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.
North Dakota puts its psychiatric inpatient rules inside the hospital licensing chapter, and one sentence in that chapter decides who is covered. NDAC 33-07-01.1-36 says “Any facility that provides or purports to provide psychiatric inpatient or inpatient and outpatient diagnosis or treatment on other than an emergency basis shall comply with this section.” The same section bars primary care hospitals from offering psychiatric services at all and requires a North Dakota licensed psychiatrist to be in charge. The HHS Health Facilities Unit administers it. Outside a hospital, we could not find a license for an adult mental health residence at all.
Three 24-Hour Settings Compared
The first and third columns restate the statutes and rules named in them. The middle column is our reading of what is missing from those sources.
| Item | Psychiatric hospital or hospital psychiatric service | Non-hospital adult mental health residence | Freestanding SUD program at Level III.7 |
|---|---|---|---|
| License | Hospital license, psychiatric as a specialized hospital type (N.D.C.C. 23-16, NDAC 33-07-01.1) | No separate state license found | BHD license under N.D.C.C. 50-31 and NDAC 75-09.1-04, with no hospital license needed (N.D.C.C. 23-16-01) |
| Office | HHS Health Facilities Unit | None identified | HHS Behavioral Health Division |
| State fee | $10 for each licensed acute care bed, charged to hospitals that are not government facilities | None identified | $150 nonrefundable application fee |
| License term | Annual. A provisional license can run 90 days or less and be renewed twice at most | None identified | Provisional up to one year, unrestricted up to two years |
| Who must lead clinically | A psychiatrist licensed in North Dakota in charge of psychiatric services | None identified | Physician services 24 hours a day, seven days a week |
| Certificate of Need | None (N.D.C.C. 23-17.2 is repealed) | None | None |
| Daily bed report to HHS | Yes (N.D.C.C. 50-06-41.3) | The statute reaches private providers of residential behavioral health services | Yes |
What NDAC 33-07-01.1-36 Asks of a Psychiatric Service
Quoted from the Legislative Branch’s copy of the rule. Section -36 took effect April 1, 1994 and was last amended January 1, 2024.
The section works as a gate before it works as a standard. “A hospital may not hold itself out to the public as providing psychiatric services unless such psychiatric service has been licensed by the department and meets the requirements for a psychiatric hospital in this section.” So a general acute hospital that wants to open a behavioral health wing needs that service licensed, and a primary care hospital cannot do it at all, since the rule says flatly that “Primary care hospitals may not provide psychiatric services.”
Leadership is spelled out. “The physician in charge of the psychiatric services must be a psychiatrist who is licensed to practice medicine in North Dakota,” and psychiatrists on the service need three years of approved psychiatry residency or the equivalent. Recruiting that person tends to set the opening date more than anything on the paperwork side. The section also carries restraint, seclusion and discharge provisions. We have not summarized those here, so read them in the rule itself before writing policy.
Accreditation enters twice. Under 33-07-01.1-06, “A hospital may request that the department consider it in compliance with this chapter” if it meets the standards of a nationally recognized accrediting agency, and “For those portions of the accrediting agency survey report which the department accepts,” the hospital is treated as meeting the matching licensure requirements. HHS can still monitor anything the accreditor does not review, and a denial of accreditation brings an onsite state survey. Section -36 then adds a reporting duty: “Hospitals accredited by a national accrediting entity in the category of psychiatric services shall submit, upon receipt, all accreditation survey results, recommendations, and plans of correction to the department.”
Adult Mental Health Residences Outside a Hospital
This section is our interpretation, built from the statutes and HHS pages listed in the Sources. No HHS office has told us this in writing.
Operators from states with a residential mental health license usually go looking for North Dakota’s version. We did not find one. No mental health program category appears on HHS’s public health licensing list. NDAC Article 75-05 is titled Human Service Center Licensure Standards, and its license requirement points to N.D.C.C. 50-06-05.2, which now calls those centers state-operated behavioral health clinics. Private programs are not its subject. The commitment statute, N.D.C.C. 25-03.1-02, defines a “private treatment facility” as one “licensed under chapter 23-16 or 50-31,” meaning a hospital or an SUD program. Read together, those sources suggest that 24-hour psychiatric treatment in North Dakota is either a hospital service or, where addiction is the primary problem, a BHD-licensed SUD program.
Two loose ends deserve a phone call before you sign a lease. HHS’s public health licensing page lists basic care facilities, assisted living and a summary of standards for non-medical residential facilities, and we have not tested whether a group residence for adults with mental illness would fit any of them. And if the residents’ primary need is substance use treatment, the program belongs on a BHD license at Level III.1, III.5 or III.7, which North Dakota Drug and Alcohol Inpatient Treatment Licensing covers. Any residential or inpatient behavioral health provider, public or private, also owes HHS’s bed management system a daily report under N.D.C.C. 50-06-41.3.
Ketamine on a North Dakota Psychiatric Unit
Ketamine appears nowhere in the hospital rule or chapter 23-16, so the points below rest on our reading of the North Dakota Board of Nursing’s January 2026 guidance, federal hospital and drug rules, and the Spravato label.
If a ketamine or esketamine series is going to begin during a North Dakota inpatient stay, the licensed psychiatric service is the setting built for it. Under the federal hospital pharmacy standard at 42 CFR 482.25, the medical staff owns the formulary (“A formulary system must be established by the medical staff”), and every scheduled drug needs a paper trail, since “Current and accurate records must be kept of the receipt and disposition of all scheduled drugs.” Ketamine sits in Schedule III (21 CFR 1308.13(c)(7)). Spravato adds its own conditions: the FDA label says it “is available only through a restricted program under a REMS called the SPRAVATO REMS,” and “patients must be monitored for at least 2 hours at each treatment session.”
Nursing is where North Dakota differs. The Board of Nursing’s January 2026 update of Role of the Nurse in Sedation/Analgesia lists ketamine with propofol, methohexital and etomidate and treats giving them “for analgesia/sedation” as “outside the scope of practice for nurses EXCEPT” in four situations. The one a psychiatric unit could realistically use is a CRNA or anesthesiologist being present. The guidance covers RNs and APRNs who are not CRNAs, and it keeps LPNs out of sedation and analgesia altogether. It does not address low-dose ketamine given for depression. Our reading is that a unit should not assume RN-run infusions are allowed. Either build the protocol around one of the listed exceptions or get the Board’s written view first. The Board has fielded ketamine questions before. Its October 28, 2021 minutes record providers asking about ketamine for pain in non-intubated critical care patients, so a direct question is not unusual.
People held under the commitment act need a separate decision. We have not worked through how chapter 25-03.1 treats consent to a medication like ketamine. A first protocol limited to voluntary adults who sign their own consent is the cautious starting point, and extending it to anyone else is a question for the hospital’s counsel.
Arrange the Outpatient Prescriber Early
A ketamine series rarely ends with the inpatient stay, so pick the outpatient prescriber early in the stay and, once the patient signs a release, forward dosing records and notes on how the patient responded along with the discharge paperwork. That prescriber picks up North Dakota’s monitoring rules. The PDMP is run by the State Board of Pharmacy, and chapter 19-03.5 leaves a practitioner who “administers a controlled substance to a patient” out of the definition of a dispenser. Our reading is that in-office doses are not dispenser-reported, but confirm that with the Board of Pharmacy. If that prescriber is an APRN with prescriptive authority, Board of Nursing rules require a PDMP query before prescribing a controlled substance to someone new to the practice, a repeat query every six months, and another whenever misuse is a concern.
Ownership of the outpatient practice is unsettled here. We found no North Dakota statute, rule or appellate medical case on corporate practice of medicine. What exists is a letter the Attorney General sent to Cass County’s prosecutor on October 23, 1990. It reads state public policy as barring a corporation other than a professional corporation “from employing physicians to provide medical care,” yet it binds no one and leaves any criminal charge to local prosecutors. In our view a physician-owned practice that buys nonclinical services from a management company avoids the issue, and a North Dakota health care attorney should review any other structure. For how a stand-alone clinic gets set up, see North Dakota Drug and Alcohol Outpatient Treatment Licensing.
Budgeting Clinical Staff for a Psychiatric Service
The psychiatrist in charge is the fixed cost, and the nursing schedule is the large one. For therapists and counselors, BLS (OEWS, May 2025) reports a $68,630 median for North Dakota’s substance abuse, behavioral disorder and mental health counselors, and a quarter of them earn $55,450 or less while a quarter earn $77,320 or more. The national figure in that release is $59,350. Our arithmetic puts five clinicians at the state median near $343,150 a year in base pay. A North Dakota unit has two levers that keep that number from running away. For co-occurring caseloads, North Dakota’s addiction counselor rules give a trainee up to 12 months of registered trainee status to finish the 960 clinical training hours the LAC requires, and an LAC who supervises those trainees at their lower pay rate commonly shaves 40 to 60 percent from that slice of the clinical budget compared with hiring licensed counselors for every seat. Social workers, counselors and psychologists have their own boards and supervised tiers, which this guide does not cover. Nursing follows the same logic, since an RN charge nurse on each shift leading LPNs is cheaper than staffing the floor entirely with RNs, keeping in mind that the Board of Nursing places sedation and analgesia outside LPN scope. Bed count and acuity decide the real roster.
What Slows North Dakota Inpatient Mental Health Projects
Hiring the psychiatrist who will run the service is the usual bottleneck, and nothing can be licensed without that person named. The second stall is quieter. A group plans a stand-alone adult mental health residence, spends weeks looking for the license to apply for, and only then learns that the realistic choices are a hospital service, an SUD program under BHD, or a model HHS has to weigh in on directly.
Frequently Asked Questions
Does North Dakota license residential mental health programs for adults?
Not as a separate category that we could find. Inpatient psychiatric care is licensed as a hospital service by the HHS Health Facilities Unit under NDAC 33-07-01.1-36, and the commitment statute defines a private treatment facility as one licensed under chapter 23-16 (hospitals) or 50-31 (SUD programs). We reached that from the statutes and HHS pages rather than any HHS statement, so ask HHS about any non-hospital model before committing to it.
What fee and license term apply to a North Dakota psychiatric hospital?
Chapter 23-16 sets the fee at $10 per licensed acute care bed for hospitals that are not government facilities, and the license expires one year after it is issued. If HHS issues a provisional license instead, it runs 90 days at most and can be renewed only twice. The Health Facilities Unit answers at (701) 328-2352.
Does a new psychiatric bed in North Dakota go through Certificate of Need review?
No. Chapter 23-17.2, the old review for expanding hospital facilities, appears as repealed, and the one moratorium in chapter 23-16 freezes nursing facility beds only, for a window that runs August 1, 2025 to July 31, 2029.
Sizing up a psychiatric service or a residential mental health idea in North Dakota? Tell us what you have in mind.
Sources
- NDAC chapter 33-07-01.1 (hospital licensing, 33-07-01.1-02 license terms, -06 accreditation, -36 psychiatric services): Chapter 33-07-01.1 (PDF) (checked October 15, 2026)
- N.D.C.C. chapter 23-16 (hospital licensing, fees, III.7 exemption, nursing bed moratorium): Chapter 23-16 (PDF) (checked October 15, 2026)
- HHS Health Facilities Unit: Hospitals and Critical Access Hospitals and Contact the Health Facilities Unit (checked October 15, 2026)
- HHS licensing hub and public health licensing list: Licensing, Regulation and Certification and Public Health Regulation, Licensure and Certification (checked October 15, 2026)
- N.D.C.C. Title 23 chapter list, 23-17.2 repealed, via Justia mirror: Title 23 (checked October 15, 2026)
- N.D.C.C. chapter 25-03.1 (treatment facility definitions): Chapter 25-03.1 (PDF) (checked October 15, 2026)
- N.D.C.C. chapter 50-06 (50-06-05.2 state-operated clinics, 50-06-41.3 daily bed reporting): Chapter 50-06 (PDF) (checked October 15, 2026)
- NDAC Article 75-05 (human service center licensure): Article 75-05 and Chapter 75-05-00.1 (PDF) (checked October 15, 2026)
- N.D.C.C. chapter 50-31 (SUD program license and fee): Chapter 50-31 (PDF) (checked October 15, 2026)
- NDAC 75-09.1-01 (SUD license terms) and 75-09.1-04 (Level III.7): Chapter 75-09.1-01 (PDF) and Chapter 75-09.1-04 (PDF) (checked October 15, 2026)
- North Dakota Board of Nursing, Role of the Nurse in Sedation/Analgesia (updated January 2026): Sedation/Analgesia guidance (PDF) (checked October 15, 2026)
- North Dakota Board of Nursing, minutes of October 28, 2021: Board minutes (checked October 15, 2026)
- eCFR, 42 CFR 482.25: Hospital pharmaceutical services (checked October 15, 2026)
- 21 CFR 1308.13(c)(7), via Cornell LII: Ketamine in Schedule III (checked October 15, 2026)
- U.S. FDA, Spravato prescribing information (revised April 2025): Spravato label (PDF) (checked October 15, 2026)
- N.D.C.C. chapter 19-03.5 (prescription drug monitoring program): Chapter 19-03.5 (PDF) (checked October 15, 2026)
- North Dakota Board of Nursing, APRN drug monitoring requirements: Drug Monitoring (checked October 15, 2026)
- North Dakota Attorney General, letter to Cass County State’s Attorney (October 23, 1990): AG letter (PDF) (checked October 15, 2026)
- NDAC 4.5-02.1-01 (addiction counselor licensure and clinical trainees): Chapter 4.5-02.1-01 (PDF) (checked October 15, 2026)
- N.D.C.C. chapter 43-45 (Board of Addiction Counseling Examiners), via Justia mirror: Chapter 43-45 (checked October 15, 2026)
- U.S. Bureau of Labor Statistics, OEWS May 2025, North Dakota, SOC 21-1018: North Dakota OEWS and national estimates (checked October 15, 2026)
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