North Dakota 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: SFN 971, Substance Abuse Treatment License Application (PDF) | Questions: HHS Behavioral Health Division, dhsbhd@nd.gov, 701-328-8920

A medically monitored ASAM Level 3.7 program in North Dakota does not have to become a hospital. Since the 2023 session, the hospital licensing chapter itself says so. House Bill 1050 added language to N.D.C.C. 23-16-01 stating that “American society of addiction medicine level 3.7 substance use treatment programs” “licensed by the department of health and human services that are independent from a medical hospital” “are not required to obtain a license under this chapter.” So a freestanding 3.7 unit, with its round-the-clock physician services and 24-hour skilled nursing, answers to one office, the Behavioral Health Division (BHD) of the North Dakota Department of Health and Human Services, and not to the Health Facilities Unit that surveys hospitals.

This guide covers adult residential care and social detoxification. Counseling, IOP and day treatment are in North Dakota Drug and Alcohol Outpatient Treatment Licensing, and the state’s other license tracks, including psychiatric hospitals, are summarized on the North Dakota Behavioral Health Licensing page.

The 2023 Carve-Out for Freestanding 3.7 Programs

The statutory language and bill history below come from the Legislative Assembly’s own code and session law files. The effective date is our reading of the state constitution, because the bill doesn’t print one.

HB 1050 became Session Laws 2023, chapter 250. The governor approved it on March 14, 2023, and it was filed with the Secretary of State on March 15. The chapter has no emergency clause and no date of its own, and Article IV, section 13 of the North Dakota Constitution says a law takes effect “on August first after its filing” unless something else applies. We therefore treat August 1, 2023 as the date the exemption started.

The same bill also amended several sections of chapter 50-31, the SUD licensing statute, mostly to swap “substance abuse” for “substance use disorder.” One older requirement in 50-31-04 deserves early attention, because the bill kept it in place: every licensed program must “obtain and provide to the department a local or state authority certification as to the safety of the premises.” For a residential building that usually means a fire or building official signs off before BHD will treat the file as complete, in our experience, so book that inspection early.

The exemption has limits. It reaches a 3.7 program that is licensed by HHS and “independent from a medical hospital.” A unit run inside a hospital stays under hospital licensing (N.D.C.C. ch. 23-16 and NDAC ch. 33-07-01.1), and nothing in the carve-out touches psychiatric beds.

Residential Levels the Rules Recognize

NDAC Article 75-09.1 is organized by ASAM level, one chapter apiece. The adult residential chapters are 75-09.1-02 (Level III.1, clinically managed low-intensity), 75-09.1-03 (Level III.5, clinically managed high-intensity) and 75-09.1-04 (Level III.7, medically monitored intensive inpatient). Withdrawal management outside a hospital has a single chapter, 75-09.1-08, titled “Social Detoxification ASAM Level III.2-D.” We found no separate chapter for medically monitored or medically managed withdrawal, so a program planning medically supervised detox beds should raise that with BHD before designing the unit. SFN 971 asks you to tick each level you want, from 0.5 through 3.7.

The rules still write levels in Roman numerals, the older ASAM style, but III.7 and 3.7 are the same level. That matters if a referral source wants outside proof of the level you run. CARF’s ASAM Level of Care Certification “is available for adult Levels of Care 3.1, 3.5, and 3.7,” and ASAM describes it as delivered “in partnership with CARF International.” North Dakota doesn’t require it and BHD’s license won’t print it. A hospital discharge planner can look a program up through CARF’s Find a Provider tool using the ASAM Level of Care 3.7 filter. Both organizations confine the certification to those three residential levels and say nothing about withdrawal management, so a III.2-D social detox unit sits outside it. That limit is our reading of how both organizations describe the program.

A rule rewrite is coming but is not law yet. HHS posted a draft replacement for Article 75-09.1 in 2024, and its draft rules page now gives an anticipated effective date of “July 1, 2027, pending completion of the formal rulemaking process and required approvals.” Write policies to the current chapters and watch for the formal notice.

No Certificate of Need, but a Daily Bed Report

Chapter 23-17.2 of the Century Code, which once governed approval of hospital expansion, now carries a “[Repealed]” tag, and nothing resembling need review appears anywhere in chapter 23-16. Chapter 23-16 does freeze one kind of bed: nursing facility beds, between August 1, 2025 and July 31, 2029. Residential SUD beds aren’t part of that freeze. In our reading a new residential program needs no state approval of need.

What a residential program does pick up is a reporting duty. N.D.C.C. 50-06-41.3, most recently amended and reenacted by Senate Bill 2113 (signed May 2, 2025), says “Public and private providers of residential or inpatient behavioral health services” “shall participate in and report daily” to HHS’s behavioral health bed management system. Assign someone to that report from opening day.

Medication for Opioid Use Disorder in a North Dakota Residence

The current general standards in 75-09.1-01 contain no clause we could find that requires a residential program to provide MOUD or keeps it from refusing an applicant already on a maintenance dose. The pending draft would change that. It says “A program shall allow the use of medications approved by the Food and Drug Administration,” including medications for opioid use disorder, but it remains a draft until HHS finishes rulemaking. We would write the policy to the draft’s standard now, since a program built that way won’t need to rework admissions in 2027.

Methadone for addiction belongs to a different license. BHD is the state opioid treatment authority under 50-31-07, and 50-31-08 says “A separate license is required for each location at which an opioid treatment program is operated.” A residential program doesn’t become one. It signs a coordination agreement with a licensed OTP so a resident’s doses continue during the stay. Buprenorphine needs much less. DEA’s January 12, 2023 letter to registrants says “A DATA-Waiver registration is no longer required” and that buprenorphine prescriptions “only require a standard DEA registration number.” At Level III.7, where 75-09.1-04-02 already requires a physician’s services 24 hours a day, starting or continuing buprenorphine fits the staffing you have to carry anyway.

Adding Ketamine to a North Dakota Residential Program

We found no BHD guidance or 75-09.1 provision on ketamine. The licensing conclusions here are our interpretation of the rules cited. The nursing material is the Board of Nursing’s own January 2026 guidance, and the drug rules are federal and state statute.

The licensing side is lighter than the staffing side. Under 75-09.1-01-02, a new application is required when ownership changes or when the program changes its level of care. A medication added to a resident’s medical care is neither, so in our reading it doesn’t reopen the license. Send BHD a short description of the protocol at dhsbhd@nd.gov anyway and keep the reply with your policy manual. The Ketalar label lists only anesthetic uses, so ketamine isn’t MOUD and adds nothing to the opioid medication access discussed above. We would screen first for residents whose depression or post-traumatic stress lingered once withdrawal was over and a standard antidepressant trial had not helped. A history of misusing dissociatives counts against a resident, and your physician sets the final criteria.

The Nursing Board Draws a Tight Line

The North Dakota Board of Nursing’s sedation and analgesia guidance, updated January 2026, says giving anesthetic agents “(e.g., Propofol, methohexital, ketamine, and etomidate)” “for analgesia/sedation is outside the scope of practice for nurses EXCEPT in the following situations.” The exceptions are narrow: a CRNA or anesthesiologist present, intubated and ventilated critical care patients, assisting with emergency intubation, and refractory symptoms at the end of life. The guidance applies the word “nurse” to RNs and to APRNs who aren’t CRNAs, and it carves LPNs out completely, calling this work “not within the scope of the LPN.” The guidance never discusses low-dose ketamine for depression. Whether a psychiatric dose counts as analgesia or sedation is the open question, and until the board answers it we would not build a residential protocol around an RN pushing IV ketamine with no anesthesia provider present. Ask the board in writing. A 3.7 program, with physician services around the clock and 24-hour skilled nursing under 75-09.1-04-02, is the residential setting closest to what the guidance contemplates.

Registration, the PDMP and Spravato

Ketamine’s federal classification, set by 21 CFR 1308.13(c)(7), is Schedule III, and DEA’s rule at 21 CFR 1301.12 requires “A separate registration” for “each principal place of business or professional practice,” so the residence needs a registration at its own address if the drug is stored and given there. Check with the Board of Pharmacy before the first order on whether a state controlled substance registration is also needed. We couldn’t settle that from anything the board publishes. On the prescription drug monitoring program, N.D.C.C. 19-03.5-01 leaves a practitioner out of the “dispenser” definition “when the practitioner administers a controlled substance to a patient,” which in our reading means doses given in the building aren’t reported. Prescribing is another matter: an APRN with prescriptive authority must pull a PDMP report before writing a controlled substance prescription for a new client, under NDAC 54-05-03.1-10(4). For esketamine, the Spravato Medication Guide says it “can only be administered at healthcare settings certified in the SPRAVATO REMS program,” and that the provider “must monitor you for at least 2 hours after taking SPRAVATO.”

Finishing the Series After Discharge

Most residents leave before an induction series and its boosters are done. The rest happens at an outpatient ketamine practice, and North Dakota hasn’t settled who may own one. No North Dakota statute, rule or appellate ruling on corporate practice of medicine turned up in our search. The closest thing is a 1990 Attorney General letter to the Cass County State’s Attorney, which says “North Dakota public policy prohibits a corporation, other than a professional corporation,” “from employing physicians to provide medical care,” and then leaves any prosecution decision “to the state’s attorney in each and every case.” A letter like that doesn’t bind a court. Given it, our recommendation is the conservative build: a practice owned by a North Dakota licensed physician, with outside money held in a management company that bills the practice a flat fee unrelated to how many infusions it gives. Clinic ownership and staffing get their own treatment in the ketamine section of North Dakota Drug and Alcohol Outpatient Treatment Licensing.

Referrals between the two need a lawyer’s eye. We found no North Dakota patient brokering statute, but BHD’s own rule already reaches the residence: 75-09.1-01-08(2) requires “a policy that prohibits fee splitting with other programs, agencies, entities, or individuals” “as consideration for referral of the client to be served.” Federally, 18 U.S.C. 220 covers a non-hospital setting providing residential treatment “pursuant to licensure or certification under State law,” and a violation can bring a fine up to $200,000, up to 10 years in prison, or both, “for each occurrence.”

Staffing Each Residential Level

Each level carries its own floor. At III.1, 75-09.1-02-02 says “A program shall provide staff twenty-four hours per day” and sets at least five hours a week of professionally directed treatment, including two support or group sessions. III.5 steps up to “Onsite, twenty-four hour per day clinical staffing by licensed counselors, other clinicians, and other allied health professionals such as counselor aides,” seven days a week (75-09.1-03-02). III.7 adds “twenty-four-hour skilled nursing care, daily onsite counseling services, and a physician’s services twenty-four hours per day seven days per week” (75-09.1-04-02). The phrase “medical director” doesn’t appear in any of those chapters. Across every level, substance use counseling and assessment fall to a licensed addiction counselor (LAC), and an LAC has to sit in on level-of-care and treatment planning meetings (75-09.1-01-15(6)).

Counselor pay in North Dakota sits well above the national figure. BLS reports a statewide median of $68,630 for substance abuse, behavioral disorder, and mental health counselors (OEWS, May 2025), $9,280 above the national median of $59,350, with the state’s 25th and 75th percentiles at $55,450 and $77,320. Pay a clinical director and five counselors the state median and payroll reaches roughly $411,780 a year (6 x $68,630, our estimate), before overnight staff, nursing, physician coverage and benefits. You rarely have to fund that full figure on day one, because North Dakota’s counselor license has a built-in training stage. Under N.D.C.C. 43-45-04 the Board of Addiction Counseling Examiners keeps a register of clinical trainees and addiction counselor trainees, and an LAC candidate has to log 960 clinical training hours under NDAC 4.5-02.1-01, with trainee status allowed for up to twelve months plus a twelve-month extension at the supervisor’s request. A licensed clinical director supervising several trainees who are finishing those hours, at pay below a licensed counselor’s, typically trims clinical staffing costs somewhere between 40 and 60 percent, measured against filling every counselor seat with a fully licensed LAC. The LAC requirement for counseling and assessment still applies, so trainees work within the board’s supervision rules. A single RN can also direct several LPNs on routine medication passes, though the Board of Nursing’s guidance keeps LPNs away from sedation and analgesia work entirely. We fix the real roster once you know which levels you are licensing and how many beds each gets.

Accreditation Entitles You to a License

This section quotes NDAC 75-09.1-01-25 and 75-09.1-01-03 and BHD’s provider booklet directly.

North Dakota’s accreditation rule is unusually strong. Under 75-09.1-01-25, “The department shall issue a license to a program that has a current accreditation of a nationally recognized body that reviews and certifies providers of drug and alcohol services.” The rule names no accreditor. In our reading CARF and The Joint Commission both fit the description, though BHD hasn’t published a list. At application and renewal you submit “the accreditation agency’s most recent review and certification.” BHD’s licensing provider booklet calls these “deemed status” providers and says they get a license “valid up to two years.”

What the rule does not say is that accreditation replaces BHD’s own visits. Section 75-09.1-01-03 requires an onsite review before a provisional license becomes unrestricted and continued reviews “on at least a biennial basis,” with no exception for accredited programs, and N.D.C.C. 50-31-04 says the department “shall evaluate every licensed” program. Ask BHD how it schedules reviews for a deemed-status program before you plan around fewer visits.

How to Submit Your BHD Residential Application

The application is SFN 971, revision 2-2026. It must be notarized, and Section 4 is an attestation and disclosure covering fraud, investigations, exclusions and discipline. Attach your policies and procedures written to Article 75-09.1 (BHD may send them back for revisions), proof of registration with the North Dakota Secretary of State, the names of the licensed addiction counselors on staff, and the entity responsible for the program, per BHD’s licensing process page. Mail the packet to the Behavioral Health Division, 600 E Boulevard Ave, Dept. 325, Bismarck, ND 58505-0250, and email a copy to dhsbhd@nd.gov. Questions go to the same address or 701-328-8920.

The fee comes from statute, not the form. N.D.C.C. 50-31-03.1 requires “a one hundred fifty dollar nonrefundable fee,” yet neither SFN 971 nor BHD’s licensing page mentions it. A second statute, N.D.C.C. 50-06-01.7, separately lets BHD set nonrefundable application fees “not to exceed three hundred dollars,” so ask BHD what amount it collects today and how it wants it paid before you mail anything. BHD says “An initial review of the application and policy manual may take up to 6 weeks.” A new program usually starts on a provisional license of up to one year, converts to an unrestricted license (two years at most) after an onsite review, and gets a written license report within 30 days of that review (75-09.1-01-03 and -04). Under 75-09.1-01-02, BHD may declare an application withdrawn if missing documents are still outstanding sixty days after it tells you the file is incomplete.

What Holds Up North Dakota Residential Files

The delay we expect most often is the policy manual. BHD reviews it against every applicable chapter, and a manual copied from another state usually lacks the level-specific hour and staffing rules North Dakota writes into each chapter. A second snag is the premises safety certification under 50-31-04, which depends on a local inspector’s calendar rather than BHD’s. A third is a plan that mixes a 3.7 unit with hospital space, since the 2023 exemption applies only when the program is independent from a medical hospital.

Frequently Asked Questions

Weighing a freestanding 3.7 build against a hospital-based unit in North Dakota? Send us your plan.

Sources

• N.D.C.C. ch. 23-16, section 23-16-01 (3.7 exemption) and 23-16-01.1: Hospitals and related institutions (PDF) (checked October 15, 2026)
• North Dakota Legislative Assembly, 2023 HB 1050: Bill overview and Session Laws 2023, chapter 250 (PDF) (checked October 15, 2026)
• 2023 HB 1050 enrolled text, N.D.C.C. 50-31-04 and 50-31-08: Enrolled bill (PDF) (checked October 15, 2026)
• North Dakota Constitution, article IV, section 13: Effective date of laws (PDF) (checked October 15, 2026)
• N.D.C.C. ch. 50-31, sections 50-31-03.1, 50-31-04, 50-31-07, 50-31-08: Substance use disorder treatment programs (PDF) (checked October 15, 2026)
• N.D.C.C. ch. 50-06, sections 50-06-01.7 and 50-06-41.3: Department of Health and Human Services, BHD fee authority and bed management reporting (PDF) (checked October 15, 2026)
• Session Laws 2025, chapter 441 (SB 2113), section 28 amending 50-06-41.3: Public Welfare chapters (PDF) (checked October 15, 2026)
• North Dakota Legislative Assembly, 2025 SB 2113: Bill overview (checked October 15, 2026)
• N.D.C.C. Title 23 chapter list, 23-17.2 repealed (Justia mirror of the 2025 code): Title 23 (checked October 15, 2026)
• NDAC Article 75-09.1: Substance Abuse Treatment Programs, chapter list (checked October 15, 2026)
• NDAC 75-09.1-01, sections -02, -03, -04, -08, -15, -25: General standards (PDF) (checked October 15, 2026)
• NDAC 75-09.1-02, 75-09.1-03, 75-09.1-04: Level III.1 (PDF), Level III.5 (PDF) and Level III.7 (PDF) (checked October 15, 2026)
• HHS: Draft administrative code revisions, Article 75-09.1 and draft rule text (PDF) (checked October 15, 2026)
• HHS Behavioral Health Division: Licensing and licensing process (checked October 15, 2026)
• HHS: SFN 971, Substance Abuse Treatment License Application, rev. 2-2026 (PDF) (checked October 15, 2026)
• HHS Behavioral Health Division: Licensing provider booklet, February 2023 (PDF) (checked October 15, 2026)
• N.D.C.C. ch. 43-45 (Justia mirror): Addiction counselors (checked October 15, 2026)
• NDAC 4.5-02.1-01: Addiction counselor licensure (PDF) (checked October 15, 2026)
• U.S. Bureau of Labor Statistics, OEWS May 2025, SOC 21-1018: North Dakota and national estimates (checked October 15, 2026)
• CARF: ASAM Level of Care Certification (checked October 15, 2026)
• ASAM: Level of Care Certification (checked October 15, 2026)
• CARF: Find a Provider (certification filter) (checked October 15, 2026)
• DEA Diversion Control Division: Dear Registrant letter, January 12, 2023 (PDF) (checked October 15, 2026)
• North Dakota Board of Nursing: Role of the Nurse in Sedation/Analgesia, updated January 2026 (PDF) (checked October 15, 2026)
• North Dakota Board of Nursing, NDAC 54-05-03.1-10: APRN drug monitoring program duties (checked October 15, 2026)
• N.D.C.C. ch. 19-03.5: Prescription drug monitoring program (PDF) (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 registrations for separate locations (checked October 15, 2026)
• U.S. FDA: Spravato prescribing information and Medication Guide (PDF) (checked October 15, 2026)
• U.S. FDA: Ketalar (ketamine hydrochloride) prescribing information, indications (PDF) (checked October 15, 2026)
• North Dakota Attorney General, letter to Cass County State’s Attorney, October 23, 1990: Corporate employment of physicians (PDF) (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)