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West Virginia Drug and Alcohol Outpatient 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: OHFLAC: Opening a Behavioral Health Center | Questions: (304) 558-0050

An outpatient substance use disorder program in West Virginia is licensed as a behavioral health center by the Office of Health Facility Licensure and Certification (OHFLAC), which now sits inside the Office of the Inspector General. The license comes from W. Va. Code § 27-9-1 and the current rule, 71 CSR 25, effective May 1, 2026. OHFLAC’s service list names Outpatient and Partial Hospitalization as separate service types. It doesn’t list intensive outpatient on its own, so our reading is that an IOP falls under the outpatient category (worth confirming with OHFLAC before you apply). Section 27-9-1 says nothing about accreditation, and the Medicaid accreditation mandate in § 9-5-29a only reaches residential SUD facilities. Commercial payers and referral sources, in our experience, still ask whether you hold CARF or Joint Commission accreditation.

OHFLAC Licensing Under 71 CSR 25

The licensing sequence runs in a fixed order, and skipping ahead doesn’t work. The Secretary of State’s rules site now marks every version of the old 64 CSR 11, including the May 1, 2024 one, as historical; the active Behavioral Health Centers Licensure rule is 71 CSR 25 (OHFLAC’s own how-to page still cites 64-11, so don’t let that throw you). OHFLAC’s published steps start with a Certificate of Need or exemption from the West Virginia Health Care Authority. Next comes Life Safety Program review of the site and of any construction or renovation plans, and then the Behavioral Health Services Application for Licensure, filed once your policies and procedures are written. OHFLAC schedules the initial survey after it has a regular or provisional recommendation from the State Fire Marshal. Under sections 4.1.5 and 4.1.6 of the 2026 rule, the Director has 60 days from receipt of a complete application both to decide on it and to complete the onsite inspection, so long as the Fire Marshal’s recommendation is positive. A program found in substantial compliance gets a 6-month initial license, and OHFLAC does a full on-site review before it expires.

Most Outpatient SUD Programs Qualify for a CON Exemption

The exemption’s scope is narrower than the word “behavioral health” suggests. W. Va. Code § 16-2D-11(b) lists “providing behavioral health facilities and services” (item 19) as exempt from Certificate of Need, and item 23 exempts alcohol or drug treatment facilities and services unless the project is an opioid treatment program. None of this is automatic. Subsection (a) says that to get an exemption you must “file an exemption application” and explain which exemption applies and why. The Health Care Authority’s exemption form asks for the project’s location, the services, the exemption you’re relying on and an implementation timeline. A clean filing keeps CON off the critical path for most outpatient operators. Opioid treatment programs are the exception, covered in the medication section below.

Medication for Opioid Use Disorder in Outpatient Care

Methadone is where West Virginia parts ways with most states. W. Va. Code § 16B-13-12 puts a moratorium on licensing new opioid treatment programs that didn’t already hold 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.” Separately, § 16-2D-9(4) bars the Health Care Authority from issuing a CON for an opioid treatment program, with one narrow exception for a single program in the CTN-0131 clinical trial. So an outpatient program can’t plan on adding methadone dispensing. That may not hold forever. Solutions Oriented Addiction Response West Virginia (SOAR-WV) sued the state in federal court in March 2026 (Civil Action No. 3:26-0175, Southern District of West Virginia). On August 14, 2026, Judge Robert C. Chambers dismissed the Governor, the Department of Health and some other defendants but let the case proceed against the Health Care Authority and its two top officials. The order recites SOAR-WV’s allegation that “there currently are only nine approved treatment facilities in West Virginia.” Until something changes, patients who need methadone get referred to one of those existing programs.

Buprenorphine is the realistic route for an outpatient program, and the state adds its own layer. On the federal side, DEA’s January 2023 letter to registrants says “all prescriptions for buprenorphine only require a standard DEA registration number” now that the X-waiver is gone. Since June 27, 2023, DEA-registered practitioners have also had to check a box on the registration form affirming they completed a one-time, eight-hour training on treating opioid and other substance use disorders. On the state side, W. Va. Code § 16B-13-4 says nobody may operate an office-based medication-assisted treatment program without a registration from the OHFLAC director. The statute defines that as any clinic, office or program that prescribes, administers or dispenses a partial opioid agonist, which is how buprenorphine products fit in, and the implementing rule is 71 CSR 28. Two exemptions are worth knowing. A practice treating no more than 30 patients can file an attestation instead, confirming it requires counseling and drug screens, has diversion controls and has completed addiction treatment training, but after that it can’t open office-based MAT at any other location. A licensed behavioral health center can also attest in place of registering, as long as it tells OHFLAC before starting or ending office-based MAT at another of its licensed sites. Registrations otherwise come in three forms: an initial 12-month registration, a provisional one capped at six months, and a renewal good for up to a year. Naltrexone isn’t an opioid agonist, so on our reading it sits outside the office-based MAT definition and needs only ordinary prescribing authority.

Opening a Ketamine Clinic in West Virginia

Based on West Virginia’s behavioral health licensing rule and its pharmacy and professional entity statutes. No West Virginia law speaks to ketamine clinics by name, so the licensing conclusion below is our interpretation.

Start by asking whether the clinic needs an OHFLAC license at all. Section 2.5 of the May 2026 behavioral health center rule, as we read the final file on October 7, 2026, exempts individual practitioners and groups of practitioners working within the scope of their chapter 30 professional licenses, so a physician practice giving ketamine for depression looks to us like a medical office, not a behavioral health center. Put the service inside your licensed outpatient program instead and you are changing the services on an OHFLAC license. The 2025 text of the rule called for an amended license application in that case (section 4.2.3), and we could not confirm that subsection in the May 2026 final file, so ask OHFLAC what it wants.

Ownership

West Virginia lets physicians practice through a professional limited liability company (W. Va. Code § 31B-13-1301), and no one may be a member who isn’t licensed or otherwise legally authorized to render the company’s professional services (§ 31B-13-1302). The Board of Medicine takes PLLC applications. The common setup is a PLLC owned by the physicians plus a separately owned MSO that supplies space, staff and billing for a fee, leaving every clinical decision to the doctors. We found no West Virginia statute, rule, Attorney General opinion or court ruling barring a lay company from owning a medical practice, so a lay-owned company employing the physician may also work, though counsel should sign off on that before you choose it. Nurse practitioners who want to own should notice that the statute’s list of PLLC professions doesn’t include nursing. An APRN can apply to prescribe without a collaborative agreement after three years of documented collaborative practice (W. Va. Code § 30-7-15b), but the entity question is separate and belongs with counsel.

Before the First Vial

Three registrations come first: DEA at the clinic’s address (21 CFR 1301.12), the Board of Pharmacy’s annual controlled substance registration for that location (W. Va. Code § 60A-3-302), and Controlled Substances Monitoring Program access for any prescriber handling Schedule II through V drugs (§ 60A-9-5a(a)). Ketamine is Schedule III under federal law (21 CFR 1308.13(c)(7)). The state’s mandatory database lookup is tied to Schedule II drugs, opioids and benzodiazepines, so it doesn’t attach to a ketamine dose, and doses given in the office aren’t reported (§ 60A-9-4(f)). A clinic offering Spravato must be certified as an outpatient healthcare setting in the REMS and must enroll each patient.

If your counseling program is where most patients will come from, give the clinic its own charts and its own ketamine inventory, and make sure no payment moves because a patient was referred, since West Virginia’s Patient Brokering Act (W. Va. Code § 16-62-2) and the federal Eliminating Kickbacks in Recovery Act (18 U.S.C. § 220) both reach payments for referrals. How a residential program can begin ketamine and then hand patients to a clinic is covered in West Virginia Drug and Alcohol Inpatient Treatment Licensing.

Staffing an Outpatient Program

A small outpatient program typically needs a clinical director and two to three counselors, and the counselor licensure transition underway here is worth understanding before hiring. Senate Bill 897, passed March 14, 2026, approved by the Governor April 1, 2026 and in effect June 12, 2026, created state licensure and certification for alcohol and drug counselors in W. Va. Code § 16-68, run by the Bureau for Behavioral Health, which has until July 1, 2027 to be fully able to administer it. For an OHFLAC-licensed outpatient center, the key line is § 16-68-21: the article does not apply to “paid alcohol and drug counselors who are working at a licensed behavioral health center.” Separately, anyone with a master’s degree who is certified by WVCBAPP as a substance abuse counselor on or before July 1, 2027 is deemed a licensed alcohol and drug counselor under § 16-68-12. 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 between $42,730 and $61,560, so a clinical director plus two to three counselors commonly runs $160,000 to $210,000 a year in clinical payroll before benefits. The gap between West Virginia’s wages and the national number is real, and it works in your favor here. A master’s-level clinical director who already holds WVCBAPP certification will carry the new state license automatically under that grandfather clause. Newer counselors can work toward certification, which under § 16-68 means 300 hours of supervised practical training, supervised work experience, 360 hours of approved education and a state exam. Once your program model is set, the actual staffing budget follows from it.

How to Submit Your OHFLAC Application

Start with the West Virginia Health Care Authority for your Certificate of Need exemption (100 Dee Drive, Charleston, WV 25311, 304-558-7000, Certificate of Need program). Contact the OHFLAC Life Safety Program at 304-558-0050 for site and plan review, then send your Behavioral Health Services Application for Licensure to the OHFLAC Behavioral Health Program, same number, once your policies are ready. OHFLAC’s office is in the State Capitol Complex, Building 6, Suite 825, Charleston, WV 25305. Some older OHFLAC forms carry a different mailing address, so confirm where paper filings go before you mail anything.

What Delays West Virginia Outpatient Applications

In our work, three mistakes account for most of the delays on outpatient applications. The first is skipping the CON exemption filing entirely, assuming the general behavioral health exemption applies automatically. The second is a fire and safety review scheduled too late in the buildout to keep the licensing timeline on track. The third is policies and procedures written generically rather than matched to the specific services on the application.

Frequently Asked Questions

Does West Virginia require a Certificate of Need for outpatient SUD treatment?

Usually not. W. Va. Code § 16-2D-11 exempts behavioral health services and alcohol or drug treatment services, opioid treatment programs excluded, but you still have to file an exemption application with the West Virginia Health Care Authority.

How long does it take to get an OHFLAC outpatient license?

The current rule, 71 CSR 25 (effective May 1, 2026), gives OHFLAC 60 days after it receives a complete application to decide on it and to inspect, provided the State Fire Marshal’s recommendation is positive. Total project time, with buildout and the CON exemption filing, usually runs longer.

Is accreditation required for an outpatient SUD program in West Virginia?

No. The licensing statute, W. Va. Code § 27-9-1, doesn’t mention accreditation, and the Medicaid accreditation requirement in § 9-5-29a covers residential SUD facilities only. Many operators pursue it anyway for commercial payer and referral relationships.

Filing a CON exemption for a West Virginia outpatient program? Reach out here.

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