COLA vs CAP vs Joint Commission vs a State CLIA Survey

Nonwaived labs can meet CLIA through a state agency survey (Certificate of Compliance) or through a CMS-approved accreditor (Certificate of Accreditation). CMS approves seven accreditors: ACHC, A2LA, AABB, ASHI, CAP, COLA and The Joint Commission. CAP and COLA accredit the most labs. The best fit depends on your setting, specialties and other accreditations.

Last reviewed and facts last verified Oct 18, 2026 · By Sound Lab Consultants CLIA team · Sound Lab Consultants is not affiliated with any accrediting organization.

Key facts and official sources

  • Accreditation can grant "deemed status" when the accreditor's requirements are equal to or more stringent than CLIA. Source: 42 CFR 493.551

  • CMS-approved accreditors and the specialties each covers: CMS AO specialty list (Sept 2026)

  • COLA was approved for histocompatibility effective July 10, 2026, and now covers all CLIA specialties. Source: 91 FR 35217 (CMS-3486-N)

  • Labs with a Certificate of Accreditation, by accreditor, from CMS CLIA statistics, Aug 2026 (non-exempt labs):

    • CAP: 6,953

    • COLA: 5,641

    • The Joint Commission: 2,347

    • AABB: 190

    • ACHC: 149

    • ASHI: 107

    • A2LA: 8

What is the difference between a state survey and accreditation?

  • Certificate of Compliance: the state survey agency inspects the lab against 42 CFR 493 on a two-year cycle.

  • Certificate of Accreditation: a CMS-approved accreditor inspects the lab against its own standards. The lab still holds a CLIA certificate, pays CLIA fees and must meet CLIA proficiency testing requirements (§493.551(b)).

How do COLA, CAP and The Joint Commission compare?

  • Survey cycle

    • COLA: Two-year accreditation cycle

    • CAP: On-site inspection every two years, with a self-inspection in the off year

    • The Joint Commission: Two-year award for laboratory accreditation

  • Notice

    • COLA: Check with COLA

    • CAP: Labs are notified up to two weeks before inspection (as CAP states for US labs)

    • The Joint Commission: Full laboratory surveys receive 14 days' notice (as TJC states)

  • Standards

    • COLA: COLA Accreditation Manual

    • CAP: Discipline-specific CAP accreditation checklists

    • The Joint Commission: Joint Commission laboratory standards

  • Who inspects

    • COLA: COLA surveyors

    • CAP: Peer inspectors from working labs

    • The Joint Commission: Joint Commission surveyors

  • CLIA specialties

    • COLA: All CLIA specialties (since July 10, 2026)

    • CAP: Per CMS AO list

    • The Joint Commission: Per CMS AO list

Sources: cola.org/accreditation, cap.org (Inspection Tools and Training), jointcommission.org (Accreditation Process). Confirm current details with each organization.

What about ACHC, AABB, ASHI and A2LA?

All four are CMS-approved. AABB focuses on blood banking and transfusion-related specialties, and ASHI on histocompatibility. ACHC and A2LA appear on the CMS list across most specialties. See the CMS specialty list for exact coverage.

Can CMS still inspect an accredited lab?

Yes. Accredited labs are generally not routinely inspected by the state agency, but they remain subject to CMS validation and complaint surveys.

How do you choose?

Ask these questions:

  1. What does your organization already have? Hospitals accredited by The Joint Commission often keep their lab with TJC or CAP to simplify surveys.

  2. Which specialties do you test? Confirm the accreditor covers every one on the CMS list.

  3. What support do you want? Compare each organization's education, self-assessment tools and corrective action process.

  4. What will it cost? Ask each accreditor for its current fees, and compare them with CLIA compliance survey fees.

  5. How ready are you? All three expect the same core CLIA quality systems: PT, QC, competency, personnel and procedures.

No option is "easier." They use different standards and survey styles to meet the same CLIA baseline.

How do you switch from a state survey to accreditation?

Apply to the accreditor. Then notify your state agency of the certificate change using Form CMS-116, so your lab moves from a Certificate of Compliance to a Certificate of Accreditation. Plan the timing around your current survey window.

Frequently asked questions

Is COLA easier than CAP?

Neither is easier. They use different standards documents and survey styles, and both must be at least as stringent as CLIA.

Does accreditation replace CLIA?

No. Accredited labs still hold a CLIA Certificate of Accreditation, pay CLIA fees and meet CLIA PT requirements.

Does COLA cover all CLIA specialties?

Yes. CMS approved COLA for histocompatibility effective July 10, 2026, so COLA now covers all CLIA specialties.

Can a hospital lab use The Joint Commission for CLIA?

Yes. The Joint Commission is a CMS-approved accreditor for laboratories.

Not sure which path fits your lab?

Sound Lab Consultants helps labs prepare for state, COLA, CAP and Joint Commission surveys and run mock inspections.

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