Kentucky Behavioral Health Licensing: DBHDID & OIG Guide

For owners, clinical leads and investors planning to open, grow, move or keep a licensed substance use disorder or mental health program in Kentucky.

Table of Contents

Additional Kentucky Licensing Guides

Kentucky Split Its Licensing Office in April 2023

Dates and agency roles here come from the Cabinet for Health and Family Services’ own pages and the Kentucky Administrative Regulations.

Some older Kentucky how-to articles still send addiction programs to the Office of Inspector General with their applications. That advice went stale on April 5, 2023. The Inspector General’s applications page now says, in its own words, “Effective April 5, 2023, AODE oversite transitioned to the Department for Behavioral Health,” and it sends alcohol and other drug entity (AODE) applicants and renewals to the Department for Behavioral Health, Developmental and Intellectual Disabilities (DBHDID). Inside DBHDID, the Division of Program Integrity runs AODE licensure through its Substance Use Disorder Program Licensure Branch, and applications are filed online through the Kentucky Online Gateway.

The Office of Inspector General (OIG), Division of Health Care kept everything else on the behavioral health side. It still licenses behavioral health services organizations (BHSOs, the mental health license), hospitals including psychiatric hospitals, chemical dependency treatment services under 902 KAR 20:160, residential crisis stabilization units and community mental health centers, and those forms are paper PDFs. Both offices sit inside the same Cabinet, but they run separate rules, separate fee schedules and separate filing systems. Our reading is that a co-occurring operator should expect two files with two offices whenever the project mixes an AODE with an OIG-licensed service.

Readers of the regulation pages also get caught by the history line on 908 KAR 1:370, the core AODE rule, which now ends “Crt eff. 7-1-2026.” Under KRS 13A.3104 that entry marks a certification letter, the agency’s notice that the rule carries on unchanged, so nothing in the wording changed this July. Going by the history line, the most recent wording change was a technical amendment effective October 28, 2020. An actual amendment is in the pipeline. The Legislative Research Commission logged the filing at 11:20 a.m. on July 13, 2026. Its main job is to write the 2026 peer support law (HB 470) into the rule, and the filing says “There are no new or increased fees as a result of the proposed amendment.” As of October 14, 2026 it was still marked proposed.

Primary Regulatory Agencies

Each role below is described the way the agency’s own page or rule describes it.

Department for Behavioral Health, Developmental and Intellectual Disabilities, Division of Program Integrity, which licenses outpatient and residential alcohol and other drug entities under 908 KAR 1:370, 1:372 and 1:374 through its Substance Use Disorder Program Licensure Branch
Cabinet for Health and Family Services, Office of Inspector General, Division of Health Care, which licenses behavioral health services organizations (902 KAR 20:430), psychiatric hospitals (902 KAR 20:180), chemical dependency treatment services (902 KAR 20:160) and residential crisis stabilization units (902 KAR 20:440). Certificate of Need sits with OIG too, in its Division of Certificate of Need.
Kentucky Board of Alcohol and Drug Counselors, which credentials alcohol and drug counselors and peer support specialists under KRS 309.080 to 309.089

Kentucky Behavioral Health Licensing Snapshot

Rows restate the statute or rule they name, except the Certificate of Need row, which reads three CON statutes together and is our interpretation.

Primary SUD Regulator	DBHDID, Division of Program Integrity (AODE licensure since April 5, 2023)
Mental Health Facility Licensing	OIG, Division of Health Care: BHSOs, psychiatric hospitals, residential crisis stabilization units
Residential Treatment	AODE residential license under 908 KAR 1:372, with 24-hour staffing and at least one awake staff person at all times
Outpatient Treatment	AODE outpatient, intensive outpatient and partial hospitalization under 908 KAR 1:374. Mental health outpatient is a BHSO license from OIG
Withdrawal Management	Clinically managed residential (908 KAR 1:372) and ambulatory (908 KAR 1:374) at DBHDID. Medically managed intensive inpatient (902 KAR 20:111) sits in a hospital or chemical dependency program at OIG
Facility License Required	Yes. No SUD program may operate without a KRS 222.231 license unless it holds a chemical dependency treatment services license or is federal
Certificate of Need	Required for psychiatric beds, chemical dependency beds, partial hospitalization and residential SUD programs over 16 beds. Exempt: outpatient behavioral health, crisis units and residential SUD of 16 beds or fewer (KRS 216B.020)
National Accreditation	Required within one year for BHSOs and crisis units, required up front for AODE partial hospitalization, not required for other AODE outpatient or residential
Inspection	Annual unannounced survey for AODEs under 908 KAR 1:370. KRS 222.231(11) sets a floor of every two years for fully accredited agencies
License Renewal	One-year term. AODE $500 plus $80 per outpatient extension site. BHSO $750 initial and $500 renewal
Key Regulations	KRS 222.231, 908 KAR 1:370, 1:372 and 1:374, 902 KAR 20:430, 20:180, 20:160, 20:111, 20:440 and 20:008, KRS 216B.020 and 216B.061, 900 KAR 5:020, KRS 309.080 to 309.089

Which Kentucky Rules Reach Which Program

This side-by-side is our arrangement. No single Cabinet document sorts the programs this way.

Program	Agency and rule	Accreditation	Certificate of Need
Residential SUD treatment	DBHDID, 908 KAR 1:372	Not required	Exempt at 16 beds or fewer
Clinically managed residential withdrawal management	DBHDID, 908 KAR 1:372	Not required	Exempt at 16 beds or fewer
Outpatient SUD and IOP	DBHDID, 908 KAR 1:374	Not required	Exempt
SUD partial hospitalization	DBHDID, 908 KAR 1:374	Required (908 KAR 1:374)	Required
Chemical dependency treatment service (inpatient, under 30 days)	OIG, 902 KAR 20:160	Required within a year only if it adds outpatient behavioral health services	Required
Outpatient mental health (BHSO)	OIG, 902 KAR 20:430	Required within one year	Exempt, except partial hospitalization
Residential crisis stabilization unit	OIG, 902 KAR 20:440	Required within one year	Exempt
Psychiatric hospital	OIG, 902 KAR 20:180	Joint Commission or other CMS-approved accreditation accepted, with no annual on-site licensing inspection once accreditation reports are filed (KRS 216B.185)	Required

Reading KRS 216B.061, 216B.015 and 216B.020 side by side produced the CON column, so treat it as our interpretation. On levels of care, Kentucky’s AODE rules tell programs to assess and reassess clients against “the most recent version of The American Society of Addiction Medicine (ASAM) Criteria,” but nowhere in 908 KAR 1:372 does a residential license carry a level number. When referral partners want a 3.5 or 3.7 they can check for themselves, the route is CARF’s ASAM Level of Care Certification, offered for adult Levels 3.1, 3.5 and 3.7 and, per ASAM, delivered in partnership with CARF. The certification will not appear on a DBHDID license. Where it does appear is CARF’s provider search, whose Certification filters list “ASAM Level of Care 3.1,” 3.5 and 3.7. Neither organization mentions withdrawal management in that program, and we would not present it as covering a withdrawal management unit. A separate certification expectation in Kentucky Medicaid’s 907 KAR 15:022 belongs to the payer side, outside the license, and we don’t work on it.

Programs Covered

Residential SUD treatment and clinically managed residential withdrawal management (AODE)
Outpatient SUD, intensive outpatient and partial hospitalization (AODE)
Outpatient mental health under a BHSO license
Psychiatric hospitals and residential crisis stabilization units
Hospital-type chemical dependency treatment services under 902 KAR 20:160

Key Licensing Requirements

Each item restates a rule or an agency form named in the Sources list.

An AODE Initial Licensure Application in DBHDID’s online AODE system on the Kentucky Online Gateway, with the $500 fee, for each modality the program will offer. Clients cannot be admitted until the license for that modality is issued.
For mental health outpatient, OIG’s “Application for License to Operate a Behavioral Health Services Organization,” the $750 fee, Fire Marshal approval and disclosure of anyone holding 25 percent or more ownership
A Certificate of Need before any psychiatric bed, chemical dependency bed, partial hospitalization program or residential SUD program above 16 beds
Accreditation by The Joint Commission, CARF, COA or a comparable body within one year for a BHSO or crisis unit, and as a standing condition for AODE partial hospitalization
A clinical services supervisor, meaning an LCADC, a CADC who has logged 4,000 clinical hours since certification, or another licensed professional named in 908 KAR 1:370
From January 1, 2027, KRS 309.0831 registration for every alcohol and drug peer support specialist an AODE or BHSO employs

Frequently Asked Questions

What do Kentucky’s licensing fees add up to?

The state fees are small. An AODE license costs $500 a year, and each outpatient extension site adds $80. A BHSO pays $750 to start and $500 to renew. A psychiatric hospital with 25 beds or fewer pays $750 plus $25 per bed each year. Certificate of Need, when it applies, adds an application fee of $1,000 for projects with capital spending up to $200,000, half a percent of capital spending for projects between $200,000 and $5 million, and a flat $25,000 above $5 million (900 KAR 6:020). Build-out, accreditation and payroll will cost far more than any of these, and those depend on the building and the census you plan.

How long does Kentucky behavioral health licensing take?

Neither DBHDID’s nor OIG’s rules set a decision deadline for these applications. As an estimate of our own, not a state figure, plan on three to five months for an outpatient AODE or a BHSO, and four to six when a residential AODE stays at or under 16 beds. Statute requires an inspection before an AODE is licensed, and OIG issues a provisional license first and then inspects unannounced within three months. Anything that needs a Certificate of Need, such as psychiatric beds or partial hospitalization, should plan on 12 months or more.

Which Kentucky mistakes cost applicants the most time?

Filing an addiction treatment application with the wrong office tops the list. Since April 5, 2023 AODEs file with DBHDID online, while BHSOs, psychiatric hospitals and crisis units still go to OIG on paper. The second is the accreditation clock. A BHSO that is not accredited within a year of its first license can lose it, and a lot of owners only learn that at renewal. The third is the 16-bed line, because a residential SUD program at 17 beds no longer fits the CON exemption.

Can anyone guarantee a Kentucky license?

No one can. DBHDID and OIG make those calls, and 908 KAR 1:370 lists grounds for denial that include misrepresentation and a history tied to revoked facilities. What can be controlled is an application that matches the current rule for each modality and goes to the right office the first time.

How much staff will I need to open a program in Kentucky?

An AODE needs an administrator, a clinical services supervisor and credentialed clinicians, case managers carry no more than 30 clients each, and a residential site keeps staff on duty 24 hours a day with someone awake at all times. BLS reports a median of $54,190 for Kentucky substance abuse, behavioral disorder and mental health counselors, with the 25th percentile at $41,730 and the 75th at $72,590 (BLS OEWS, May 2025), below the $59,350 national median. Payroll for three counselors paid the Kentucky median would run $162,570 a year by our arithmetic, and that is before the supervisor, benefits and night coverage. Kentucky hands new programs a cheaper first hire in the temporary CADC. A temporary CADC holds a bachelor’s degree in any field, carries the credential for two years and meets with a supervisor at least two hours twice a month, so a program can hire counselors who are still finishing their hours at lower wages under an LCADC or an experienced CADC supervisor, and a roster built like that commonly saves 40 to 60 percent of the clinical wages an all-credentialed counseling team would draw. The nursing budget works the same way when one RN supervises a group of LPNs rather than every shift being an RN shift. Census and the levels you license set the final roster.

Licensing

Who licenses addiction and mental health programs in Kentucky?

Two offices in the same Cabinet. DBHDID’s Division of Program Integrity licenses AODEs, which covers nonhospital outpatient and residential SUD treatment. OIG’s Division of Health Care licenses BHSOs for mental health, psychiatric hospitals, crisis stabilization units and the hospital-type chemical dependency treatment services in 902 KAR 20:160. The Kentucky Board of Alcohol and Drug Counselors credentials the counselors.

Can a mental health license cover substance use treatment?

Only as a second diagnosis. 902 KAR 20:430 limits BHSO substance use work to clients where “The mental health disorder is the primary diagnosis and SUD is the secondary diagnosis.” A program whose clients come in mainly for addiction treatment belongs on an AODE license with DBHDID.

Does accreditation help with a Kentucky license?

It depends which license. For a BHSO or crisis unit it is mandatory. The Joint Commission, CARF, COA or a comparable national body must accredit the program within a year of the first license. A BHSO gets one extension at most, and only by requesting it at least 60 days before renewal, and 902 KAR 20:430 directs OIG to revoke the license of a BHSO that fails to get or keep accreditation. AODE partial hospitalization “shall be fully accredited” under 908 KAR 1:374. Ordinary AODE outpatient and residential programs need none. KRS 222.231(11) says fully accredited agencies are inspected “at least every two (2) years,” but 908 KAR 1:370 still calls for an annual survey visit for every AODE, so our reading is that accredited programs should still expect DBHDID yearly.

Facility

Which projects need a Certificate of Need?

KRS 216B.061 bars establishing a health facility or making a substantial change in beds or services without a CON, and KRS 216B.015 counts alcohol abuse, drug abuse and mental health services among health facilities. KRS 216B.020(1) then exempts crisis units, free-standing residential SUD programs with “sixteen (16) or fewer beds,” and outpatient behavioral health “but not including partial hospitalization programs.” Our reading is that psychiatric beds, 902 KAR 20:160 chemical dependency beds, partial hospitalization and residential SUD above 16 beds all go through CON.

How tight is the bed supply?

The 2025 State Health Plan update, incorporated in 900 KAR 5:020 effective January 22, 2026, caps licensed and approved adult and geriatric psychiatric beds at 0.2 for every 1,000 people of adult and geriatric age in an area development district. Chemical dependency beds licensed under 902 KAR 20:160 “shall not exceed a maximum rate of 11.4 beds” per 100,000 residents, with hospital-based units in existing space getting priority.

What does a residential AODE building need?

Under 908 KAR 1:372 each resident gets at least 120 square feet, every eight residents share at least one toilet and one sink, and a shower or tub is needed per 15. 908 KAR 1:370 bars extension sites for residential care, which by our reading means every residential address carries its own license.

Staffing

What counselor credentials does Kentucky recognize?

KRS 309.080 sets up five tiers: registered alcohol and drug peer support specialist, certified alcohol and drug counselor (CADC), licensed alcohol and drug counselor, licensed clinical alcohol and drug counselor (LCADC) and LCADC associate. The CADC calls for a bachelor’s degree, IC&RC work experience and supervision, six hours of ethics, three of domestic violence and two of HIV training, and a written exam. The LCADC calls for a master’s or doctorate, 2,000 hours of SUD experience, 180 classroom hours and the IC&RC AADC exam.

What changes for peer support specialists in 2027?

HB 470, signed April 10, 2026 and published as Acts chapter 80, rewrote KRS 222.233. Until January 1, 2027, AODEs and behavioral health service organizations may employ alcohol and drug peer support specialists who are either registered or meet the regulations in effect on or after July 15, 2024. After that date they may “only employ an alcohol and drug peer support specialist who is registered under KRS 309.0831.” The act also repealed KRS 309.0836, the temporary peer support registration.

Who can run a BHSO’s clinical program?

Under 902 KAR 20:430 the program director must be a psychiatrist, physician, psychologist, licensed psychological practitioner, APRN, LPCC, LMFT, licensed professional art therapist, licensed behavior analyst or LCSW. Associate-level clinicians such as licensed professional counselor associates and certified social workers can deliver services as behavioral health professionals under clinical supervision.

Operations

How do medications for opioid use disorder fit?

The AODE definition lists “Withdrawal management services, including medication-assisted treatment,” and residential withdrawal management must offer MAT “provided onsite or through referral.” Outpatient AODEs refer clients for medications for addiction treatment. Methadone sits with narcotic treatment programs, a separately licensed modality, so a program without one coordinates with a licensed opioid treatment program.

Where do incident reports go?

908 KAR 1:370 Section 9 requires an AODE to keep an incident file for accidents or injuries needing hospitalization or ending in death and for fires, disasters or security threats that substantially interrupt services. It sets no deadline for a report to the licensing office. Suspected abuse is reported under the statutes instead. KRS 620.030 covers children, with reports going to police, the Kentucky State Police, the Cabinet or a prosecutor, and KRS 209.030 sends adult reports to the Cabinet. Both say the report is made “immediately.”

How do I reach the AODE office?

DBHDID’s AODE online system flyer lists a help desk at 502-564-0104 or 866-231-0003, Option 4 on either, weekdays 8 a.m. to 4 p.m. Eastern, and chfs.aodehelpdesk@ky.gov. OIG’s Division of Health Care answers at 502-564-7963.

Enforcement

What happens after a survey finds problems?

DBHDID issues a written notice and the AODE has ten calendar days to send a plan of correction, with another ten if the first plan is rejected. OIG-licensed facilities get ten days under 902 KAR 20:008.

Can a license be pulled immediately?

Yes, when the Cabinet finds immediate danger. KRS 222.231 gives an AODE five calendar days from receiving an emergency order to ask for a hearing, which must be held within ten working days, and 908 KAR 1:370 confines that hearing to one question, “whether there is immediate danger.” A regular denial or revocation turns final and conclusive 30 days after notice if no written hearing request has arrived by then. See Kentucky License Reinstatement for what follows a revocation.

Our Part in a Kentucky Project

Work we take on in Kentucky

Sorting a project between DBHDID and OIG, building AODE and BHSO applications and policies against the current rules, planning around the 16-bed CON line, and preparing BHSOs and partial hospitalization programs for the accreditation Kentucky requires.

Work we hand to others

Billing, payer contracts and enrollment with public or commercial payers stay off our desk, and so does marketing. Tell us what you need on that side and we’ll suggest someone who handles it.

Not sure whether your Kentucky project files with DBHDID, OIG or both? Ask us.

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.

Sources

CHFS Office of Inspector General, Division of Health Care (AODE transfer to DBHDID, OIG application list): Applications (checked October 14, 2026)
CHFS OIG, Division of Certificate of Need: Certificate of Need (checked October 14, 2026)
CHFS OIG, Division of Health Care contact list: Contact list (PDF) (checked October 14, 2026)
DBHDID, Division of Program Integrity: Division of Program Integrity (checked October 14, 2026)
DBHDID, AODE online system flyer (KOG application, help desk): AODE Online System (PDF) (checked October 14, 2026)
KRS 222.231 (AODE license, inspection, emergency orders): KRS 222.231 (checked October 14, 2026)
908 KAR 1:370 (AODE licensing procedures, fees, staffing, incidents, enforcement): 908 KAR 1:370 (PDF) (checked October 14, 2026)
908 KAR 1:370, proposed amendment filed July 13, 2026: 908 KAR 1:370 REG (checked October 14, 2026)
908 KAR 1:372 (residential AODEs): 908 KAR 1:372 (checked October 14, 2026)
908 KAR 1:374 (outpatient AODEs, partial hospitalization accreditation): 908 KAR 1:374 (checked October 14, 2026)
2021 Ky. Acts ch. 125 (KRS 13A.3104 certification letters): Acts ch. 125 (PDF) (checked October 14, 2026)
902 KAR 20:430 (behavioral health services organizations): 902 KAR 20:430 (checked October 14, 2026)
OIG, BHSO license application: BHSO application (PDF) (checked October 14, 2026)
902 KAR 20:180 (psychiatric hospitals): 902 KAR 20:180 (checked October 14, 2026)
902 KAR 20:160 (chemical dependency treatment services): 902 KAR 20:160 (checked October 14, 2026)
902 KAR 20:111 (medically managed intensive inpatient withdrawal management): 902 KAR 20:111 (checked October 14, 2026)
902 KAR 20:440 (residential crisis stabilization units): 902 KAR 20:440 (checked October 14, 2026)
902 KAR 20:008 (OIG license procedures and fees): 902 KAR 20:008 (checked October 14, 2026)
KRS 216B.015 (health facility definition): KRS 216B.015 (checked October 14, 2026)
KRS 216B.020 (CON exemptions): KRS 216B.020 (checked October 14, 2026)
KRS 216B.061 (Certificate of Need): KRS 216B.061 (checked October 14, 2026)
KRS 216B.185 (hospital accreditation): KRS 216B.185 (checked October 14, 2026)
900 KAR 5:020 (State Health Plan): 900 KAR 5:020 (checked October 14, 2026)
CHFS, 2025 Update to the State Health Plan (January 2026): State Health Plan update (PDF) (checked October 14, 2026)
900 KAR 6:020 (CON fees): 900 KAR 6:020 (checked October 14, 2026)
KRS 309.080 (counselor credential definitions): KRS 309.080 (checked October 14, 2026)
KRS 309.083 (CADC requirements): KRS 309.083 (checked October 14, 2026)
Kentucky Board of Alcohol and Drug Counselors, Temporary CADC instructions: TCADC instructions (PDF) (checked October 14, 2026)
Kentucky Board of Alcohol and Drug Counselors, LCADC instructions: LCADC instructions (PDF) (checked October 14, 2026)
2026 HB 470, Acts ch. 80 (peer support specialists): Acts ch. 80 (PDF) (checked October 14, 2026)
KRS 620.030 (child abuse reporting): KRS 620.030 (checked October 14, 2026)
KRS 209.030 (adult abuse reporting): KRS 209.030 (checked October 14, 2026)
907 KAR 15:022 (Medicaid ASAM certification, cited only to show it is a payer rule): 907 KAR 15:022 (checked October 14, 2026)
CARF, ASAM Level of Care Certification: Level of Care Certification (checked October 14, 2026)
ASAM, Level of Care Certification: ASAM Level of Care Certification (checked October 14, 2026)
CARF provider search: Find a Provider (checked October 14, 2026)
U.S. Bureau of Labor Statistics, OEWS May 2025, Kentucky, SOC 21-1018: Kentucky OEWS and national estimates (checked October 14, 2026)