The article analyses the theme of institutional accreditation in Italy, its implementation problems at the regional level in the framework provided in national legislation, and the experience of two regions, Emilia Romagna and Lombardia, which developed different accreditation models. In order to do this, national indications and the role assigned by the norm to the regions on accreditation are considered, together with the delays of the central level and those connected to the process of power devolution to the regions culminating in the modification of Title V of the Constitution. The analysis of some economic, cultural and political problems within the regions, which have influenced the modalities and start-up times of accreditation policies, introduces the accreditation models of Emilia Romagna and Lombardia, that are examined on the basis of different responses given to common critical aspects.only subscribers can see the full article