CARF's ASAM Level of Care Certification

Plenty of residential programs say they follow the ASAM Criteria. CARF's ASAM Level of Care Certification is how a program proves it. CARF describes it as "the only program approved by the American Society of Addiction Medicine for the assessment, verification, and certification of residential substance use disorder treatment services." Certification is available for adult Levels 3.1, 3.5 and 3.7, and each level is surveyed and certified on its own.

We are not affiliated with CARF or ASAM. What follows is drawn from CARF's published certification pages and fee schedule.

Who needs it?

In California, a residential AOD facility needs either this certification or a DHCS Level of Care Designation as a condition of licensure. DHCS says an approved residential ASAM Level of Care Certification "is sufficient to meet the DHCS requirement," and that a facility holding one does not also need a DHCS designation (see California's residential AOD license). California is the only state where we have verified a licensing requirement. Elsewhere, programs pursue it to show payers and regulators that their residential levels are delivered consistent with the ASAM Criteria, which is how CARF itself describes its value.

Is it the same as CARF accreditation?

No. CARF accreditation reviews a program against CARF's own standards manuals. The level of care certification applies a separate manual, the Rating Elements for Certification of ASAM Levels of Care (2026 Edition), which CARF says it applies to applications submitted after October 15, 2025. A program can hold either or both. The base fee is lower for a facility that already holds CARF accreditation, or has a CARF accreditation application pending with the fee paid.

What are the steps?

CARF lists nine:

1. Initial contact with CARF's Certification Support Team.
2. Self-assessment against the 2026 Edition rating elements for the location seeking certification.
3. Application through CARF's Customer Connect portal; CARF may request more information.
4. Fees. The base fee is due with the application; other fees within 10 calendar days of invoice.
5. Scheduling. CARF schedules the survey during the six months after the application process is complete, and tries to give at least 30 calendar days' notice of the date.
6. Survey on the scheduled date.
7. Decision. CARF issues the decision letter, Plan of Action form and certificate (if certified) about six to eight weeks after the survey.
8. Plan of Action within 90 days of certification, addressing each rating element not satisfactorily demonstrated.
9. Reporting. An annual report is due on the first and second certification anniversaries, and certain events must be reported within 30 days.

The 30-day events are change in leadership, change in ownership, change in organization name, change in mail or email address, relocation, change of levels of care, cessation of services and change of licensure status. A program that changes its state license status, or is sold, has to tell CARF as well as the state.

How does CARF decide?

Each level of care is scored separately, and CARF's scoring weighs two kinds of rating elements. Defining elements address what is definitional to delivering that level, and "all defining elements for a particular LOC must be satisfied to achieve certification for that LOC." Non-defining elements must be substantially satisfied, but not every one. CARF gives an example: Level 3.5 has over 300 discrete rating elements, and if one defining element is missed, certification for 3.5 will not be issued even if most other elements are met.

That makes the defining elements the center of any readiness plan. At the end of the survey, the surveyor holds a brief wrap-up identifying any defining elements not rated as satisfied, and no additional information may be presented at that point.

What happens on survey day?

Surveys are on site unless CARF indicates a remote survey. The day typically starts around 8:00 a.m. with an orientation, followed by a tour, a document review, a clinical records review and the wrap-up.

CARF's tour list is detailed: building exterior and street address display; outdoor spaces and how they are monitored and secured; the reception area; individual, group and family therapy spaces; where the daily schedule and meal plan are posted; the meal area; quiet spaces; visitation areas; staff supervision areas, including cameras and monitoring stations; areas for awake night staff; for Level 3.7, nursing staff areas and the space between them and patient sleeping areas; sleeping areas; storage for belongings; and bathrooms.

For clinical records, the surveyor selects active records for each level and the program selects closed records, and the program guides the surveyor through them. Every record should contain the assessment results, the treatment plan and the other documentation the rating elements require. CARF also suggests a mock survey to find gaps before the real one.

Records stay with the program. When we run a mock survey, we coach your staff on how to present records and which elements to check, but we never receive or review patient charts.

How much does it cost?

CARF's fee schedule for applications submitted by March 15, 2027, for surveys starting between July 1, 2026 and June 30, 2027:

• Base: $4,540 standard, or $3,520 for a facility delivering CARF-accredited services or with a CARF accreditation application pending and paid. The base covers one survey event for one level of care at one facility with its own address.
• Each additional level of care: $500.
• Additional adjacent service facilities: $2,000 for 1 to 3, or $4,000 for 4 to 7, but only if they are commonly owned and operated, immediately adjacent, jointly licensed as a single treatment facility under one license number, and run with common staff, documentation and procedures. Otherwise each facility needs its own application and fees.
• Separately addressed sleeping facility: variable; CARF provides an estimate.
• Rescheduling: $1,000.
• Review of a certification decision: $500 for a summary review, or 70 percent of the fees invoiced for a full review.

CARF states that fees are nonrefundable and subject to change before invoice. The program pays CARF directly.

Where do we fit in?

Our ASAM Level of Care Certification Readiness service is $1,995. We map your program to the levels you will seek, cross-walk your policies, staffing and schedules to the defining elements, prepare the building for the tour and coach staff for the records review. The program applies to CARF, pays CARF and is surveyed. A standalone Mock Survey is $1,495, and if California licensing is part of the plan, the residential State License package is $2,995. For the broader residential picture, see licensing a residential SUD program.