North Dakota Behavioral Health Licensing: HHS Guide

Aimed at anyone about to open, buy, relocate or renew a substance use or mental health program in North Dakota, from a first-time owner to the clinical lead who will sign the policy manual.

Table of Contents

Additional North Dakota Licensing Guides

One Department Since 2022, Two Licensing Offices, and SUD Rules Waiting on a Rewrite

Agency roles and dates below come from HHS’s own web pages, the Century Code and the Administrative Code. Where we draw a conclusion from them, we say so.

On September 1, 2022, North Dakota folded its Department of Health and its Department of Human Services into a single Department of Health and Human Services (HHS), the result of House Bill 1247 from the 2021 session. Behavioral health licensing still sits with two different offices inside that one department. The Behavioral Health Division (BHD) describes itself as “responsible for licensing all substance abuse treatment programs in North Dakota,” working from N.D.C.C. chapter 50-31 and NDAC Article 75-09.1. The Health Facilities Unit licenses hospitals, psychiatric hospitals among them, under chapter 23-16 and NDAC chapter 33-07-01.1. BHD’s own licensing page still names the pre-merger “Department of Human Services” as the licensing office, while the current SFN 971 application (revision 2-2026) carries the merged department’s name across the top.

The bigger surprise for operators coming from other states is on the mental health side. HHS’s public health licensing list runs alphabetically from ambulatory surgical centers through basic care, home health and hospitals to tattoo shops, and the department’s behavioral health licensing link opens the SUD program page. Nothing there licenses a private outpatient therapy clinic or a non-hospital adult mental health residence. The state’s commitment statute points the same direction: its definition of a private treatment facility covers only places holding a chapter 23-16 or chapter 50-31 license. Our reading is that North Dakota does not appear to have a separate license for private mental health outpatient or residential programs, and that inpatient psychiatric care is licensed through hospital licensing. The organizational exception is the certified community behavioral health clinic. Under N.D.C.C. 50-06-41.4, a section SB 2113 created (signed May 2, 2025), a CCBHC “must be certified by the department” before it can operate.

Then there is timing. HHS put out a redraft of Article 75-09.1 in spring 2024, and the agency’s draft rules page now pegs the anticipated effective date at July 1, 2027, “pending completion of the formal rulemaking process and required approvals.” An earlier memo had aimed for July 1, 2026. None of the draft is in force, so a program applying this fall is licensed under the rules that took effect October 26, 2004 and were amended in 2018. Those still label levels of care in Roman numerals such as III.5 and III.7. The same HHS page schedules a revised draft for informal comment on October 26, 2026 and then prints several later steps with 2026 dates that have already gone by, which we read as typos for 2027.

Primary Regulatory Agencies

Each office’s role is taken from its own web page or the statute that sets it up.

HHS Behavioral Health Division, which licenses substance use disorder treatment programs at every ASAM level the rules recognize, outpatient through medically monitored intensive inpatient, under N.D.C.C. 50-31 and NDAC Article 75-09.1, using application form SFN 971
HHS Health Facilities Unit, which licenses hospitals, including psychiatric hospitals as a specialized hospital type, under N.D.C.C. 23-16 and NDAC 33-07-01.1 (phone (701) 328-2352)
Board of Addiction Counseling Examiners, the seven-member board created by N.D.C.C. 43-45 that licenses addiction counselors and also signs up clinical trainees while they finish their training

North Dakota Behavioral Health Licensing Snapshot

Rows cite their own source. Two of them, mental health and withdrawal management, also carry our reading and flag it.

Primary SUD Regulator	HHS Behavioral Health Division (N.D.C.C. 50-31, NDAC Article 75-09.1)
Mental Health Facility Licensing	HHS Health Facilities Unit licenses psychiatric hospitals and hospital psychiatric services (NDAC 33-07-01.1-36). We found no separate state license for private adult mental health outpatient or residential programs. CCBHCs need HHS certification (N.D.C.C. 50-06-41.4)
Residential Treatment	BHD licenses adult Levels III.1, III.5 and III.7 under NDAC 75-09.1-02, -03 and -04. A freestanding III.7 program licensed by HHS and independent of a hospital is exempt from hospital licensure (N.D.C.C. 23-16-01)
Outpatient Treatment	BHD licenses Level I outpatient, Level II.1 intensive outpatient and Level II.5 partial hospitalization or day treatment (NDAC 75-09.1-05 to -07)
Withdrawal Management	Social detoxification, ASAM Level III.2-D (NDAC 75-09.1-08), is the only stand-alone detox chapter. The article has no chapter for medically monitored or medically managed withdrawal management that we could find
Facility License Required	Yes for every SUD treatment program (N.D.C.C. 50-31-02) and for every hospital, psychiatric hospitals included (N.D.C.C. 23-16)
Certificate of Need	None. The hospital CON chapter, N.D.C.C. 23-17.2, is repealed, and the only bed moratorium in chapter 23-16 covers nursing facility beds
National Accreditation	Not required, but an SUD program holding current accreditation from a nationally recognized body is entitled to its license, since NDAC 75-09.1-01-25 says HHS “shall issue” one. Hospitals may ask HHS to accept an accreditor’s survey (NDAC 33-07-01.1-06)
Inspection	BHD visits onsite before converting a provisional license to an unrestricted one, then reviews unrestricted programs at least every two years
License Renewal	SUD: provisional license up to one year, unrestricted license up to two years, $150 nonrefundable application fee (N.D.C.C. 50-31-03.1). Hospitals: annual license, $10 per licensed acute care bed for non-government facilities
Key Regulations	N.D.C.C. 50-31 and NDAC Article 75-09.1 (SUD programs), N.D.C.C. 23-16 and NDAC 33-07-01.1 (hospitals), N.D.C.C. 50-06-41.3 and 50-06-41.4 (bed reporting and CCBHCs), N.D.C.C. 43-45 and NDAC 4.5-02.1 (addiction counselors), N.D.C.C. 50-25.1 and 50-25.2 (abuse reporting)

Program by Program: Who Licenses What in North Dakota

No HHS document sorts programs this way. The arrangement, and the mental health rows in particular, are our reading of the sources listed at the end.

Program	Who licenses or certifies	Governing text	What accreditation does
Adult residential SUD, Levels III.1 and III.5	BHD	NDAC 75-09.1-02 and -03	HHS must issue the license to a currently accredited program (75-09.1-01-25)
Medically monitored intensive inpatient SUD, Level III.7	BHD, with no hospital license if the program is independent of a hospital	NDAC 75-09.1-04, N.D.C.C. 23-16-01	Same as above
Social detoxification, Level III.2-D	BHD	NDAC 75-09.1-08	Same as above
Outpatient, IOP and partial hospitalization (Levels I, II.1, II.5)	BHD	NDAC 75-09.1-05, -06 and -07	Same as above
Psychiatric hospital or hospital psychiatric service	Health Facilities Unit	N.D.C.C. 23-16, NDAC 33-07-01.1-36	Accepted portions of an accreditor’s survey count toward licensure compliance (33-07-01.1-06)
Private adult mental health outpatient or residential program	No separate state license found	Clinicians practice under their own board licenses	No licensing effect we could find
Certified community behavioral health clinic	HHS certification	N.D.C.C. 50-06-41.4	The statute tells HHS to build an assessment of need in the proposed location into its certification rules

North Dakota is one of the states that names ASAM levels right in its rule chapter titles, and SFN 971 asks applicants to tick boxes for 0.5, 1, 2.1, 2.5, 3.1, 3.2D, 3.5 and 3.7. That makes a separate credential worth a look for residential operators. CARF’s ASAM Level of Care Certification is open to adult Levels 3.1, 3.5 and 3.7, and ASAM credits CARF as its partner in delivering it. Roman numerals aside, III.5 in the rule and 3.5 at CARF are the same level. Nothing we read in BHD’s pages or the rule text requires the certification, and we would not expect a BHD license to mention it. Anyone checking a program’s claim can search for it in CARF’s provider search, where the Certification filters include “ASAM Level of Care 3.7” alongside 3.1 and 3.5. Withdrawal management is not among the certified levels on either organization’s page, so it does not reach a III.2-D social detox program.

Programs Covered

Adult residential SUD treatment at Levels III.1, III.5 and III.7
Social detoxification at Level III.2-D
Outpatient, intensive outpatient and partial hospitalization SUD treatment
Psychiatric hospitals and hospital psychiatric services
Outpatient mental health practices and certified community behavioral health clinics

Key Licensing Requirements

Drawn from SFN 971, BHD’s licensing page and the rule and statute sections cited.

A notarized SFN 971 Substance Abuse Treatment License Application, with the Section 4 attestation and disclosure, mailed to BHD at 600 E Boulevard Ave, Dept. 325, Bismarck, ND 58505-0250 and emailed to dhsbhd@nd.gov
Written policies and procedures covering Article 75-09.1, which BHD may send back for revisions
Proof of North Dakota Secretary of State registration and a list of which licensed addiction counselors will be on staff
A local or state authority certification that the premises are safe (N.D.C.C. 50-31-04)
For an accredited program, the accreditor’s most recent review and certification, filed at application and at each renewal
For a psychiatric hospital, a hospital license from the Health Facilities Unit with a North Dakota licensed psychiatrist in charge of psychiatric services

Frequently Asked Questions

What does a North Dakota behavioral health license cost?

Fees are the cheap part. N.D.C.C. 50-31-03.1 sets a $150 nonrefundable application fee for an SUD program license. SFN 971 and BHD’s licensing page are both silent on it, so confirm the payment method with BHD before mailing the packet. A separate statute, N.D.C.C. 50-06-01.7, lets BHD set licensing and certification application fees up to $300, so by our reading that figure could change. Hospitals, psychiatric hospitals included, pay $10 per licensed acute care bed each year if they are not government facilities. There is no Certificate of Need filing to pay for. The money goes into the building, the policy manual and the payroll you carry before the first admission.

How long does North Dakota licensing take?

BHD’s licensing page allows up to 6 weeks for its first look at the application and policy manual. A new program typically starts on a provisional license good for no more than a year, and BHD must conduct an onsite review before converting it to an unrestricted license, with a license report due within 30 days of that visit. As a planning estimate (ours, not HHS’s), allow 2 to 4 months for an outpatient program and 4 to 8 months for residential, where the premises safety certification and the 24-hour staffing build take longer. On the hospital side, a psychiatric hospital that is not yet compliant can be given a provisional license lasting no more than 90 days, which HHS may renew twice at most.

Where do North Dakota applicants usually lose time?

Mostly in the same spots. Owners of mental health programs spend weeks hunting for a license HHS does not issue. SUD applicants treat the 2024 draft rules as current and write policies against text that is not in force until at least July 1, 2027 by HHS’s own estimate. And BHD may treat an SFN 971 packet as withdrawn if the missing pieces are not in within 60 days of its notice that the file is incomplete (NDAC 75-09.1-01-02), which means starting over.

Can you guarantee a North Dakota license?

No, and nobody outside HHS can. BHD decides whether a policy manual meets Article 75-09.1 and can ask for revisions, and the Health Facilities Unit decides whether a hospital meets chapter 33-07-01.1. What we can control is a packet built against the rule actually in force, chapter by chapter, with nothing left for BHD to chase.

How much staff does a new North Dakota program need?

Substance use counseling and assessment have to be done by a licensed addiction counselor under NDAC 75-09.1-01-15, Level III.5 residential needs onsite clinical staffing around the clock, and Level III.7 adds 24-hour skilled nursing and physician services every day. BLS puts the North Dakota median for substance abuse, behavioral disorder and mental health counselors at $68,630, with the 25th percentile at $55,450 and the 75th at $77,320 (BLS OEWS, May 2025), which is $9,280 above the $59,350 national median. Run the numbers for three counselors at that median and base wages come to roughly $205,890, benefits not included. North Dakota’s trainee registration gives a new program a lawful way to bring that figure down. Someone working toward the LAC’s 960 clinical training hours can hold clinical trainee status with the Board of Addiction Counseling Examiners for 12 months, and the supervisor can ask for up to 12 more. Put one licensed clinical lead over several of those trainees, pay them as trainees, and the counseling line commonly lands somewhere between 40 and 60 percent under the cost of an all-licensed team. At Level III.7 the nursing line shrinks the same way when a single RN directs a handful of LPNs instead of staffing every shift with RNs. Final headcount follows the ASAM levels on the license and the beds you expect to fill.

Licensing

Which office handles which kind of program?

For addiction treatment, BHD. Under N.D.C.C. 50-31-02 a person “may not establish, conduct, or maintain in this state a substance use disorder treatment program” without a license, and BHD is the office that issues it. For inpatient psychiatric care, the Health Facilities Unit, through hospital licensing. NDAC 33-07-01.1-36 adds that a hospital may not hold itself out as offering psychiatric services unless that service “has been licensed by the department.” Outpatient mental health practices answer to their clinicians’ licensing boards rather than to a facility license, by our reading.

Does accreditation get a program licensed?

For SUD programs it comes close. NDAC 75-09.1-01-25 says “The department shall issue a license to a program that has a current accreditation of a nationally recognized body that reviews and certifies providers of drug and alcohol services,” and the program files the accreditor’s most recent review and certification with each application and renewal. The rule names no accreditor. CARF and The Joint Commission are the bodies we would expect BHD to accept, but that is our reading, so confirm yours before you rely on it. Nothing in 75-09.1-01-25 or the license sections waives BHD’s onsite reviews for accredited programs, and BHD’s 2023 provider booklet only promises deemed-status programs a license lasting as long as two years. Ask BHD how it handles the visit for an accredited program.

Is the 2024 draft of Article 75-09.1 in effect?

No. HHS posted it for comment in 2024, and the agency’s own page now anticipates July 1, 2027. Until a final rule is adopted, the 2004 rules with their 2018 amendments govern. The draft’s ideas, such as a new Level 1.7 and different fee language, are worth watching but not worth building a policy manual around yet.

Facility

Does a Level III.7 program need a hospital license?

Not if it stands on its own. HB 1050, signed in 2023 and filed March 15, 2023, added an exemption to N.D.C.C. 23-16-01 for “American society of addiction medicine level 3.7 substance use treatment programs” that are “licensed by the department of health and human services” and “independent from a medical hospital.” Those programs “are not required to obtain a license under this chapter.” A III.7 unit run inside a hospital falls outside that carve-out.

Does North Dakota still run a Certificate of Need program?

Not for these programs. Chapter 23-17.2, Certification of Need for Expansion of Hospital Facilities, is marked repealed, and chapter 23-16 contains no certificate of need. Its only moratorium stops nursing facility beds from being added between August 1, 2025 and July 31, 2029. A CCBHC is the one behavioral health setting where need comes up, because SB 2113 requires the certification rules to include an “assessment of need in the proposed location.” Opioid treatment programs have their own need stage with BHD and are licensed separately.

What does BHD need to know about the building?

N.D.C.C. 50-31-04 calls for “a local or state authority certification as to the safety of the premises.” Address changes have to be reported, and a change of ownership or level of care means a new application, not an amendment (NDAC 75-09.1-01-02).

Staffing

What credentials do North Dakota addiction counselors hold?

The Board of Addiction Counseling Examiners licenses three tiers: licensed addiction counselor (LAC), licensed clinical addiction counselor (LCAC, available only to those who applied before January 1, 2024) and masters addiction counselor (MAC). An LAC needs a bachelor’s or higher degree with at least 27 credits across nine content areas, 960 clinical training hours and the NCAC II or MAC exam. A MAC needs 700 clinical training hours plus 2,000 postclinical hours and the NAADAC MAC exam. Practicing without a license is a class B misdemeanor under N.D.C.C. 43-45-08.

Did anything change for addiction counselors in 2025?

SB 2079, approved March 17, 2025, made licensed addiction counselors “tier 2b” mental health professionals. Because N.D.C.C. 50-25.1-03 lists tier 2 mental health professionals among mandated child abuse reporters, our reading is that LACs now carry that duty in their own right.

Operations

What do the rules say about MOUD?

Prescribers no longer need a DATA-Waiver for buprenorphine. A January 12, 2023 letter from DEA confirms a standard registration number is enough. We did not find a provision in the current general standards (75-09.1-01) that requires a program to offer or allow MOUD. The 2024 draft would require programs to “allow the use of medications approved by the Food and Drug Administration,” but that is draft text. Methadone for opioid use disorder comes from opioid treatment programs, which BHD licenses separately, so residential and outpatient programs line up a working referral with one.

What is the daily bed report?

N.D.C.C. 50-06-41.3, which SB 2113 amended and reenacted in 2025, requires public and private providers of residential or inpatient behavioral health services to “participate in and report daily” to the department’s bed management system. The Department of Corrections and Rehabilitation is carved out of the daily duty, and geropsychiatric facilities report weekly and within 48 hours of a bed opening.

Who receives incident and abuse reports?

NDAC 75-09.1-01-10(5) requires a written plan “for reporting all incidents, including serious illnesses,” injuries and alleged abuse or neglect, but it names no recipient and no deadline. Abuse reporting runs through statute. Suspected child abuse is reported to HHS or its authorized agent immediately (N.D.C.C. 50-25.1-04), and suspected abuse of a vulnerable adult goes to HHS, its designee or law enforcement as soon as possible (N.D.C.C. 50-25.2-03).

Enforcement

What happens when BHD finds a problem?

The rules sort findings into two types. Type I means a violation that shows up in at least 25 percent of the cases BHD reviews. A Type II condition covers habitual noncompliance, a Type I that keeps showing up, any illegal act and anything that threatens client health or safety, and BHD may revoke immediately on a Type II. For a Type I the program has 30 days to submit a corrective action plan and 60 days after that to fix the condition. Miss that and NDAC 75-09.1-01-26 requires a 99-day suspension, followed by immediate revocation if the problem is still there. A revoked program cannot reapply for 365 days. North Dakota License Reinstatement walks through what comes next.

Can a BHD decision be appealed?

Yes. NDAC 75-09.1-01-27 allows a written appeal within 30 days of written notice, heard under NDAC chapter 75-01-03, and N.D.C.C. 50-31-05 gives the same 30 days from service of written charges to request a hearing under chapter 28-32.

Where We Fit on a North Dakota Project

Our share of the work

Matching a program to the right ASAM-level chapter of Article 75-09.1, writing the policy manual BHD reviews, preparing accredited programs to use the 75-09.1-01-25 route, and sorting out whether a mental health project needs a hospital license, a CCBHC certification or neither.

Outside our lane

We stay out of billing, payer enrollment, Medicaid and marketing. Ask, and we can name people who handle those.

Not sure which HHS office your North Dakota program answers to? We can help sort that out.

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

Office of the Governor, HHS merger announcement (September 1, 2022, HB 1247): Health and Human Services now united (checked October 15, 2026)
HHS Behavioral Health Division, licensing page (scope, contacts, six-week review): Behavioral Health Licensing and licensing process (checked October 15, 2026)
HHS, SFN 971 Substance Abuse Treatment License Application (rev. 2-2026): SFN 971 (PDF) (checked October 15, 2026)
HHS Behavioral Health Division, Licensing Provider Booklet (February 2023): Provider booklet (PDF) (checked October 15, 2026)
HHS, draft administrative code revisions (anticipated July 1, 2027): Draft Administrative Code Revisions and 2024 draft text (PDF) (checked October 15, 2026)
HHS licensing hub, public health licensing list and Health Facilities Unit hospitals page: Licensing, Regulation and Certification, Public Health Regulation, Licensure and Certification and Hospitals and Critical Access Hospitals (checked October 15, 2026)
N.D.C.C. chapter 50-31 (SUD program license, fee, premises, appeals): Chapter 50-31 (PDF) (checked October 15, 2026)
NDAC Article 75-09.1 chapter list: Article 75-09.1 (checked October 15, 2026)
NDAC 75-09.1-01 (general standards, licenses, accreditation, enforcement, appeals): Chapter 75-09.1-01 (PDF) (checked October 15, 2026)
NDAC 75-09.1-03 (Level III.5) and 75-09.1-04 (Level III.7): Chapter 75-09.1-03 (PDF) and Chapter 75-09.1-04 (PDF) (checked October 15, 2026)
N.D.C.C. chapter 23-16 (hospital licensing, III.7 exemption, nursing bed moratorium): Chapter 23-16 (PDF) (checked October 15, 2026)
2023 HB 1050, bill overview and S.L. 2023 ch. 250: HB 1050 overview and 2023 Health and Safety session laws (PDF) (checked October 15, 2026)
NDAC chapter 33-07-01.1 (hospital licensing, accreditation, psychiatric services): Chapter 33-07-01.1 (PDF) (checked October 15, 2026)
N.D.C.C. Title 23 chapter list, 23-17.2 repealed, via Justia mirror: Title 23 (checked October 15, 2026)
N.D.C.C. chapter 25-03.1 (treatment facility definitions): Chapter 25-03.1 (PDF) (checked October 15, 2026)
N.D.C.C. chapter 50-06 (50-06-01.7 fees, 50-06-41.3 bed reporting, 50-06-41.4 CCBHCs): Chapter 50-06 (PDF) (checked October 15, 2026)
2025 SB 2113, bill overview and S.L. 2025 ch. 441: SB 2113 overview and 2025 Public Welfare session laws (PDF) (checked October 15, 2026)
2025 SB 2079, S.L. 2025 ch. 268 (tier 2b mental health professionals): 2025 Mental Health session laws (PDF) (checked October 15, 2026)
N.D.C.C. chapter 43-45 (Board of Addiction Counseling Examiners), via Justia mirror: Chapter 43-45 (checked October 15, 2026)
NDAC 4.5-02.1-01 (addiction counselor licensure, trainees, fees): Chapter 4.5-02.1-01 (PDF) (checked October 15, 2026)
N.D.C.C. chapters 50-25.1 and 50-25.2 (child and vulnerable adult abuse reporting), via Justia mirror: Chapter 50-25.1 and Chapter 50-25.2 (checked October 15, 2026)
DEA Diversion Control Division, Dear Registrant letter (January 12, 2023): DEA letter (PDF) (checked October 15, 2026)
CARF, ASAM Level of Care Certification: Level of Care Certification (checked October 15, 2026)
ASAM, Level of Care Certification: ASAM Level of Care Certification (checked October 15, 2026)
CARF provider search: Find a Provider (checked October 15, 2026)
U.S. Bureau of Labor Statistics, OEWS May 2025, North Dakota, SOC 21-1018: North Dakota OEWS and national estimates (checked October 15, 2026)