Mississippi 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: DMH Division of Certification, Become a Certified Provider (Interested Provider Portal) | Questions: DMH Division of Certification, certification@dmh.ms.gov, 601-359-1288

One line in Mississippi’s residential addiction rule explains most of what an inpatient operator has to figure out here. Describing Level 3.7, the medically monitored tier, Rule 31.8.A of the state’s Operational Standards says: “It can be free-standing or a unit of a hospital.” The free-standing version answers to the Mississippi Department of Mental Health (DMH), Division of Certification. That division sets the standards for community programs and issues what it calls Certificates of Operation. The hospital version answers to the Mississippi State Department of Health (MSDH), Division of Health Facilities Licensure and Certification, which licenses chemical dependency hospitals and units and also runs the state’s Certificate of Need program. Where your beds fall on that line decides which rulebook, which inspector and which application you deal with.

The words matter too. DMH certifies, it does not license, and its own FAQ for interested providers says plainly that services can be delivered without DMH certification at all. That same answer ties Medicaid billing to certification, and Rule 2.1.A.4 requires it of programs paid through DMH grants, but those are funding relationships that sit outside the program standards this guide covers, and we don’t handle them. MSDH is different. Its hospital rule says no one may “establish, conduct, or maintain a hospital in this state without a license.”

Outpatient levels, solo offices and stand-alone ketamine clinics are covered in Mississippi Drug and Alcohol Outpatient Treatment Licensing. Both agencies, plus the mental health tracks, are mapped on the Mississippi Behavioral Health Licensing page.

DMH Certification or an MSDH Chemical Dependency License

The rule numbers and quotations here come from DMH’s 2024 Operational Standards PDF and the MSDH minimum standards PDFs, each posted on the agency’s own site. Placing a particular program on one side or the other is our reading.

Question	DMH community residential program	MSDH chemical dependency unit
What the state issues	Certificate of Operation (certification)	Hospital license
Governing rule	DMH Operational Standards, effective November 1, 2024 (Chapters 31, 49 and 50 for SUD residential and withdrawal management)	Minimum Standards for Chemical Dependency Units (Title 15, Chapter 52), applied with the general hospital standards (Chapter 41)
Setting	Residential ASAM levels from 3.1 up through 3.7 (3.3 included), and residential withdrawal management at 3.2-WM and 3.7-WM	A hospital, a dedicated unit of a general, psychiatric or rehabilitation hospital, or a freestanding unit with beds
Medical staffing floor	At 3.7, a licensed physician oversees treatment and an RN is present “usually 24/7”	A physician responsible for care, and an RN on duty 24 hours a day, 7 days a week
Certificate of Need	Not on the statute’s facility list, in our reading	Required for licensed chemical dependency services
Term	One year of initial certification, then a four-year cycle	Renewed every year
State fees	$150 application, $300 initial certification, $300 each renewal period	Set by the Board (we did not find the schedule)

The column most operators fit is the left one. The open question is the word “freestanding.” MSDH’s chemical dependency rule defines a unit as a hospital, a dedicated hospital unit, or “a “freestanding” unit, which has beds,” and nothing we read tells a clinically managed residential house at 3.1 or 3.5 that it is outside that definition in so many words. Our reading is that it is, for three reasons. The MSDH standards are written for medical care and are applied “in conjunction with” the hospital rules, they make a physician responsible for every patient and keep an RN on duty around the clock, and the Certificate of Need statute defines a chemical dependency hospital as one serving inpatients “by or under the supervision of a physician.” DMH, for its part, treats 3.1 through 3.5 as community care. A freestanding 3.7 unit is closer to the line. If you plan medically monitored beds outside a hospital, ask MSDH’s licensure division before you sign a lease, and use MSDH’s Determination of Reviewability form if you want a formal answer on Certificate of Need.

Residential Levels in Chapter 31, Still on the Third Edition

DMH writes ASAM numbers straight into its rule, which not every state does. Rule 31.1.A lists Level 3.1 Low-Intensity (once called Transitional Residential), 3.3 Population Specific High-Intensity, 3.5 Clinically Managed High-Intensity (once called Primary Residential) and 3.7. The rule’s own labels for 3.7 drift. Rule 31.1.A says “Medically Managed” and the heading of Rule 31.8 says “Medically Monitored,” and we follow the heading.

Level 3.5 carries the most concrete schedule. Each resident gets a medical assessment within 48 hours of admission, the program needs access (on staff or by contract) to a licensed psychiatrist, psychologist or physician with SUD experience, and the week has to include at least 1 hour of individual therapy, 5 hours of group and 20 hours of psychoeducation.

Chapter 50 handles withdrawal management at three ASAM levels: ambulatory 2-WM, residential 3.2-WM and medically monitored 3.7-WM. DMH’s description of 3.2-WM adds that it is “sometimes referred to as “social detox”,” and at that level no medical or nursing staff need be on site, provided 24-hour medical evaluation and consultation and a hospital agreement are in place. At 3.7-WM a physician is reachable by phone around the clock, the assessment happens within 24 hours, an RN does a nursing assessment and residents are observed hourly for the first 24 hours. One line in Chapter 50 reaches every residential house, detox or not: “All Residential Agency Providers must have a current contract on file with a Level 4 Medically Managed Intensive Inpatient Withdrawal Management Agency Provider.”

The edition is the detail out-of-state operators miss. In Provider Bulletin PR0146 (November 28, 2023), DMH told its programs they “will be expected to continue utilizing The ASAM Criteria, 3rd Edition.” We did not see a later bulletin changing that, though we did not open every one. So a Mississippi residential program writes its placement criteria and level descriptions to the Third Edition.

That creates an odd fit with the outside credential that verifies levels. CARF’s ASAM Level of Care Certification says “Certification is available for adult Levels of Care 3.1, 3.5, and 3.7,” and ASAM describes the rating elements as updated to the Fourth Edition. A Mississippi house seeking it would be surveyed against Fourth Edition elements while its DMH paperwork stays on the Third, so plan for two sets of documents. DMH doesn’t require the certification, and nothing we read suggests it would appear on a Certificate of Operation, but anyone checking can find a certified program in CARF’s provider search by using its certification filter for the ASAM level in question. It does not reach Mississippi’s 3.3 level or any withdrawal management level, 3.7-WM included.

A Restraint Ban and an Eight-Hour Clock

Two rules in Chapter 15 change how a Mississippi house runs day to day. The first is absolute: “The use of physical, mechanical, or chemical restraints in any setting is not allowed.” Seclusion and time-out are allowed only in Crisis Residential units, and any use of either has to be reported. A residential SUD program has no restraint option at all, so its de-escalation training and its transfer agreements carry the weight.

The second is the reporting clock. A death of a person served in SUD residential treatment, and suspected or confirmed abuse, neglect or exploitation on the property, at a sponsored event or in provider transport, require a verbal report to DMH within eight hours, then a written Incident Report within 24 hours. A longer list of events, including suicide attempts, any elopement, confirmed medication errors and any vehicle accident involving a person served, is due within 24 hours. Follow-up goes into DMH’s designated system within seven calendar days. Two routine filings round this out. Each residential program enters its daily census in DMH’s electronic Bed Registry by 5:00 p.m. Central, and every SUD program sends DMH its MSAMIS data report for the month by the 10th working day after it ends.

Certificate of Need for Chemical Dependency Beds

Mississippi still runs a Certificate of Need program through MSDH, and the statute names this field directly. Under Miss. Code 41-7-191(1)(d), offering “Licensed chemical dependency services” not provided in the prior 12 months requires a certificate, and chemical dependency hospitals are covered facilities. The statute’s facility list doesn’t include a community residential program certified by DMH, and it expressly excludes private practice offices, so our reading is that a DMH-certified house needs no CON. A hospital unit or MSDH-licensed freestanding unit does.

The CON law changed this year. 2026 House Bill 3 became law (Chapter 301) when the Governor approved it on February 4, 2026, effective on passage, and it raised the capital expenditure thresholds. MSDH’s page lists the adjusted 2026 figures as $20,000,000 for non-clinical projects, $10,000,000 for clinical health services and $3,000,000 for major medical equipment. It left chemical dependency services on the list of activities that need a certificate. MSDH’s CON forms page has the Notice of Intent, the substantive review application and the Determination of Reviewability form.

Medication for Addiction Treatment in a Mississippi Residence

DMH doesn’t make a residential program prescribe MOUD itself, at least in the chapters we read (31, 49 and 50). It does require a written answer for people who arrive on it. Rule 49.1.B.6 lists, among the policies every certified SUD provider must keep, “Acceptance and accommodation of people entering treatment services utilizing medication assisted treatment (MAT) or beginning the use of medication assisted treatment after admission to treatment services.” That second clause matters for intake design, because the policy has to cover a resident who starts buprenorphine on day ten as well as one who walks in on it.

Methadone stays outside the house. Opioid treatment programs are certified separately under Chapter 53, which approves a new one only where existing services don’t meet the need and requires a current CARF certification, so a residential program sets up a written coordination agreement with a certified OTP for any resident on methadone. Buprenorphine is simpler. In a letter to registrants dated January 12, 2023, DEA wrote that “A DATA-Waiver registration is no longer required to treat patients with buprenorphine for opioid use disorder,” and that buprenorphine prescriptions “only require a standard DEA registration number.” State law adds a layer. Miss. Code 41-29-125, as it reads in a 2026 bill that reproduced the current section, says a person who dispenses controlled substances must be registered with the board that licenses them, such as the State Board of Medical Licensure or the Mississippi Board of Nursing. Pregnant women go to the front of the line under Rule 49.4.A, which says they “may not be placed on a waiting list.”

Where Ketamine Fits in a Mississippi Inpatient Program

A full-text search of DMH’s 448-page Operational Standards found no mention of ketamine, and we found nothing on it from MSDH. The licensing conclusions below are ours. The nursing, prescribing and federal points rest on the documents linked in each paragraph.

For a DMH-certified house, ketamine is a change to the program rather than a new license type. It isn’t a certifiable service, so there is no box to check. Rule 7.3 does require a written report for “Changes in service scope (such as major components of a service, age ranges, and/or the population served, etc.),” and anticipated changes are due within 48 hours of the decision to make them. Under Rule 7.3.C, DMH can require an application for a reported change, depending on its nature. We would send the protocol to certification@dmh.ms.gov and wait for DMH’s reply before the first dose. Keep the restraint ban in mind while writing that protocol. Chemical restraint is prohibited in every DMH setting, so the chart should show ketamine ordered as treatment for a diagnosed condition, with the resident’s informed consent, and never in response to behavior. In an MSDH chemical dependency unit the question goes through the unit’s physician, since the MSDH rule makes a physician responsible for patient care there.

The Nursing Board Statement Names Ketamine

Here the nursing board has put the drug’s name into a scope limit. The Board of Nursing’s position paper on IV moderate sedation, which the board last reviewed on April 11, 2025, puts ketamine by name on a short list of anesthetic agents, next to propofol, etomidate and fospropofol, that a registered nurse may not give unless the nurse is a qualified anesthesia provider. Watching over a patient who got such an agent from another licensed professional is ruled out for that nurse as well. The statement is about sedation, and the board’s list of position statements has nothing separate on low-dose psychiatric ketamine. We read the gap cautiously. Until the board says otherwise, a Mississippi program should not plan on an RN giving IV ketamine or serving as the monitor, and should keep administration with a physician or a qualified anesthesia provider. Nasal esketamine is a different product, but put the RN’s role in writing and check it with the board before relying on it.

Nurse practitioners work inside a fixed frame. Miss. Code 73-15-20, as reproduced in 2026 House Bill 40 (a bill that died, so the existing text stands), says an APRN “may not practice as an APRN if there is no collaborative/consultative relationship with a physician or dentist and a board-approved protocol or practice guidelines,” and allows Schedule II through V prescribing after a board-approved program. None of the 2025 or 2026 bills aimed at loosening that collaboration requirement was enacted.

Registrations and Reporting

Ketamine sits on the federal Schedule III list (21 CFR 1308.13(c)(7)), which means the prescriber needs a DEA registration plus the Mississippi registration from their licensing board described above. Mississippi’s prescription monitoring statute, Miss. Code 73-21-127 as carried in 2025 House Bill 856 (Chapter 509, approved April 23, 2025), makes reporting “mandatory and required by the State Board of Pharmacy for any entity dispensing controlled substances.” The same act defines administering separately from dispensing, and we could not confirm whether a dose given on the unit has to be reported, so ask the Board of Pharmacy. Spravato adds a federal layer. Its REMS program requires that healthcare settings dispensing it be certified, and “patients are required to be monitored by a healthcare provider for at least 2 hours.”

Picking the Right Residents

Ketamine has no FDA approval for treating a substance use disorder, so it is not MOUD and does nothing to satisfy Rule 49.1.B.6. The residents it may suit are the ones whose depression or post-traumatic symptoms are still heavy after withdrawal has passed and an antidepressant has had a real trial. Anyone whose history includes misuse of ketamine, PCP or other dissociatives is a poor candidate. The program’s physician writes the actual criteria, and we would hold the first dose until a resident has settled into the routine of the house.

After Discharge, an Outpatient Practice

A residential stay gives a resident round-the-clock observation for the first sessions, which is the strongest argument for starting there. The rest of a series usually happens after discharge in an outpatient ketamine practice. Who may own that practice is an open question in Mississippi as far as our research goes. No corporate practice statute, rule or case surfaced, and the entity statutes were outside what we read. The conservative build is a practice owned by a Mississippi-licensed physician, with a separate management services company handling nonclinical work. How that clinic is set up is covered in the ketamine section of Mississippi Drug and Alcohol Outpatient Treatment Licensing.

Referrals between the two need a lawyer’s review first. The federal Eliminating Kickbacks in Recovery Act, 18 U.S.C. 220, sets penalties of up to $200,000 and 10 years “for each occurrence.” Its definition of a clinical treatment facility covers a setting “other than a hospital” that offers residential or outpatient SUD treatment “pursuant to licensure or certification under State law.” A DMH-certified house fits that wording, in our reading. Because Mississippi certification is optional, whether a house that never certified falls inside it is unsettled, and we would not build a referral arrangement that depends on the answer. We found no Mississippi patient brokering statute in our search.

Staffing a Mississippi Residential Program

Chapter 31 sets two firm numbers. Staff “must be on-site and available 24 hours per day, seven (7) days per week,” and no therapist or counselor may carry more than 12 adults. The person running the program needs two years of substance use treatment or prevention work and must be licensed by a professional board or hold DMH’s Mental Health or Addictions Therapist credential (Rule 11.6.A). Rule 11.4.A adds a full-time Executive Director at the agency level, and a medication prescriber has to be a psychiatrist (board certified or board eligible), a PMHNP, or some other licensed medical professional practicing within scope (Rule 11.4.D). DMH’s FAQ adds that staffing meeting the standards “must be in place in order to begin service provision,” so payroll starts before the first admission.

Counselor pay in Mississippi runs well behind the rest of the country. For the BLS occupation group covering substance abuse, behavioral disorder, and mental health counselors, the state’s median wage is $46,990 (OEWS, May 2025), which is $12,360 less than the national median of $59,350. Mississippi’s 25th and 75th percentiles are $38,760 and $58,560. Budget a program director plus four counselors at that median and the salary line is roughly $234,950 a year (5 x $46,990, our estimate), and the overnight staff, an Executive Director, nursing at 3.7 and benefits come on top. That payroll is easier to carry than it looks, because Mississippi’s counselor licensing ladder lets provisional staff do real clinical work while they earn their hours. Before a P-LPC can move up to full LPC licensure, the Board of Examiners for Licensed Professional Counselors wants 3,000 supervised hours spread over no fewer than 18 months, with direct client service making up at least 1,200 of them (30 Miss. Code R. 2201-4.3), and in DMH’s own glossary the P-LPC appears among its examples of a professional license. DMH’s own Substance Use Therapist track, as its PLACE rules effective July 28, 2026 call it, has no experience requirement at the provisional PCSUT level and asks for 24 months of full-time supervised work before the CSUT, though PLACE credentials are tied to employment in what DMH calls the state mental health system, so ask PLACE whether your program qualifies. Provisional staff paid below the licensed rate and supervised by a licensed clinical director usually trim spending on counselors by 40 to 60 percent, set against a roster where every counselor already holds a full license. At Level 3.7 or 3.7-WM, one RN overseeing several LPNs covers nursing more cheaply than RNs on every shift. Bed count and the levels you certify decide the final roster.

Joint Commission Accreditation as Supporting Evidence

Mississippi gives accreditation a narrow role. Under Rule 49.1.D, a Joint Commission accredited SUD program with no DMH funding must submit documentation of that accreditation when it seeks certification, and “DMH will determine if the documentation is sufficient to support certification in the specific substance use disorder service areas.” That is help with an initial file, not deemed status, and CARF and COA aren’t named in the rule. We found no renewal benefit for a private program. The only inspection relief we saw, in Rule 49.1.C, is limited to state or federal institutions and correctional facilities, where DMH may accept CARF, Joint Commission or similar certification in place of its Health and Safety standards. Rule 1.4.D runs the other way too, saying DMH certification “does not exempt a provider from any other certification/accreditation/licensing entity requirements.” On the hospital side, MSDH wrote its chemical dependency standards to “closely parallel” the old Joint Commission standards for alcohol and drug programs, but we found no state deeming provision there either.

How to Submit Your DMH Residential Certification Application

Everything runs through DMH’s Interested Provider Portal, reached from the “Become a Certified Provider” link on the Division of Certification page. The order is set by Rules 2.3 and 2.8 and the agency’s process guide:

1. Create a portal account and complete the DMH Interested Agency Provider Orientation.
2. Submit the agency application with the items on the Interested Provider Application Checklist, among them proof of incorporation from the Secretary of State, criminal background checks, three professional references, the policy manual, and a proposed budget backed by evidence that you can cover three months of operating expenses.
3. Pay the $150 nonrefundable application fee through DMH’s online payment portal once DMH sends its fee notice. Miss the 30-business-day window and DMH voids the application.
4. Once the agency itself is approved, submit an Application to Add a New Program per site, get through the initial Health and Safety inspection, and pay the $300 Initial Certification fee, which DMH must receive before it will issue a Certificate of Operation.

DMH tells you within 30 business days whether the packet is being held, gives 30 calendar days to fix an incomplete one, and allows three submissions at most. Initial certification lasts one year, with one six-month extension available, and the program must reach full certification in that window. The agency’s process guide mentions a six-month initial period, but Rule 2.9.E says one year and the rule controls. DMH’s FAQ says the whole process “may take an interested provider a year to become fully certified.” Our planning estimate for a residential program is 12 months or more from first submission. The Division of Certification answers questions by mail at 239 N. Lamar Street, Jackson, MS 39201, by phone at 601-359-1288, or by email at certification@dmh.ms.gov.

A hospital-based or MSDH-licensed unit takes the other road. Certificate of Need comes first, then a hospital license application on MSDH forms (Rule 41.2.6). Contact MSDH Health Facilities Licensure and Certification at P.O. Box 1700, Jackson, MS 39215-1700, or (601) 364-1100.

What Holds Up Mississippi Residential Files

The financial packet catches more applicants than the clinical one. Under Rule 2.8.G the budget has to show three months of operating expenses, documented with six months of bank statements and a CPA’s audited statements, or, for an entity not yet operating, proforma statements a CPA compiled. A thin reserve stalls the review. Missing the Level 4 withdrawal management contract is the next most common gap we’d expect, since Chapter 50 applies it to every residential provider. And a policy manual written to the ASAM Fourth Edition, borrowed from another state, reads wrong to a DMH reviewer still working from the Third.

Frequently Asked Questions

Not sure whether your beds belong with DMH or MSDH? Talk it through with us.

Sources

• Mississippi DMH: Division of Certification (checked October 18, 2026)
• Mississippi DMH, Operational Standards for MH, IDD and Substance Use Community Service Providers (effective November 1, 2024): Operational Standards (PDF) (checked October 18, 2026)
• Mississippi DMH: Interested Provider Orientation FAQs (PDF) (checked October 18, 2026)
• Mississippi DMH: Interested Provider Process guide (checked October 18, 2026)
• Mississippi DMH: Interested Provider Application Checklist (PDF) (checked October 18, 2026)
• Mississippi DMH: Application to Add a New Program, 2024 (PDF) (checked October 18, 2026)
• Mississippi DMH: Division of Certification online payment portal (checked October 18, 2026)
• Mississippi DMH, Provider Bulletin PR0146 (November 28, 2023): ASAM Criteria edition (PDF) (checked October 18, 2026)
• MSDH: Health Facilities Licensure and Certification (checked October 18, 2026)
• MSDH, Title 15, Chapter 52: Minimum Standards for Chemical Dependency Units (PDF) (checked October 18, 2026)
• MSDH, Title 15 Part 16 Subpart 1, Chapter 41: Minimum Standards of Operation for Mississippi Hospitals (PDF) (checked October 18, 2026)
• MSDH: Certificate of Need (checked October 18, 2026)
• MSDH: Certificate of Need forms (checked October 18, 2026)
• Mississippi Legislature, 2026 HB 3 (Chapter 301), Miss. Code 41-7-173 and 41-7-191: HB 3, As Sent to Governor (checked October 18, 2026)
• Mississippi Legislature: 2026 HB 3 history (checked October 18, 2026)
• DEA Diversion Control Division: Dear Registrant letter, January 12, 2023 (PDF) (checked October 18, 2026)
• Mississippi Legislature, Miss. Code 41-29-125 as reproduced in 2026 HB 1267 (died): HB 1267, As Introduced (checked October 18, 2026)
• Mississippi Board of Nursing: Position statement, Administration and Management of IV Moderate Sedation, reviewed April 11, 2025 (PDF) (checked October 18, 2026)
• Mississippi Board of Nursing: Position statements (checked October 18, 2026)
• Mississippi Legislature, Miss. Code 73-15-20 as reproduced in 2026 HB 40 (died): HB 40, As Introduced (checked October 18, 2026)
• Mississippi Legislature: 2026 bills affecting Miss. Code 73-15-20 (checked October 18, 2026)
• 21 CFR 1308.13(c)(7), via Cornell LII: Schedule III, ketamine (checked October 18, 2026)
• Mississippi Legislature, 2025 HB 856 (Chapter 509), Miss. Code 73-21-73 and 73-21-127: HB 856, As Sent to Governor (checked October 18, 2026)
• Janssen, SPRAVATO REMS: SPRAVATO REMS (checked October 18, 2026)
• 18 U.S.C. 220, via Cornell LII: Illegal remunerations for referrals to recovery homes, clinical treatment facilities, and laboratories (checked October 18, 2026)
• CARF: ASAM Level of Care Certification (checked October 18, 2026)
• ASAM: Level of Care Certification (checked October 18, 2026)
• CARF: Find a Provider (certification filter) (checked October 18, 2026)
• Mississippi DMH: Division of Professional Licensure and Certification (PLACE) (checked October 18, 2026)
• Mississippi DMH, PLACE: Professional Credentialing Rules and Requirements, effective July 28, 2026 (PDF) (checked October 18, 2026)
• Board of Examiners for Licensed Professional Counselors, 30 Miss. Code R. 2201-4.3, via Cornell LII: LPC licensure requirements (checked October 18, 2026)
• U.S. Bureau of Labor Statistics, OEWS May 2025, SOC 21-1018: Mississippi estimates (checked October 18, 2026)
• U.S. Bureau of Labor Statistics, OEWS May 2025, SOC 21-1018: National estimates (checked October 18, 2026)