Maryland Mental Health Inpatient Licensing

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.

Maryland splits inpatient mental health care into two tracks that have almost nothing in common. Community-based residential programs are licensed by the Maryland Department of Health, Behavioral Health Administration (BHA) under COMAR 10.63 and depend on accreditation. Hospital-level psychiatric care runs through the Maryland Health Care Commission (MHCC) Certificate of Need process and the Office of Health Care Quality (OHCQ). Choosing the wrong track is the most expensive early mistake an operator can make.

Two Tracks for Inpatient Mental Health Care

Community Residential Programs Are Accreditation-Based

Mental health follows the same accreditation-first rule the SUD side runs on. BHA licenses residential mental health programs such as Residential Rehabilitation Programs (10.63.04.05) and Residential Crisis Services (10.63.04.04) as accreditation-based licenses. An RRP carries two extra conditions: a licensed Psychiatric Rehabilitation Program for Adults has to operate it, and each site can house no more than three people unless it is also licensed as a group home. The program must be accredited by an organization the Maryland Department of Health has approved, currently ACHC, CARF, the Council on Accreditation, and The Joint Commission. A fifth body, the National Commission on Correctional Health Care, is on the list for correctional facilities only. BHA publishes a crosswalk for each accreditor at its accreditation-based licensing page, and it warns that not every accreditor is approved for every program type. Before you sign a survey contract, check that the accreditor’s crosswalk actually lists residential crisis services or RRPs, whichever one you plan to run. You will also need an Agreement to Cooperate with the Core Service Agency or Local Behavioral Health Authority in each jurisdiction (COMAR 10.63.01.05). BHA’s current version of the form, DHMH #4781 revised July 31, 2025, goes in with the initial application and every renewal, and again when you add a service or ask for any other change to the license.

Hospital-Level Psychiatric Care Requires a Certificate of Need

What moves a project onto this heavier track is the setting: the beds sit in a hospital. OHCQ licenses hospitals under COMAR 10.07.01, and its hospital page counts a mental health program among the specialized services that define a special hospital. Opening a new psychiatric hospital, or adding inpatient psychiatry to an existing one, needs a Certificate of Need from MHCC under Health-General Article 19-120, and MHCC measures the project against the State Health Plan chapter for acute psychiatric services, COMAR 10.24.21. A recent adult example shows the scale. In September 2021, MHCC approved a 16-bed adult inpatient psychiatric unit at Luminis Health Doctors Community Medical Center at an approved cost of $7,787,303, with a condition that the hospital be designated by the Maryland Department of Health to perform evaluations of people brought in on emergency petition. That decision also says first-use approval is not a license and does not replace what OHCQ or other parts of the Maryland Department of Health require before a facility operates, so the CON is only half the job.

If your model is a small residential program with clinical support rather than a hospital, the community track is almost always the right one, and as we read the statute it avoids the CON entirely. A Certificate of Need does not turn a program into a BHA-licensed community program, and the reverse is also true.

Ketamine on Maryland’s Hospital and Community Tracks

Neither COMAR 10.63 nor the hospital rules in COMAR 10.07.01 mention ketamine. What follows is our reading of how the general rules apply, so confirm it with OHCQ, BHA and counsel before you build a protocol around it.

Inside a hospital, ketamine moves through the hospital’s own approvals rather than a state filing. COMAR 10.07.01.24 has every Maryland hospital set criteria for granting physicians delineated clinical privileges for specific services, so the psychiatrist who will order ketamine needs privileges that cover it, on criteria the hospital itself writes. In our experience the medical staff and pharmacy leadership will also want a written protocol for dosing, vital sign monitoring and recovery before they sign off. A unit planning to use Spravato has to be certified in the REMS, which applies to inpatient healthcare settings as well as outpatient ones, and a healthcare provider monitors each patient for at least 2 hours after a dose. OCSA’s establishment instructions call for a CDS registration at each location where controlled substances are administered or stored, so check that the hospital’s registration covers the unit, alongside its DEA registration.

The community licenses are a different fit. In our reading, Residential Rehabilitation Programs and Residential Crisis Services under COMAR 10.63.04 are built around rehabilitation and crisis support rather than on-site medical treatment, so a resident there who is a good candidate gets ketamine from an outside prescriber, and the program’s job is coordination and a safe ride home.

Consent needs its own conversation for anyone admitted involuntarily. Our view is that a ketamine series is elective treatment that should begin only once the patient can give informed consent, and counsel should review the protocol before it is offered to anyone held on an emergency petition or an involuntary admission.

Plan the Outpatient Handoff Before the First Dose

In our experience a psychiatric admission ends well before a ketamine series would, so the continuation plan has to exist from the start. Choose the outpatient practice when ketamine is first proposed, send the dosing record and response notes with the patient, and book the first outpatient session before discharge. That practice can operate as a licensed professional’s solo or group practice outside BHA licensing (COMAR 10.63.01.04). The ownership and registration details are in the ketamine section of Maryland Drug and Alcohol Outpatient Treatment Licensing.

Staffing a Residential Mental Health Program

Maryland’s graduate-counselor pathway is the real lever on residential payroll here. The regulations themselves set only a floor. A residential crisis program has to keep staff on site 24 hours a day, 7 days a week, whenever someone is there receiving services (COMAR 10.63.04.04). An RRP needs on-site staff as residents’ needs require plus staff on call around the clock (10.63.04.05). The clinical director, prescriber relationship and acuity-matched nursing that most operators budget for are our planning assumptions, not lines in COMAR. Maryland’s mental health and addiction counselors earn a median of $59,530 a year statewide (BLS OEWS, May 2025), with the middle half between $50,030 and $73,220, so a program with a clinical director, several clinicians, and 24-hour direct-care coverage commonly runs well past $450,000 a year in payroll before prescriber and nursing costs. The number is real, and there is a common way to bring it down. Programs often fill clinical roles with Licensed Graduate Professional Counselors, who are licensed by the Maryland Board of Professional Counselors and Therapists. Under COMAR 10.58.12.04 an LGPC must work under a Board-approved supervisor and cannot practice independently or supervise anyone else, so the clinical director (typically an LCPC) needs that Board approval. The arrangement lowers clinical payroll while giving staff a genuine route to independent licensure. Pairing one RN with several LPNs for medical oversight, rather than staffing every shift with a registered nurse, trims nursing cost as well. Once your census and program type are set, the actual matrix follows from them.

COMAR 10.63 Is Being Rewritten

The Maryland Department of Health has proposed repealing the current COMAR 10.63 and replacing it with general chapters plus a separate chapter for each program type. The package went to the legislature’s AELR Committee on July 10, 2026, appeared in the August 21, 2026 Maryland Register, and took public comment through September 21, 2026. The department’s announcement page still shows it as proposed. Before you file, email BHA’s Office of Licensing and Compliance at bha.licensingcompliance@maryland.gov and ask which version will apply to your application.

What Delays Maryland Inpatient Mental Health Projects

In our experience, three issues cause most of the delays on these projects. The most common delay is treating a community residential program like a hospital, which sends an operator into a CON review they never needed. The second is treating accreditation as a later step, when BHA requires it before licensing a community program. The third is paying for a promise of speed. In an April 17, 2026 alert, BHA warned about people offering to speed up applications for a fee, said it reviews applications in the order they arrive, and told providers to be wary of anyone who promises a license.

Frequently Asked Questions

Figuring out whether your Maryland program needs the community track or a Certificate of Need? Reach out here.

Sources

• COMAR 10.63.01.02: Definitions (accreditation-based license) (checked October 7, 2026)
• COMAR 10.63.01.05: Agreements with the CSA, LAA or LBHA before licensure (checked October 7, 2026)
• COMAR 10.63.02.02: Covered Programs and Services (checked October 7, 2026)
• COMAR 10.63.04.04: Residential Crisis Services (checked October 7, 2026)
• COMAR 10.63.04.05: Residential Rehabilitation Program (checked October 7, 2026)
• Maryland BHA: Accreditation Based Licensing Information (checked October 7, 2026)
• Maryland BHA: Agreement to Cooperate, DHMH #4781 (rev. 7/31/2025) (checked October 7, 2026)
• Maryland BHA: COMAR 10.63 Online Application Guide (checked October 7, 2026)
• Maryland BHA: COMAR 10.63 Proposed Regulations Announcement (checked October 7, 2026)
• Maryland BHA: April 17, 2026 licensing alert (checked October 7, 2026)
• Health-General Article 19-114: Certificate of Need definitions (health care facility) (checked October 7, 2026)
• Health-General Article 19-120: When a Certificate of Need is required (checked October 7, 2026)
• Health-General Article 19-318: Hospital license required (checked October 7, 2026)
• COMAR 10.24.21: State Health Plan, Acute Psychiatric Services (checked October 7, 2026)
• MHCC: Certificate of Need, Doctors Community Medical Center psychiatric unit, September 23, 2021 (checked October 7, 2026)
• COMAR 10.07.01: Acute General Hospitals and Special Hospitals (checked October 7, 2026)
• Maryland OHCQ: Hospitals (checked October 7, 2026)
• COMAR 10.58.12.04: Licensed Graduate Professional Counselors (checked October 7, 2026)
• COMAR 10.07.01.24, via Justia: Physician credentialing and delineated clinical privileges (checked October 9, 2026)
• COMAR 10.63.01.04, via Justia: Exempt providers, including solo and group practice (checked October 9, 2026)
• Maryland OCSA: Establishment CDS registration instructions (checked October 9, 2026)
• SPRAVATO REMS: Inpatient and outpatient healthcare setting requirements (checked October 9, 2026)