West Virginia 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: OHFLAC steps to open a behavioral health center | Questions: (304) 558-0050

Residential substance use disorder treatment in West Virginia is licensed by the Office of Health Facility Licensure and Certification (OHFLAC), which state law places within the Office of Inspector General. There is no stand-alone residential SUD license. A residential program is licensed as a behavioral health center under W. Va. Code § 27-9-1 and the Behavioral Health Centers Licensure rule, 71 CSR 25, whose current version took effect May 1, 2026 (the older 64 CSR 11 is now marked historical). “Residential” is one of the service types OHFLAC lists for a behavioral health center, alongside outpatient, partial hospitalization, case management and public inebriate shelter.

Accreditation Is a Medicaid Payment Condition, Not a License Condition

Licensing is only half of what a residential program needs before West Virginia Medicaid will pay for its work. Under W. Va. Code § 9-5-29a, neither the Bureau for Medical Services nor its contracted managed care organizations may reimburse services rendered on or after January 1, 2026, at a residential SUD treatment facility unless the site was, at the time of treatment, both licensed by OHFLAC and accredited by CARF, the Joint Commission, or Det Norske Veritas (DNV) to operate an inpatient facility that provides behavioral health services. DNV is an unusual name to see alongside CARF and the Joint Commission in state law, and it’s worth confirming which of the three fits your organization. A facility beginning operations through a change of ownership, or opening at a new site, gets one year from its start of operations to complete accreditation. The section is set to expire July 1, 2031 unless the Legislature continues it. A private-pay program isn’t barred from licensure by this section; it simply can’t bill Medicaid without the accreditation.

ASAM Level 3.7 in West Virginia: Medicaid Designation and CARF Certification

An OHFLAC behavioral health center license doesn’t name an ASAM level, so nothing on the license itself tells a referral source that you run a 3.7 program. That designation comes from the Medicaid side. The Bureau for Medical Services says it “is required to designate the ASAM® level of care for all licensed residential treatment facilities,” and its Residential Adult Services Level 3.7 application (effective March 1, 2026) has the facility attest that it is licensed by OHFLAC as an LBHC or hospital and accredited by CARF, the Joint Commission, or DNV, or will be within one year of starting operations.

For a credential anyone can look up, CARF offers an ASAM Level of Care Certification, delivered in partnership with ASAM and available for adult residential Levels 3.1, 3.5 and 3.7. CARF runs it as a certification program under its own name, and certified programs appear in CARF’s provider search under the “ASAM Level of Care 3.7” filter. It doesn’t replace the OHFLAC license or the accreditation § 9-5-29a requires, and it covers the residential level only, not 3.7 withdrawal management. Our read is that it pairs well with the BMS designation, though neither BMS nor the statute names it as a requirement.

The Facility License: OHFLAC and 71 CSR 25

OHFLAC’s published sequence starts with a Certificate of Need or an exemption from the West Virginia Health Care Authority, then Life Safety Program approval of your site and architectural plans before construction, then a Behavioral Health Services Application for Licensure. OHFLAC asks the State Fire Marshal for a recommendation, then schedules the initial licensure survey. Under 71 CSR 25, that inspection “shall be performed within 60 days of receipt of a complete application, provided a positive recommendation has been received from the Fire Marshal.” The rule has the Director decide on a complete application within that same 60-day window, again once the Fire Marshal’s positive recommendation is in. An initial license expires not more than six months from issuance and can’t be reissued. OHFLAC’s how-to page says that after the initial license is issued it conducts “a full on-site licensure review, including, but not limited to, interviews, observations, and review of consumer records and services.” A regular license then lasts up to two years, with the renewal inspection falling 30 to 90 days before expiration. One quirk: OHFLAC’s own how-to page still cites the old 64-11 rule number.

Most Residential SUD Facilities Are Exempt From Full CON Review, But a Bed Cap Still Applies

The exemption looks broader at first glance than it actually turns out to be. W. Va. Code § 16-2D-11(b) lists “providing behavioral health facilities and services” and the establishment of “an alcohol or drug treatment facility and drug and alcohol treatment services” among the services exempt from Certificate of Need, with the drug and alcohol exemption carving out opioid treatment programs. Exempt doesn’t mean automatic. Subsection (a) still requires you to file an exemption application with a statement of which exemption applies and why, and the Health Care Authority’s FAQ lists a nonrefundable $1,000 filing fee. Opioid treatment programs get no exemption, and § 16-2D-9(4) goes further, barring the Authority from issuing a CON for one at all, apart from a single CTN-0131 clinical trial program. And § 16-2D-9(5) bars a CON to add licensed substance abuse treatment beds in any county that already has more than 250 of them, a limit § 9-5-29a(d) extends to all licensed SUD beds. Check your target county’s current bed count with the Health Care Authority before you commit to a site.

Medication for Opioid Use Disorder in a Residential Setting

State law boxes in methadone access in West Virginia from two directions. W. Va. Code § 16B-13-12 imposes a moratorium on licensing new opioid treatment programs that lacked a certificate of need when the section was enacted in the 2016 session, and it lasts “until the Legislature determines that there is a necessity for additional opioid treatment programs.” Pair that with the CON ban in § 16-2D-9(4), and in our view a new OTP isn’t a realistic project. Medication-assisted treatment licensing now sits in Chapter 16B, Article 13; the old Article 16-5Y sections show as repealed, so treat any guide still citing them as out of date.

The moratorium is in federal court. Solutions Oriented Addiction Response West Virginia v. State of West Virginia, No. 3:26-cv-00175 (S.D. W. Va.), was filed March 5, 2026 under Title II of the ADA and Section 504 of the Rehabilitation Act. The complaint alleges that “the same nine clinics have been operating for over fifteen years” and that “the nearest OTP outside of Charleston is 45 minutes away.” Those are the plaintiff’s allegations, not findings. On August 14, 2026, Judge Robert C. Chambers ruled on the defendants’ motion to dismiss and split it. He dismissed the State, the Governor, the Secretary of Health and the Department of Health for lack of standing, and kept the case going against the West Virginia Health Care Authority and its executive director and chairman. That ruling was on standing only, with the court taking the complaint’s facts as true for the motion, so nothing about the moratorium’s merits has been decided. For now, a residential program should plan on a written coordination agreement with an existing OTP that covers transport and dose continuity.

Buprenorphine is simpler. DEA’s January 2023 letter to registrants says a DATA-Waiver “is no longer required” and that buprenorphine prescriptions “only require a standard DEA registration number,” while noting the change doesn’t override state law. On the state side, office-based MAT ordinarily needs an OHFLAC registration under § 16B-13-4, but a licensed behavioral health center can instead file an attestation with OHFLAC (covering counseling, drug screens and diversion control) under subsection (l), and must notify OHFLAC before starting or ending MAT at another licensed site.

Can a West Virginia Residential Program Offer Ketamine?

West Virginia’s licensing rule, pharmacy law and nursing board records never address ketamine for depression or PTSD. What follows is how we read those sources together, so run the plan past OHFLAC before the first dose.

We found no rule that keeps a licensed behavioral health center from giving ketamine to a resident whose depression or PTSD sits alongside the addiction, but the license paperwork changes. The Behavioral Health Centers Licensure rule calls for an amended license application when there is “a change in the services to be provided,” and separately asks for 60 days’ notice to the Director before “a significant change in the population served or type of service provided” (71 CSR 25, sections 4.2.2 and 4.2.3, as they read in the 2025 text mirrored by Cornell LII). We could not check those two subsections against the final file that took effect May 1, 2026, so ask OHFLAC whether both steps still apply. Our view is that a medically supervised ketamine series is that kind of change, and we would file whatever OHFLAC asks for before launch rather than wait for a surveyor to raise it.

Drug Control Paperwork for the Address

Federal law lists ketamine as a Schedule III depressant (21 CFR 1308.13(c)(7)), and DEA wants a separate registration for each principal place of professional practice where controlled substances are dispensed (21 CFR 1301.12). West Virginia adds its own annual registration: W. Va. Code § 60A-3-302 requires one from the Board of Pharmacy for every person who “dispenses any controlled substance within this state,” with a separate registration for each place of practice, and the fee list in § 60A-3-301 has a line for hospitals and clinics. Ask the Board of Pharmacy which category fits a residential site that only administers doses on the premises.

The Controlled Substances Monitoring Program asks less of a ketamine program than of an opioid one. Practitioners who prescribe or dispense Schedule II through V drugs have to register for database access, but the mandatory lookup in § 60A-9-5a(b) is tied to Schedule II drugs, opioids and benzodiazepines, and ketamine is none of those. A dose a practitioner gives directly to a patient isn’t reportable either (§ 60A-9-4(f)). We’d still pull the resident’s history before the first session, because the clinical picture matters even where the statute doesn’t demand it.

Who Can Give the Dose

The Board of Registered Nurses hasn’t settled this for psychiatric use. Its Practice Committee agreed in May 2018 that an on-site CRNA giving ketamine infusions with documented competencies was within CRNA scope, and in 2019 the committee recommended that an appropriately trained RN may give non-anesthetic ketamine for acute and chronic pain under the state’s palliative care definition. Neither set of minutes shows what the full Board did with those items. By the committee’s October 23, 2025 meeting, a speaker noted that the Board had rescinded its Administration of Anesthetic Agents position statement in March 2025, hospital representatives asked for guidance on RN-given medications at sub-dissociative doses, and the committee sent a proposed anesthetics position statement on to the full Board for review. We found no Board position on RN-administered ketamine for depression or PTSD, so a program planning to rely on RNs should get the Board’s answer in writing. On the prescriber side, an APRN starts out prescribing under a collaborative agreement and can apply for independent authority after three years of documented collaborative practice (W. Va. Code § 30-7-15b). Section 30-7-15a bars Schedule I and caps Schedule II narcotics at three days, and says nothing about Schedule III.

Where Spravato Fits

Spravato, the esketamine nasal spray, is FDA-approved for treatment-resistant depression and for depressive symptoms in adults with major depressive disorder and acute suicidal ideation or behavior. Neither is an addiction indication, so it has no place in the opioid use disorder pathway described above. Under its REMS the site must be certified, the drug is never sent home with the patient, a provider observes each patient for at least two hours after administration, and outpatients must be enrolled.

Planning for Life After Discharge

Few residents finish a ketamine series before their discharge date, so the outpatient hand-off belongs in the treatment plan from intake. The usual next stop is an outpatient ketamine clinic, often a physician-owned professional limited liability company with a management services organization running the business side. Our search turned up no West Virginia statute, rule, Attorney General opinion or court ruling that bars lay ownership of a medical practice, which gives operators more room than in many states. How that clinic gets set up is covered in the ketamine section of West Virginia Drug and Alcohol Outpatient Treatment Licensing.

Money that moves between the residential program and an affiliated clinic is where the legal exposure sits. West Virginia’s Patient Brokering Act, W. Va. Code § 16-62-2, makes it a felony for any person, a health care provider or facility included, to pay or accept anything of value or split fees in return for patient referrals. Fines run up to $50,000 with one to five years in prison, or up to $100,000 with two to five years when 10 or more patients are involved. The federal Eliminating Kickbacks in Recovery Act (18 U.S.C. § 220) separately covers referrals to licensed treatment facilities for services a health care benefit program pays for. Have counsel review the referral arrangement before the first resident is discharged to the clinic.

Staffing a Residential Program

West Virginia’s counselor licensure is mid-transition right now, which changes how a new program should staff. In our view a residential SUD program should plan on a clinical director and enough credentialed staff to match its population’s acuity. On the credential side, 2026 SB 897 (passed March 14, 2026, approved by the Governor April 1, 2026, in effect June 12, 2026) created state licensure and certification for alcohol and drug counselors, now codified at W. Va. Code § 16-68 and run by the Bureau for Behavioral Health (BBH), which must be fully able to administer the program by July 1, 2027. Certification under § 16-68-5 takes 300 hours of supervised practical training, three years of supervised paid work or unpaid internship (a master’s degree counts for one year), 360 hours of approved education with at least 240 in alcohol and drug counseling, and a department exam. Licensure under § 16-68-4 adds a master’s degree with at least 18 graduate semester hours in counseling, though someone holding WVCBAPP certified clinical supervisor status as of July 1, 2027 can use that in place of the degree. Anyone applying for BBH certification before July 1, 2027 can substitute current West Virginia Certification Board for Addiction and Prevention Professionals (WVCBAPP) certification (§ 16-68-6), and master’s-level counselors holding WVCBAPP substance abuse counselor certification by that date are deemed licensed (§ 16-68-12).

Here’s the part that matters most for a residential operator: § 16-68-21 says the article doesn’t apply to “paid alcohol and drug counselors who are working at a licensed behavioral health center.” Your OHFLAC-licensed program’s own counseling staff fall outside the new BBH license, so the 2027 date mostly affects counselors who also practice privately or move to settings that aren’t licensed centers. That’s our reading of the statute, so confirm with OHFLAC what counselor qualifications it will look for at survey.

Round-the-clock coverage adds real cost, and West Virginia’s numbers run lower than most neighboring states. West Virginia’s substance abuse, behavioral disorder, and mental health counselors earn a median of $49,430 a year statewide (BLS OEWS, May 2025), 17% below the $59,350 national median, with the middle half earning between $42,730 and $61,560, so a residential program with a clinical director, several counselors, and 24-hour direct-care staff commonly runs $320,000 to $380,000 a year in payroll before nursing coverage. West Virginia’s wages sit below the national line here, and that’s a real advantage for the operator building this budget. Many residential programs pair one RN with several LPNs for medical oversight rather than staffing every shift with a registered nurse, and build a clinical director role around an experienced, WVCBAPP-certified clinician. The real numbers behind that staffing plan come down to census and level of care, once those are set.

How to Submit Your OHFLAC Application

Start with the West Virginia Health Care Authority for your Certificate of Need or exemption (304-558-7000, hca.wv.gov). Contact the OHFLAC Life Safety Program at 304-558-0050 before any new construction or renovation. Once construction is complete and your policies and procedures are developed, submit a Behavioral Health Services Application for Licensure to the OHFLAC Behavioral Health Program at the same number, 304-558-0050.

What Delays West Virginia Residential Applications

In our experience, four issues account for most of the delays on these applications. The most common mistake is treating accreditation as a later-stage item because it isn’t part of the OHFLAC license application itself. Given the payment-eligibility stakes attached to it, it belongs in your planning from day one. The second is skipping the Certificate of Need exemption filing because “behavioral health is exempt,” when the exemption still has to be requested and documented. The third is building in a county already at or near the 250-bed cap. The fourth is a staffing plan that assumes every counselor needs the new BBH license, or the reverse, one that forgets the July 1, 2027 cutoff for counselors who also see clients outside the licensed center.

Frequently Asked Questions

Sorting out OHFLAC licensing and the accreditation payment condition for a West Virginia residential program? Reach out here.

Sources

• W. Va. Code § 27-9-1: Behavioral health center license required (checked October 7, 2026)
• W. Va. Code § 16B-13-2: Definitions, OHFLAC within the Office of Inspector General (checked October 7, 2026)
• WV Secretary of State, 71 CSR 25: Behavioral Health Centers Licensure rule page and May 1, 2026 final file, sections 4.1.5, 4.1.6, 4.4.1, 4.4.2 and 4.6.8 (checked October 7, 2026)
• OHFLAC: Steps to open a behavioral health center and BHC service types (checked October 7, 2026)
• Office of Inspector General: OHFLAC contact page (checked October 7, 2026)
• W. Va. Code § 9-5-29a: Medicaid accreditation requirement for residential SUD facilities (checked October 7, 2026)
• Bureau for Medical Services: Application for Residential Adult Services Level 3.7 (checked October 7, 2026)
• CARF International: ASAM Level of Care Certification and provider search (checked October 7, 2026)
• ASAM: Level of Care Certification (checked October 7, 2026)
• W. Va. Code § 16-2D-9: Health services that cannot be developed (checked October 7, 2026)
• W. Va. Code § 16-2D-11: Certificate of Need exemptions (checked October 7, 2026)
• West Virginia Health Care Authority: Certificate of Need FAQ (checked October 7, 2026)
• W. Va. Code § 16B-13-12: Opioid treatment program moratorium (checked October 7, 2026)
• W. Va. Code § 16B-13-4: Office-based MAT registration and exemptions (checked October 7, 2026)
• W. Va. Code Article 16-5Y: Repealed MAT sections (checked October 7, 2026)
• SOAR-WV v. State of West Virginia, No. 3:26-cv-00175 (S.D. W. Va.): Filed complaint and Memorandum Opinion and Order, ECF No. 33, August 14, 2026 (checked October 7, 2026)
• DEA Diversion Control: Dear Registrant letter on the DATA-Waiver, January 12, 2023 (checked October 7, 2026)
• W. Va. Code Article 16-68: Licensure and certification of alcohol and drug counselors, including § 16-68-4, § 16-68-5, § 16-68-6, § 16-68-12 and § 16-68-21 (checked October 7, 2026)
• 2026 SB 897: bill history (checked October 7, 2026)
• W. Va. Code R. § 71-25-4 (2025 text), via Cornell LII: Amended license application and 60-day notice of service changes, sections 4.2.2 and 4.2.3 (checked October 9, 2026)
• eCFR, 21 CFR 1308.13(c)(7) and 1301.12: Ketamine in Schedule III and Separate DEA registration for each location (checked October 9, 2026)
• W. Va. Code §§ 60A-3-301 and 60A-3-302: Controlled substance registration fees and Board of Pharmacy registration requirement (checked October 9, 2026)
• W. Va. Code §§ 60A-9-4 and 60A-9-5a: Controlled Substances Monitoring Program reporting and Practitioner database access duties (checked October 9, 2026)
• WV Board of Registered Nurses, Practice Committee minutes: May 31, 2018, June 6, 2019 meeting and October 23, 2025 (checked October 9, 2026)
• W. Va. Code §§ 30-7-15a and 30-7-15b: APRN prescriptive authority limits and Collaborative agreements and independent prescribing (checked October 9, 2026)
• FDA: Spravato prescribing information, and SPRAVATO REMS (checked October 9, 2026)
• W. Va. Code § 16-62-2: Patient Brokering Act prohibition and penalties (checked October 9, 2026)
• 18 U.S.C. § 220, via Cornell LII: Illegal remunerations for referrals to recovery homes, clinical treatment facilities, and laboratories (checked October 9, 2026)