Nebraska 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: no online form, so request the initial application from the DHHS Licensure Unit at dhhs.ddbhfacilities@nebraska.gov | Questions: Office of Developmental Disabilities & Behavioral Health Facilities, (402) 471-9607

Nebraska puts a clock on withdrawal management that most states leave to the clinical team. In a licensed Mental Health Substance Use Treatment Center, detox is called an “emergency detoxification program,” and 175 NAC 18-006.08(G) recognizes two kinds. Civil protective custody is involuntary, started by law enforcement, and lasts 24 hours at most. Social setting detox is voluntary, started by the client or someone acting for them, and the rule caps it at 5 calendar days. A licensed physician has to document that the facility’s detox policies are appropriate. You won’t find a separate detox license to apply for. The withdrawal beds sit on the same residential license as the treatment beds, and DHHS counts them as inpatient beds when it sets the fee.

This guide follows an adult residential addiction program from application to opening day. Office-based and outpatient addiction care, which Nebraska no longer licenses as a facility, is in Nebraska Drug and Alcohol Outpatient Treatment Licensing. Psychiatric hospitals and residential mental health care are in Nebraska Mental Health Inpatient Licensing, and the full state picture is on Nebraska Behavioral Health Licensing.

One License Once a Stay Passes 24 Hours

Statute wording in this section comes from the Nebraska Legislature’s online code and rule wording from the Secretary of State’s official rules site. The DHHS lines are from the Licensure Unit’s own program page.

Neb. Rev. Stat. 71-423 defines the license by length of stay. A Mental Health Substance Use Treatment Center provides treatment “for a period of more than twenty-four consecutive hours to persons residing at such facility who have a mental illness or substance use disorder or both.” It is one of the health care facilities listed in 71-413 under the Health Care Facility Licensure Act (71-401 to 71-479), and 175 NAC 18-003 says anyone intending to establish, operate, or maintain one “must first obtain a license from the Department.” The licensing body is the Nebraska Department of Health and Human Services, Division of Public Health, Licensure Unit, and the program page puts these centers under its Office of Developmental Disabilities & Behavioral Health Facilities.

The same license covers both diagnoses. DHHS says “A facility may choose to provide services for mental illness disorders, for substance use disorders, or for both mental illness and substance use disorders.” Two rule chapters apply together: 175 NAC 18, titled Mental Health Substance Use Facilities and effective March 20, 2024, and the general facility chapter, 175 NAC 1, effective January 20, 2025. You may still see older material pointing mental health programs to Chapter 19 of Title 175. That chapter now appears on the Secretary of State’s list with no text at all, and 175 NAC 18 is the only chapter for these centers. Licensed professionals caring for clients under their own license in private practice are exempt, as are self-run and self-help programs.

The DHHS Division of Behavioral Health is a different office with a different job. Its job is money and oversight for publicly funded care, routed through Nebraska’s six behavioral health regions, and its regulations page says the law lets it regulate “the use of public funds for services.” That funding relationship sits outside the facility license, and we don’t handle it.

How Detox Fits Inside the Residential License

The two detox types don’t look alike in practice, so it helps to set them next to ordinary residential treatment. Everything in the table is in 175 NAC 18 except the last row, which comes from the fee schedule in 18-004.02.

Question	Civil protective custody detox	Social setting detox	Residential treatment
Who starts it	Law enforcement, involuntary	The client or a designee, voluntary	Admission under the facility’s own criteria
Longest stay the rule allows	24 hours	5 calendar days	No cap in 175 NAC 18
Medical role the rule names	Documented approval of detox policies	Documented approval of detox policies	Medical and clinical oversight of needs found in the assessment
Treatment plan review	No separate interval stated	No separate interval stated	Every 30 days for any inpatient level
Fee treatment	Counted as inpatient beds	Counted as inpatient beds	Counted as inpatient beds

One sentence in 18-006.08(G)(ii) reads “An inpatient facility must provide an emergency detoxification program.” Read literally, every residential center would need detox. We haven’t seen DHHS explain how it applies that line to a program that only admits people after withdrawal, so a program planning no detox beds should ask the Licensure Unit in writing before the policy manual is final. Restraint is the other place civil protective custody shows up, which the accreditation section below covers.

No ASAM Numbers on a Nebraska License

Neither 175 NAC 18 nor 175 NAC 1 uses ASAM levels. The rule asks for a program description listing “The levels of care and treatment provided, including inpatient and outpatient components, when applicable,” and it scales treatment plan reviews by intensity instead of by level number. So a referral source reading a Nebraska license learns the facility type and bed count, not whether the program runs at 3.1, 3.5 or 3.7. A program that wants its level verified by someone other than the state can turn to CARF’s ASAM Level of Care Certification, which “is available for adult Levels of Care 3.1, 3.5, and 3.7,” and ASAM describes the same three adult residential levels. It doesn’t reach withdrawal management, so Nebraska’s social setting and civil protective custody beds sit outside it. Nebraska doesn’t require it for the license. A program that earns it shows up in CARF’s provider search under the certification filter for its level.

Accreditation Decides Restraint, Seclusion and Locked Doors

Nebraska’s accreditation rule is about what staff may do in a crisis, not about skipping inspections. Under 175 NAC 18-006.05, locked or secured units, and restraint and seclusion written into a treatment plan, are reserved for centers holding Joint Commission, CARF, or Council on Accreditation status (the rule spells the last one out as Council on Accreditation for Children and Family Services). Without one of those, “a non-accredited mental health substance use treatment center is prohibited from using mechanical and chemical restraints and seclusion.” A non-accredited center falls back on hands-on restraint and time-out, and only after a physician has documented approval of its methods. Civil protective custody is the narrow exception the rule carves out.

The inspection side gives accreditation much less weight. Under 71-438(1), DHHS “may accept” an accreditor’s findings as evidence of compliance, which is permission, not a promise. We read both 175 NAC 1 and 175 NAC 18 for a deemed status provision or an inspection waiver for accredited centers and found neither. Two follow-on rules matter once a center is accredited. A facility licensed on the strength of accreditation DHHS has accepted must report to DHHS when that status is sanctioned, modified, terminated, or withdrawn (71-438(2)), and 71-448(4) makes an accreditor’s report of that kind a ground for discipline against any license under the Act. Our advice is to decide early whether the population you plan to serve will ever need seclusion or a locked unit, because that choice settles whether accreditation is a launch requirement or a later project.

Certificate of Need Stops at Long-Term Care and Rehab Beds

The Nebraska Health Care Certificate of Need Act (71-5801 to 71-5870) is still on the books, but 71-5829.03 limits it to two bed types, long-term care and rehabilitation. The definitions in 71-5803.10 and 71-5803.13 tie those to nursing facility, long-term care hospital and rehabilitation hospital beds. DHHS’s own hospital licensing page describes the program the same way: “CON prohibits new nursing home and rehabilitation beds, with a few specific exceptions.” Our reading is that a residential addiction center needs no CON.

Medications for Opioid Use Disorder in a Nebraska Residence

175 NAC 18 neither requires a center to offer medication for opioid use disorder nor bans it. The medication rule at 18-006.10(E) is about method: clients “receive medications only as legally prescribed by a medical practitioner in accordance with the five rights.” Unlicensed staff who give medications must follow 172 NAC 95, the medication aide rules.

State drug law treats buprenorphine differently from other opioids. Neb. Rev. Stat. 28-412(1) makes it unlawful to prescribe a listed narcotic for detoxification or maintenance treatment, “except buprenorphine,” outside that section’s registration track. Methadone maintenance therefore runs through a separately registered opioid treatment program, and a residential center that doesn’t hold that registration coordinates with one for any resident who doses there. Buprenorphine is the simple case. A DEA letter dated January 12, 2023 confirms that “A DATA-Waiver registration is no longer required to treat patients with buprenorphine for opioid use disorder,” and DHHS states that “Nebraska does not issue a separate state-controlled substance registration,” so a prescriber’s DEA number is the whole registration picture. In our view the cleanest setup is a named prescriber under written agreement, a pharmacy plan for continuing doses, and an admission policy that says plainly a resident on buprenorphine or naltrexone keeps taking it.

Adding Ketamine to a Mental Health Substance Use Treatment Center

No Nebraska licensing rule names ketamine. What follows is our reading of 175 NAC 1 and 18, the Board of Nursing’s advisory opinions and the statutes cited, so put the plan in front of the Licensure Unit before the first dose.

We see room for it. Because the center’s license covers mental illness and substance use disorder together, a resident’s co-occurring depression or PTSD is already within what the facility is licensed to treat, and 175 NAC 18 contains no list of permitted or banned drugs. The same medication rule applies as for anything else: a legally prescribed order and the five rights. The rule separately asks inpatient facilities for “Medical and clinical oversight of client needs as identified in the client assessment,” which for ketamine means the assessment has to say why it is being used and who watches the resident afterward.

The paperwork question is whether ketamine is a new service. 175 NAC 1-005.01(C) requires notice at least 30 days before a licensee changes “the type of services provided,” and the DHHS program page says of added services that “An onsite inspection is required before the additional services can be provided.” In our reading a ketamine protocol inside a licensed center could trigger both, so we’d send the written notice early and ask whether DHHS wants an inspection before starting.

What the Board of Nursing Has Said

Nebraska’s Board of Nursing has two advisory opinions on point, and the DHHS page that lists them says “These opinions are informational only and are nonbinding.” The Sub-Anesthetic Ketamine opinion, adopted in June 2014 and reaffirmed in May 2022, deals with nurses giving low-dose ketamine for pain in acute care. It leaves out IV bolus dosing and expects that “Qualified personnel and equipment are available for resuscitation at all times.” It says nothing about infusions for depression, so a residential center borrowing it should treat it as a floor for nursing competency and pump protocols, not a green light. The Esketamine (Spravato) Direction and Monitoring opinion from July 2022 restates the REMS condition that patients “be monitored by a healthcare provider for at least 2 hours following administration of the medication,” and it recognizes that a nurse practitioner board certified in psychiatric mental health may diagnose, prescribe and administer. Since July 1, 2026, 2026 LB905 has folded the old APRN board into the Board of Nursing, so questions about either opinion go to that one board now.

Registration, the PDMP and Spravato

Ketamine is Schedule III under Nebraska law (28-405, item 25: “Ketamine, its salts, isomers, and salts of isomers.”). With no state controlled substance registration in Nebraska, the prescriber needs DEA registration and nothing more from the state on that front. The prescription monitoring statute, 71-2454(2)(b), covers drugs that are “dispensed,” entered daily by the dispenser, and in our reading a dose given and observed on the unit isn’t a PDMP entry. That doesn’t excuse the record. Section 28-411(1) still has a practitioner who administers controlled substances keep a record of what was received and of what was “administered or professionally used by him or her,” apart from doses given under a prescriber’s medical order. For Spravato, the manufacturer’s REMS information says it “can only be administered at healthcare settings certified in the SPRAVATO REMS Program,” so the center itself must be certified before the nasal spray is used there.

Residents We Would and Would Not Start

The FDA label for Ketalar lists only anesthetic uses, and no ketamine product is approved to treat a substance use disorder. That keeps ketamine out of the MOUD column above. The resident we’d consider has finished withdrawal, has had a fair antidepressant trial, and is still held back in treatment by depression or trauma symptoms. We’d pass on anyone with a recent history of ketamine, PCP or other dissociative use, and on anyone still in social setting detox, whose 5-day window is too short and too unsettled to judge a response.

Finishing the Series After Discharge

A residential stay gives the first doses round-the-clock observation, but a course of treatment usually runs past discharge. The later sessions belong in an outpatient practice, and Nebraska doesn’t license outpatient-only programs as facilities, so the questions become who owns the practice and who prescribes. Our search turned up nothing in Nebraska’s statutes, rules or appellate decisions that forbids a layperson from owning a medical practice. The Nebraska Professional Corporation Act does limit a professional corporation’s shareholders to “individuals who themselves are duly licensed,” which only matters if you choose that form. Our preference is still a practice entity owned by the treating physician, with a separate management company handling the lease, staff and billing for a fee unrelated to patient volume. The outpatient guide’s ketamine clinic section covers that setup in more detail.

The referral path between the two needs a lawyer’s eye. Under 18 U.S.C. 220, a clinical treatment facility is “a medical setting, other than a hospital, that provides detoxification, risk reduction, outpatient treatment and care, residential treatment, or rehabilitation for substance use, pursuant to licensure or certification under State law.” A Nebraska center licensed to treat substance use disorder fits that description, so in our reading any payment tied to referrals into it, for services a health care benefit program covers, falls under the statute, which carries up to $200,000 and 10 years in prison “for each occurrence.” We’d read a center licensed only for mental health, and an unlicensed outpatient ketamine practice, as outside the definition, but the safer plan is no referral payments in either direction. Nebraska adds its own rule for credential holders: 38-179 treats splitting fees “with any person for bringing or referring a consumer” as unprofessional conduct. We didn’t find a separate Nebraska patient brokering statute.

Staffing a Residential Center in Nebraska

175 NAC 18 sets no staff ratios, names no medical director and says nothing about round-the-clock nursing or awake overnight staff. What it demands is judgment backed by records: “a sufficient number of staff with the required training and skills” for the people the center serves, an administrator plus a named stand-in, written notice to DHHS within 5 working days when the administrator position goes vacant, credential checks, health screening, orientation and training files. The center must arrange licensed mental health professional services that fit its clients and give every client access to a qualified health care professional. Before hiring unlicensed direct care staff, it runs a criminal background check plus four registry checks: the Nurse Aide Registry, the Adult Protective Services Central Registry, the Central Register of Child Protection Cases and the Nebraska State Patrol Sex Offender Registry.

Counselor pay in Nebraska runs above the national figure. The May 2025 BLS figures show Nebraska substance abuse, behavioral disorder, and mental health counselors earning a median $63,770 (OEWS, May 2025), a range of $47,040 at the 25th percentile to $81,740 at the 75th. Nationally the median is $59,350. A clinical director and five counselors paid at the state median come to about $382,620 a year (6 x $63,770, our estimate), and that is before the administrator, overnight staff, nursing and benefits. That figure drops a good deal once you build the team around Nebraska’s provisional counselor license. Under 38-313 and 38-314, a Provisional Alcohol and Drug Counselor (PLADC) needs a high school diploma or equivalent, 270 hours of education and 300 hours of supervised practical training, may hold provisional status once for up to six years, and can’t provide services without clinical supervision. Becoming a Licensed Alcohol and Drug Counselor (LADC) takes the IC&RC exam and 6,000 hours of paid, supervised work (38-316), with one hour of face-to-face supervision for every 40 hours worked (38-317), and a master’s degree in a listed field substitutes for 4,000 of those hours. Put a clinical director in charge of that supervision, start PLADC hires below the licensed rate while they log hours, and clinical payroll typically lands 40 to 60 percent under what an all-LADC roster would cost. One RN overseeing several LPNs covers medication and monitoring at lower cost than an all-RN schedule. Census and how much detox you run will set the final roster.

Two details trip up new teams. 172 NAC 15-005.03 throws out any Nebraska hours a counselor logs before holding the provisional license, so get each new hire’s PLADC in hand before their first shift. And counselor oversight moved on July 1, 2026, when 2026 LB905 retired the Board of Alcohol and Drug Counseling and handed LADC and PLADC matters to the Board of Mental Health Practice. The DHHS alcohol and drug counselor page hadn’t been updated to name the new board when we checked.

How to Submit Your MHSU Application

DHHS doesn’t post the initial application. The program page simply says “Contact the Licensure Unit for an initial license application.” Email dhhs.ddbhfacilities@nebraska.gov or call (402) 471-9607 (fax (402) 742-2326), Monday to Friday, 8:00 a.m. to 5:00 p.m. The mailing address is DHHS Licensure Unit, Attn: MHSU, PO Box 94669, Lincoln NE 68509-4669, and the office sits on the 3rd floor of the Nebraska State Office Building, 301 Centennial Mall South, Lincoln NE 68508.

The packet carries more than the form. Section 71-433 asks for the owner, the people in control and evidence the applicant can comply, signed by two officers if the applicant is a corporation or two members if it is an LLC. 175 NAC 1-003.02 adds schematic plans, State Fire Marshal approval for occupancy, a current zoning permit, Secretary of State registration for an out-of-state entity, and either architect or engineer certification for new construction or a local operating permit or structural safety statement for an existing building. Every initial, renewal and reinstatement application also needs lawful presence documents under Neb. Rev. Stat. 4-108 to 4-111.

The fee depends on licensed beds: $250 for 1 to 16, $275 for 17 to 50 and $300 for 51 or more (175 NAC 18-004.02). DHHS says the announced onsite inspection “Takes place onsite within 30 working days of receiving a completed application. The facility should be furnished and ready to operate.” Nothing in the statute or rules gives a deadline for issuing the license after that visit, and the facility “cannot operate until completion of an onsite inspection and the Licensure Unit has issued a license.” If DHHS finds substantial compliance without imminent danger, 71-437 allows a provisional license of up to one year that can’t be renewed. Every license expires on September 30, and renewals go through the online link on the DHHS Licensure Unit home page. Licenses are not transferable, so a buyer of an existing center applies as new.

Where Nebraska Residential Files Stall

The building approvals cause most of the waiting we’d expect. Fire Marshal occupancy approval and the zoning permit both have to be in the packet, and the inspection won’t happen until the place is furnished and ready, so a lease signed before either approval is a risk. Next comes the detox question above, left unasked until the inspector reads the policy manual. Restraint policies copied from an accredited program are another, because a center without TJC, CARF or COA accreditation can’t use mechanical or chemical restraint or seclusion at all. Finally, watch the notice deadlines. Under 175 NAC 1-005.01, DHHS should hear about a sale, lease, move or change in services at least 30 calendar days ahead, while the DHHS web page gives shorter windows for some of those changes. The rule is the one we’d plan around.

Frequently Asked Questions

Weighing whether your Nebraska center needs accreditation before it opens? Send us a note.

Sources

• Neb. Rev. Stat. 71-401: Health Care Facility Licensure Act (checked October 19, 2026)
• Neb. Rev. Stat. 71-423: Mental health substance use treatment center, defined (checked October 19, 2026)
• Neb. Rev. Stat. 71-413: Health care facility, defined (checked October 19, 2026)
• Neb. Rev. Stat. 71-433: License application contents (checked October 19, 2026)
• Neb. Rev. Stat. 71-437: Provisional license (checked October 19, 2026)
• Neb. Rev. Stat. 71-438: Accreditation as evidence of compliance (checked October 19, 2026)
• Neb. Rev. Stat. 71-448: Grounds for disciplinary action (checked October 19, 2026)
• Neb. Rev. Stat. 71-5829.03: Certificate of Need, long-term care and rehabilitation beds (checked October 19, 2026)
• Neb. Rev. Stat. 71-5803.10 and 71-5803.13: Long-term care bed and rehabilitation bed definitions (checked October 19, 2026)
• Nebraska Secretary of State, Title 175 (175 NAC 1 and 175 NAC 18): Health Care Facilities rules (checked October 19, 2026)
• Nebraska Secretary of State, Title 172, 172 NAC 15: Alcohol and Drug Counselors (checked October 19, 2026)
• Nebraska DHHS, Licensure Unit: Mental Health Substance Use Treatment Centers (checked October 19, 2026)
• Nebraska DHHS, Licensure Unit: Licensing home page (checked October 19, 2026)
• Nebraska DHHS, Licensure Unit: Hospital Licensing and Certificate of Need (checked October 19, 2026)
• Nebraska DHHS: Division of Behavioral Health (checked October 19, 2026)
• Nebraska DHHS: Behavioral Health Regulations, Contracts and Guidance (checked October 19, 2026)
• Nebraska DHHS, Licensure Unit: Alcohol and Drug Counselor (checked October 19, 2026)
• Neb. Rev. Stat. 38-313 to 38-317: Alcohol and Drug Counseling Practice Act, licensure requirements (checked October 19, 2026)
• Nebraska Legislature, 2026 LB905 slip law: Board of Mental Health Practice and Board of Nursing changes (PDF) (checked October 19, 2026)
• U.S. Bureau of Labor Statistics, OEWS May 2025, SOC 21-1018: Nebraska estimates (checked October 19, 2026)
• U.S. Bureau of Labor Statistics, OEWS May 2025, SOC 21-1018: National estimates (checked October 19, 2026)
• Neb. Rev. Stat. 28-412: Narcotic drugs for detoxification or maintenance treatment (checked October 19, 2026)
• DEA Diversion Control Division: Dear Registrant letter, January 12, 2023 (PDF) (checked October 19, 2026)
• Nebraska DHHS, Licensure Unit: Nursing controlled substance information (checked October 19, 2026)
• Neb. Rev. Stat. 28-405: Schedules of controlled substances (ketamine, Schedule III) (checked October 19, 2026)
• Neb. Rev. Stat. 28-411: Practitioner records of controlled substances (checked October 19, 2026)
• Neb. Rev. Stat. 71-2454: Prescription drug monitoring program (checked October 19, 2026)
• Nebraska DHHS, Board of Nursing: Nursing Advisory Opinions (checked October 19, 2026)
• Nebraska Board of Nursing: Sub-Anesthetic Ketamine advisory opinion (PDF) (checked October 19, 2026)
• Nebraska Board of Nursing: Esketamine (Spravato) Direction and Monitoring advisory opinion (PDF) (checked October 19, 2026)
• Janssen, J&J Medical Connect: How will I take SPRAVATO (REMS and monitoring) (checked October 19, 2026)
• U.S. Food and Drug Administration: KETALAR (ketamine) prescribing information, indications (PDF) (checked October 19, 2026)
• Neb. Rev. Stat. 21-2202: Nebraska Professional Corporation Act, definitions (checked October 19, 2026)
• Neb. Rev. Stat. 38-179: Unprofessional conduct, fee splitting for referrals (checked October 19, 2026)
• 18 U.S.C. 220, via Cornell LII: Illegal remunerations for referrals to recovery homes, clinical treatment facilities, and laboratories (checked October 19, 2026)
• CARF: ASAM Level of Care Certification (checked October 19, 2026)
• ASAM: Level of Care Certification (checked October 19, 2026)
• CARF: Find a Provider (Certification filter) (checked October 19, 2026)