Delaware Drug and Alcohol Inpatient Treatment Licensing

Author: A. Ant, CADC-II, Licensing & Accreditation Expert

Disclaimer: This content is provided for general informational purposes only and should not be construed as legal, regulatory, or licensing advice. Requirements change frequently. Consult qualified professionals for guidance specific to your situation.

Apply now: DSAMH Application for Licensure and/or Certification (PDF) | Questions: DSAMH Provider Enrollment, DHSS_DSAMH_ProviderEnrollment@delaware.gov (the unit publishes no phone line)

A residential license in Delaware arrives with its ASAM level already written into the name. The Division of Substance Abuse and Mental Health (DSAMH), part of the Department of Health and Social Services, lists its license types in policy DSAMH057 (revised July 22, 2026), and the residential ones read Clinically Managed Residential ASAM Level 3.1, Clinically Managed Residential ASAM Level 3.5, Medically Monitored ASAM Level 3.7 and WM Medically Monitored Inpatient ASAM Level 3.7. So before you draft a single policy, you are choosing a level. The standards those licenses are measured against are older: 16 Del. Admin. Code 6001, the Substance Abuse Facility Licensing Standards, final since November 2010.

The scope here is adults in residential beds, including residential withdrawal management. Ambulatory programs are in Delaware Drug and Alcohol Outpatient Treatment Licensing, and the full picture for the state, including psychiatric hospitals and mental health group homes, is on Delaware Behavioral Health Licensing.

Delaware Signed a New Treatment Law in August 2026, and 6001 Still Governs for Now

The dates and quotations here come from the General Assembly’s bill record and the Delaware Code site. How the two timing sections fit together is our reading.

Senate Substitute 1 for Senate Bill 161 was signed on August 31, 2026 and became 85 Del. Laws c. 461. The Act creates a new 16 Del. C. Chapter 56, titled Behavioral Health, and repeals Chapter 22, the Substance Abuse Treatment Act that 6001 was written under. Section 10 names it the Rick Urey Behavioral Health Treatment Act.

Section 12 is where the timing gets complicated. Act Sections 1 through 5, which carry Chapter 56’s licensing, discipline, client-rights and incident provisions, are “to be implemented the earlier of” a deadline and an event, and so is the Chapter 22 repeal in Section 8. The deadline is two years from enactment, which lands on August 31, 2028. The event is a notice from the DSAMH Director “published in the Register of Regulations that final regulations to implement this Act have been adopted.” Until one of those things happens, our reading is that a residential applicant files under 6001 exactly as before, and DSAMH’s own August 2026 policy says the Division “shall continue to license and certify, per current regulations” the adult SUD programs it covers. When we checked on October 14, 2026 we had not found a Register notice or proposed Chapter 56 regulations, though the state’s new online Register would not fully load for us, so ask Provider Enrollment where things stand when you file.

Three features of Chapter 56 are worth building toward now. Section 5606 allows a civil money penalty of up to $10,000 per violation. Section 5642 requires a staff member to report an incident to the Division immediately. And Section 5608 lets DSAMH set new licensing fees by regulation, with no amount written into the statute yet.

Residential License Types and the 6001 Categories Behind Them

The license names come from DSAMH057 as revised in 2026. The 6001 category in the third column is how DSAMH’s 2024 version of the same policy matched them up.

ASAM level	DSAMH license type	6001 category it maps to	Staffing floor in 6001
3.1	Clinically Managed Residential ASAM Level 3.1	Transitional Residential Treatment	A counselor available to clients 24 hours a day, 7 days a week (§13.1.2.4)
3.5	Clinically Managed Residential ASAM Level 3.5	Residential Treatment	Awake staff around the clock, plus a counselor on site 8 or more hours daily and on call 24 hours (§12.2)
3.7	Medically Monitored ASAM Level 3.7	Residential Treatment	Same residential floor (§12.2)
3.7 WM	WM Medically Monitored Inpatient ASAM Level 3.7	Residential Detoxification Services	Physician on call 24 hours, and qualified medical personnel or a licensed nurse on site (§10.3)

Two practical points follow from that table. First, 6001 §4.2.3 says “A separate application shall be completed for each program at each location,” so a building with withdrawal management beds next to 3.5 beds is filing at least two applications, each with its own $15 fee. Second, the application form (revised September 7, 2022) predates the 2026 table and still carries check boxes for levels the table doesn’t list, among them “WM Clinically Managed Residential Withdrawal Management ASAM Level 3.2” and “Clinically Managed Population-Specific High Intensity Residential Treatment ASAM Level 3.3.” Tell Provider Enrollment in writing which DSAMH057 license type you are after rather than trusting a check box to say it.

Because DSAMH already names the level, a referral source can see what Delaware licensed you for. What it can’t see is an outside reviewer’s check that the program really runs at that level. That outside check is what CARF’s ASAM Level of Care Certification supplies. CARF says certification “is available for adult Levels of Care 3.1, 3.5, and 3.7,” and ASAM says it is “Delivered in partnership with CARF International (CARF).” We found nothing in 6001 or DSAMH057 that requires it, and DSAMH doesn’t print it on the license. It shows up instead in CARF’s provider search, whose Certification filter offers “ASAM Level of Care 3.7.” For a Delaware program, the natural match is the Medically Monitored ASAM Level 3.7 license (that pairing is ours, not DSAMH’s). Withdrawal management appears nowhere in how CARF or ASAM describe the certification, so a WM 3.7 unit relies on its DSAMH license alone.

No Certificate of Public Review for a Freestanding SUD Residence

Delaware’s version of certificate of need is the Certificate of Public Review, run by the Delaware Health Resources Board under 16 Del. C. Chapter 93. Review attaches to “The construction, development or other establishment of a health-care facility,” and § 9302(4) defines that term as a hospital, nursing home, freestanding birthing center, freestanding surgical center, freestanding acute inpatient rehabilitation hospital or freestanding emergency center. A DSAMH-licensed residential SUD program isn’t named, so our reading is that it doesn’t need a CPR. A psychiatric hospital is a different story, since it holds a hospital license under Chapter 10. That route is covered in Delaware Mental Health Inpatient Licensing.

MOUD for Delaware Residents

We looked for a 6001 provision requiring a residential program to offer, allow or refer for medication for opioid use disorder and didn’t find one. That isn’t a reason to skip the policy. Someone admitted mid-course on buprenorphine or methadone still needs tomorrow’s dose, and the admission policy should say who provides it before the first referral call comes in.

Methadone sits on its own license, which DSAMH057 calls Opioid Treatment Program ASAM Level 1, so a residential program partners with a licensed OTP for any resident who doses there. Office-based buprenorphine involves far less paperwork. DEA’s January 12, 2023 letter to registrants says “A DATA-Waiver registration is no longer required to treat patients with buprenorphine for opioid use disorder.” DSAMH’s buprenorphine policy (DSAMH024, revised February 19, 2025) expects prescribers to hold a “current DEA registration that includes Schedule III authority,” and Delaware adds its own controlled substance registration on top of the federal one (16 Del. C. § 4732). If your program also carries co-occurring services, 6001 defines a Qualified Psychiatric Practitioner as a Delaware-licensed physician or nurse practitioner with “specific training in the use of buprenorphine and Opioid antagonist medications.” For naltrexone, SAMHSA says it “can be prescribed and administered by any practitioner licensed to prescribe medications.”

Adding Ketamine Under a 6001 Residential License

Neither 6001 nor any DSAMH policy we read mentions ketamine. The conclusions below are our interpretation of the rule, the controlled substance statute and the nursing law, so describe the plan to Provider Enrollment in writing before anyone orders the drug.

Our view is that a DSAMH residential program may add ketamine to its medical care for a resident with co-occurring depression or PTSD. The rule’s change-notice section, 6001 §4.10.3, is about name, ownership, governing authority, premises and location. It says nothing about adding a medication. DSAMH’s buprenorphine policy does tell programs to “contact DSAMH prior to expanding services beyond MOUD treatment,” and although that policy was written for buprenorphine prescribers, we read it as a fair signal of what DSAMH expects to hear before a program changes its medical services.

The license type decides how easy this is. A WM Medically Monitored Inpatient 3.7 unit already must have a physician on call 24 hours a day and qualified medical personnel or a licensed nurse on site (§10.3). A 3.5 residence only has to keep staff awake and a counselor on site eight hours a day under §12.2, and nothing we read in that section puts a nurse in the building. A house like that would need to schedule nursing coverage for every dosing day and the observation time after it.

Registering the Site for a Schedule III Drug

Ketamine is a Schedule III drug under 21 CFR 1308.13(c)(7). On the state side, 16 Del. C. § 4732(a) says practitioners “must obtain biennially a registration issued by the Secretary,” and § 4732(e) adds that “A separate registration is required at each principal place of business or professional practice.” If ketamine will be stored at the residence, plan on a Delaware registration and a DEA registration tied to that address. The Delaware Prescription Monitoring Program FAQ says “The administration of a drug does not have to be reported to the PMP,” and 16 Del. C. § 4798 defines administering as direct application to the patient’s body. A dose given in the building is administration. Anything sent home with a resident is a different question to put to the PMP.

Delaware’s Board of Nursing hasn’t published anything we could find about RN administration of ketamine, which leaves the physician’s orders and the program’s written protocol to define the nurse’s part. A nurse practitioner can hold the prescribing role without a physician partner. Delaware has repealed its collaborative agreement section, 24 Del. C. § 1936, and § 1935(a)(1) now provides that “The board of nursing grants full-practice and prescriptive authority upon the issuance of an APRN license.” The NP still carries the same DEA and Delaware controlled substance registrations as any other prescriber at the residence. Esketamine adds a federal layer: the FDA medication guide says “SPRAVATO can only be administered at healthcare settings certified in the SPRAVATO REMS program,” and it tells patients the provider will watch them “for at least 2 hours after taking SPRAVATO.”

Picking the Right Resident

Ketamine can’t carry the addiction treatment. The FDA hasn’t approved it for any substance use disorder, and it doesn’t count as MOUD. In our view it fits late in a stay, once a resident’s depression or PTSD has persisted past withdrawal and through at least one ordinary antidepressant trial. We’d screen out anyone with past misuse of dissociative drugs, ketamine itself and PCP included. Your medical director sets those lines. Delaware law doesn’t.

The Practice That Takes Over at Discharge

A ketamine series rarely ends on the day a resident leaves, so the rest of it belongs to an outpatient practice. Delaware has no corporate practice of medicine bar that we could locate in statute, rule or appellate decision. The Professional Service Corporation Act (8 Del. C. Chapter 6) does limit a PC’s shares to licensed individuals, but the chapter is permissive, and our reading is that it doesn’t amount to a general ban on lay ownership. Even so, we’d set it up cautiously: physicians own a professional corporation that employs the clinicians and makes the medical calls, and a separately owned management company supplies space, staff and billing support by contract. One open question sits further out. Once Chapter 56 is implemented, a “program” means “the treatment services delivered by a provider organization to treat a behavioral health condition,” and only some settings are exempt, so an entity-run ketamine clinic could fall inside it. For the clinic’s own registrations and ownership details, see the ketamine section of Delaware Drug and Alcohol Outpatient Treatment Licensing.

Get counsel’s sign-off on how residents move from the residence to the clinic before the first referral. Under the Eliminating Kickbacks in Recovery Act, 18 U.S.C. § 220, a non-hospital setting offering residential treatment or detoxification “pursuant to licensure or certification under State law” counts as a clinical treatment facility, a description a DSAMH licensee meets, and violators can be “fined not more than $200,000, imprisoned not more than 10 years, or both, for each occurrence.” We found no Delaware patient brokering statute. Chapter 56 will add its own marketing limits once implemented, including a ban on soliciting “within 500 feet of another provider organization’s facility” (§ 5604).

The 6001 Roster and What It Costs

6001 names the roles and their minimum qualifications. The Administrator needs a bachelor’s degree and five years in human services, two of them in substance use and two in management (§6.1.1.2.1). The Clinical Director qualifies with “A master’s degree in counseling or a related discipline and five (5) years of documented clinical experience in human services” (§6.1.2.1.1), or under §6.1.2.1.2 with a bachelor’s degree, CADC or CCDP certification and five years of substance use experience. A Clinical Supervisor holds a bachelor’s degree with a full CADC or CCDP, or a bachelor’s degree plus five years of experience (§6.1.3.1). A Counselor I can qualify through “Full certification as a certified alcohol and drug counselor (CADC) in the state of Delaware,” and §6.1.4.1 lists other qualifying routes as well. A Counselor II gets at least an hour of supervision per 20 hours of client services (§6.1.5.2). Everyone gets at least 20 hours of training a year (§5.1.7.4), and someone trained in crisis intervention and first aid or CPR has to be on site at all times (§9.3.3).

Delaware’s substance abuse, behavioral disorder, and mental health counselors earn a median of $56,020 a year according to BLS, below the $59,350 national median, with the middle half of the state’s counselors earning between $43,760 and $64,790 (OEWS, May 2025). A 3.5 residence covering counselor hours seven days a week might carry a clinical director, a clinical supervisor and five counselors. Seven salaries at the state median come to about $392,140 a year, before awake overnight staff, nursing and benefits. Few Delaware residential programs end up paying every one of those seats at the median. The state’s credential ladder is why. 6001’s Counselor II tier works under regular supervision, and the Board of Mental Health and Chemical Dependency Professionals builds supervised hours into its licenses: the LCDP calls for 3,200 hours of counseling experience with 1,600 of them supervised (24 Del. C. § 3044), and the LPCMH requires the same 1,600 supervised hours, often earned while holding the associate license (LACMH), which lasts two years and can be renewed twice (§§ 3032 and 3033). A CADC-holding clinical supervisor overseeing Counselor II staff and associates who trade some salary for those hours can shrink the clinical payroll line by 40 to 60 percent relative to a staff of fully licensed counselors only. In a WM 3.7 unit, the “licensed nurse” language in §10.3 leaves room for one RN to lead several LPNs. We size the roster once your license types and bed count are fixed.

Deemed Status Earns a Two-Year License and a 24-Hour Reporting Duty

This section is drawn from 6001 Part IV and DSAMH’s License Frequency Schedule policy. Read it alongside your accreditor’s own event definitions.

6001 Part IV has one section per accreditor, and each sets a different bar for the two-year license. The Joint Commission route is §17.1.1: “Programs with Full Accreditation may qualify for a 2-year license.” For CARF, §18.1.1 says “Programs with Three-Year Accreditation may qualify for a two (2) year license,” so a one-year CARF award doesn’t get you there. COA programs need a three-year or four-year award (§19.1.1). DSAMH’s License Frequency Schedule (DSAMH058) describes the same two-year term for a program that “possesses at least three (3) years or full accreditation.” The deemed status request goes in on Attachment C of the application, with the accreditation certificate, the latest survey report and your corrective action response, at least 90 days before the current license expires.

The Program Exemptions sections (§17.5, §18.5 and §19.5) then excuse a deemed program from parts of 6001 and name specific standards that are carved back in. Read that list line by line before retiring any policy. The reporting obligations are where deemed programs get caught. You tell DSAMH’s Quality Assurance Unit about a scheduled accreditor visit at least 30 days ahead, and about an unannounced one “within twenty-four (24) hours of the first day of the visit.” Joint Commission programs “must report all sentinel events to DSAMH within twenty-four (24) hours” with the root cause analysis and action plan (§17.3.2), CARF programs report significant events within 24 hours with the investigation report (§18.3.2), and COA programs report hazardous or emergency situations within 24 hours (§19.3.2). DSAMH “can revoke Deemed Status standing at any time,” including after a failed accreditation, a sentinel or significant event, or a late report, and the program then waits a year before it can reapply (§17.4.2).

How to Submit Your DSAMH Residential Application

Everything starts with an email to DSAMH Provider Enrollment at DHSS_DSAMH_ProviderEnrollment@delaware.gov. 6001 §4.2.2 requires first-time applicants to “schedule a meeting with DSAMH Quality Assurance staff,” and DSAMH now runs that as a Meet and Greet, with a Provider Enrollment Questions and Answers form to finish beforehand. One of its readiness questions asks whether you already hold a Delaware business license.

The Application for Licensure and/or Certification (revised September 7, 2022, also posted as a Word file) goes back to the same email address with its attachments: the policy and procedure manual, a sample clinical chart, bylaws, the facility zoning permit, floor plans, the facility occupancy permit, an org chart, insurance, accreditation documents, the most recent audit report, and Attachments A (personnel), B (governing body), C (deemed status) and D. The licensure fee is $15 per application, non-refundable, by check to the Office of the Secretary, Administration, Financial Management Supporting DSAMH, 1901 N. DuPont Highway, New Castle, DE 19720. The form is clear that “The Division shall not consider any application until all documents have been submitted and payment has been received.”

Two clocks run in DSAMH057. The first says an applicant “shall apply for and complete the application process within 90 days of the decision” to seek licensure. The second says “Applications must be completed and approved within six (6) months of contact with Provider Enrollment.” Approval brings a New Provisional license for 180 days, a Policy and Compliance audit inside that window, and a corrective action plan due within 10 days of any findings. Under DSAMH020, a provisional license can be extended by 90 days, for a ceiling of 270 days, before DSAMH stops extending it. Renewals of a full license go in between 90 and 120 days before expiration (6001 §4.4.2).

Where Delaware Residential Timelines Slip

From what we see, the six-month window in DSAMH057 catches people who contact Provider Enrollment long before the building has its zoning and occupancy permits, because the application can’t be completed without them. The other repeat problem is a policy manual written for the wrong level, for instance 3.5 staffing in a program that applied for Medically Monitored 3.7, which shows up fast in the provisional audit.

Frequently Asked Questions

Choosing between a 3.5 and a 3.7 license type for a Delaware residence? Tell us about the building.

Sources

• DSAMH, 16 Del. Admin. Code 6001 (posted August 2026): Substance Abuse Facility Licensing Standards, incl. Part IV deemed status (PDF) (checked October 14, 2026)
• Delaware Register of Regulations, 14 DE Reg. 471: Final order adopting 6001, effective November 2010 (checked October 14, 2026)
• Delaware General Assembly, SS 1 for SB 161 (85 Del. Laws c. 461): Bill detail, signed August 31, 2026 (checked October 14, 2026)
• Delaware General Assembly, SS 1 for SB 161, Sections 6, 8, 10 to 12: Enacted bill text and implementation timing (checked October 14, 2026)
• Delaware Code, 16 Del. C. Chapter 56: Behavioral Health (enacted 2026) (checked October 14, 2026)
• Delaware Code, 16 Del. C. §§ 5601 to 5609: Chapter 56 Subchapter I, definitions, license requirement, exemptions, penalties, fees (checked October 14, 2026)
• Delaware Code, 16 Del. C. §§ 5641 to 5649: Incidents, reports and investigations (checked October 14, 2026)
• Delaware Code, 16 Del. C. Chapter 22: Substance Abuse Treatment Act, repeal note (checked October 14, 2026)
• DSAMH, DSAMH057 (revised July 22, 2026): SUD treatment licensure and certification guidelines, license types and exemptions (PDF) (checked October 14, 2026)
• DSAMH, DSAMH057 (2024 version): License types mapped to 6001 categories (PDF) (checked October 14, 2026)
• DSAMH, DSAMH020 (revised October 29, 2025): Path to Full Licensure or Certification (PDF) (checked October 14, 2026)
• DSAMH, DSAMH058: License Frequency Schedule Policy (PDF) (checked October 14, 2026)
• DSAMH, DSAMH024 (revised February 19, 2025): Buprenorphine Prescribing Practitioners Policy (PDF) (checked October 14, 2026)
• DSAMH, Application for Licensure and/or Certification (revised 9/7/22): Application form, fee and attachments (PDF) (checked October 14, 2026)
• DSAMH, Application for Licensure and/or Certification: Word version (checked October 14, 2026)
• DSAMH, Provider Enrollment Questions and Answers: Pre-meeting form (PDF) (checked October 14, 2026)
• DSAMH: Provider Policies and Resources (contact, satellite and ownership forms) (checked October 14, 2026)
• Delaware Code, 16 Del. C. Chapter 93: Certificate of Public Review, §§ 9302 and 9304 (checked October 14, 2026)
• DEA Diversion Control Division: Dear Registrant letter on the DATA-Waiver, January 12, 2023 (PDF) (checked October 14, 2026)
• SAMHSA: Naltrexone (checked October 14, 2026)
• CARF: ASAM Level of Care Certification (checked October 14, 2026)
• ASAM: Level of Care Certification (checked October 14, 2026)
• CARF: Find a Provider (Certification filter) (checked October 14, 2026)
• 21 CFR 1308.13(c)(7), via Cornell LII: Schedule III, ketamine (checked October 14, 2026)
• Delaware Code, 16 Del. C. § 4732: Controlled substance registration, separate registration per location (checked October 14, 2026)
• Delaware Division of Professional Regulation: Prescription Monitoring Program FAQs (checked October 14, 2026)
• 16 Del. C. § 4798, via Justia (verbatim mirror): Prescription Monitoring Program definitions (checked October 14, 2026)
• Delaware Code, 24 Del. C. Chapter 19: Nursing, § 1935(a)(1) APRN full-practice authority and § 1936 (repealed) (checked October 14, 2026)
• U.S. FDA: Spravato prescribing information and Medication Guide (PDF) (checked October 14, 2026)
• Delaware Code, 8 Del. C. Chapter 6: Professional Service Corporation Act, §§ 603 and 610 (checked October 14, 2026)
• 18 U.S.C. § 220, via Cornell LII: Illegal remunerations for referrals to recovery homes, clinical treatment facilities, and laboratories (checked October 14, 2026)
• Delaware Code, 24 Del. C. Chapter 30: Board of Mental Health and Chemical Dependency Professionals (checked October 14, 2026)
• Delaware Code, 24 Del. C. §§ 3032 and 3033: LPCMH requirements and LACMH term (checked October 14, 2026)
• Delaware Code, 24 Del. C. § 3044: LCDP requirements (checked October 14, 2026)
• U.S. Bureau of Labor Statistics, OEWS May 2025, SOC 21-1018: Delaware occupational employment and wage estimates (checked October 14, 2026)
• U.S. Bureau of Labor Statistics, OEWS May 2025: Substance abuse, behavioral disorder, and mental health counselors (national) (checked October 14, 2026)