By Tom Sefcik
TL;DR: CARF accreditation is certainly worth the effort and expenditure for a health and human services organization regarding financials, quality of care, and standing in its community, and preparation is imperative to success. When your facility relies on commercial insurance payers, state contracts, or grant funding to mandate or heavily favor formal accreditation, groundwork is required for a positive survey by CARF.
The investigative questions of Who, What, When, Where and Why are answered here to assure and guide you in the accreditation preparation process.
Who is on your CARF Preparation Team?
Preparing for CARF accreditation is not a one-person job. To achieve the goal of as few recommendations of change as possible, a well-rounded team must be in place. Organization is imperative, and appointing a designated CARF facilitator will provide a “go-to” person that can set the strategic plan, and manage the paperwork, assessments, timing, implementation and review.
The team will also include executive leadership, who will establish internal accreditation ownership, financial planning, and governance compliance. Program and clinical managers are the day-to-day contributors of the team. This staff understands person-centered practices, treatment plans, and continuous reviews.
Administrative and quality assurance personnel come in to play to manage documentation, human resources, risk management, financial planning, and health and safety manuals. Finally, an external CARF consultant can be a critical part of the team with experience in compliance, who can also assist with gap analyses, policy writing and mock surveys.
What Does CARF Commitment Entail?
Section 1 of the CARF Standards Manual introduces its ASPIRE to Excellence® as the framework for becoming CARF accredited. As you will see below, ASPIRE is an acronym incorporating the steps and reasons for CARF accreditation. These standards are simple, and they specifically address business practices and quality improvement. Knowing the CARF commitment in your preparation process will be valuable in managing the steps your team must undergo.
From the CARF website regarding ASPIRE:
This quality framework focuses on integrating all organizational functions while effectively engaging input from all stakeholders, including persons served. It provides a logical, action-oriented approach to ensure that organizational purpose, planning, and activity result in the desired outcomes. Using these standards will help your organization identify and implement change and to maintain sustainability.
When an organization applies for CARF accreditation, it must adhere to the ASPIRE to Excellence framework, below.
A Assess the environment – analyze risk, financial health, and legal compliance
S Set strategy – implement a functional strategic plan, avoiding rigid or stagnant policies
P Persons served and other stakeholders – maintain active input for all audiences
I Implement the plan – standardize operational frameworks to reduce mistakes
R Review results – measure, analyze, and document clinical service outcomes
E Effect change – submit mandatory Quality Improvement Plans (QIP) to maintain standing
A commitment to CARF accreditation also entails a financial investment in obtaining approval through an application fee plus surveyor daily rates. You will also encounter the hidden costs of internal labor—the CARF accreditation application itself is 38 pages!
Setting up the systems to track measurable client outcomes, manage policy updates, conduct gap analysis, conduct chart audits and clean up personnel files, plus a potential mock survey takes valuable staff time, especially if you have a small team. The workload can overwhelm a provider if there is little advance preparation or organization.
When can you expect to receive CARF accreditation?
The entire CARF accreditation process can take 12 to 18 months from when you decide to become CARF accredited and decide to collect data to the final accreditation decision. The preparation phase is the first and longest stage, for while in operation and serving clients, you must collect data for at least six months. When you include the time to review the standards for expectations, establish templates, and create the process for collecting data, this stage can often take up to a year.
Three months before the survey, organizations must submit an official survey application. This time can overlap the 6-12 months, but the facility must prepare the facility or agency and be ready once the date for the survey is set. The CARF survey itself takes two to three days, depending on the size of the organization and what areas are to be surveyed. Then, the waiting period begins. CARF surveyors have six to eight weeks to turn in their report and provide an official decision and written report from CARF. Within 60 days, your official CARF certificate will arrive, to hang on your administrator’s wall.
The process isn’t over once you receive your decision, however. A facility has 90 days after receiving notification of accreditation to submit a plan addressing any areas needing improvement that were noted in the recommendations. To sum it up, it typically takes six to 12 months of dedicated internal work to receive CARF accreditation.
Where do I find details about the CARF accreditation process?
The CARF manual is almost 450 pages long. It covers everything from accreditation policies and procedures to detailed standards that organizations must meet, requirements for documentation, and more. Think of it as your CARF Field Guide, maneuvering you through the accreditation process.
You’ll rely on it to help you identify specific standards that apply to your organization and ensure that your policies and practices align with CARF requirements. Just remember that CARF standards are updated annually, so you’ll need to spend some time familiarizing yourself with the most up-to-date version.
A CARF consultant has a great deal of experience assisting behavioral health and human services organizations in their pursuit of CARF and often serves as a CARF surveyor in addition to providing CARF consulting. The familiarity of the documents, the process and the details make it well worth your while to hire a CARF consultant to assist with survey preparation.
Why Is CARF Accreditation Worth It?
Several solid reasons make it worthwhile to pursue CARF accreditation.
- CARF accreditation requirement for payment – Because some markets require CARF accreditation, and others only offer preferred vendor status if the organization has the accreditation, it makes it mandatory for survival of the health and human services provider. State agencies, managed care networks and grant-makers establish these rules, and there is not much you can do to avoid it.
- Organizational growth – Operational maturity is launched when you become CARF accredited. During the preparation stages, your agency is forced to become more organized through building standardized, transparent systems for clinical documentation and risk management.
- Better quality of care – The responsibility keeping track of outcomes ensures more methodical approach to serving clients, which increases quality of care. This higher standard of care creates a competitive advantage, and can attract prospective clients, families and referral partners with the CARF seal posted on its doors. The highest level of accreditation is three years, and serves as an assurance to patients, families, regulators, and insurance payers that the facility operates with proven operational and clinical excellence.
- Acknowledgement – The recognition your agency or facility will receive for becoming CARF accredited is also a worthy reason to begin the process of CARF accreditation.
Contact Us to find out more about how PowderHorn Consulting can assist your organization with CARF accreditation.
