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Indiana Drug and Alcohol Outpatient Treatment Licensing

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Written by

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: DMHA Outpatient Certification | Regular Certification | Questions: DMHA-CL@fssa.in.gov

Outpatient substance use disorder treatment in Indiana is certified by the Family and Social Services Administration’s Division of Mental Health and Addiction (DMHA) under 440 IAC 4.4, and one number decides which certification you need: how many direct service providers you have. Get that count right before you hire, because it includes people many operators forget to add.

The Staff Count Decides Your Track

ItemOutpatient CertificationRegular Certification
Direct service providers10 or fewer, full-time or part-time11 or more
AccreditationNot requiredRequired from a DMHA-approved accreditor
Staffing testAt least 50% licensed or credentialed, and at least one addiction-credentialed providerNo 50% test in 440 IAC 4.4; your accreditor’s standards apply
TermTwo yearsExpires 90 days after the accreditation expires
Renewal request30 days before expiration30 days before expiration

The definition of a direct services provider is broad. Under 440 IAC 4.4-1-1, it includes any individual, contractor, employee, or volunteer who provides counseling, psychological, medical, or social services on your behalf. Volunteers and contractors count toward the threshold. If an outpatient-certified program reaches 11 direct service providers, 440 IAC 4.4-2-5 requires it to notify DMHA immediately and begin the regular certification process, so track the number monthly.

What Outpatient Certification Requires

The qualification test itself is simple to state but easy to get wrong in practice. To qualify, you must list every direct service provider with education, degrees, and proof of licensure or credentials. At least half must be one of the following: a licensed clinical social worker, licensed mental health counselor, or licensed marriage and family therapist, a psychologist, a physician, an advanced practice nurse or certified nursing specialist, or an individual credentialed in addictions counseling by a credentialing body DMHA approves. At least one provider must hold a specific addictions counseling credential. If either test fails for more than 30 days, 440 IAC 4.4-2-5 says you must immediately notify DMHA with a plan of correction, and DMHA may continue the certification for another 60 days while you fix it.

The uniform criteria in 440 IAC 4.4-2-4.5 set clocks you can audit yourself against. The intake assessment must occur within two weeks of first contact and screen for co-occurring disorders, the treatment plan must be completed by the third session and reviewed at least every 60 calendar days, and the discharge summary must be finished within 30 calendar days of discharge. If you plan to call a service intensive outpatient, check it against the rule’s own definition in 440 IAC 4.4-1-1: counseling and education sessions at least two hours long, at least three days a week, for at least four weeks per consumer. The rule text has no separate partial hospitalization definition, even though DMHA’s certification pages list partial hospitalization among the services both certification types cover.

Regular Certification and the Temporary Route

Crossing the 11-provider line isn’t a paperwork formality, it changes the whole compliance track. Once you hold 11 or more direct service providers, you need regular certification and an accreditor DMHA approves. DMHA’s approved accreditation list includes CARF, The Joint Commission, the Council on Accreditation (whose survey must use addiction standards for regular certification), ACHC, and NCQA. A program that is not yet accredited can hold a temporary certification under 440 IAC 4.4-2-3.5 for 12 months, extendable once by up to 12 more, if it keeps at least one addiction-credentialed provider and shows proof of an accreditation application. Fail to become accredited within 24 months and you cannot reapply for regular certification for a year, though you may apply for outpatient certification if you still qualify.

No Certificate of Need

Indiana’s certificate of need program, run by the Indiana Department of Health under IC 16-29-7, covers comprehensive care beds in comprehensive care facilities (nursing homes). Nothing in that chapter reaches addiction treatment, so in our reading an outpatient program never enters that process.

Medication for Opioid Use Disorder in Outpatient Care

Opioid treatment programs sit on a separate track. IC 12-23-18-0.5 requires each OTP location to be specifically approved and its facility certified by DMHA, apart from outpatient or regular certification. IC 12-23-18-5.5 then opens with “The division may not grant specific approval to be a new opioid treatment program.” The exceptions are narrow: a hospital licensed under IC 16-21, an institution licensed under IC 12-25, or a certified community mental health center may apply, and since July 1, 2018 DMHA may approve no more than nine additional programs, tied to a showing of need. A freestanding outpatient clinic is not on that list, so in practice it handles methadone by referring to an existing certified OTP, and we suggest putting that referral arrangement in writing. Buprenorphine is simpler. DEA’s January 2023 letter to registrants says “all prescriptions for buprenorphine only require a standard DEA registration number,” with no patient caps, though DEA guidance says practitioners must attest to the required training when they apply for or renew a registration. Detoxification and withdrawal management must be supervised by a physician or a clinical nurse specialist licensed in Indiana, and DMHA asks for a CEO-signed letter on letterhead confirming that arrangement.

Opening a Ketamine Clinic Alongside Indiana Outpatient Care

We found no Indiana statute or rule written for ketamine clinics. What follows is our interpretation of the medical practice act, the controlled substance registration rules and DMHA’s certification categories.

As we read DMHA’s categories, a practice that treats depression with ketamine doesn’t need a DMHA certificate. DMHA’s quality assurance page lists licensure or certification for private mental health institutions, community mental health centers, addiction service providers and residential providers, and an office-based ketamine practice fits none of them. If the practice begins offering addiction treatment, ask DMHA whether the 440 IAC 4.4 certification discussed above applies. Keep in mind ketamine (Schedule III, 21 CFR 1308.13(c)(7)) is labeled by the FDA only for anesthesia, so it isn’t a medication for opioid use disorder and doesn’t fill the buprenorphine or methadone role described above.

Ownership Under the Medical Practice Act

The place to start in Indiana is the medical practice statute. IC 25-22.5-1-2 lists the employers whose relationships with physicians aren’t treated as the unlicensed practice of medicine: hospitals licensed under IC 16-21 or IC 12-25, and health care organizations whose members are physicians, hospitals and other listed licensed providers, provided the entity doesn’t “direct or control independent medical acts, decisions, or judgment.” A company owned by lay investors isn’t on that list. We found no court ruling or attorney general opinion that bans lay ownership outright, but we’d still form the practice as a professional corporation (IC 23-1.5-3-1 lets a professional corporation issue shares only to licensed professionals and a few listed holders, such as other professional corporations) and have an investor-owned management services organization handle the lease, non-clinical staff and billing for a flat fee. Dosing protocols and patient selection stay with the physicians.

Registrations, INSPECT and Spravato

Each clinic address needs an Indiana controlled substance registration, held by the prescriber or the facility, and a DEA registration (21 CFR 1301.12(a)). The Professional Licensing Agency says the CSR address “should match the address on your DEA Registration.” Nurse practitioners practice under a practice agreement with a collaborating practitioner (IC 25-23-1-19.4), so write ketamine into it. INSPECT doesn’t collect doses “administered directly to the patient,” and the exemption for practitioner dispensing stops at a 72-hour supply (IC 25-26-24-3), so as we read it a larger take-home supply is reportable, with dispenser data due every 24 hours. A clinic offering Spravato must be certified in the REMS, its outpatients must be enrolled, and each session carries at least two hours of monitoring.

Referrals Back and Forth

Shared ownership between your outpatient program and the clinic is where the federal Eliminating Kickbacks in Recovery Act comes in. 18 U.S.C. § 220 covers payments for referrals to a “clinical treatment facility,” which it defines as a non-hospital medical setting providing substance use treatment “pursuant to licensure or certification under State law,” and a DMHA-certified program fits that description. The clinic should chart in its own system and order ketamine under its own registrations, never out of the certified program’s stock. Have counsel look at any payment that moves with patients. For starting ketamine during a residential stay, see the ketamine section of Indiana 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 wage math behind that staffing decision is worth walking through. Indiana counselors earn a median of $53,760 a year statewide (BLS OEWS, May 2025), about 9% below the $59,350 national median, with the middle half between $42,210 and $66,340, so a clinical director plus two to three counselors commonly runs $190,000 to $260,000 a year in clinical payroll before benefits. Indiana operators rarely pay that full figure, and here’s the structure that gets them under it. Addiction counselors are state licensed here through the Behavioral Health and Human Services Licensing Board at the Professional Licensing Agency, as the Licensed Addiction Counselor (LAC) and the master’s-level Licensed Clinical Addiction Counselor (LCAC), with associate tiers for people accruing supervised hours. Because the 50% rule counts anyone credentialed in addictions counseling by a DMHA-approved body, including the Indiana Counselors Association on Alcohol and Drug Abuse (CADAC II through V) and the Indiana Association for Addiction Professionals, a common approach staffs the program with credentialed counselors at lower wages and an LCAC clinical director. Keep the licensed and credentialed share at or above half at all times, since that threshold, not a specific headcount, is what the regulation actually tracks.

DMHA Is Revising the Addiction Rules

A compliance plan built entirely around today’s text could be outdated by the time it matters. DMHA’s addiction providers page says “Indiana is in the process of revising the administrative rules for addiction services” and that the new rules “will be structured around the ASAM Criteria.” The same page still points providers to Article 4.4 as the current rule, so ask DMHA which rule text governs your application before you file.

How to Submit Your DMHA Application

DMHA’s outpatient and regular certification pages both route applications through its Provider Portal. Enter your policies as rich text for admission criteria, confidentiality (access, consent, and notice), consumer intake assessments, consumer progress, consumer rights, discharge planning, and treatment planning. Write the confidentiality policy around 42 CFR Part 2, which covers federally assisted SUD programs, and remember 440 IAC 4.4-2-5 requires a written statement of rights for each consumer plus documentation that staff explained those rights out loud. Then upload a detoxification letter if applicable (on company letterhead, signed by the CEO, stating that a physician or clinical nurse specialist licensed in Indiana will supervise those services, with current license numbers) and your current fire and safety inspection report, with a follow-up report if a violation was cited. Regular certification also needs your accreditation letter, full report, survey recommendations, and your responses. DMHA’s quality assurance page lists DMHA-CL@fssa.in.gov as the certification and licensure contact for questions.

What Delays Indiana Outpatient Applications

In our experience working Indiana files, four mistakes cause most of the delays. The first is miscounting the staff threshold by leaving out contractors and volunteers, which lands an operator on the wrong track. The second is missing the moment the eleventh provider joins, since that triggers an immediate notice to DMHA. The third is a fire and safety report that is out of date or cites an open violation. The fourth is a licensed and credentialed share that slips below half for more than 30 days.

Frequently Asked Questions

How long does it take to open an outpatient SUD program in Indiana?

We have not found a processing time published by DMHA. Our planning estimate is roughly 4 to 8 months for outpatient certification with 10 or fewer providers, and 9 to 15 months for regular certification, since the accreditation survey drives the longer track.

When does an Indiana outpatient program need accreditation?

When it has 11 or more direct service providers, including contractors and volunteers who provide counseling, psychological, medical, or social services. Programs with 10 or fewer can hold an outpatient certification without accreditation.

Does Indiana require a Certificate of Need for outpatient addiction treatment?

Not in our reading. IC 16-29-7, Indiana’s certificate of need law, is written for comprehensive care beds in nursing homes, and we found nothing in it that reaches an outpatient addiction program.

How long does an Indiana outpatient certification last?

Two years from the date it is issued. A regular certification instead expires 90 days after the accreditation expires, and both types must be renewed by submitting a request 30 days before expiration.

Figuring out whether your Indiana program needs outpatient or regular certification? Reach out here.

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