Maryland Mental Health Outpatient 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.

Outpatient mental health programs in Maryland are licensed by the Maryland Department of Health, Behavioral Health Administration (BHA) under COMAR 10.63, and every one of the common program types carries an accreditation-based license. A program-level Outpatient Mental Health Center and a mobile treatment team go through the same gate: an approved accreditor first, then BHA. COMAR 10.63.01.04 lists the exemptions, and two of them matter most for outpatient planning. A health professional licensed under the Health Occupations Article who works in a solo or group practice is exempt from this licensing, as are outpatient behavioral health services delivered in a hospital’s regulated space when the hospital holds approved behavioral health accreditation.

The Program Types and What the Accreditor Crosswalk Says

BHA maintains a crosswalk for each approved accreditor that maps every Maryland program type to the accreditor’s own service categories. The rows below come from BHA’s ACHC crosswalk, marked revised March 5, 2020, so check the current crosswalk on BHA’s accreditation-based licensing page before you build a survey plan.

Maryland Program Type	COMAR 10.63.03 Section	ACHC Service Type in BHA’s Crosswalk	Certificate of Need (our reading of HG 19-114)
Outpatient Mental Health Center	10.63.03.05	Outpatient Treatment	Not required
Mobile Treatment Services	10.63.03.04	Assertive Community Treatment Team	Not required
Psychiatric Day Treatment Program	10.63.03.08	Partial Hospitalization Services	Not required
Psychiatric Rehabilitation Program for Adults	10.63.03.09	Psychosocial Rehabilitation	Not required
Psychiatric Rehabilitation Program for Minors	10.63.03.10	Psychosocial Rehabilitation for Minors	Not required
Integrated Behavioral Health Program	10.63.03.02	Outpatient Treatment	Not required

Accreditation Comes Before the License

Which accreditor you pick actually matters, since coverage isn’t uniform across them. The Maryland Department of Health currently approves ACHC, CARF, the Council on Accreditation, and The Joint Commission for community programs. A fifth body, the National Commission on Correctional Health Care, is on the list for correctional facilities only. BHA’s own page warns that not every approved accreditor is approved for every licensed program type, so match the accreditor to your exact program list before you sign. The license runs on the accreditor’s clock, too: COMAR 10.63.06.05 sets an accreditation-based license term at the accreditation period plus 3 months, and the renewal packet has to reach the Department at least 60 days before the current license expires. Between surveys, COMAR 10.63.01.05 still lets the Department or its designee make announced or unannounced visits to investigate a complaint and to inspect and copy financial, treatment and service records.

The Local Step Most Operators Miss

This local sign-off gets lumped in with the state application in most summaries, but it’s genuinely its own approval. Before you apply, sign an Agreement to Cooperate with the Core Service Agency, Local Addictions Authority, or Local Behavioral Health Authority in each county, or Baltimore City, where you will operate. BHA’s form, revised July 31, 2025, is required with an initial application, a renewal, an added service, and any change of location or ownership. If you offer both mental health and substance use services in a jurisdiction without a Local Behavioral Health Authority, BHA’s introductory licensing guidance calls for agreements from both the Core Service Agency and the Local Addictions Authority. Adding a substance use track later counts as a change in service array under COMAR 10.63.06.07, which means sending BHA’s approval unit evidence that your accreditation covers the new service and notice to the local authority, and the form itself asks for an agreement when a service is added.

Certificate of Need, as We Read the Statute

The Maryland Health Care Commission runs Certificate of Need review, and the statute ties that review to a “health care facility” as Health-General § 19-114 defines it: hospitals, related institutions, ambulatory surgical facilities, home health agencies, hospices, freestanding medical facilities and similar. Psychiatry is one of the listed medical services in § 19-120, which matters for hospital psychiatric beds. A community program licensed by BHA under COMAR 10.63 does not appear on that facility list, so our reading is that an outpatient mental health program does not need a CON. That is our interpretation of the statute, not an MHCC ruling, so ask the Commission if your project includes any inpatient or hospital component.

Ketamine and Spravato at a Maryland Outpatient Mental Health Center

BHA has no ketamine-specific rule. Where we say a step fits or is needed beyond what COMAR states, that is our reading, and a written answer from BHA should control.

An Outpatient Mental Health Center already has the clinical frame for this. COMAR 10.63.03.05 requires the center to offer medication management at a minimum and to employ a psychiatrist as medical director with overall responsibility for clinical services, on site at least 20 hours a week. The same rule calls for clinical staff authorized under the Health Occupations Article to provide the services they deliver, so dosing and monitoring belong with prescribers and nurses working inside their own scope. We treat ketamine or Spravato as part of medication management rather than a new program type, which means no separate BHA license category covers it. Before the first dose, confirm that your accreditor’s survey scope includes the service and ask BHA in writing whether it wants notice, because COMAR 10.63.06.07 only spells out filings for new sites and new program types.

The drug supply is what triggers registrations. OCSA requires a Maryland Controlled Dangerous Substances registration for each location where CDS is administered or stored, and its instructions say to hold it before applying to DEA. The federal registration is tied to the site as well (21 CFR 1301.12). That rule’s carve-out covers only an office where a practitioner registered elsewhere in the state writes prescriptions and keeps no supply, so it won’t help a center that gives doses on the premises. For Spravato, the center itself enrolls in the REMS as an outpatient healthcare setting, a healthcare provider monitors each patient for at least 2 hours, and no dose ever goes home with the patient.

Maryland’s PDMP query mandate (Health-General 21-2A-04.2) starts when a prescriber begins a course of an opioid or a benzodiazepine, so ketamine by itself does not require a lookup. We could not confirm from a primary source whether doses given in the office must be reported to the PDMP, so ask the program before you build the workflow.

Some operators would rather keep ketamine off the BHA license entirely. A licensed health professional in solo or group practice, working within the professional board’s rules, is exempt from COMAR 10.63 licensing (10.63.01.04), so a separate physician practice can run the treatment room and take referrals from the center. Our guide to Maryland Drug and Alcohol Outpatient Treatment Licensing works through ownership, management and referral rules for that setup under its ketamine heading.

Staffing an Outpatient Mental Health Program

A small program typically needs a clinical director and two to three clinicians, and Maryland’s licensing ladder does real work in keeping that affordable. 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 clinical director plus two to three clinicians commonly runs $210,000 to $290,000 a year in clinical payroll before benefits. Most clinics here don’t pay that number in full, and the licensing ladder is why. The Maryland Board of Professional Counselors and Therapists licenses counselors at the graduate level as LGPC and at the clinical level as LCPC. Under COMAR 10.58.12.04, an LGPC has to practice under a Board-approved supervisor and may not practice independently or supervise anyone else. A common approach staffs the clinic with LGPC clinicians under an LCPC clinical director who holds Board supervisor approval, which keeps payroll manageable while giving staff a defined path to the clinical license. Social workers answer to the Board of Social Work Examiners and psychologists to the Board of Examiners of Psychologists, so confirm each hire’s credential with the board that issued it.

One position the counseling payroll above does not cover: an Outpatient Mental Health Center must employ a medical director who is a psychiatrist, has overall responsibility for clinical services, and is on site at least 20 hours per week (COMAR 10.63.03.05). That psychiatrist is licensed through the Maryland Board of Physicians. The same rule requires the center to offer, at a minimum, individual, group and family therapy plus medication management, delivered by multidisciplinary staff authorized under the Health Occupations Article. A Psychiatric Day Treatment Program has its own floor of a psychiatrist and a registered nurse on the team (COMAR 10.63.03.08), and a PRP-A must be directed by a qualified rehabilitation specialist employed at least 20 hours a week below 30 participants and 40 hours a week at 30 or more (COMAR 10.63.03.09). Once your program model is confirmed, the staffing matrix and cost estimate follow from it.

COMAR 10.63 Is Being Rewritten

The Maryland Department of Health sent a full proposed replacement of COMAR 10.63 to the AELR Committee on July 10, 2026. It ran in the Maryland Register on August 21, 2026, with comments taken through September 21, 2026. The proposal splits program types into separate chapters, among them 10.63.16 for the Outpatient Mental Health Center and 10.63.19 for a Mental Health Partial Hospitalization Program, plus separate chapters for PRP-A, PRP-M and Mobile Treatment Services. BHA’s announcement page did not show it as adopted when we checked on October 7, 2026, so the current 10.63.03 text is the one in force until a final action is published. Ask the licensing unit which version it will apply if your application straddles an adoption date.

How to Submit Your BHA Application

Finish accreditation before you file. A survey on the calendar will not carry the application, because COMAR 10.63.06.03 asks for the accreditor’s final letter or certificate granting accreditation, the most recent survey report, and any corrective action plan that survey required. Sign the Agreement to Cooperate (DHMH #4781) with each local authority. BHA moved licensing applications to an online process effective February 10, 2025, so plan on submitting the application and its attachments through that system. Questions about the process go to bha.licensingcompliance@maryland.gov. Per BHA’s April 17, 2026 alert, applications are reviewed in the order received.

What Delays Maryland Outpatient Mental Health Applications

In our experience, three issues drive most of the friction on these applications. The most common delay is an accreditor that does not cover every program on the application. The second is a missing agreement from one of the jurisdictions listed. The third is buying a promise of speed. BHA’s April 17, 2026 alert calls any offer to expedite a license application in exchange for money misinformation and cautions providers about consultants who guarantee licensure.

PRP operators have one more timing issue to plan around. MDH announced on June 24, 2026 that new Maryland Medicaid enrollments for psychiatric rehabilitation programs are paused from July 1 through December 31, 2026 in Anne Arundel, Baltimore City, Baltimore County, Carroll, Frederick, Harford, Howard, Montgomery, Prince George’s and Washington. The Department says it is still processing licensure applications during the pause, so a new PRP in those jurisdictions can be licensed but not yet enrolled to bill Medicaid.

Frequently Asked Questions

Matching your Maryland program types to the right accreditor crosswalk? Reach out here.

Sources

• COMAR 10.63.01.04: Exempt Providers (checked October 7, 2026; Justia mirror re-checked October 9, 2026)
• COMAR 10.63.01.05: post-licensing inspections and agreements to cooperate (checked October 7, 2026)
• COMAR 10.63.02.02: Covered Programs and Services (checked October 7, 2026)
• COMAR 10.63.03: Program descriptions, including .02, .04, .05, .08, .09 and .10 (checked October 7, 2026; .05 re-checked October 9, 2026 via the Justia mirror)
• COMAR 10.63.06.03, .05 and .07: accreditation documents, license term and renewal, modifications (checked October 7, 2026; .07 re-checked October 9, 2026 via the Justia mirror)
• COMAR 10.58.12.04: Licensed Graduate Professional Counselors and 10.58.12.05, Licensed Clinical Professional Counselors (checked October 7, 2026)
• Maryland Health-General § 19-114: definitions, Certificate of Need (checked October 7, 2026)
• Maryland Health-General § 19-120: Certificate of Need requirements (checked October 7, 2026)
• MDH Behavioral Health Administration: Accreditation Information (checked October 7, 2026)
• MDH Behavioral Health Administration: ACHC crosswalk, revised March 5, 2020 (checked October 7, 2026)
• MDH Behavioral Health Administration: Agreement to Cooperate, DHMH #4781, revised 7/31/2025 (checked October 7, 2026)
• MDH Behavioral Health Administration: Introduction to Accreditation and Licensing Requirements (checked October 7, 2026)
• MDH Behavioral Health Administration: memo on the online licensing application, January 2025 (checked October 7, 2026)
• MDH Behavioral Health Administration: licensing alert, April 17, 2026 (checked October 7, 2026)
• MDH Behavioral Health Administration: COMAR 10.63 proposed regulations announcement and transmittal 26-079 (checked October 7, 2026)
• MDH Newsroom: pause on certain behavioral health provider enrollments, June 24, 2026 (checked October 7, 2026)
• Maryland health occupations boards: Board of Professional Counselors and Therapists, Board of Social Work Examiners, Board of Examiners of Psychologists, Maryland Board of Physicians (checked October 7, 2026)
• Maryland OCSA: Practitioner CDS registration instructions (checked October 9, 2026)
• 21 CFR 1301.12 (Cornell LII mirror of the official text): Separate registrations for separate locations (checked October 9, 2026)
• SPRAVATO REMS: Healthcare setting certification and monitoring (checked October 9, 2026)
• Health-General 21-2A-04.2, text posted by the Maryland Department of Health PDMP: Prescriber use mandate (checked October 9, 2026)