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Nebraska Drug and Alcohol Outpatient Treatment Licensing

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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: there is no DHHS facility application for an outpatient-only program, and counselor licenses start on the DHHS Alcohol and Drug Counselor page | Questions: DHHS Licensure Unit, dhhs.ddbhfacilities@nebraska.gov, (402) 471-9607

Nebraska stopped licensing outpatient addiction programs as facilities more than eight years ago. The roster the DHHS Licensure Unit keeps of licensed treatment centers, updated September 15, 2026, carries the explanation in its legend: “Per LB1034, effective 7/19/2018, Mental Health Substance Abuse Treatment Centers which only provide outpatient services are no longer licensed by the Department.” A Nebraska IOP or counseling clinic opening today has no facility license to apply for, no state licensing inspection and no annual facility fee. What it does have is a set of individual credentials, drug registrations and contracts that do the work a facility license does elsewhere, and a hard line at 24 hours that turns it into something else entirely.

This guide covers outpatient and intensive outpatient addiction treatment, buprenorphine in an office setting and how a ketamine clinic is put together. Residential treatment and detox are in Nebraska Drug and Alcohol Inpatient Treatment Licensing. Counseling and therapy clinics on the mental health side are in Nebraska Mental Health Outpatient Licensing, and the overview sits at Nebraska Behavioral Health Licensing.

What the 2018 Change Left in Place

The statute language below was read on the Nebraska Legislature’s site, and the quotes about clinics and the roster come straight from DHHS’s own pages and PDF.

LB1034 did its work by narrowing a definition. Neb. Rev. Stat. 71-423 now describes a Mental Health Substance Use Treatment Center as one serving people “for a period of more than twenty-four consecutive hours” who reside there, so a program where every client goes home at night isn’t one. The 71-423 source note lists “Laws 2018, LB1034, § 53.” as its last amendment.

The obvious fallback, a health clinic license, doesn’t catch these programs either. The DHHS Health Clinics page lists four clinic types that need one (a hemodialysis clinic, a public health clinic, an ambulatory surgical center and a clinic performing ten or more abortions a week), and none is a behavioral health service. It also says “A healthcare practitioner facility (a clinic, office or residence of a practitioner or group of practitioners credentialed under the Uniform Credentialing Act) is not required to be a licensed health clinic.” Put those together and our reading is that a freestanding outpatient program staffed by credentialed counselors needs no DHHS facility license of any kind.

Three Ways Outpatient Care Can Be Set Up

The table compares where outpatient services can sit in Nebraska. The middle column is our interpretation of the program description rule in 175 NAC 18-006.07, which asks a licensed center to list “inpatient and outpatient components, when applicable.”

ItemOutpatient-only programOutpatient component of a licensed residential centerProgram that keeps clients over 24 hours
DHHS facility licenseNone since July 19, 2018Covered by the center’s MHSU licenseMHSU license required (71-423)
Rule chaptersCounselor and prescriber rules only175 NAC 1 and 175 NAC 18175 NAC 1 and 175 NAC 18
State licensing inspectionNoneAnnounced first visit (DHHS targets 30 working days after the application is complete), unannounced visits afterAnnounced first visit (DHHS targets 30 working days after the application is complete), unannounced visits after
Annual facility feeNone$250 to $300 by licensed beds$250 to $300 by licensed beds
Treatment plan review at 10 or more hours a weekNot set by state ruleEvery 30 days (175 NAC 18-006.08(F))Every 30 days

The far right column is the one to watch. An outpatient program that adds a sober living arrangement, an overnight crisis bed or a weekend retreat where clients stay over is heading toward “more than twenty-four consecutive hours,” and 71-458 treats operating such a facility unlicensed as a Class I misdemeanor.

Credentials Carry the Weight

With no facility license, the state’s grip on an outpatient addiction program runs through the people in it. The Alcohol and Drug Counseling Practice Act (38-301 to 38-321) and 172 NAC 15 create two tiers. A Provisional Alcohol and Drug Counselor holds that status once, for up to six years, may not provide services without clinical supervision, and has to tell clients so and name the supervisor (38-313(2)). A Licensed Alcohol and Drug Counselor has passed the IC&RC Alcohol and Drug Counselor exam at a scaled score of at least 500 and logged 6,000 hours of paid, supervised clinical work. LADCs renew with 40 hours of continuing education every 24 months, at least 20 of them specific to alcohol and drugs, according to the DHHS counselor page.

The board behind those licenses changed this year. 2026 LB905, signed by the Governor on April 14, 2026 and in force from July 1, 2026, did away with the Board of Alcohol and Drug Counseling and wrote into the Act that “Beginning July 1, 2026, board means the Board of Mental Health Practice.” That board picks up two licensed alcohol and drug counselor members. For a clinic owner, the practical effect is that LADCs and the clinic’s licensed mental health practitioners now fall under one board.

The treatment center page also exempts “Services provided by licensed professionals in private practice caring for clients under their own license,” which matters only if a practice ever drifts toward residential care. Accreditation, for its part, plays no licensing role for an outpatient-only program because there is no license for it to support. Public funding through the regional behavioral health authorities and enrollment for some Medicaid services do ask for national accreditation, and those are payer relationships outside licensing that we don’t handle.

Buprenorphine, Naltrexone and Methadone From an Outpatient Office

An office-based opioid program in Nebraska needs only what the prescriber already holds. The waiver is gone, per a DEA letter of January 12, 2023 (“A DATA-Waiver registration is no longer required”), and DHHS confirms there is no state controlled substance registration to add on top. Nebraska’s own narcotic treatment statute, 28-412, carves buprenorphine out of its limits on prescribing narcotics for detoxification or maintenance, “except buprenorphine” in the statute’s words. A counseling clinic can therefore partner with a buprenorphine prescriber, or employ one, without any state facility paperwork.

Methadone is different. Other narcotics used for detox or maintenance fall under the registration track in 28-406 and 28-412, which is the opioid treatment program route, and that sits outside this guide. A clinic whose clients dose at an OTP should keep a written coordination agreement with that program and a release for each client. In our view naltrexone injections belong in the same intake conversation, since a client stepping down from residential care may arrive already on one.

Opening a Ketamine Clinic in Nebraska

We found no Nebraska law written for ketamine clinics. The conclusions on facility licensing and ownership are our reading of the statutes, DHHS pages and nursing opinions linked below.

A practitioner office giving ketamine for depression doesn’t fit any facility license we could find in Nebraska. It isn’t a treatment center, because patients leave the same day and 71-423 needs a stay of more than 24 hours. It isn’t a licensed health clinic, because the DHHS list of clinics needing a license doesn’t include it and a credentialed practitioner’s office is expressly excused. In our reading, that leaves the clinic regulated through its prescribers, its DEA registration and its own protocols. A residential center that wants to start ketamine during a stay is a different case, and the inpatient guide’s ketamine section covers it, along with how a course begun in residence carries on here after discharge.

Ownership and Who Can Prescribe

We searched for a Nebraska statute, rule, board rule or appellate decision barring lay owners from a medical practice and found none. The closest thing is the Professional Corporation Act, which describes a professional corporation as one that “has as its shareholders only individuals who themselves are duly licensed or otherwise legally authorized” to render the same service (21-2202), and that limit applies only to an owner who picks that corporate form. Our reading is that Nebraska doesn’t prohibit lay ownership outright. We’d still set the clinic up with the treating physician owning the practice entity that holds the DEA registration and makes every clinical call, and a management services company handling the space, nonclinical staff and billing for a flat fee.

Nebraska gives nurse practitioners plenty of room on the clinical side. Under 38-2317, an NP applicant shows 2,000 hours of practice, which can be logged under a transition-to-practice agreement, a collaborative or integrated practice agreement, or independent practice, and DHHS says on its nurse licensing page that “Prescriptive authority is granted to nurse practitioners, certified registered nurse anesthetists, and certified nurse midwives at the time of licensure.” The Board of Nursing’s esketamine opinion recognizes a psychiatric mental health board certified NP as able to diagnose, prescribe and administer Spravato. We didn’t confirm whether an NP can own a share of a medical professional corporation, so an NP-led clinic should use an ordinary business entity and get counsel’s view.

Monitoring, Records and Spravato

Ketamine sits in Schedule III of Nebraska’s controlled substances list (28-405), and a DEA registration for the clinic location covers the state side because Nebraska issues no separate registration. The PDMP statute (71-2454) requires dispensed prescriptions to be entered daily by the dispenser. Infusions given in the chair aren’t dispensed in our reading, but under 28-411 the practitioner still records controlled substances received and those “administered or professionally used,” apart from doses given on a medical order. Prescriptions a patient fills at a pharmacy go into the PDMP the usual way.

The Board of Nursing’s sub-anesthetic ketamine opinion was written for pain management in acute care, excludes IV bolus dosing, and is nonbinding, but its expectations for nurse competency, infusion pumps with guardrails and resuscitation equipment are a sensible starting point for an office protocol. Spravato brings the manufacturer’s program with it. The REMS information limits administration to “healthcare settings certified in the SPRAVATO REMS Program,” and the REMS and the Nebraska opinion agree on a two-hour minimum of observation per session.

Referrals Into and Out of the Clinic

No ketamine product is FDA approved to treat addiction (the Ketalar label lists anesthetic uses only), so a clinic shouldn’t present it as addiction treatment. Referral money is the bigger legal question. The federal kickback statute for addiction care, 18 U.S.C. 220, reaches referrals to a clinical treatment facility, which it defines as “a medical setting, other than a hospital, that provides detoxification, risk reduction, outpatient treatment and care, residential treatment, or rehabilitation for substance use, pursuant to licensure or certification under State law.” In our reading an unlicensed Nebraska outpatient clinic, and a ketamine practice treating depression, may sit outside that definition, but a licensed residential addiction partner does not, and Nebraska’s 38-179 already counts dividing fees in exchange for a referral as unprofessional conduct for any credential holder. We found no separate Nebraska patient brokering law. Keep referral relationships free of payments either way.

Staffing an Outpatient Program

No state rule sets an outpatient staffing pattern, since there’s no outpatient licensing rule. Payers and accreditors may, and the credentials above set who can do what. For budgeting, BLS puts the Nebraska median for substance abuse, behavioral disorder, and mental health counselors at $63,770 (OEWS, May 2025), a few thousand dollars over the national median of $59,350. Nebraska’s middle half of earners runs from $47,040 to $81,740. Four clinicians (a clinical director and three counselors) paid the Nebraska median would cost roughly $255,080 a year (4 x $63,770, our estimate), with front desk, billing, a prescriber’s time and benefits on top. A Nebraska IOP rarely needs four fully licensed counselors on day one. PLADCs earn their 6,000 LADC hours on the job with an hour of face-to-face supervision per 40 hours worked (38-317), and degrees cut the total: an associate degree in addictions counts for 1,000 hours, a bachelor’s in counseling, addictions, social work, sociology or psychology for 2,000, and a master’s in those fields for 4,000 (38-316(5)). When a clinical director supervises those hours and provisional staff accept a lower rate in exchange, the clinical salary line usually runs 40 to 60 percent below a clinic staffed only with LADCs. If the clinic gives injections or runs ketamine sessions, an RN directing a pair of LPNs costs less than staffing every chair with an RN. Your group calendar and how many prescribers you contract will decide the rest.

One timing rule catches new hires. 172 NAC 15-005.03 says hours worked in Nebraska before the provisional license is issued “will not be considered,” so a counselor who starts seeing clients while the PLADC application is pending loses those hours.

How to Submit Your Outpatient Applications

Because the program itself isn’t licensed, the filings are personal and federal. Each counselor applies for the PLADC or LADC through the DHHS Alcohol and Drug Counselor page, with the PLADC built on a high school diploma or its equivalent, 270 hours of coursework spread over eight subjects, and 300 hours of supervised practical training (38-314). Questions about counselor licenses go to the DHHS Office of Behavioral Health Licensing at DHHS.BHLicensure@nebraska.gov or (402) 471-2062. Each prescriber holds a Nebraska license and a DEA registration for the clinic address. If your plans include any stay over 24 hours, that is the point to contact the Licensure Unit for an initial treatment center application at dhhs.ddbhfacilities@nebraska.gov or (402) 471-9607, or by mail to DHHS Licensure Unit, Attn: MHSU, PO Box 94669, Lincoln NE 68509-4669. The office answers Monday to Friday, 8:00 a.m. to 5:00 p.m.

Outpatient Mistakes We Expect in Nebraska

The first is advertising a “state licensed” IOP when Nebraska issues no such license. Describe the credentials your staff hold instead. A second is a counselor who starts before the PLADC issues and loses the hours. A third is the overnight creep described above, where a recovery residence or crisis bed under the same owner starts to look like a treatment stay longer than 24 hours. The last is paperwork that still names the Board of Alcohol and Drug Counseling, which ceased to be the counselors’ board on July 1, 2026.

Frequently Asked Questions

Does Nebraska license outpatient or IOP substance use programs?

No. Since LB1034 took effect on July 19, 2018, DHHS no longer licenses Mental Health Substance Use Treatment Centers that provide only outpatient services. The facility license now covers only programs where clients stay more than 24 consecutive hours, and a credentialed practitioner’s office is not required to hold a health clinic license either.

Does a ketamine clinic in Nebraska need a facility license?

In our reading, no. An outpatient practitioner office is neither a treatment center, which requires stays over 24 hours, nor one of the clinic types DHHS lists as needing a health clinic license. The clinic still needs a DEA registration, licensed prescribers, Spravato REMS certification if it uses Spravato, and the controlled substance records Neb. Rev. Stat. 28-411 calls for.

Which board oversees alcohol and drug counselors in Nebraska?

Since July 1, 2026, it has been the Board of Mental Health Practice. 2026 LB905 confined the old Board of Alcohol and Drug Counseling to the period before that date and gave the mental health board two seats for licensed alcohol and drug counselors.

Building a Nebraska IOP that might someday keep clients overnight? Let’s talk.

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