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South Carolina Behavioral Health Licensing

This page is for anyone about to file with South Carolina’s health department for an addiction or mental health program, whether the building is new, being sold, moving or due for renewal, and for anyone still working from a policy binder that says DHEC on the cover.

Additional South Carolina Licensing Guides

A New Rule Number Over Text That Still Says DHEC

Dates, rule numbers and agency roles in this section come from the S.C. Code, the official Code of State Regulations and DPH’s own licensing pages. Where a sentence adds our own reading, it says so.

South Carolina’s addiction treatment rule changed its number and kept its words. What older guides, consultants and policy manuals call Regulation 61-93 is now Regulation 60-93, Standards for Licensing Facilities for Chemically Dependent or Addicted Persons. The history note in Chapter 60 of the official Code of State Regulations records the transfer from 61-93 by State Register Document No. 5352, effective May 23, 2025, and the same filing moved the hospital rule to 60-16 and the crisis stabilization unit rule to 60-125.

The agency had already changed by then. 2023 Act No. 60 abolished the Department of Health and Environmental Control and, as of July 1, 2024, S.C. Code 44-1-20 reads “There is created the South Carolina Department of Public Health.” Facility licensing now sits with the DPH Bureau of Health Facilities Licensing under Healthcare Quality. Open R.60-93 to its definitions, though, and you will still find “Department. The South Carolina Department of Health and Environmental Control.” Our reading is that DPH administers the rule all the same, because the 2025 transfer touched only its number, but anything you file today should cite R.60-93 and DPH.

The behavioral health agencies were reorganized a year later. 2025 Act No. 3, approved April 28, 2025, created the Department of Behavioral Health and Developmental Disabilities (DBHDD) from three component offices. The former Department of Alcohol and Other Drug Abuse Services became the Office of Substance Use Services (OSUS), and the former Department of Mental Health became the Office of Mental Health (OMH). As we read their pages, neither office issues facility licenses. OSUS describes partnering with county alcohol and drug abuse authorities and “a system of state-licensed and nationally accredited service providers,” which describes a funding network rather than a licensing role. A separate proposal for an Executive Office of Health and Policy never became law: S.915 stalled when the 2023 to 2024 session ended, and H.3613 has sat in House Judiciary since January 2025.

The latest piece is 2026 Act No. 146 (H.4189), signed by the Governor on May 15, 2026 and effective on approval. Among hundreds of conforming edits that followed the DHEC split, it rewrote the license appeal language in S.C. Code 44-7-320(B) and the contested case procedure in 44-1-60, under which the licensee gets thirty calendar days from the mailing date to ask the Administrative Law Court for a hearing. The online code runs only through the 2025 session, so the appeal wording it prints for both sections is out of date.

Primary Regulatory Agencies

Descriptions follow each office’s own web page, application form or enabling statute.

South Carolina Behavioral Health Licensing Snapshot

Rows restate the statute, rule or DPH page listed under Sources. A row that carries our own reading says so.

Primary SUD RegulatorDPH Bureau of Health Facilities Licensing, under R.60-93 (numbered R.61-93 until May 23, 2025)
Mental Health Facility LicensingDPH licenses psychiatric hospitals under R.60-16 and crisis stabilization unit facilities under R.60-125. We found no DPH license category for an outpatient mental health clinic
Residential TreatmentA Residential Facility license offering a Residential Treatment Program, staffed at 1 per 10 patients from 7 a.m. to 7 p.m. and 1 per 20 overnight
Outpatient TreatmentAn Outpatient Facility license, with satellites allowed in the main facility’s county or a contiguous county at $50 each
Withdrawal ManagementMedical or Social Withdrawal Management on a Residential Facility license, staffed at 1 per 10 patients at all times
Facility License RequiredYes for any listed facility caring for two or more unrelated persons (S.C. Code 44-7-260). Outpatient and residential services on the same premises need separate licenses
Certificate of NeedLimited. Hospitals, psychiatric hospitals included, need CON for establishment, construction or bed changes until the repeal on January 1, 2027. Freestanding SUD facilities have needed none since 2023 Act No. 20
National AccreditationNot required, and no deemed status, inspection waiver or fee reduction appears in R.60-93, R.60-16 or R.60-125
InspectionBefore the initial license, then as DPH decides, announced or not. Inspection fees are billed apart from license fees
License RenewalAnnual fees, renewal filed before the expiration date, and no renewal while enforcement is pending
Key RegulationsS.C. Code 44-7-110 et seq., 44-7-260 and 44-7-320, R.60-93 (SUD facilities), R.60-16 (hospitals), R.60-125 (crisis stabilization units), R.60-15 (CON), S.C. Code 44-53-290 (controlled substances registration), S.C. Code Title 40, Chapter 75 (counselors)

License, Form and CON Status by Program

No DPH publication lines these programs up side by side. We assembled the table from the rules and forms cited, so the arrangement is ours.

ProgramDPH license and ruleApplication formCertificate of Need
Residential SUD treatmentResidential Facility, Residential Treatment Program (R.60-93)3293-ENG-DPHNo
Medical or social withdrawal managementResidential Facility (R.60-93)3293-ENG-DPHNo
Outpatient SUD treatmentOutpatient Facility (R.60-93)3295-ENG-DPHNo
Psychiatric hospitalHospital license, specialized hospital (R.60-16)3292-ENG-DPHYes, through December 31, 2026
Crisis stabilization unitCrisis stabilization unit facility (R.60-125)4042-ENG-DPHExempt, no written exemption needed
Outpatient mental health practiceNone that we found. Each clinician works under a personal professional licenseNoneNo

A search of the entire R.60-93 text turns up no mention of ASAM. South Carolina licenses a Residential Treatment Program and two kinds of withdrawal management in its own terms, so a level number never appears on a DPH license. An operator who wants a residential level that outsiders can verify has a separate route: CARF’s Level of Care Certification. CARF certifies adult residential programs at ASAM Levels 3.1, 3.5 and 3.7 only, and ASAM says the program is delivered in partnership with CARF. In our view it maps onto a South Carolina Residential Treatment Program. Withdrawal management stays outside it, because neither organization certifies a withdrawal management level. Nothing on a DPH license would show it, as we read the rule, but a referral source can find it in CARF’s provider search by choosing the “ASAM Level of Care 3.7” certification filter, or the 3.1 or 3.5 option.

Programs Covered

  • Residential Treatment Programs licensed under R.60-93
  • Medical and social withdrawal management
  • Outpatient SUD facilities and their satellite sites
  • Office-based outpatient mental health practices
  • Psychiatric hospitals
  • Crisis stabilization unit facilities

Key Licensing Requirements

Taken from R.60-93 and the current DPH application forms, which carry 07/2025 and 08/2026 revision dates.

  • A DPH application on form 3293-ENG-DPH (residential) or 3295-ENG-DPH (outpatient), signed under oath and notarized, with proof of payment
  • Documents showing you own or lease the property, proof that the administrator meets the qualifications and, for a residential program, an emergency evacuation plan
  • Disclosure of every owner holding 5 percent or more
  • A full-time administrator with a related bachelor’s degree or a higher one, plus at least one counselor with full certification or licensure
  • A pre-licensure inspection showing substantial compliance before any patient is admitted
  • DPH authorization before adding services or beds, relocating or changing the service type

Frequently Asked Questions

What does South Carolina charge to license a behavioral health program?

DPH bills in two parts. The R.60-93 license fee is $75 a year for an outpatient facility plus $50 per satellite, and $10 per bed or $75, whichever is greater, for a residential facility. Inspection fees come on top: $450 for an outpatient initial, relocation or routine inspection, and $350 plus $25 per licensed bed for a residential one. A 16-bed residential program therefore pays $160 for the license and $750 for the initial inspection, while an outpatient clinic pays $75 and $450. Construction adds plan review fees from $750 to $2,500 or more and $500 site inspections at 50, 80 and 100 percent completion. A psychiatric hospital pays $10 per licensed bed under R.60-16. Rent, buildout and pre-opening payroll will dwarf every one of those numbers.

How long does licensing take in South Carolina?

Neither R.60-93 nor DPH’s licensing page publishes a decision deadline. The rule fixes the order instead: no license until the facility shows substantial compliance, no patients before the license, and for construction, plan approval before work begins with site inspections along the way. Our planning estimate, not a DPH figure, is 3 to 5 months for an outpatient facility and 5 to 9 months for a residential facility, most of it spent on the building and the plan of correction cycle. A new psychiatric hospital runs longer, and one that starts before December 31, 2026 must clear Certificate of Need review before construction.

Where do South Carolina applications usually stall?

Stale paperwork comes first. Policies citing R.61-93 and DHEC, or a form saved before the current 07/2025 SUD versions, tell a reviewer the packet was built from old material. Next is the same-premises rule, since a building with outpatient groups downstairs and residential beds upstairs needs two licenses. Then there is adding a service or beds after licensure without DPH authorization, which section 102.O of R.60-93 forbids. Some operators also budget months for a Certificate of Need that a freestanding SUD facility has not needed since May 16, 2023.

Will you guarantee a South Carolina license?

No. The Bureau of Health Facilities Licensing inspects, decides and issues the license, and nobody outside DPH controls that call. What we deliver is an application and a policy set written to the current R.60-93 or R.60-16 text, with the correct form and the correct rule number throughout.

What staffing and payroll should a South Carolina program budget for?

R.60-93 sets the floor. Every licensed SUD facility needs a full-time administrator with at least a bachelor’s degree in a related field and at least one counselor who is fully certified or licensed. A residential treatment program keeps 1 staff member or volunteer on duty for every 10 patients from 7 a.m. to 7 p.m. and 1 for every 20 overnight, withdrawal management holds 1 per 10 around the clock, and a medical withdrawal management program also needs a physician, licensed nurse or other authorized healthcare provider present at all times. On pay, BLS puts the South Carolina median for the substance abuse, behavioral disorder and mental health counselor occupation at $52,370 (OEWS, May 2025). The 25th percentile is $43,070 and the 75th is $65,070, and the state median sits $6,980 under the national figure of $59,350. Budget about $209,480 in yearly base salary for four counselors paid at the South Carolina median, with benefits extra. South Carolina’s own counselor rule keeps most of those seats from needing a fully credentialed hire. Under section 508 of R.60-93, a counselor who is not yet credentialed may work under direct on-site supervision while finishing certification, or moving from LAC Associate to full licensure, within three years of hire. One credentialed clinical lead can therefore supervise several of these counselors at an earlier-career wage, and teams built that way commonly spend 40 to 60 percent less on counseling salaries than a roster made up entirely of credentialed staff. Nursing in medical withdrawal management can work the same way, with one RN providing the general supervision the rule calls for over licensed nurses on the other shifts, once DPH confirms that its term licensed nurse covers LPNs in your program. Census and the services you license decide the final count.

Licensing

Which agency licenses addiction and mental health programs now?

DPH. Its Bureau of Health Facilities Licensing licenses SUD facilities under R.60-93, psychiatric hospitals under R.60-16 and crisis stabilization unit facilities under R.60-125. DBHDD’s offices fund and operate services, and Act 3 gives OMH “jurisdiction over all of the state’s mental hospitals, clinics and centers,” but by our reading of their pages neither OMH nor OSUS issues a facility license to a private operator.

Does CARF or Joint Commission accreditation shorten DPH’s process?

No. We searched the full text of R.60-93, R.60-16 and R.60-125 and found no deemed status, no inspection waiver and no fee break tied to accreditation. The only accreditation language in R.60-93 sits in the counselor qualifications. Accreditation can still carry weight with referral partners, but DPH inspects an accredited facility exactly as it inspects one without it.

Is a change to R.60-93 in the works?

We found none. A scan of State Register issues from June 2025 through September 25, 2026 showed no proposed or final change to R.60-93 or R.60-125, and DPH’s regulation development page says no emergency regulations are in effect. The October 23, 2026 issue had not been published when we checked.

Facility

Does a South Carolina program need a Certificate of Need?

Only a hospital project, and only until the end of 2026. Since 2023 Act No. 20, S.C. Code 44-7-160 requires CON for nursing homes and for “the construction or other establishment of a hospital” or “a change in the existing bed complement of a hospital,” and the statute’s definition of a health care facility names psychiatric hospitals and alcohol and substance abuse hospitals. Subsection (C) then provides “Effective January 1, 2027, Section 44-7-160(B) is repealed.” A freestanding R.60-93 outpatient or residential facility is not a hospital, so by our reading it needs no CON. Questions go to CONInfo@dph.sc.gov.

Can outpatient and residential services share one license?

No. Section 102.H of R.60-93 calls for separate licenses for separate facilities and for outpatient and residential services on the same premises. An outpatient facility can add satellites, but only in its own county or a contiguous one, and each satellite adds $50 to the license fee plus a $250 service modification inspection.

Do I need DPH approval before building or renovating?

Yes. DPH’s Act 20 FAQ says construction or alteration of a licensed facility “still requires plan and specification approval prior to beginning the construction or alteration.” Health Facilities Construction answers at (803) 545-4215. Get that review moving before you sign a construction contract, because R.60-93 also bills site inspections at 50, 80 and 100 percent completion.

Staffing

Which counselor credentials does R.60-93 accept?

Section 508 recognizes several routes. A counselor may hold the credential administered by the South Carolina Association of Alcohol and Drug Abuse Counselors Certification Commission, NAADAC certification, a credential from an IC&RC-approved board, or one from a body approved by the former DAODAS (now OSUS). Licensure as a psychiatrist, psychologist, social worker, professional counselor or marriage and family therapist also qualifies. At least one counselor on staff has to be fully credentialed. The state’s licensed addiction counselor credential requires a master’s degree or higher and a board-approved exam (S.C. Code 40-75-220), an associate license covers the stretch before supervised experience is complete, and an addiction counselor supervisor needs five years in practice.

What does the administrator position require?

A full-time administrator with at least a bachelor’s degree in a related field (section 502). When the administrator changes, DPH must hear within 72 hours, with the new name and effective date in writing within 10 days.

Operations

How do buprenorphine and other addiction medications fit?

R.60-93 never mentions buprenorphine, naltrexone or medication-assisted treatment, so by our reading it neither requires a program to offer them nor bars it. Since DEA’s January 2023 letter, buprenorphine for opioid use disorder needs only a standard DEA registration. On top of that, the state requires its own Controlled Substances Registration, issued by DPH’s Bureau of Drug Control, and DPH says providers cannot prescribe, administer, possess or dispense controlled substances without it. Methadone is dispensed only through a separately licensed opioid treatment program, and a program that lacks one should arrange coordination with one.

Which incidents must a South Carolina SUD facility report to DPH?

Section 601 lists incidents a facility reports “immediately, not to exceed twenty-four (24) hours,” through DPH’s electronic reporting system, among them suspected abuse or neglect by staff, a death, an overdose reversal with naloxone, a medication error, an attempted suicide and a residential patient’s elopement. A separate written investigation report follows within five days. A fire calls for an immediate phone call, email or fax to DPH, and the full written account is due no later than 48 hours after it. Theft or loss of controlled substances goes to local law enforcement and the Bureau of Drug Control within 72 hours. Incident records stay on file for six years after the patient stops receiving services.

Enforcement

What penalties can DPH impose?

S.C. Code 44-7-320 lets DPH deny, suspend or revoke a license, assess a monetary penalty, or both, within a range of $100 to $5,000 per violation. R.60-93 sorts violations into three classes. A first Class I violation, one presenting imminent danger, runs $500 to $1,500, a first Class II runs $300 to $800 and a first Class III runs $100 to $300, with repeat offenses climbing to $5,000. Until every finally assessed penalty is paid, no license is issued, reissued or renewed.

How does an appeal work after 2026 Act No. 146?

Act 146 rewrote both ends of the process. Since May 15, 2026, 44-7-320(B) has DPH send its notice by certified mail, return receipt requested, and the decision “may be appealed by requesting a contested case hearing pursuant to Section 44-1-60 and the Administrative Procedures Act.” Act 146 also rewrote 44-1-60 from top to bottom. A licensee now has thirty calendar days after the decision is mailed to request a contested case hearing before the Administrative Law Court, and the older step of asking for a final review conference first no longer appears. The online code still prints the pre-2026 wording of both sections, so work from the act and put the 30-day date on the calendar the day a notice arrives. An emergency suspension triggers a preliminary hearing within five calendar days under 44-7-320(A)(3). The road back after an action is covered in South Carolina License Reinstatement.

How We Work in South Carolina

What we take on

License applications under R.60-93 and R.60-16, policy manuals rewritten from R.61-93 references to the current text, plan of correction responses after a DPH inspection, sequencing a psychiatric hospital project around the 2027 CON repeal, and preparation for CARF or Joint Commission surveys.

What we refer out

Billing, payer enrollment and marketing. We are glad to point you to people who specialize in them.

Still running a South Carolina program on an R.61-93 era policy manual? Tell us where it stands.

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.

Sources

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