,700), which counts toward total accreditation fees.
On-site Survey & Evaluation. Triennial formal surveys, which are unannounced or “predictable unannounced.” Each survey includes tracer activities, interviews, file reviews, and a final debrief of findings.
Continuous Compliance & Updates.
- With Accreditation 360, TJC moves to ongoing engagement and continuous readiness models rather than episodic preps.
- Major standards updates—like the NPSG and emergency management revisions—become effective in July 2025 and January 2026, with ramp-up periods encouraged.

CARF vs. Joint Commission Accreditation: Head-to-Head Comparison

	CARF	Joint Commission (TJC)
Cost	~US $995 application fee + US $3,000–5,000 survey fee	~US $1,990 annual subscription + US $5,000–10,000 per triennial survey
Prep Timeline	12–18 months for full prep	6–12 months typical prep
Survey Cycle	Scheduled every 3 years; annual conformance reports	Unannounced triennial surveys; continuous readiness required
Standards Focus	Program-specific; emphasizes Measurement-Informed Care	Broad organizational systems (NPSGs, safety, equity, HR, EHRs)
Accreditation Scope	Modular (you can accredit specific programs only)	Organization-wide across all services
Outcome Data Requirements	Required MIC protocols with PHQ-9, GAD-7, DAST-10	Increasing emphasis on patient safety and equity tracking
Best For	Small to midsize providers; targeted programs (e.g., IOP, SUD)	Larger, integrated systems; hospitals; Medicaid/MCO-focused programs
Reimbursement Compatibility	Recognized by many state agencies; good for value-based contracts	Often required for Medicaid and some national payers
Regulatory Positioning	Strong documentation; peer-reviewed process	Aligns closely with CMS; emphasizes legal defensibility
Survey Experience	Peer surveyors; scheduled in advance	Clinical experts; unannounced surveys with tracer methodology

What to Consider When Making the Final Decision

Facility Size and Resource Availability

Smaller facilities with limited administrative capacity may benefit from CARF’s modular approach, which allows for accrediting individual programs without requiring organization-wide compliance. The peer-review model also tends to be more consultative.

On the other hand, larger organizations with multiple levels of care often find Joint Commission’s comprehensive structure more appropriate, particularly if they’re already subject to CMS regulations or operate in a hospital-aligned system.

Target Population and Service Mix

CARF tends to be well-suited for organizations focused on behavioral health, substance use treatment, and specialized services such as crisis stabilization or supported housing. If you operate a program serving a narrowly defined population (e.g., outpatient SUD), CARF’s tailored program standards may offer better alignment.

Joint Commission is broader in scope and better suited for facilities providing integrated care — for example, those combining behavioral, medical, and pharmacy services. Its emphasis on equity, safety, and organizational governance aligns well with facilities serving complex or high-acuity populations.

Reimbursement Requirements

Medicaid programs in several states, as well as some national payers, either require or prefer Joint Commission accreditation — particularly for higher reimbursement tiers or participation in managed care networks. CARF is widely recognized in behavioral health and has strong value-based care alignment, especially with its emphasis on Measurement-Informed Care.

Before deciding, confirm whether your primary payers (including MCOs and state contracts) have a stated accreditation preference. This can directly affect both your billing eligibility and your competitiveness for government-funded programs.

Geographic Location and Market Expectations

Local context matters. In some states or regions, one accreditation may dominate. If competitors in your area are all Joint Commission-accredited, following suit could protect your market positioning. Conversely, in areas where CARF has strong visibility, its program-level flexibility could give you an edge — especially when marketing outcomes or negotiating payer contracts.

Is It Worth Pursuing Double Accreditation?

For most behavioral health providers, choosing between CARF and the Joint Commission is a matter of fit. Matching your organization’s structure, services, and goals to the accreditor best positioned to support them. But what about pursuing both?

Dual Accreditation: Strategic, but Rare

Holding both CARF and Joint Commission accreditation is uncommon, but not unheard of. Larger health systems or multi-state organizations sometimes pursue dual accreditation to satisfy varied payer requirements, serve different populations across service lines, or build broader institutional credibility. For example, a hospital system might be Joint Commission-accredited at the organizational level, while its standalone outpatient SUD programs hold CARF accreditation to meet state contract mandates.

However, dual accreditation can be resource-intensive—requiring parallel compliance efforts, dual surveys, and separate quality assurance cycles. Unless there’s a clear strategic or financial incentive, most providers benefit more from doing one accreditation well than splitting focus.

Whether you’re leaning toward CARF, Joint Commission, or still weighing the pros and cons — Simplifyance provides hands-on support for behavioral health providers navigating every phase of the accreditation process. Whether you want to automate compliance task management with our platform or partner with our expert consultants for full-service accreditation and licensing support, we’ve got you covered.

References & Sources

1. Krumholz HM, Lin Z, Keenan PS, et al. Relationship Between Hospital Readmission and Mortality Rates for Patients Hospitalized With Acute Myocardial Infarction, Heart Failure, or Pneumonia. JAMA. (Published on February 13th, 2013.) <https://jamanetwork.com/journals/jama/fullarticle/1570282>

2. CARF International. For Providers. (n.d.) <https://carf.org/accreditation/providers/>

3. Greenspace. New Standards for CARF Accreditation: The Impact of Measurement-Based Care. (Published on April 15th, 2025.) <https://greenspacehealth.com/en-us/new-standards-for-carf-accreditation-the-impact-of-measurement-based-care>

4. Joint Commission International. International Patient Safety Goals. (n.d.) <https://www.jointcommission.org/standards/national-patient-safety-goals/hospital-national-patient-safety-goals>

5. CARF International. Steps to accreditation. (n.d.) <https://carf.org/accreditation/steps-accreditation/>

6. Joint Commission International. Joint Commission Launches a Transformative Approach to Healthcare Accreditation. (Published on June 30th, 2025.) <https://www.jointcommission.org/en-us/knowledge-library/news/2025-06-joint-commission-launches-a-transformative-approach-to-healthcare-accreditation>

CARF vs. Joint Commission: Which Accreditation Will Best Serve Your Facility in 2025?

Table of Contents