Certification is awarded to a health care program that is in compliance with all standards at the time of the on-site review or has successfully addressed all requirements for improvement (RFI) in an Evidence of Standards Compliance (ESC) submission.
Provisional Certification results when a health care program fails to demonstrate resolution of all RFIs in an ESC or Measures of Success (MOS) submission or meet all requirements for timely submission of data and information to The Joint Commission.
Conditional Certification results when a health care program fails to resolve the requirements of a Provisional Certification status or was in substantial noncompliance with applicable Joint Commission standards. The program must remedy identified problem areas through submission of an ESC and subsequently undergo an on-site follow-up review. Conditional Certification also results when a program fails to meet requirements for the timely submission of data and information to The Joint Commission; or review findings demonstrate systemic patterns, trends or repeat findings from previous reviews.
Preliminary Denial of Certification results when a health care program fails to resolve the requirements of a Conditional Certification status or was in significant noncompliance with applicable Joint Commission standards. Preliminary Denial of Certification also results when there is evidence of an immediate threat to health or safety for patients or the public within the program or there is credible evidence indicating that the program submitted falsified documents or misrepresented information in seeking certification.
Denial of Certification results when a health care program does not permit the performance of any review by The Joint Commission. Denial of Certification also results when a program fails to meet requirements for the timely submission of data and information to The Joint Commission, or resolve a Conditional Certification status prior to withdrawing from the certification process, or submit payment for review fees or annual fees.
More information about certification decisions, policies and procedures can be found in The Joint Commission’s certification manuals.