New Hampshire Drug and Alcohol Inpatient Licensing

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

Apply now: Health Facility Application, Initial or Renewal (HFA, mail to 129 Pleasant Street, Concord, NH 03301) | Questions: hfa-licensing@dhhs.nh.gov or (603) 271-9039

New Hampshire Drug and Alcohol Inpatient Licensing: Facility and Program Requirements

Correction (October 2026): an earlier version said BDAS separately certifies every SUD program under RSA 172 and He-A 300 and described a BDAS “Application for Substance Use Disorder Program Certification.” The general He-A 301 certification rule is listed as expired in the official He-A table of contents. BDAS certification under He-A 304 covers opioid treatment programs, and the residential facility license comes from HFA.

New Hampshire runs residential SUD treatment through one state facility license, and the rule behind it reaches further into clinical practice than most operators expect.

One license, with clinical rules built in

Health Facilities Administration (HFA) licenses the facility itself under RSA 151 and the He-P 800 rules. The license covers the physical operation, whoever runs it, and the clinical side too: screening, ASAM-based assessment, personnel and medication services all sit inside the same rule. The Bureau of Drug and Alcohol Services (BDAS) comes in only if the program also dispenses methadone or buprenorphine as an opioid treatment program, which BDAS certifies under He-A 304. A 24-hour residential program is a Substance Use Disorder Residential Treatment Facility, or SUD-RTF, under the specific rule He-P 826, a category that explicitly excludes hospitals, so don’t assume hospital-based residential SUD units follow the same checklist.

Requiring ASAM-based assessment isn’t the same as having an outside body verify the level of care you deliver. That second piece is what CARF’s ASAM Level of Care Certification does for adult residential programs at Levels 3.1, 3.5 and 3.7. HFA’s SUD-RTF license may not reflect it at all, which is why the certification’s value lies in being checkable: referral sources and health plans can confirm it through CARF’s provider search.

What He-P 826 actually asks for

He-P 826 defines its credential tiers with unusual precision, and getting them right matters. The rule requires a Medical Director, specifically defined as a New Hampshire-licensed practitioner under RSA 329 or RSA 326-B, responsible for overseeing medical care quality in the facility. It also defines the counselor tier precisely: a “licensed counselor” is a Master Licensed Alcohol and Drug Counselor (MLADC), a Licensed Alcohol and Drug Counselor (LADC), or a licensed mental health professional who has demonstrated competency treating substance use disorders. A “licensed clinical supervisor” is either an RN licensed under RSA 326-B or someone licensed by the board overseeing alcohol and drug use professionals or mental health practice. Personnel files that blur these categories (treating any counselor as interchangeable with a clinical supervisor) are exactly what an inspector flags first.

Medication-assisted treatment in a residential setting

New Hampshire has leaned hard into expanding MAT access given the state’s disproportionate exposure to the opioid crisis, and that shows up in how residential programs are expected to operate. If your SUD-RTF isn’t itself certified as an opioid treatment program, you still need an actual, working pathway to buprenorphine or methadone access for residents who need it, meaning a coordination relationship with a real OTP that actually moves quickly, not a name on a resource list. Merrimack River Medical Services is one OTP operator in the state (check its current site list before you write it into policy), and naming the specific partner a program coordinates with holds up far better during an HFA inspection than describing the pathway in the abstract. Section 826.16(e)(9) of the 2018 rule text lists this among the core services: the licensee must “provide referral to, and assistance in accessing, medication-assisted SUD treatment, either on site or off site,” when clinically appropriate. Programs treating withdrawal management as separate from MAT access, rather than as something that should be coordinated together, tend to be the ones that struggle here.

Adding Ketamine to a New Hampshire SUD-RTF

Drawn from He-P 826’s change-of-service and medical director provisions and New Hampshire’s professional entity law. HFA hasn’t addressed ketamine directly, so this is an interpretation to confirm with HFA.

He-P 826 builds the opening for this into the rule itself. Every SUD-RTF already has a Medical Director, a New Hampshire-licensed practitioner responsible for the quality of medical care, and the 2018 text of He-P 826.08 requires written notice to the department at least 30 days before a change in services, with a description of the change and any new personnel it brings. The department then decides whether the added service fits the current license or needs a revised one. That 2018 version is the one we could read, so ask HFA whether the rule in force today handles service changes the same way.

New Hampshire APRNs have plenary authority to prescribe and administer controlled substances, which makes a psychiatric APRN a realistic owner of the ketamine protocol in a smaller residential program. No New Hampshire Board of Nursing guidance specific to psychiatric ketamine turned up in research for this page, so the facility’s written protocol has to set the dosing ceiling, the monitoring and who stays on site.

Who It’s For

A New Hampshire client becomes a realistic candidate once withdrawal is over and mood can be judged, and only when depression or PTSD has held up against standard treatment. A history of using ketamine or other dissociatives rules a client out. And because New Hampshire residential programs are expected to run a working MAT pathway, staff should be clear that ketamine sits outside it as an off-label psychiatric treatment.

After Discharge

The point of starting in residential care is supervision between sessions, and clients who respond can finish the series at an outpatient ketamine clinic once they leave. New Hampshire has no explicit corporate practice of medicine prohibition, so physicians can work as employees of a health care organization, and when they form their own professional corporation or PLLC the owners have to be licensed. The ketamine section of New Hampshire Drug and Alcohol Outpatient Licensing covers setting that clinic up beside an outpatient program. Referrals between an SUD-RTF and an affiliated clinic still need counsel’s review under the federal Eliminating Kickbacks in Recovery Act (18 U.S.C. § 220).

Staffing an SUD-RTF

New Hampshire’s addiction counselors earn a median of $52,460 a year statewide. LADCs typically run $45,000 to $60,000, MLADCs $55,000 to $75,000 or more. SUD-RTF programs cost more than outpatient care, since He-P 826 requires a Medical Director on top of counseling staff, and New Hampshire’s tight behavioral health workforce can make that recruitment itself a real cost and timeline factor. A single clinical supervisor overseeing several LADCs working toward their MLADC hours, at reduced wages in exchange for the supervised experience their next credential requires, can cut clinical staffing costs by 40 to 60% compared to a full roster of MLADCs. On the nursing side, most SUD-RTF programs can run with one RN fulfilling the licensed clinical supervisor role while relying on LPNs for the rest of nursing coverage.

How to Submit Your HFA Application

The license application goes to the Health Facilities Administration using the Health Facility Application, Initial or Renewal, mailed or hand-delivered to 129 Pleasant Street, Concord, NH 03301. For application questions, HFA’s contact is hfa-licensing@dhhs.nh.gov or (603) 271-9039. He-P 826.06 governs license terms and renewals. A license expires the following year on the last day of the month before the month it was issued, and the renewal application is due at least 120 days ahead of that date. If the license lapses with no complete renewal on file, the program is back to filing an initial application under He-P 826.04. Those terms come from the 2018 text of the rule, so confirm them with HFA before you build a calendar around them. A residential program that will also operate as an opioid treatment program files a separate He-A 304 certification application with BDAS.

Frequently Asked Questions

Does licensing a residential facility also cover the SUD program itself?

For most programs, yes. The HFA license under RSA 151 and He-P 826 covers the residential SUD program, including its clinical services. A separate BDAS certification under He-A 304 is needed only if the program also runs as an opioid treatment program dispensing methadone or buprenorphine.

Does a hospital-based residential SUD unit follow the same He-P 826 checklist?

No. The SUD-RTF category under He-P 826 explicitly excludes hospitals, so a hospital-based unit follows a different set of standards entirely.

What happens if my MAT referral relationship is just a name on a list?

Probably not well. He-P 826 makes referral to, and help accessing, MAT a core service, and in our experience an untested resource list is a weak way to show a resident can actually get buprenorphine or methadone. Programs that treat withdrawal management and MAT access as coordinated, not separate, tend to handle this well.

See our New Hampshire Behavioral Health Licensing page for the full picture.

This content is provided for general informational purposes only and should not be construed as medical, clinical, legal, financial, tax, accounting, insurance, licensing, accreditation, regulatory, billing, employment, or compliance advice. Requirements change often. Consult qualified professionals for guidance specific to your situation.

Working through HFA licensure for a New Hampshire residential program? Let’s talk it through.

Sources

• CARF: ASAM Level of Care Certification (checked October 8, 2026)
• 18 U.S.C. § 220 (Cornell LII): Illegal remunerations for referrals to recovery homes, clinical treatment facilities, and laboratories (checked October 8, 2026)
• NH Admin. Rules He-P 826.03 (Justia): SUD-RTF definitions (checked October 8, 2026)
• NH Admin. Rules He-P 826.14 (Justia): Duties and Responsibilities of the Licensee (checked October 8, 2026)
• NH Admin. Rules He-P 826.06 (Justia): License Expirations and Procedures for Renewals, 2018 text (checked October 9, 2026)
• NH Admin. Rules He-P 826.08 (Justia): Requirements for Organizational or Service Changes, 2018 text (checked October 9, 2026)
• NH Admin. Rules He-P 826.16 (Justia): Required Services, 2018 text (checked October 9, 2026)
• NH RSA 326-B:11, APRN scope (Office of Legislative Services): Advanced Practice Registered Nurse (checked October 9, 2026)
• NH Admin. Rules He-A 304.01 (Justia): Opioid treatment program certification, purpose (checked October 8, 2026)
• NH Office of Legislative Services: He-A rules table of contents (checked October 8, 2026)
• NH DHHS: Health Facilities Administration (checked October 8, 2026)
• NH DHHS: Health Facility Licensing Unit contact details (checked October 8, 2026)