Minnesota Drug and Alcohol Inpatient Treatment 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.

Apply now: Substance use disorder treatment program license application (DHS-7118) | Questions: DHS Mental Health, Substance Use Disorder, and Children’s Residential Facility Licensing Unit, dhs.mhcdlicensing@state.mn.us, 651-431-6500

Every residential bed in a Minnesota substance use disorder program sits under two licenses. The Minnesota Department of Human Services (DHS) licenses the treatment program itself under Minnesota Statutes chapter 245G. Then 245G.21, subd. 4 adds that a residential program “must have the appropriate license from the Department of Health,” which puts the building in front of the Minnesota Department of Health (MDH) as well. Operators coming from states with a single facility license tend to budget time for one approval. Here you are lining up two, plus a county letter that has to go out before DHS will even take the application.

Which MDH License Goes With the Program

The statute says “appropriate” and stops there. One candidate is MDH’s supervised living facility license (Minnesota Rules chapter 4665 and Minn. Stat. 144.50, subd. 6). For residential mental health programs, 245I.23, subd. 19 lists a Department of Health board and lodging or boarding care home license as the other options, which gives a sense of the menu. MDH’s supervised living facility page carries its own application and takes questions at 651-201-4200. Which category fits your building is a question for MDH and your DHS licensor together, and we’d settle it before signing a lease, since the answer can change what the physical plant has to look like. That last point is our experience, not a rule.

Chapter 245G also keeps the two licenses tied together after you open. Under 245G.03, subd. 3, a license holder has to notify DHS before a change in its MDH licensure, a move, or a change in residential capacity. A change in ownership needs a brand new license.

Minnesota Puts ASAM Levels in the Statute Book

The hour requirements here are quoted from Minn. Stat. 254B.19, the statute Minnesota titles “American Society of Addiction Medicine Standards of Care.”

Plenty of states mention the ASAM Criteria in a rule or a payer manual. Minnesota writes the residential levels into a statute and attaches minimum service hours to each. At Level 3.1 a program “must provide at least 5 hours of psychosocial treatment services per week.” Levels 3.3 and 3.5 call for “daily psychosocial treatment services seven days a week.” Levels 3.2 and 3.7 withdrawal management are handed off entirely: “withdrawal management must be provided according to chapter 245F.” Section 245G.07, subd. 1a then ties a client’s psychosocial service hours back to these numbers for the level the client is placed in.

A change is queued. The 2025 special session rewrote parts of 245G and 254B.19 to follow the ASAM 4th edition, effective “July 1, 2026, or upon federal approval, whichever is later,” and DHS’s September 2025 implementation plan said the policy was awaiting federal approval. We have not confirmed whether that approval has come through, so ask your licensor which version your policies should cite.

CARF offers a way to have a residential level checked from outside. Its ASAM Level of Care Certification, which ASAM describes as covering “adult residential programs at levels 3.1, 3.5, and 3.7,” is voluntary in Minnesota. Nothing we read in chapter 245G or 254B.19 requires it, and a DHS license has no field for it. The proof sits with CARF instead. CARF’s provider search has a certification filter with “ASAM Level of Care 3.7” next to 3.1 and 3.5, so anyone weighing a referral can check a Minnesota program’s level there. Neither CARF nor ASAM describes the certification as covering 3.7 withdrawal management, so a Minnesota program would use it for the 245G residential side, and its 245F beds would stand on the withdrawal management license alone. That split is our reading.

Withdrawal Management Runs on Its Own License

Detox beds next to residential beds don’t ride along on the 245G license. DHS licenses withdrawal management under chapter 245F, which defines two program types, and the staffing gap between them is the first thing to decide. A clinically managed program must “have a licensed practical nurse on site 24 hours a day and a medical director” (245F.12, subd. 2). A medically monitored program must “have a registered nurse on site 24 hours a day and a medical director” (subd. 3). Both need “one technician awake and on duty at all times for every ten patients,” with no technician responsible for more than 15, and one full-time alcohol and drug counselor for every 16 patients (245F.14). DHS’s withdrawal management page links the same DHS-7118 application the residential program uses. A withdrawal management program licensed as a hospital falls outside chapter 245F altogether (245F.03).

What the State Charges

Fees rose sharply on January 1, 2026. Under Minn. Stat. 245A.10, subd. 3(a), each new application carries a “$2,100 application fee,” and DHS’s 2025 implementation plan for SUD programs confirms the 245G figure. Annual license fees scale with licensed capacity, and the same plan’s fee table shows the bottom tier for a 245G program going from $600 to $2,600. The 2026 legislature amended 245A.10 again, but DHS’s 2026 implementation plan for SUD programs lists no change to these schedules, so the table below reflects the statute as DHS currently describes it.

Licensed capacity	245G annual fee	245F withdrawal management annual fee
1 to 24	$2,600	$2,600
25 to 49	$3,000	$3,000
50 to 74	$5,000	$5,000 (50 or more)
75 to 99	$10,000	$5,000
100 to 199	$15,000	$5,000
200 or more	$20,000	$5,000

DHS also adds $500 to the renewal invoice for each satellite location, and its plan says renewal invoices go out in late September. MDH’s facility license fees are separate and set under Minn. Stat. 144.122. We haven’t confirmed the current amounts, so get them from MDH directly.

Medications for Opioid Use Disorder in a Minnesota Residential Program

Minnesota is lighter here than many states. We found no provision in chapter 245G, chapter 245F or the 254B rate statutes that requires a non-OTP residential program to offer MOUD or forbids turning away a client who takes it. What 245G does require is education. Section 245G.04, subd. 3 says the opioid information given to clients must cover “treatment options, including the use of a medication for opioid use disorder,” and 245G.07 lists “medications for addiction and psychiatric disorders and the importance of medication adherence” as a psychoeducation topic. Our advice goes past the statute: write down how a resident who arrives on buprenorphine or methadone keeps getting it, and who does the prescribing or dosing.

Methadone for opioid use disorder stays with opioid treatment programs, which are regulated separately under 245G.22, so a residential program coordinates with a licensed OTP rather than becoming one. Buprenorphine is far simpler. DEA’s January 12, 2023 letter to registrants says “all prescriptions for buprenorphine only require a standard DEA registration number.” Every 245G and 245F program, along with IRTS and residential crisis stabilization programs, must also keep a supply of opiate antagonists on hand under Minn. Stat. 245A.242, with staff trained before they have direct contact with clients. DHS’s 2026 implementation plans list a 2026 law change, effective July 1, 2026, under which a nasal opiate antagonist such as Narcan can be kept on site without a standing order, while intramuscular administration still needs one.

Ketamine Inside a 245G Residential Program

Chapter 245G never mentions ketamine, and we found nothing DHS has published on it. What follows is our reading of the statutes and board material cited, so describe the plan to your DHS licensor before the first dose.

Our answer is a qualified yes. Section 245G.03, subd. 3 lists the changes a license holder must report to DHS in advance: MDH licensure, the services in 245G.18 to 245G.22, location, residential capacity, ownership. A new medication in the program’s medical services is not on that list. Two other provisions decide how it gets done. Under 245G.08, subd. 2, the program’s written procedures for getting a client medical care need sign-off from a physician, APRN or PA. Subdivision 5 limits what trained unlicensed staff may give under delegation: oral, topical, suppository, eye or ear drop, inhaled and intranasal medications, plus an intramuscular opiate antagonist or epinephrine. IV or IM ketamine is not on that list, so in our view a licensed nurse or prescriber has to give it. Intranasal Spravato fits a delegable route on paper, but the REMS conditions described below still govern where and how it is given.

The Minnesota Board of Nursing’s statement on RN administration of anesthetic-class medications (adopted 2005, revised August 2024) allows a registered nurse to give them once the nurse “has acquired the knowledge and skills,” leaves LPNs out, and expects the RN to check that facility policy permits it. Its monitoring list runs to respiratory rate, oxygen saturation, blood pressure, cardiac rate and rhythm, and level of consciousness. Ketamine isn’t named, and the statement reads as written for procedural sedation, so applying it to a sub-anesthetic depression protocol is our extension. Staffing tells you where this fits best. A 245F medically monitored unit already has an RN on site around the clock and a medical director. A residential house where RN involvement is the monthly on-site supervision 245G.08 sets for delegated medication is not built for it.

DEA, the PMP and Spravato

Federally, ketamine is a Schedule III controlled substance (21 CFR 1308.13(c)(7)), so the prescriber needs a DEA registration that covers the site. Minnesota’s Board of Pharmacy says the state “does not require a separate registration, license, or credential specifically for controlled substances.” That FAQ is written for pharmacies, and our reading is that prescribers likewise need their Minnesota license and DEA registration without a third state registration. On the Minnesota Prescription Monitoring Program, Minn. Stat. 152.126, subd. 1 says “Dispensing does not include the direct administering of a controlled substance,” so doses given in the building shouldn’t need to be reported. Take-home supply would be dispensing. Any prescriber holding a DEA registration must still register with the PMP (subd. 6(c)). Spravato is narrower: the FDA medication guide says it “can only be administered at healthcare settings certified in the SPRAVATO REMS program,” with monitoring for at least 2 hours after each dose, and its approved uses are treatment-resistant depression and depressive symptoms in adults with major depressive disorder with suicidal thoughts or actions.

Who Should Be Offered It

Ketamine is not a medication for opioid use disorder and doesn’t count toward anything 245G says about MOUD. The resident we’d consider is someone with documented depression or PTSD symptoms that an earlier antidepressant course didn’t move, assessed once acute withdrawal is behind them. A misuse history involving ketamine, PCP or another dissociative should rule a resident out. Those screening lines are clinical judgment for your medical staff to set, not anything Minnesota law prescribes.

After Discharge: A Separate Clinic

Discharge dates and dosing calendars rarely line up, so the remaining sessions would come from an outpatient ketamine clinic, and ownership of that clinic runs into Minnesota’s corporate practice of medicine doctrine. In Isles Wellness, Inc. v. Progressive Northern Insurance Co. (2005), the Minnesota Supreme Court said “with limited exceptions, the corporate practice of medicine doctrine exists in Minnesota,” and the Professional Firms Act limits ownership of a professional firm to licensed professionals and a few listed categories (Minn. Stat. 319B.07). Read together, those two authorities point toward a clinic owned by physicians through a chapter 319B firm, with outside money coming in through a management services contract rather than equity in the practice. That conclusion is our reading. The outpatient guide covers that structure in its Minnesota Drug and Alcohol Outpatient Treatment Licensing ketamine section, and residents with a primary psychiatric diagnosis are better served by the options in Minnesota Mental Health Inpatient Licensing.

Any money or favors moving between the residential program and the clinic should go past counsel first. The federal Eliminating Kickbacks in Recovery Act, 18 U.S.C. 220, reaches any “clinical treatment facility,” defined as a non-hospital medical setting providing residential treatment or detoxification “pursuant to licensure or certification under State law,” which describes a 245G or 245F program. Minnesota’s own illegal remunerations crime, Minn. Stat. 609.542, was enacted in Laws 2025, chapter 38 and took effect August 1, 2025. It covers kickbacks tied to items or services paid by a federal health care program or by the chapter 254B behavioral health program, and where the value involved tops $35,000 the penalty runs to 20 years in prison, a $100,000 fine, or both.

Staffing a Residential Program

Chapter 245G sets the core roster. A license holder “must have a treatment director,” must employ an alcohol and drug counselor supervisor with “three or more years of experience providing individual and group counseling,” and every counselor has to be licensed under chapter 148F or exempt from it (245G.10 and 245G.11). Residential sites need “a responsible staff member on duty 24 hours a day,” group counseling tops out at 16 clients, and residential health monitoring procedures are approved and signed by an RN (245G.21, subd. 7). A medical director isn’t on the 245G list. That requirement belongs to 245F.

BLS puts the Minnesota median for substance abuse, behavioral disorder, and mental health counselors at $58,780 a year, with the middle half of the field between $48,910 and $65,430 (OEWS, May 2025). The national median is $59,350. Six clinical salaries at the state median, say a treatment director, a counselor supervisor and four counselors, come to about $352,680 a year before nursing, overnight staff and benefits, and filling all six at the 75th percentile pushes that toward $392,580. Most of that figure is negotiable, because Minnesota licenses counselors in stages. The Board of Behavioral Health and Therapy (BBHT) issues a temporary permit, which DHS materials call ADC-T, to applicants with an associate degree or equivalent, 270 clock hours of alcohol and drug counseling coursework and an 880-hour practicum. The permit holder practices under a Minnesota LADC’s supervision for up to twelve months unless renewed. A counselor supervisor overseeing several permit holders who are finishing their LADC, at wages below a fully licensed counselor’s, can cut clinical staffing costs by roughly 40 to 60 percent against an all-licensed roster. Keep 245G.11, subd. 10(c) in view while you plan: “No more than 50 percent of the treatment staff may be student interns or former students.” Nursing follows the same logic. Chapter 245G asks an RN to sign the health monitoring procedures and visit monthly to supervise delegated medication, not to cover every shift, and a clinically managed 245F unit meets its 24-hour nurse rule with an LPN, so one RN can anchor a team of LPNs. We map the actual roster after the bed count and the split between 3.1, 3.5 and withdrawal management beds are settled.

Joint Commission, Not CARF, Changes the Inspection

This section summarizes Minn. Stat. 245G.031 as enacted.

Minnesota gives accreditation exactly one licensing benefit, and only one accreditor qualifies. Section 245G.031 lets an accredited program ask for alternative licensing inspections, and it defines “accrediting body” as “The Joint Commission.” CARF and COA accreditation earn nothing under this section. Eligibility comes later than most new operators expect. The program needs at least one full DHS inspection after its initial license, and “substantial and consistent compliance,” which the statute defines as no conditional, suspended or revoked license and no substantiated maltreatment the facility was responsible for in the past five years, with every correction-order violation from the past two years fixed. Programs serving clients with children under 245G.19 and opioid treatment programs are excluded. A program that qualifies requests it on DHS’s forms, gets its policies approved first, sends survey results to DHS within ten days of final approval of a corrective action plan, and tells DHS if the accreditation lapses. Read that way, it changes how DHS inspects and leaves the license requirement in place.

How to Submit Your DHS Application

DHS’s substance use disorder licensing page links the substance use disorder treatment program license application, DHS-7118, under “Apply for a license.” Questions go to the Mental Health, Substance Use Disorder, and Children’s Residential Facility Licensing Unit at dhs.mhcdlicensing@state.mn.us or 651-431-6500, and the page says a self-monitoring checklist is available by email on request. DHS also runs the Provider Hub, its online tool for applying for and managing licenses.

Before filing, consider DHS’s Application Information Session, a two-hour Microsoft Teams webinar on application requirements and policy writing for 245G, 245F and other behavioral health licenses. The 2026 schedule lists March 18, June 17, September 16 and December 16, registration is required, and the page doesn’t call it mandatory. The packet itself has to show that you notified the county under 254B.03, subd. 2 at least 60 days earlier (245G.03, subd. 2(b)), and the applicant has to satisfy the chapter 245C background study requirements along with chapters 245A and 260E (245G.03, subd. 1). From July 1, 2026, DHS’s implementation plans describe a new attestation under 245A.04, subd. 1(j) on whether an unaffiliated business or consultant helped prepare the application or policies. The SUD plan says it applies to “Applicants and license holders that receive public funds,” and that where a required attestation is missing, “The commissioner shall not issue a license.” Ask your licensor whether the requirement reaches your program. Once the application is complete, DHS has 90 working days to act on it (245A.04, subd. 1).

What Slows Minnesota Residential Applications

From what we see, the clock most often slips before DHS ever opens the file. Someone mails the county letter late, or files the DHS application before the 60 days have run. The MDH facility license is the other usual drag, especially when nobody settled early which MDH category the building needs. Older guidance causes trouble too. DHS application packets from 2013 and 2015 still circulate with a $500 fee and Rule 31 references, and policies written from them won’t match chapter 245G.

Frequently Asked Questions

Working out whether your building needs a supervised living facility license or something else from MDH? Talk it through with us.

Sources

• Minnesota DHS: Substance use disorder treatment licensing (application DHS-7118, licensing unit contact) (checked October 11, 2026)
• Minnesota DHS: Substance use disorder treatment program license application, DHS-7118 (checked October 11, 2026)
• Minnesota DHS: Withdrawal management licensing (checked October 11, 2026)
• Minnesota DHS: Behavioral Health Application Information Session (checked October 11, 2026)
• Minnesota DHS: Provider Hub (checked October 11, 2026)
• Minnesota DHS: SUD 2025 Legislative Changes Implementation Plan (PDF) (checked October 11, 2026)
• Minnesota DHS: SUD implementation plan for 2026 legislative changes (PDF) (checked October 11, 2026)
• Minn. Stat. ch. 245G (incl. 245G.03, 245G.04, 245G.07, 245G.08, 245G.10, 245G.11, 245G.21): Substance Use Disorder Treatment (checked October 11, 2026)
• Minn. Stat. 245G.031: Alternative licensing inspections (checked October 11, 2026)
• Minn. Stat. ch. 245F: Withdrawal Management Programs (checked October 11, 2026)
• Minn. Stat. 254B.19: American Society of Addiction Medicine standards of care (checked October 11, 2026)
• Minn. Stat. 254B.03: County notice before new 245G licensure (checked October 11, 2026)
• Minn. Stat. 245A.04: Application procedures (checked October 11, 2026)
• Minn. Stat. 245A.10: Fees (checked October 11, 2026)
• Minn. Stat. 245A.242: Emergency overdose treatment (checked October 11, 2026)
• Minnesota Department of Health: Supervised Living Facilities (checked October 11, 2026)
• Minnesota Board of Behavioral Health and Therapy: Temporary permit application (PDF) (checked October 11, 2026)
• BLS OEWS, May 2025, SOC 21-1018: Occupational Employment and Wage Statistics tables (checked October 11, 2026)
• CARF: ASAM Level of Care Certification (checked October 11, 2026)
• ASAM: Level of Care Certification (checked October 11, 2026)
• CARF: Find a Provider (Certification filter) (checked October 11, 2026)
• DEA Diversion Control Division: Dear Registrant letter, January 12, 2023 (PDF) (checked October 11, 2026)
• Minnesota Board of Nursing: Statement of Accountability, RN administration of medications classified as anesthetics (PDF) (checked October 11, 2026)
• Minnesota Board of Pharmacy: General FAQs (checked October 11, 2026)
• Minnesota Board of Pharmacy: PMP reporting requirements (checked October 11, 2026)
• Minn. Stat. 152.126: Prescription monitoring program (checked October 11, 2026)
• eCFR, 21 CFR 1308.13(c)(7): Schedule III, ketamine (checked October 11, 2026)
• U.S. FDA: Spravato prescribing information and Medication Guide (checked October 11, 2026)
• Minnesota Supreme Court via Justia (verbatim opinion): Isles Wellness, Inc. v. Progressive Northern Ins. Co. (2005) (checked October 11, 2026)
• Minn. Stat. 319B.07: Professional firms, ownership (checked October 11, 2026)
• 18 U.S.C. 220 (govinfo): Illegal remunerations for referrals to recovery homes, clinical treatment facilities, and laboratories (checked October 11, 2026)
• Minn. Stat. 609.542: Illegal remunerations (checked October 11, 2026)
• Minnesota House Research, New Laws 2025, chapter 38 (H.F. 2115): Human services policy law, state anti-kickback statute, effective August 1, 2025 (checked October 11, 2026)
• Minn. Stat. 245I.23: Intensive residential treatment services, Department of Health setting licenses (subd. 19) (checked October 11, 2026)