This page is for operators, clinical leaders, and investors opening, expanding, relocating, or maintaining a licensed behavioral health or substance use disorder program in West Virginia.

Table of Contents

Additional West Virginia Licensing Guides

A Facility License, a Certificate of Need Exemption, and a New Counselor Licensure System All Move at Once Here

This is the part most West Virginia guides haven’t caught up to, since several of these pieces changed within the past two years.

West Virginia licenses behavioral health centers through the Office of Health Facility Licensure and Certification (OHFLAC), the office W. Va. Code § 27-9-1 names as the licensing authority. OHFLAC now sits inside the Office of Inspector General, which state law places in the Department of Health. That arrangement traces to HB 2006 (2023), which broke the old Department of Health and Human Resources into three departments starting January 1, 2024 and moved the Bureau for Behavioral Health into the new Department of Human Services. The rule changed address too. What used to be 64 CSR 11 is now 71 CSR 25, Behavioral Health Centers Licensure, filed by the Office of the Inspector General, and the current version took effect May 1, 2026. The Secretary of State’s rules database marks every 64 CSR 11 version as historical.

Certificate of Need is lighter here than in many states but not absent. W. Va. Code § 16-2D-11 lists behavioral health services and alcohol or drug treatment facilities as exempt, yet you still file an exemption application with the Health Care Authority. Opioid treatment programs are carved out of that exemption, and § 16-2D-9(5) bars adding licensed substance abuse treatment beds in any county that already has more than 250 of them. On staffing, SB 897 (passed March 14, 2026, approved by the Governor April 1, 2026) created state licensure and certification for alcohol and drug counselors in W. Va. Code § 16-68, and the Bureau for Behavioral Health has until July 1, 2027 to be fully able to run it.

One more fact worth knowing if you’re planning a residential SUD facility: for services on or after January 1, 2026, W. Va. Code § 9-5-29a bars the Bureau for Medical Services and its managed care plans from paying a residential SUD facility unless it holds both the OHFLAC license and CARF, Joint Commission, or DNV accreditation. A new site or a change of ownership gets one year from its start of operations to become accredited. That’s a genuine reason to prioritize accreditation planning early, and the Medicaid enrollment or billing side itself sits outside licensing entirely. Getting the sequencing right across licensing, Certificate of Need, and the new counselor system matters more here than the headline rules alone suggest.

Primary Regulatory Agencies

Each role below ties back to a statute or agency page listed under Sources at the bottom.

Office of Health Facility Licensure and Certification (OHFLAC), part of the Office of Inspector General in the Department of Health. It licenses behavioral health centers (71 CSR 25) and opioid treatment programs (71 CSR 27), registers office-based MAT programs (71 CSR 28) and recovery residences, and licenses hospitals (71 CSR 12)
Bureau for Behavioral Health (BBH), part of the Department of Human Services, which W. Va. Code § 16-68 puts in charge of the new alcohol and drug counselor licensure and certification program
West Virginia Health Care Authority, which runs Certificate of Need review and decides exemption applications

West Virginia Behavioral Health Licensing Snapshot

A reference table, not analysis, drawn from the statutes cited in each row.

Primary SUD Regulator	OHFLAC, licensing behavioral health centers under 71 CSR 25 and opioid treatment programs under W. Va. Code § 16B-13 and 71 CSR 27
Primary Mental Health Regulator	OHFLAC, under the same 71 CSR 25 behavioral health center rule; hospitals are licensed separately under 71 CSR 12
Residential Treatment	OHFLAC-licensed behavioral health center (“Residential” is one of OHFLAC’s listed service types)
Outpatient Treatment	OHFLAC-licensed behavioral health center (OHFLAC lists Outpatient and Partial Hospitalization as service types)
Withdrawal Management	No separate withdrawal management category appears in OHFLAC’s behavioral health center service types; confirm with OHFLAC how a detox service will be listed on your license
Facility License Required	Yes, an OHFLAC behavioral health center license (W. Va. Code § 27-9-1); an opioid treatment program needs its own license under § 16B-13-3
Certificate of Need	Behavioral health and non-OTP drug and alcohol treatment are on the § 16-2D-11 exemption list, but the exemption still has to be applied for. No CON may issue for a new opioid treatment program, and no SUD beds may be added in a county that already has more than 250 licensed (§ 16-2D-9)
National Accreditation	Not listed as an OHFLAC licensing condition. W. Va. Code § 9-5-29a ties Medicaid payment for residential SUD services on or after Jan 1, 2026 to CARF, Joint Commission, or DNV accreditation
Inspection	OHFLAC schedules the initial licensure survey once the State Fire Marshal sends its recommendation, and runs a full on-site licensure review before the initial license expires
License Renewal	Initial license is 6 months and can’t be re-issued. Under 71 CSR 25 (2026) a regular license runs up to two years, and OHFLAC inspects 30 to 90 days before it expires (sections 4.4.1, 4.4.2 and 4.6.8)
Key Regulations	W. Va. Code § 27-9 and 71 CSR 25 (behavioral health centers), § 16B-13 with 71 CSR 27 and 71 CSR 28 (opioid treatment and office-based MAT; the old article 16-5Y is repealed), § 16-2D (Certificate of Need), § 16-59 (recovery residences), § 16-68 (alcohol and drug counselor licensure)

Which Requirements Apply to Which West Virginia Program

Organized this way because OHFLAC’s own material doesn’t lay it out program by program.

Program	OHFLAC License	Accreditation Required	Certificate of Need
Residential SUD treatment	Yes	No, though a separate state payment rule applies for residential SUD facilities specifically	Exemption application; no added beds in a county already over 250 licensed SUD beds
Outpatient SUD treatment	Yes	No	Exemption application
Opioid treatment programs	Yes, a separate OTP license under § 16B-13-3	Yes, under federal rules: 42 CFR 8.11 requires accreditation for SAMHSA certification	Not exempt, and § 16-2D-9(4) bars a CON for a new OTP (one narrow clinical-trial exception); § 16B-13-12 also keeps a moratorium on new OTP licenses
Residential mental health	Yes	No	Exemption application
Outpatient mental health	Yes	No	Exemption application

Programs Covered

Residential substance use disorder treatment
Outpatient substance use disorder treatment, including intensive outpatient
Withdrawal management services, coordinated with medication-assisted treatment where clinically indicated
Residential and outpatient mental health treatment

Key Licensing Requirements

Taken from OHFLAC’s published steps for opening a behavioral health center, plus the statutes they rest on.

A Certificate of Need or an exemption from the West Virginia Health Care Authority, which is OHFLAC’s step one
OHFLAC Life Safety Program approval of your site and architectural plans before construction starts, then a pre-opening inspection request two to three weeks before you occupy the space
A Behavioral Health Services Application for Licensure to OHFLAC once construction is done and your policies and procedures are written
A State Fire Marshal recommendation of “regular” or “provisional,” which OHFLAC needs before it schedules the initial licensure survey
Staff credentials that fit each role. Professional counselors (LPC, LPCA) are licensed by the West Virginia Board of Examiners in Counseling, and note that the new § 16-68 alcohol and drug counselor license does not apply to paid counselors working at a licensed behavioral health center (§ 16-68-21)

Frequently Asked Questions

How much does it cost to get licensed in West Virginia?

OHFLAC’s own licensure application is a modest part of the total. Budget for facility buildout, staff credentialing, and policy development, and add accreditation survey and preparation costs if you’re pursuing CARF or Joint Commission accreditation, which residential SUD operators in particular have real reasons to prioritize. Accreditation survey fees commonly run from a few thousand dollars into the low five figures. Most new outpatient programs budget between $150,000 and $350,000 in total pre-opening investment; residential programs run higher, driven mainly by facility buildout. Those are our planning ranges, not state-published figures.

How long does West Virginia behavioral health licensing take?

A realistic range for an outpatient program is 6 to 10 months from planning to an OHFLAC license. A residential SUD program commonly runs 12 to 18 months once accreditation is factored in. The OHFLAC review is rarely the long pole. Under 71 CSR 25 (sections 4.1.5 and 4.1.6), once the State Fire Marshal has made a positive recommendation, OHFLAC is to inspect and decide on a complete application within 60 days, so most of the calendar goes to the earlier steps: the CON exemption, Life Safety plan approval and construction, the Fire Marshal recommendation, and, for residential SUD facilities, accreditation.

What trips people up most often during West Virginia’s licensing process?

Skipping the Certificate of Need exemption filing because the project seems too small to need it, when the exemption still has to be documented. Others include signing a lease in a county that already has more than 250 licensed substance abuse treatment beds, where § 16-2D-9(5) blocks any new SUD beds, and, for a residential SUD facility, underestimating how early accreditation needs to start given the one-year window in the separate state payment rule for that category.

Do you guarantee West Virginia licensure?

We can’t promise an outcome that ultimately rests with a state regulator, and we’d be skeptical of anyone who tells you otherwise. What we can commit to is a program built against OHFLAC’s and BBH’s actual current requirements, with your accreditation timeline planned out properly if your program needs one.

How much staff will I need to open a behavioral health program in West Virginia?

It depends on service type and census, but a small outpatient program with a clinical director and two to three counselors commonly runs $160,000 to $210,000 a year in clinical payroll before benefits. 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 national median of $59,350, with the middle half earning between $42,730 and $61,560. Lower wages sound like a warning sign until you’re the one building the budget. In West Virginia they’re room to work with. On credentials, SB 897 (2026) added a state license and certification for alcohol and drug counselors in W. Va. Code § 16-68, which the Bureau for Behavioral Health must be fully able to administer by July 1, 2027. For a licensed facility, though, § 16-68-21 says the article doesn’t apply to paid alcohol and drug counselors working at a licensed behavioral health center, so in our reading the new license mainly reaches counselors in private practice, which § 16-68-3 restricts to licensed counselors or certified counselors under a licensed counselor’s supervision. A common approach builds the clinical director role around a fully credentialed clinician and staffs remaining counseling roles with candidates completing their supervised training and experience requirements. A real staffing matrix and cost estimate, mitigation strategies included, follow once the program model itself is defined.

Licensing

Who licenses substance use disorder and mental health programs in West Virginia?

OHFLAC licenses the facility for both populations, under W. Va. Code § 27-9-1 and the behavioral health center rule, 71 CSR 25. Since the reorganization that took effect January 1, 2024, OHFLAC has been part of the Office of Inspector General within the Department of Health, while the Bureau for Behavioral Health landed in the Department of Human Services. Opioid treatment programs carry a separate OHFLAC license under § 16B-13-3.

Does West Virginia require accreditation before I can be licensed?

No. Neither § 27-9-1 nor OHFLAC’s published steps for opening a behavioral health center list accreditation, and OHFLAC runs its own licensure survey either way. Opioid treatment programs are the exception, since federal rules (42 CFR 8.11) require OTP accreditation. For a residential SUD facility specifically, state law separately ties payment eligibility to holding CARF, Joint Commission, or DNV accreditation, which is a strong practical reason to pursue it even though licensure itself doesn’t require it. That payment rule sits outside the license, and we don’t handle enrollment.

Does West Virginia license programs by ASAM level?

Not through OHFLAC. Its behavioral health center service types are categories like residential, outpatient, and partial hospitalization, with no ASAM numbers attached. The ASAM level comes from Medicaid instead: the Bureau for Medical Services says it “is required to designate the ASAM® level of care for all licensed residential treatment facilities,” and its Level 3.7 application (effective March 1, 2026) asks you to attest to an OHFLAC license as a behavioral health center or hospital plus CARF, Joint Commission, or DNV accreditation (a new site or new owner can attest it will be accredited within a year of opening). A third piece sits outside both. CARF, working with ASAM, offers an ASAM Level of Care Certification for adult residential Levels 3.1, 3.5 and 3.7. West Virginia doesn’t put it on the license and the BMS application doesn’t name it, but anyone can check it in CARF’s provider search using the “ASAM Level of Care 3.7” filter. It covers residential levels, not withdrawal management at 3.7.

Facility

Do I need a physical location before I apply?

Yes. OHFLAC’s Life Safety Program reviews your building and architectural plans before construction, and a pre-opening inspection is required before you can occupy the space.

Does opening a second location change my license?

Yes. Under the 2024 version of the rule, a license was “valid for the provider named and location or locations listed in the application and is not transferable.” A new site has to get onto a license through OHFLAC before it opens, with its own Life Safety review, and it should go through the CON exemption step as well.

Does a Certificate of Need apply to my facility?

Usually as an exemption rather than a full review. W. Va. Code § 16-2D-11 exempts “providing behavioral health facilities and services” and alcohol or drug treatment facilities other than opioid treatment programs, but you still file an exemption application with a statement of which exemption applies. Two limits sit in § 16-2D-9: the Health Care Authority cannot issue a CON for a new opioid treatment program, and it cannot approve added licensed substance abuse treatment beds in a county that already has more than 250.

Do recovery residences need anything from OHFLAC?

Yes, a registration. W. Va. Code § 16-59-4 requires a recovery residence to register with OHFLAC before doing business in the state. The initial and renewal registration fee is $250 (the statute allows inflation adjustments), and running an unregistered residence can bring a civil money penalty of up to $20,000 a day. Certification through the West Virginia Alliance for Recovery Residences is a different, voluntary track that OHFLAC says is “separate from the registration requirements.”

Staffing

What credentials do addiction counselors need in West Virginia?

Inside a licensed behavioral health center, the new state credential isn’t mandatory: § 16-68-21 says the article doesn’t apply to paid alcohol and drug counselors working there, so in our experience WVCBAPP certification, or another professional license, remains the working credential for facility staff. For private practice, W. Va. Code § 16-68 (added by 2026’s SB 897) sets two tiers run by the Bureau for Behavioral Health. Certification 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 commissioner-approved education, and a department exam. The license adds a master’s degree with at least 18 graduate semester hours in counseling or related subjects. Anyone with a master’s who holds WVCBAPP substance abuse counselor certification on or before July 1, 2027 is deemed licensed under § 16-68-12, and BBH has until that same date to be fully able to run the program.

Do mental health programs use a different credentialing process?

Yes. Professional counselors are licensed by the West Virginia Board of Examiners in Counseling under W. Va. Code § 30-31, which issues the LPC and the associate-level LPCA (plus LMFT and LMFTA for marriage and family therapists). That board is separate from the § 16-68 alcohol and drug counselor program.

Who can supervise counselors completing their hours?

For LPCAs, the Board of Examiners in Counseling sets the rules, and its site points to an Approved Licensed Professional Supervisor (ALPS) program, so confirm a supervisor’s standing with the board before counting hours. On the addiction side, § 16-68-3 says a certified alcohol and drug counselor in private practice has to work under a licensed alcohol and drug counselor.

Operations

How does medication for opioid use disorder fit into a West Virginia license?

Federally, buprenorphine got simpler once Congress ended the DATA-waiver program; DEA’s January 2023 letter says buprenorphine prescriptions now “only require a standard DEA registration number.” West Virginia adds its own layer. A program that prescribes, administers, or dispenses a partial opioid agonist such as buprenorphine is an office-based MAT program and needs an OHFLAC registration under W. Va. Code § 16B-13-4, unless it qualifies for one of the attestation exemptions, including one for licensed behavioral health centers. Naltrexone needs only ordinary prescribing privileges. Methadone is a different story: it requires a licensed opioid treatment program, and § 16B-13-12 keeps a moratorium on licensing new ones, so most programs coordinate with an existing OTP through a written agreement.

What is the practical filing sequence for a new facility?

OHFLAC publishes the order on its “opening a behavioral health center” page, and it runs like this: Certificate of Need or exemption from the Health Care Authority; Life Safety Program site and plan approval before construction, then a pre-opening inspection; the Behavioral Health Services Application for Licensure once the build-out and policies are done; a State Fire Marshal recommendation; the initial licensure survey; and a 6-month initial license, followed by a full on-site review before it expires. For a residential SUD facility, fit the accreditation survey in after you open, inside the one-year window in § 9-5-29a.

Do I need a separate certification from the Bureau for Behavioral Health?

Not for the facility license. That comes from OHFLAC alone, and we found no general BBH certification that every licensed program must hold. BBH does run optional programs, such as working with BMS to bring providers toward Certified Community Behavioral Health Clinic (CCBHC) status, and it must be fully able to run the § 16-68 alcohol and drug counselor program by July 1, 2027.

Enforcement

Can OHFLAC suspend or revoke my license?

Yes. W. Va. Code § 27-9-1 lets the OHFLAC director “impose a civil money penalty, suspend, or revoke the license of any center for good cause after reasonable notice,” with due process rights set out in the rule. The 2024 version of that rule also allowed entry onto premises reasonably believed to be running without a license, with a petition to circuit court for an inspection warrant if entry was refused.

What happens if my accreditation lapses?

Your OHFLAC license itself isn’t directly affected, since accreditation isn’t a licensing condition. For a residential SUD facility, though, a lapse does affect eligibility under that separate state payment rule, so it’s worth treating the accreditation renewal calendar with real seriousness regardless of its licensing status.

Is there a fast reinstatement path after a license lapses?

We didn’t find one. The current rule, 71 CSR 25, provides for initial, regular, and provisional licenses (section 4.4), and the 2024 version it replaced had no abbreviated reinstatement track, so our working assumption is that a lapsed or revoked license means reapplying from the start, including any Certificate of Need step. Confirm with OHFLAC before you plan around that.

What’s Included and What Isn’t

What we help with in West Virginia

We help behavioral health and SUD operators sequence the CON exemption, OHFLAC licensure, and, for facilities pursuing it, the CARF or Joint Commission accreditation survey itself, so the pieces land in the right order.

What falls outside that scope

We don’t handle CMS, Medicare, or Medicaid enrollment, billing, or reimbursement matters, including the Medicaid payment condition that applies to residential SUD facilities in West Virginia, and marketing isn’t something we provide directly either. Our focus is licensing, certification, and accreditation, not payer credentialing. If you need marketing help, we’re happy to point you toward people who specialize in it.

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.

Sorting out OHFLAC, CON, and the new counselor system for a West Virginia program? Let’s talk it through.

Sources

W. Va. Code § 27-9-1, behavioral health center license: License; regulations (checked October 7, 2026)
WV Secretary of State, 71 CSR 25: Behavioral Health Centers Licensure, 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)
WV Secretary of State, 64 CSR 11 version history: Behavioral Health Centers Licensure (historical) (checked October 7, 2026)
64 CSR 11 (2024 version), section 4, Cornell LII mirror: Licensure (checked October 7, 2026)
WV Secretary of State, 71 CSR 27, 71 CSR 28 and 71 CSR 12: Opioid Treatment Programs, Office-Based MAT, Hospital Licensure (checked October 7, 2026)
2023 HB 2006, enrolled: DHHR reorganization (checked October 7, 2026)
W. Va. Code § 5F-2-1a and § 16B-2-1: Department transfers, Office of the Inspector General (checked October 7, 2026)
W. Va. Code § 16B-13-2, -3, -4 and -12: OTP license, office-based MAT registration, OTP moratorium, definitions (checked October 7, 2026)
W. Va. Code art. 16-5Y: former MAT article, repealed (checked October 7, 2026)
W. Va. Code § 16-2D-9 and § 16-2D-11: Health services that cannot be developed, Exemptions from certificate of need (checked October 7, 2026)
WV Health Care Authority: Certificate of Need (checked October 7, 2026)
W. Va. Code § 9-5-29a: Residential SUD facility licensure and accreditation for Medicaid payment (checked October 7, 2026)
OHFLAC: Office of Health Facility Licensure and Certification, Opening a behavioral health center, Behavioral health center service types (checked October 7, 2026)
W. Va. Code § 16-59-4 and OHFLAC FAQ: Recovery residence registration, Recovery Residence FAQ (checked October 7, 2026)
W. Va. Code art. 16-68 and 2026 SB 897 status: Licensure and certification of alcohol and drug counselors, § 16-68-21, SB 897 bill history (checked October 7, 2026)
W. Va. Code art. 30-31 and WV Board of Examiners in Counseling: Licensed professional counselors, Becoming a licensed counselor (checked October 7, 2026)
WV Bureau for Behavioral Health: CCBHC initiative (checked October 7, 2026)
WV Bureau for Medical Services: Residential Level 3.7 application, Chapter 504 Appendix D (checked October 7, 2026)
CARF and ASAM: ASAM Level of Care Certification, ASAM Level of Care Certification, CARF provider search (checked October 7, 2026)
DEA Diversion Control: Dear Registrant letter on the end of the DATA-waiver (checked October 7, 2026)
42 CFR 8.11, eCFR: Opioid treatment program certification (checked October 7, 2026)