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North Dakota 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: SFN 971 license application (PDF) | Questions: Behavioral Health Division, dhsbhd@nd.gov or 701-328-8920

An outpatient addiction program in North Dakota that already holds national accreditation is in an unusually good position. NDAC 75-09.1-01-25 doesn’t say the state “may” license an accredited program. It says “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.” That is firmer wording than we usually see in state SUD rules. The license still comes from the Behavioral Health Division (BHD) of the Department of Health and Human Services, and it still requires an application, but the accreditation survey you already passed carries real weight in the decision.

Residential levels, the freestanding 3.7 exemption and the medication rules for a residence are in North Dakota Drug and Alcohol Inpatient Treatment Licensing. For mental health clinics and the state’s full licensing map, see North Dakota Behavioral Health Licensing.

What Accreditation Does and Doesn’t Buy

The rule text quoted here is from NDAC chapter 75-09.1-01 and N.D.C.C. 50-31-04, both read on the Legislative Assembly’s site. How BHD applies them in practice is something we flag as unconfirmed.

When you apply or renew, 75-09.1-01-25(2) has you hand over “proof of accreditation or deemed status in the form of the accreditation agency’s most recent review and certification.” BHD’s provider booklet describes the result as a deemed-status license “valid up to two years.” The rule doesn’t name accreditors. We read CARF and The Joint Commission as fitting “a nationally recognized body,” but BHD hasn’t said that in writing, so confirm yours before relying on it.

The visits don’t disappear. Section 75-09.1-01-03 requires BHD to conduct “continued license reviews for programs with unrestricted licenses on at least a biennial basis” and contains no exception for accredited programs. Section 50-31-04 of the Century Code adds that the department “shall evaluate every licensed substance use disorder treatment program.” HHS’s 2024 draft rewrite says a program with active accreditation at renewal “may be exempt from the site visit requirement per the discretion of the department,” but that is draft language, and the current rules contain nothing like it. Our advice is to expect BHD onsite and to treat accreditation as the thing that secures the license itself.

Three Outpatient Levels, Defined by Weekly Hours

Article 75-09.1 gives each adult outpatient level its own chapter and draws the line between them by programming hours per week. The figures below come straight from those chapters.

LevelNDAC chapterWeekly programmingStaffing language in the rule
Level I outpatient75-09.1-07No more than 8 hours (fewer than 9 contact hours)Counseling and assessment by a licensed addiction counselor, who also attends team meetings
Level II.1 intensive outpatient75-09.1-068 to 19 hoursMedical and nursing services as the assessment and treatment plan call for
Level II.5 partial hospitalization or day treatment75-09.1-05At least 20 hoursMultidisciplinary staff, plus medical and nursing services as assessed

A program running both an evening IOP track and weekly aftercare groups is licensed for both levels, and SFN 971 has a checkbox for each. The DUI seminar at Level 0.5 (75-09.1-09) is a separate box as well. Under 75-09.1-01-02, adding a level later means a new application, not a phone call.

Solo Counselors and Private Practice

North Dakota’s program license reaches private-practice addiction counselors too. BHD’s licensing process page tells an addiction counselor “applying as a private practice” to supply confirmation of registration and licensure from the board, which in our reading means a solo LAC practice goes through BHD with SFN 971 like any clinic. The board side is set by N.D.C.C. 43-45-05.3: “A person may not engage in the private practice of addiction counseling unless that person” is registered with the Board of Addiction Counseling Examiners. Chapter 50-31 has no exemptions section and doesn’t define what counts as a treatment program, so a counselor working inside a medical or mental health practice should ask BHD directly whether the practice needs its own license.

No Certificate of Need for Outpatient Care

The Century Code lists chapter 23-17.2, North Dakota’s old certificate of need law for hospital expansion, as repealed. An outpatient SUD clinic needs no need review from the state. The one outpatient service with a step BHD itself calls a “Certificate of Need” is an opioid treatment program, whose first licensing stage goes to the State Opioid Treatment Authority. That track is separate from the license described here.

Buprenorphine, Methadone and the Draft MOUD Rule

Office-based buprenorphine is the simplest medication pathway an outpatient program can add. The DEA’s January 2023 notice says the DATA-Waiver is no longer required and that “all prescriptions for buprenorphine only require a standard DEA registration number.” Methadone for opioid use disorder belongs to opioid treatment programs, which BHD licenses one location at a time under N.D.C.C. 50-31-08. A clinic that doesn’t run one should name the OTP its clients use and put the coordination arrangement on paper.

Current chapter 75-09.1-01 has no provision we found requiring an outpatient program to allow MOUD. HHS’s pending draft would require it, with the line “A program shall allow the use of medications approved by the Food and Drug Administration,” and would add a Level 1.7 medically managed outpatient chapter. HHS’s draft rules page now anticipates “July 1, 2027, pending completion of the formal rulemaking process and required approvals.” None of it is in force today, so treat Level 1.7 as a planning signal, not a license you can apply for.

Opening a Ketamine Clinic in North Dakota

North Dakota has no ketamine clinic statute. On facility licensing and ownership, what follows is how we read HHS’s licensing list and a 1990 Attorney General letter. The nursing, DEA, PDMP and Spravato points rest on the board guidance, federal rules and statute linked in each paragraph.

HHS’s licensing, regulation and certification hub names facility types such as ambulatory surgical centers, rural health clinics and hospitals, plus a separate behavioral health link that leads to the SUD program license. No category fits a physician office that gives ketamine for depression. Our conclusion is that a clinic of that kind needs no state facility license, which leaves the drug, the clinicians and the owners as the regulated parts. A clinic that also treats addiction is different, because SUD treatment brings it back under chapter 50-31.

Ownership Without a Settled Rule

Corporate practice of medicine in North Dakota rests on thin authority, with nothing in the Century Code, the Administrative Code or the state’s appellate reports that we could find. A 1990 letter from the Attorney General to the Cass County State’s Attorney concluded that “North Dakota public policy prohibits a corporation, other than a professional corporation,” “from employing physicians to provide medical care,” and said the call on any crime “must be left to the state’s attorney in each and every case.” It is an advisory letter, not a binding opinion or a court decision, so the question stays open as far as we can tell. The structure we recommend anyway is a professional practice whose owner is a physician licensed in North Dakota, contracting with a management services organization for space, staff and billing, with the clinical calls and the controlled substance registration staying with the practice. We did not review North Dakota’s professional entity statute for this guide, so have counsel confirm who may hold equity in the practice entity.

Nurse practitioners have their own prescribing route. The Board of Nursing grants prescriptive authority separately, after a graduate APRN program and 30 contact hours of pharmacotherapy, and NDAC 54-05-03.1-09 sets no collaboration or supervision condition. We read that as letting an APRN with prescriptive authority order ketamine independently. Whether an APRN may own the practice is a separate entity question we left unconfirmed.

Who Can Push the Dose

This is the point where North Dakota’s rules bite hardest. The Board of Nursing guidance on sedation and analgesia, updated January 2026, puts ketamine given “for analgesia/sedation” “outside the scope of practice for nurses” unless one of its listed exceptions applies, the first being a CRNA or anesthesiologist present. The guidance treats RNs and non-CRNA APRNs as “nurses” for this purpose and says the practice “is not within the scope of the LPN.” It never mentions psychiatric dosing. Until the board says otherwise, our suggestion is a clinic model where a physician or a CRNA is in the room for infusions, with RNs handling monitoring tasks the guidance doesn’t restrict.

Controlled Substance Rules for the Clinic

On the federal list, ketamine is a Schedule III substance (21 CFR 1308.13(c)(7)). Under 21 CFR 1301.12, DEA requires a separate registration for each principal place of professional practice, so a second clinic location means a second registration. We found no Board of Pharmacy page saying whether North Dakota also wants its own controlled substance registration alongside DEA’s, so call the board. The state’s PDMP statute, N.D.C.C. 19-03.5-01, excludes a practitioner from the dispenser definition “when the practitioner administers a controlled substance to a patient,” so in our reading in-clinic infusions aren’t reportable dispensing. APRN prescribers still have the PDMP check duties in NDAC 54-05-03.1-10(4), including for a “New or unestablished client requiring prescription for controlled substance.” A Spravato service needs REMS certification: the FDA-approved Spravato labeling says “Patients treated in outpatient healthcare settings (such as medical offices and clinics) must be enrolled in the program,” and each patient is monitored for at least 2 hours after a dose.

Many clinic patients will arrive mid-series from a residential stay. The referral rules for that handoff, including BHD’s fee-splitting rule and the federal kickback statute, are in the ketamine section of North Dakota Drug and Alcohol Inpatient Treatment Licensing.

Staffing an Outpatient Program

The Level I chapter is specific about who does what. Under 75-09.1-07-03(5), counseling or assessment about alcohol or drug use “must be provided by a licensed addiction counselor,” an LAC has to be present in team meetings that decide level of care and treatment plans, and case management and educational services don’t need an LAC. The IOP and day treatment chapters say less, asking for multidisciplinary staff and medical and nursing services as the treatment plan requires.

Budget against a high state wage. North Dakota’s median for substance abuse, behavioral disorder, and mental health counselors is $68,630 a year according to BLS OEWS for May 2025, compared with $59,350 nationally. The state’s 25th percentile is $55,450 and its 75th is $77,320. A clinical director plus three counselors, all paid at the median, comes to about $274,520 a year in clinical salary before benefits (4 x $68,630, our estimate). That number shrinks quickly once you use the training tier North Dakota’s counselor rules already provide. The Board of Addiction Counseling Examiners is where clinical trainees register, and a trainee may stay in that status up to twelve months (with up to twelve more at the supervisor’s request) while logging the 960 hours of clinical training required for an LAC under NDAC 4.5-02.1-01. An LAC clinical director overseeing trainees at trainee pay, while they earn those hours, usually brings counseling payroll down somewhere in the 40 to 60 percent range relative to a roster made up entirely of LACs. Where the program offers medication services, one RN supervising LPNs is the usual nursing model, keeping in mind that sedation work stays off the LPN’s task list. The exact hires depend on which levels you run and how many groups a week you schedule.

How to Submit Your BHD Outpatient Application

Every outpatient level uses SFN 971 (revision 2-2026), signed in front of a notary, with its Section 4 attestation and disclosure completed. BHD wants a policy and procedure manual covering Article 75-09.1, Secretary of State registration, the licensed addiction counselors you will use and the name of the responsible entity. A private-practice counselor also includes the board registration. The completed packet is mailed to the Behavioral Health Division, 600 E Boulevard Ave, Dept. 325, Bismarck, ND 58505-0250, and emailed to dhsbhd@nd.gov. BHD’s licensing page says: “For any questions, please contact the Behavioral Health Division at dhsbhd@nd.gov or 701-328-8920.”

Two statutes touch the fee. N.D.C.C. 50-31-03.1 requires “a one hundred fifty dollar nonrefundable fee” with every application, and 50-06-01.7 separately lets BHD set nonrefundable licensing application fees “not to exceed three hundred dollars.” Neither SFN 971 nor the BHD licensing page states an amount, so ask BHD what it currently collects and how. The page also says “An initial review of the application and policy manual may take up to 6 weeks.” Our estimate for an outpatient program from filing to a license is 2 to 4 months, allowing for a round of policy revisions and the onsite review that moves a provisional license to an unrestricted one.

Common Outpatient Setbacks

Most delays we see trace back to the manual. Policies that don’t match the hour limits for the level checked on SFN 971, such as an IOP schedule that drops under 8 hours a week, draw revision requests. The other recurring problem is staffing on paper only. BHD asks you to name your licensed addiction counselors, and a program that lists one LAC for several levels may be asked how that person also attends every treatment planning meeting the Level I rule requires.

Frequently Asked Questions

Does an accredited outpatient SUD program in North Dakota still need a BHD license?

Yes, but accreditation takes the discretion out of the decision. Under NDAC 75-09.1-01-25 the department must license a program accredited by a nationally recognized body that reviews drug and alcohol services. You still file SFN 971 with the accreditor’s most recent review, and the rules still call for BHD onsite reviews at least every two years.

How many hours a week can a North Dakota IOP run?

Level II.1 intensive outpatient under NDAC 75-09.1-06 must offer no less than 8 and no more than 19 hours of programming a week. Level I outpatient is capped at 8 hours, and Level II.5 day treatment or partial hospitalization starts at 20 hours.

What does a North Dakota outpatient SUD license cost?

N.D.C.C. 50-31-03.1 sets a 150 dollar nonrefundable application fee. A separate statute, 50-06-01.7, lets the Behavioral Health Division set application fees up to 300 dollars, and neither SFN 971 nor BHD’s licensing page lists an amount, so confirm the current fee with BHD before filing.

Mapping your North Dakota outpatient levels to the right chapters before you file? Get in touch.

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