Montana 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: “Initial or Change of Ownership Application for Substance Use Disorder Facilities” in the DPHHS OIG licensing portal | Questions: OIG Licensure Bureau, 406-444-2676

The level number on a Montana residential application decides who has to be awake in the building at 3 a.m. The DPHHS Office of Inspector General (OIG), Licensure Bureau licenses substance use disorder facilities by ASAM level, and ARM 37.106 Subchapter 14 gives each residential level, from 3.1 up to 3.7-WM, a staffing list of its own. Ask for 3.5 and you owe residents at least 30 hours a week of skilled treatment on site. Ask for 3.7 and an RN or LPN has to be on site around the clock. Then there is a second key. A program seeking payment for SUD treatment delivered in the facility also needs “state approval” from the DPHHS Behavioral Health and Developmental Disabilities Division (BHDD), and BHDD wants proof of local need county by county.

Residential, inpatient and withdrawal management levels are the subject here. Clinic-based care, IOP and partial hospitalization get their own treatment in Montana Drug and Alcohol Outpatient Treatment Licensing. Montana Behavioral Health Licensing maps every license type the state issues.

The Residential Levels Subchapter 14 Recognizes

We read the level names, rule numbers and staffing terms below in DPHHS’s printable copy of Subchapter 14 and checked them against the official Administrative Rules of Montana text.

ARM 37.106.1411 lists what an SUDF license can cover: ASAM 3.7 medically monitored intensive inpatient, 3.7-WM, 3.5, 3.3, 3.2-WM, 3.1, 2.5 partial hospitalization and outpatient. Each residential level then gets a rule of its own (37.106.1471 for 3.1, 1472 for 3.3, 1473 for 3.5, 1475 for 3.7, and 1480 for both withdrawal management levels). Level 3.3 is written for adults only. Medically monitored withdrawal is the one level with a licensing condition attached to the building, because 37.106.1480 says a 3.7-WM provider “must be licensed as an inpatient substance use disorder facility.” The numbering, with a 3.3 and a 3.2-WM, follows the third edition of the ASAM Criteria, which is our reading of why it looks different from newer ASAM material.

Level	Rule	Medical and nursing coverage	Counselor coverage	Treatment hours or setting
3.1	37.106.1471	No prescriber availability clause	Clinical director, LACs or mental health professionals in sufficient numbers, awake staff whenever clients are present	At least 5 hours a week of skilled treatment
3.3 (adults)	37.106.1472	Physician, PA or APRN available for consultation within 24 hours, in person or by telephone	24-hour awake staff, LAC or mental health professional on site or on call 24/7	Daily skilled treatment on site
3.5	37.106.1473	Same as 3.3	Same as 3.3	At least 30 hours a week on site
3.7	37.106.1475	Medical director, physician, NP or PA on call 24/7, RN on site or on call 24/7, RN or LPN on site 24/7	LAC or mental health professional on site or on call 16 hours a day	Medically monitored intensive inpatient
3.7-WM	37.106.1480	RN on site 24 hours a day to monitor clients	See 37.106.1480	Inpatient SUDF license required
3.2-WM	37.106.1480	Physician-approved protocols	Sufficient staff on duty 24 hours a day, seven days a week	Clinically managed withdrawal

None of these rules sets a numeric staff-to-client ratio. The phrase the rules keep returning to is “in sufficient numbers,” so the census and acuity you describe in your policies become the yardstick a surveyor uses.

Two leftovers in the rule text can trip up a policy writer. The official subchapter title is still “Minimum Standards for Chemical Dependency Facilities,” and 37.106.1413(38) defines an SUDF as “a chemical dependency facility, as defined in 50-5-101, MCA,” a term the current statute no longer defines because SB 516 (Ch. 414, L. 2025) wrote “substance use disorder facility” into the statute effective October 1, 2025. We read both as stale cross-references rather than a second license type. Every effective rule in Subchapter 14 except 37.106.1489 dates from the September 24, 2022 rewrite, with nothing newer on the official site.

Where CARF’s ASAM Certification Fits a Montana License

Montana already writes ASAM levels into its rules, and BHDD’s amended state approval rule says “Approved facilities must follow the ASAM Criteria in the provision of services.” Nobody at the state, though, verifies that a program delivers the level printed on its license. That job belongs to the ASAM Level of Care Certification run by CARF, which CARF says “is available for adult Levels of Care 3.1, 3.5, and 3.7.” ASAM’s page calls the program “Delivered in partnership with CARF International” and says residential providers apply to CARF directly. For a Montana 3.5 or 3.7 house it works as outside proof of the level OIG licensed, and a referral source can look it up through the certification filter in CARF’s Find a Provider directory. Level 3.3 has no certification track, since CARF lists only the three levels above, and the CARF page we read says nothing about withdrawal management, so we would not plan on certifying a 3.7-WM unit. Montana’s rules, as far as we found, never require the certification.

Getting the OIG License, Step by Step

Steps are drawn from OIG’s Substance Use Disorder Initial Application Letter and MCA Title 50, chapter 5. The month range in the last paragraph is an estimate we use for planning, and the state publishes no such number.

OIG’s letter to new SUDF applicants lists the pieces: the application with its fee, a BFS Plan Submittal Form that goes to the Licensure Bureau’s Construction Consultant, a floor plan of the inpatient or residential space, approval from the local building authority, which for new construction means a Certificate of Occupancy, a State Fire Marshal or designee certification, a well water report and septic inspection where the site needs them, and the administrator’s attestation that the rules were reviewed. Policies and procedures go in “at least forty-five (45) days prior to the expected facility opening date.” It also warns against filing earlier than six months ahead of your target licensure date.

The statute sets the outer clock. MCA 50-5-203 requires the application “At least 45 days prior to the opening of a facility,” a lead time SB 516 raised from 30 days, and since October 1, 2025 the application must carry an attestation or supporting documentation showing the applicant has read and understands the requirements for that facility type. Once you tell OIG the building is ready, 50-5-204 gives the department 45 days to conduct the initial inspection. OIG “will issue a six (6) month provisional license” once every item clears, and a Licensure Bureau surveyor visits within those six months. ARM 37.106.310 then sets the term at one to three years, and a facility in operation for less than a year may be offered only one.

Montana’s Certificate of Need statute (MCA 50-5-301) reaches long-term care facilities and nothing on the behavioral health side, and OIG’s letter confirms SUD facilities “are not required to be reviewed by the Health Planning Program.” The fee in 50-5-202 runs on bed count, $20 for a facility of up to 20 beds and then $1 per bed from 21 up, which works out to $24 for a 24-bed house. We could not see what the online portal actually charges, because each license request page sits behind a reCAPTCHA. Our own estimate for a residential build, once construction review, the fire marshal and any well or septic work are counted, is roughly 5 to 8 months to a provisional license.

BHDD State Approval, the Second Key

MCA 53-24-208 and ARM 37.27.106 set up the second credential. Under the rule as amended by MAR Notice 2026-170 (in force August 22, 2026 under the ARM history line, with DPHHS stating in its adoption notice that it intends the change to reach back to October 1, 2025), a facility seeking reimbursement for SUD facility-based treatment “must be state approved and licensed pursuant to ARM Title 37, chapter 106, subchapter 14.” The order matters. Full approval requires evidence of an active OIG license, so the license comes first. BHDD has 30 days to flag missing items in writing, and an applicant who doesn’t answer within 30 days of that notice is denied. After approval BHDD inspects “once every two years, on-site or remotely.”

The statute requires applicants to “demonstrate that a local need currently exists for proposed services,” and BHDD’s Facility State Approval Application turns that into paperwork: county-by-county need documentation and a projected services form for every county listed. The form adds that “listing telehealth to all counties will not be accepted.” A residential program drawing from across the state should build its need case around the counties it actually expects to serve. Billing and payer contracts are a separate matter from licensure and not something we take on.

Accreditation Splits by Accreditor in Montana

The statute and rule text here is quoted directly. Which accreditors qualify is our reading of the CMS list against MCA 50-5-103.

Under MCA 50-5-103(4), accreditation from an organization “approved by the U.S. centers for medicare and medicaid services” makes a facility eligible for licensure for the accreditation period, and the facility “may not be subjected to an inspection by the department for purposes of the licensing process.” OIG can still inspect to answer a written complaint. ARM 37.106.310 adds a three-year license for that accreditation, provided the facility hands OIG “the full accreditation entity or department inspection report.” The Joint Commission appears on CMS’s accrediting organization list. CARF and COA do not, which in our reading leaves a CARF-only facility subject to the usual OIG licensing inspections.

CARF does count somewhere else. The state approval statute lets BHDD treat a facility accredited by “the commission on accreditation of rehabilitation facilities” as eligible for approval during the accreditation period, though “The department shall inspect a facility considered eligible for approval under this section” (53-24-208(9)). Montana doesn’t require accreditation for either credential. A facility in the middle of an accreditation review that won’t finish before its license expires can be given a provisional license under 50-5-207(2)(c).

Medication for Opioid Use Disorder in a Montana SUDF

The most useful MOUD sentence in Subchapter 14 is a prohibition. ARM 37.106.1457(11) says “A SUDF cannot require clients to discontinue the use of any medication prescribed by a licensed health care professional for admission.” In our reading, a person admitted on buprenorphine or methadone stays on it, and 37.106.1457(8) adds that prescribed medication “must not be stopped or changed in dosage or administration” without consulting a licensed professional. We did not find a rule requiring a Montana SUDF to offer MOUD itself.

Methadone for opioid use disorder is dispensed only by an opioid treatment program, which Montana regulates separately, and a house that admits methadone patients needs a dosing arrangement with one in place before the first admission. Buprenorphine is easier. DEA’s January 12, 2023 letter to registrants says “A DATA-Waiver registration is no longer required to treat patients with buprenorphine for opioid use disorder,” which means any prescriber holding an ordinary DEA registration may now write it.

Adding Ketamine to a Montana Residential Program

Ketamine appears nowhere in Montana’s facility licensing rules, and OIG has published nothing on it that we could locate. What follows is our reading of the rules and statutes cited, so ask the Licensure Bureau to confirm your plan in writing before any resident is dosed.

Subchapter 14 does not prohibit offering ketamine to a resident whose depression or trauma symptoms persist alongside the addiction. The hook to watch is ARM 37.106.1426(4): “Changes in the facility location, use, or number of facility beds cannot be made without written notice to, and written approval received from, the department.” The rule never defines a change in “use,” and we would rather send OIG a written notice describing the protocol than argue later that a new medication service wasn’t one.

How practical this is depends on the license level. Staffing at 3.7 already includes a medical director, a prescriber on call at all hours and an RN or LPN on site 24 hours a day, enough people to keep a patient under observation for two hours after a dose. At 3.5 and 3.3 the rule only promises a physician, PA or APRN “available for consultation within 24 hours in person or by telephone,” so a dosing day there means bringing a clinician into the building. Level 3.1 has no prescriber clause at all, and we wouldn’t run ketamine in a 3.1 house.

Nurses, APRNs and the Order Behind the Dose

We found no Montana Board of Nursing position on RNs administering sub-anesthetic ketamine. The Nurse Practice Act defines RN practice to include “the administration of medications and treatments prescribed by physicians” and other authorized prescribers (MCA 37-8-102), so the nurse’s role rests on a valid order and the program’s own protocol. An APRN can carry the prescribing role alone. ARM 24.159.1461 lets an APRN “granted prescriptive authority by the board” prescribe and administer controlled substances within role and population focus, 24.159.1464 requires compliance with federal DEA rules, and we saw no physician collaboration requirement in those rules.

DEA, State Registration and the Prescription Drug Registry

For DEA purposes ketamine falls in Schedule III (21 CFR 1308.13(c)(7)). Each principal place of practice carries its own registration under 21 CFR 1301.12, so the facility address needs one. Montana’s own registration should not add a layer. MCA 50-32-303 says the board “shall waive the requirement for registration of practitioners, other than pharmacies,” who hold federal registration, which we read as meaning DEA registration suffices. The state’s prescription drug registry is lighter for in-house dosing too. Reporting under MCA 37-7-1503 does not apply to “a prescriber who dispenses or administers drugs to the prescriber’s patients,” and the mandatory registry check in 37-7-1515 is aimed at opioids and benzodiazepines, with ketamine not named. Esketamine is a different track. The Spravato Medication Guide says it “can only be administered at healthcare settings certified in the SPRAVATO REMS program,” and the patient must be monitored “for at least 2 hours after taking SPRAVATO.”

Who Should Get It

A ketamine series is a separate service from MOUD and does not replace the medication access described above. In our view the right resident is someone past the acute withdrawal window whose depression or trauma symptoms are still there after a fair antidepressant trial. A history of dissociative misuse, ketamine and PCP included, rules a resident out in our book. The medical director writes the final criteria.

Finishing the Series After Discharge

A resident rarely completes a series before discharge, so the plan needs an outpatient clinic to take it over. Montana leaves ownership fairly open. Our search turned up no statute, rule or appellate ruling that keeps non-clinicians from owning a medical practice, and the two old Attorney General opinions it surfaced concern osteopaths and foreign corporations rather than corporate practice. If you do form a professional corporation, MCA 35-4-301 limits its shares to people authorized to render that professional service. Physician offices fall outside the facility license definition in MCA 50-5-101, while an “outpatient center for primary care” is a licensed category, so how the clinic is set up decides whether OIG is involved. Many owners still put clinical control in a practitioner-owned entity and run the business side through a management services company. For the clinic side, the outpatient guide’s ketamine section in Montana Drug and Alcohol Outpatient Treatment Licensing goes further.

Have counsel review any referral arrangement between the house and the clinic. Under the federal Eliminating Kickbacks in Recovery Act (18 U.S.C. 220), a non-hospital setting offering “residential treatment, or rehabilitation for substance use, pursuant to licensure or certification under State law” is a clinical treatment facility under the statute, and a licensed SUDF fits that description. Each occurrence carries a possible $200,000 fine, a prison term as long as 10 years, or both. We did not locate a Montana statute aimed specifically at SUD patient brokering.

Staffing a Montana Residential SUDF

The 3.1, 3.3 and 3.5 rules each list a clinical director. The 3.7 rule is built around a medical director instead, who must be “a physician, licensed under requirements set forth in Title 37, chapter 3, MCA” (37.106.1413(20)). Counselors need their own license. MCA 37-39-310 bars practicing addiction counseling without one. The exemptions in 37-39-303 reach staff of government agencies and of educational, research or charitable institutions, plus supervised students, so a nonprofit operator should ask counsel whether any of its staff fall inside one. Either way, the Subchapter 14 level rules staff each level with licensed addiction counselors or mental health professionals by name. An LAC applicant shows 285 contact hours of addiction studies under ARM 24.219.5006, then a supervised stretch of at least seven months and 1,000 hours in a qualified program under ARM 24.219.5008. Expect one oddity: the SUDF rule’s LAC definition still points to repealed statute 37-35-202, and we treat the board’s current license as what counts.

BLS puts Montana’s median for substance abuse, behavioral disorder, and mental health counselors at $59,000 a year, against a national median of $59,350 (OEWS, May 2025), with Montana’s 25th and 75th percentiles at $46,170 and $74,010. Six clinical salaries at that median, say a clinical director plus five counselors, total about $354,000 a year before nursing, overnight awake staff and benefits. Montana’s candidate license means you rarely need a fully licensed counselor in every one of those seats. Under MCA 37-39-307 someone who has finished the education but not the supervised hours can be licensed as an LAC candidate on a training and supervision plan, renewing the $85 candidate registration each year. Filling several of those seats with candidates working toward their 1,000 hours under the clinical director’s supervision, at candidate pay, typically trims clinical payroll by 40 to 60 percent compared with hiring only licensed counselors. Nursing has similar room at 3.7. The rule requires an RN on site or on call plus an RN or LPN on site around the clock, and it places LPNs under RN supervision, so one RN can oversee a team of LPNs covering the shifts. A 3.7-WM unit is the exception, because an RN must be on site around the clock. We build the actual roster once level and bed count are decided.

How to Submit Your Montana SUDF Application

OIG’s Substance Use Disorder Facilities page links the online licensing portal, where the license types include “Inpatient Substance Use Disorder Facility,” “Residential Substance Use Disorder Facility” and “Clinically Managed Residential Withdrawal Management Program ASAM 3.2.” Read the Substance Use Disorder Initial Application Letter first and fill in the Supplemental Staff Roster. The letter still prints an older DPHHS application address that no longer loads, so use the current page. The Licensure Bureau answers at 406-444-2676 and takes mail at PO Box 202953, Helena, MT 59620-2953. The bureau’s staff contacts are Tara Wooten, Licensure Bureau Chief, at 406-439-2504 or Tara.Wooten@mt.gov, and Brian Nelson, the Construction Consultant who takes the BFS Plan Submittal Form, at 406-444-6794 or Brian.Nelson@mt.gov.

After the license, the BHDD state approval form goes to bhddapprovalapps@mt.gov or PO Box 202905, Helena, MT 59620-2905, with questions to 406-444-3964. Attach the facility license and the county need documentation.

What Holds Up Montana Residential Openings

The most expensive mistake we see is licensing a level the payroll can’t support, usually 3.5 or 3.7 chosen for the referral appeal before anyone priced the nursing and the 30 hours of weekly programming. Rural properties add their own delays, since a well water report, a septic inspection and a fire marshal visit each run on someone else’s schedule. Policies copied from an older chemical dependency manual are the third, because they tend to cite the repealed counselor statute and the pre-2022 rule numbers.

Frequently Asked Questions

Deciding between 3.5 and 3.7 for a Montana house? We can run the staffing math with you.

Sources

• DPHHS OIG Licensure Bureau: Substance Use Disorder Facilities page and Facility Applications index (checked October 15, 2026)
• DPHHS OIG: Substance Use Disorder Initial Application Letter (PDF) and Supplemental Staff Roster (PDF) (checked October 15, 2026)
• DPHHS OIG: Licensure Bureau contacts (checked October 15, 2026)
• DPHHS OIG: Online licensing portal, license types (checked October 15, 2026)
• ARM 37.106 Subchapter 14, DPHHS printable copy: Substance Use Disorder Facility rules (PDF) (checked October 15, 2026)
• ARM 37.106.1411 to 37.106.1480, verbatim mirror: Subchapter 14 rule list, read against the official Subchapter 14 on rules.mt.gov, including ARM 37.106.1475 (checked October 15, 2026)
• ARM 37.106.310: official text on rules.mt.gov and verbatim mirror, licensing procedure and license terms (checked October 15, 2026)
• MCA 50-5-101: Definitions (checked October 15, 2026)
• MCA 50-5-103: Accreditation and licensing inspections (checked October 15, 2026)
• MCA 50-5-202: License fees (checked October 15, 2026)
• MCA 50-5-203: Application for license (checked October 15, 2026)
• MCA 50-5-204: Inspection and license term (checked October 15, 2026)
• MCA 50-5-207: Provisional licenses (checked October 15, 2026)
• MCA 50-5-301: Certificate of need (checked October 15, 2026)
• SB 516, Ch. 414, L. 2025: Session law (PDF) and Bill Explorer effective date record (checked October 15, 2026)
• MCA 53-24-208: Approval of facilities (checked October 15, 2026)
• ARM 37.27.106 as amended, MAR Notice 2026-170: official rule text and history on rules.mt.gov, adoption notice (PDF) and proposal notice with rule text (PDF) (checked October 15, 2026)
• DPHHS BHDD: Division page and Facility State Approval Application (PDF) (checked October 15, 2026)
• CMS: Accrediting Organizations (checked October 15, 2026)
• CARF: ASAM Level of Care Certification and Find a Provider (certification filter) (checked October 15, 2026)
• ASAM: Level of Care Certification (checked October 15, 2026)
• DEA Diversion Control Division: Dear Registrant letter, January 12, 2023 (PDF) (checked October 15, 2026)
• MCA 37-8-102: Nursing definitions (checked October 15, 2026)
• ARM 24.159.1461 and 24.159.1464, official text on rules.mt.gov: APRN prescriptive authority and prescribing practices (checked October 15, 2026)
• 21 CFR 1308.13(c)(7), via Cornell LII: Schedule III, ketamine (checked October 15, 2026)
• 21 CFR 1301.12, via Cornell LII: Separate registration for each place of practice (checked October 15, 2026)
• MCA 50-32-303: Waiver of registration for federally registered practitioners (checked October 15, 2026)
• MCA 37-7-1503: Prescription drug registry reporting and MCA 37-7-1515: Registry review (checked October 15, 2026)
• U.S. FDA: Spravato prescribing information and Medication Guide (PDF) (checked October 15, 2026)
• Montana Attorney General opinions: Op. No. 637 (1934) and Op. No. 54 (1935) (checked October 15, 2026)
• MCA 35-4-301: Professional corporation shares (checked October 15, 2026)
• 18 U.S.C. 220, via Cornell LII: Illegal remunerations for referrals to recovery homes, clinical treatment facilities, and laboratories (checked October 15, 2026)
• MCA 37-39-303, 37-39-307 and 37-39-310: Exemptions, Candidate licensure and Licensed addiction counselor (checked October 15, 2026)
• ARM 24.219.401, 24.219.5006 and 24.219.5008, official text on rules.mt.gov: Board of Behavioral Health fee schedule, LAC education requirements and LAC supervised work experience (checked October 15, 2026)
• U.S. Bureau of Labor Statistics, OEWS May 2025, SOC 21-1018: Montana and national estimates (checked October 15, 2026)