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Indiana Drug and Alcohol Inpatient Treatment Licensing

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A. Ant, CADC-II

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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: DMHA Sub-Acute Stabilization Facility Certification | Regular Certification | Questions: DMHA-CL@fssa.in.gov

Residential substance use disorder treatment in Indiana is certified, not licensed in the usual sense, by the Family and Social Services Administration’s Division of Mental Health and Addiction (DMHA) under 440 IAC 4.4 and 440 IAC 7.5. For a program that wants to hold an ASAM designation, the path is three steps in a fixed order, and accreditation sits inside the first one.

Three Steps, in Order

StepWhat DMHA IssuesRuleAccreditation Role
1Addiction Services Regular Certification440 IAC 4.4-2-3Required, from a DMHA-approved accreditor
2Sub-Acute Stabilization Facility Certification440 IAC 7.5Each location added to the accreditation within 12 months of certification
3ASAM Level 3.1 or 3.5 designationDMHA designation programRequires steps 1 and 2 first

DMHA’s designation page names two levels, 3.1 and 3.5, and nothing else. Its February 2018 ASAM FAQ was blunter about detox: withdrawal management “is not a service that contributes to ASAM designation levels 3.1 or 3.5,” and DMHA “will not be designating facilities with the withdrawal management levels at this time.” We found no DMHA designation for Level 3.3 or Level 3.7 on any DMHA or Indiana Medicaid page. Indiana Medicaid’s SUD page pays residential care through provider specialty 836 with a 3.1 or 3.5 designation, and pays Level 4 inpatient SUD care through enrolled psychiatric hospitals (provider type 01, specialty 011). Our reading is that a medically monitored 3.7 program has no separate state designation to apply for in Indiana right now, so get DMHA’s answer in writing on how it will treat your program, for state certification and for Medicaid billing, before you build a staffing model or a budget around 3.7. That gap is on the state side only. Because DMHA’s designation stops at 3.1 and 3.5, a 3.7 level will not appear on an Indiana certification, but CARF runs a separate ASAM Level of Care Certification covering adult residential Levels 3.1, 3.5, and 3.7 (its program page names no withdrawal management level, so we would not assume it reaches 3.7-WM). Payers and referral sources can check a program in CARF’s provider search, which filters by “ASAM Level of Care 3.7,” though as we read it the CARF certification does not stand in for anything DMHA requires.

As for who may run the house at all, 440 IAC 6-2-2 accepts several certifications for operating a sub-acute stabilization facility, regular addiction certification and residential care provider certification among them. DMHA’s own residential care provider page, though, says that route is for a residential setting that “does not provide SUD treatment.” A treatment program that wants an ASAM designation should plan on regular certification plus the sub-acute certification.

Regular Certification Rides on Accreditation

Nothing about regular certification works without this piece in place first. Under 440 IAC 4.4-2-3, an entity must hold accreditation from an accrediting agency DMHA has approved to get and keep regular certification. The application must include proof of accreditation, the site survey recommendations, and your responses to them, and DMHA can require any action it considers necessary in response to the survey. The certification expires 90 days after the accreditation expires, and DMHA’s approved accreditation list currently includes CARF, The Joint Commission, the Council on Accreditation (whose survey must use addiction standards for regular certification), ACHC, and NCQA, with the Commission on Accreditation for Corrections listed for addiction services run by correctional agencies.

Indiana is more forgiving than most accreditation-first states about starting order. If you are not yet accredited, 440 IAC 4.4-2-3.5 allows a temporary certification for 12 months, provided at least one direct service provider holds a DMHA-approved addiction credential and you show proof that an accreditation application was submitted before it expires. DMHA can extend it once for up to 12 more months, and if you are not accredited within 24 months, you cannot reapply for regular certification for a year. Treat those 24 months as a hard clock, not a cushion.

Fifteen Residents, and the Bed Waiver Question

Size is where the rule and DMHA’s web guidance pull in different directions. The sub-acute rule says a facility “serves at least four (4) and not more than fifteen (15) individuals” (440 IAC 7.5-4-7(b)), and the next subsection lets the division director waive that limit only “for a sub-acute stabilization facility certified before January 1, 2003.” A rehabilitative sub-acute stay is also capped at one year, which the director can waive when a less restrictive setting is shown to be inappropriate. Separately, DMHA’s bed waiver request page, filed under DMHA’s Quality Assurance/Quality Improvement section, tells a program that will have 16 or more beds to file a waiver request, and the same page notes that DMHA’s designation program currently covers ASAM 3.1 and 3.5 only. That page cites no rule and does not say whether a facility certified after 2002 can use it. Our reading is that a new facility should be designed for 15 residents or fewer unless DMHA confirms in writing that it will grant more. If you do ask, the request goes in with a completed ASAM application, a floor plan showing bathrooms, showers, and beds, a list of direct care staff and credentials, an organizational chart or staffing plan, patient-to-staff ratios, a list of evidence-based practices, and the anticipated date of first enrollment. Build the staffing plan first. Ratios and credentials make up most of what the request asks you to show.

No Certificate of Need for Behavioral Health

Indiana’s certificate of need program, run by the Indiana Department of Health, covers comprehensive care facilities, which the department’s page calls nursing homes, under IC 16-29-7. Our reading is that a residential SUD program does not need a Certificate of Need, which removes a review step that adds months to the calendar in some other states.

Medication for Opioid Use Disorder in a Residential Setting

Opioid treatment programs are a separate approval under IC 12-23-18 and 440 IAC 10, on top of the regular certification this guide covers, and the statute requires “separate specific approval and certification” for each location. Indiana also restricts who can open a new one. IC 12-23-18-5.5(a) says the division “may not grant specific approval to be a new opioid treatment program,” then exempts programs run by a hospital licensed under IC 16-21, an institution licensed under IC 12-25, or a certified community mental health center. Even for those operators, subsection (d) lets DMHA approve “not more than nine (9) additional” programs after July 1, 2018, and only where it finds a need in the proposed location. A freestanding residential program that is none of those three things cannot get its own OTP approval, so methadone access runs through a written agreement with an existing certified OTP that covers transport, dosing records and continuity for residents already on methadone. Name that partner in your policies. DMHA also has an amendment to 440 IAC 10 in rulemaking (LSA 25-797), and its docket lists only anticipated dates, so check the rule in force when you file. Buprenorphine is easier. Since Congress ended the DATA waiver on December 29, 2022, DEA says buprenorphine prescriptions “only require a standard DEA registration number,” with no patient cap. Naltrexone, oral or injectable, is not part of that DEA letter at all, and your medical director should set its protocol. If you offer detox, DMHA’s regular certification checklist asks for a statement on company letterhead, signed by the CEO, that withdrawal management runs “under the supervision of a physician or a clinical nurse specialist licensed to practice in Indiana.”

Can an Indiana Residential Program Offer Ketamine?

DMHA’s addiction and residential rules never mention ketamine. This section reads them alongside Indiana’s controlled substance registration rules and the medical practice statute, so the conclusions are ours, and DMHA should confirm them in writing for your program.

We found no rule that stops a certified sub-acute stabilization facility from giving ketamine to a resident whose depression or PTSD hasn’t responded to standard care, and no rule written with it in mind either. The residential medication rule, 440 IAC 7.5-2-9, says each residential facility “shall administer or monitor prescription medications with the direction of a physician,” and only “staff who are authorized to administer medication under state law” may give them, following the accrediting body’s requirements as well. Because regular certification rides on accreditation, the accreditor’s medication standards will shape the protocol about as much as DMHA’s rule does. Ketamine is a Schedule III drug (21 CFR 1308.13(c)(7)) whose FDA label lists only anesthesia uses, so using it for depression is off-label, and it plays no part in the opioid treatment pathway described above.

Registrations for the Building

Indiana stacks a state registration under the federal one. The Professional Licensing Agency says “a separate registration is required for each location where a practitioner administers, stores or dispenses” controlled substances, unless the practitioner works under a facility’s controlled substance registration (CSR) under 856 IAC 2, and it tells practitioners to get the Indiana CSR before applying to DEA. DEA separately requires a registration for each place where controlled substances are dispensed or kept (21 CFR 1301.12(a)). For the residential site, that means a facility CSR or the prescriber’s own CSR at that address, plus a DEA registration there. INSPECT, the state’s prescription monitoring program, exempts “a drug administered directly to the patient” from dispenser reporting, so supervised doses given in the house don’t create INSPECT reports.

Nursing and Prescriber Roles

We found no Indiana State Board of Nursing position on registered nurses giving sub-anesthetic ketamine, so the order set, vital-sign checks and rescue plan should come from the medical director in writing. Indiana nurse practitioners practice “in collaboration with a licensed practitioner as evidenced by a practice agreement” (IC 25-23-1-19.4). If an APRN will order the infusions, we’d list ketamine in that agreement by name. If the program chooses Spravato (esketamine) instead, the site must be certified in the Spravato REMS, the resident self-administers under direct observation, and the label calls for monitoring “for at least 2 hours at each treatment session.” The REMS enrolls patients treated in outpatient settings, so ask the REMS program which category a residential house falls into before the first session.

Before launch, send the protocol to DMHA at the certification address on its QA/QI page and ask your accreditor whether a new medical service needs to be reported ahead of the next survey. The residential rule doesn’t spell out a notice step for this, which is a reason to put the question in writing rather than skip it.

Where the Course Continues

A residential stay rarely lasts as long as a full ketamine series plus maintenance sessions, so the resident who responds usually finishes at an outpatient practice. Indiana’s medical practice statute protects physician employment by licensed hospitals and by health care organizations owned by physicians and other licensed providers (IC 25-22.5-1-2), which is why we’d build that practice around physician ownership. The ownership and registration details are in the ketamine section of Indiana Drug and Alcohol Outpatient Treatment Licensing. If money moves between the residential program and that practice in a way tied to referrals, the federal Eliminating Kickbacks in Recovery Act (18 U.S.C. § 220) reaches payments for referrals to a licensed or certified SUD treatment setting, with up to 10 years in prison per occurrence, so have counsel review the arrangement first.

Staffing a Residential Program

Staffing a residential program is where the real budget conversation starts. Under 440 IAC 7.5-4-7 a sub-acute stabilization facility provides “twenty-four (24) hour supervised treatment,” so plan for a clinical director, counselors whose credentials fit the acuity you accept, and direct-care and nursing coverage across every shift (that mix is our planning advice, not a ratio written into the rule). Addiction counselors are state licensed in Indiana by the Behavioral Health and Human Services Licensing Board under the Professional Licensing Agency, as the Licensed Addiction Counselor (LAC, bachelor’s level) and the Licensed Clinical Addiction Counselor (LCAC, master’s level), with associate tiers for people accruing supervised hours. DMHA also recognizes credentials from the Indiana Counselors Association on Alcohol and Drug Abuse (CADAC II through V) and the Indiana Association for Addiction Professionals.

Round-the-clock coverage adds real cost. Indiana counselors earn a median of $53,760 statewide (BLS OEWS, May 2025), about 9% below the $59,350 national median, with the middle half between $42,210 and $66,340, so a residential program with a clinical director, several counselors, and 24-hour direct-care staff commonly runs past $380,000 a year in payroll before nursing coverage. There is a way to bring that number down. One model worth pricing out puts an LCAC in the clinical director seat, fills counseling roles with LAC and associate-level clinicians who are still earning supervised hours, and pairs one RN with several LPNs for medical oversight instead of a registered nurse on every shift. Because regular certification depends on accreditation, your accreditor’s standards will shape that mix, so check its ratios before you hire, and let census and level of care set the final matrix.

DMHA Is Revising the Addiction Rules

Treat the current rule text as a moving target, not a permanent fixture. DMHA has said it is revising the administrative rules for addiction services so they are structured around the ASAM Criteria, with the ASAM levels of care and their support systems, therapies, and staffing built into the rule text. The page gives no adoption date, so ask DMHA which rule text governs your application before you file.

One change is already law. House Enrolled Act 1296 (2026) adds IC 12-23-25, effective July 1, 2026, which requires a recovery residence owner to “register with the division,” at $500 per residence for a two-year registration and $350 to renew, capped at $2,000 for an owner with several houses. An unregistered owner may not use the words “recovery residence” to describe a facility. If your residential program refers discharges to sober housing it runs, or plans to open some, that house needs its own registration, separate from the treatment certifications above.

How to Submit Your DMHA Application

DMHA takes certification applications through its Provider Portal, and its QA/QI page points providers there rather than to paper forms. For regular certification, enter policies as rich text for admission criteria, confidentiality under 42 CFR Part 2, consumer intake assessments, consumer progress, consumer rights under IC 12-27, discharge planning, and treatment planning, then upload the CEO’s detoxification letter if you provide detox, your current fire and safety inspection report (with follow-up if violations were cited), and your accreditation documentation. 440 IAC 4.4-2-3(b) also calls for the accreditor’s site survey recommendations and your responses to them. The sub-acute application is heavier on the building: besides admission criteria, discharge criteria, a list of waivers and a program description, DMHA wants floor plans with square footage and bed counts, the Department of Homeland Security construction design release or exemption, local zoning documentation, Indiana Department of Health retail food plan approval, septic approval if the site uses one, and a CEO statement on restraint, seclusion and locked egress. DMHA’s QA/QI page lists DMHA-CL@fssa.in.gov under its Certification / Licensure heading for questions.

What Delays Indiana Residential Applications

In our files, the same few mistakes account for most of the lost time. The most common delay is applying for the ASAM designation before the regular and sub-acute certifications are in place. The second is missing the 12-month window to add each sub-acute location to the accreditation. The third is a floor plan drawn past 15 residents on the assumption that a bed waiver will come through, when the rule’s own waiver covers only facilities certified before 2003. The fourth is treating the temporary certification as open-ended when the 24-month clock is fixed and a missed deadline blocks reapplication for a year.

Frequently Asked Questions

How long does it take to open a residential SUD program in Indiana?

Plan for roughly 12 to 18 months to a fully certified, ASAM-designated program, driven by the accreditation survey, the sub-acute certification, and, if you want more than 15 residents in one facility, how long DMHA takes to answer on a bed waiver. A temporary certification can let you start earlier, but it carries a hard 24-month accreditation deadline.

Does Indiana require accreditation for a residential SUD program?

Indiana gives new programs more runway on timing than most accreditation-first states do. For regular certification, yes. 440 IAC 4.4-2-3 requires accreditation from a DMHA-approved accrediting agency, and the certification expires 90 days after the accreditation does. A new program can hold a temporary certification for up to 24 months while it becomes accredited.

Does Indiana require a Certificate of Need for residential SUD treatment?

Not as we read the statute. Indiana’s certificate of need law, IC 16-29-7, is written for comprehensive care health facilities, which the Department of Health describes as nursing homes, and we found nothing in it that reaches a residential SUD program.

Which ASAM levels does DMHA designate?

Levels 3.1 and 3.5 only. An applicant needs both regular addiction certification and sub-acute stabilization facility certification before it applies, and DMHA’s 2018 ASAM FAQ says it will not designate withdrawal management levels.

Sequencing certification, accreditation, and the sub-acute step for an Indiana residential program? Reach out here.

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