South Carolina 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: Form 3293-ENG-DPH, Residential Facility application (PDF) | Questions: DPH Bureau of Health Facilities Licensing, CDAP@dph.sc.gov, 803-545-4370

The license fee is the small number in a South Carolina residential budget. A 20-bed addiction residence pays the South Carolina Department of Public Health (DPH) $200 a year to hold its license, at $10 per bed. The inspection that has to happen before that license issues costs $850 on its own, and if the building is new or being altered, plan review and three site visits during construction come on top. Those are two separate charges under two separate sections of Regulation 60-93, and operators who budget only for the first one tend to find the second when DPH sends the invoice.

R.60-93 is the rule that governs every facility for chemically dependent or addicted persons in the state. It carried the number R.61-93 until State Register Doc. No. 5352 moved it into Chapter 60 effective May 23, 2025, so older checklists, consultant handouts and even some policy manuals still cite the old number. DPH took over facility licensing when 2023 Act No. 60 split up the old Department of Health and Environmental Control on July 1, 2024, yet the rule’s definition section still reads “Department. The South Carolina Department of Health and Environmental Control.” DPH administers it all the same. Outpatient clinics are covered in South Carolina Drug and Alcohol Outpatient Treatment Licensing, and the full set of DPH tracks, psychiatric hospitals included, is on the South Carolina Behavioral Health Licensing page.

Residential Treatment and the Two Withdrawal Management Programs

Definitions, fees and staffing figures in this guide come from the R.60-93 text DPH posts and the official Chapter 60 compilation on the Legislature’s site. Where we say what a provision means for an operator, that is our reading.

South Carolina’s statute requires a license for any facility for chemically dependent or addicted persons that cares for two or more unrelated people (S.C. Code 44-7-260(A)). Under R.60-93, the residential side of that license can authorize three programs, and form 3293 has a box for each, so tick every program the building will actually offer:

• Residential Treatment Program, which the rule describes as “designed to improve the Patient’s ability to structure and organize the tasks of daily living and foster recovery”
• Medical Withdrawal Management, defined as “providing for medically-supervised Withdrawal Management”
• Social Withdrawal Management, for patients whose intoxication and physical condition are not severe enough to need direct medical supervision

A building that also runs an outpatient program needs a second license. Under §102.H, outpatient and residential services on the same premises are licensed separately even with one owner, so a residence planning a step-down IOP in the same building files two applications, one on the residential form and one on the outpatient form.

ASAM Numbers Are Not on a South Carolina License

We searched the full DPH copy of R.60-93 for any reference to ASAM and found none. The license names the program, not a level of care, so a residential license tells a referral source nothing about whether the house operates at Level 3.1, 3.5 or 3.7. CARF offers a way to put that on record. Its ASAM Level of Care Certification, which ASAM says is “Delivered in partnership with CARF International,” covers only adult residential care at Levels 3.1, 3.5 and 3.7, and anyone can confirm a certified program through CARF’s provider search. Since the license itself names no level, we would not expect it to show there. We would match it to the Residential Treatment Program side of a South Carolina license. Neither CARF nor ASAM says the certification reaches withdrawal management, so a medical or social withdrawal management program can’t lean on it.

What a Residential License Costs Before the First Admission

License fees fall under R.60-93 §102.L, and inspection fees under §202.E and F. The inspection fees are authorized separately by S.C. Code 44-7-270, which is why they show up as their own line.

Charge	Residential amount	Rule
Initial and annual license fee	$10 per bed or $75, whichever is greater	§102.L
Initial, relocation or routine inspection	$350 plus $25 per licensed bed	§202.E
Bed increase or change in services	$200 plus $25 per bed	§202.E
Follow-up inspection	$200 plus $25 per bed	§202.E
Construction plan review	$750 to $2,500 and up, scaled to total project cost	§202.F
Construction site inspections	$500 each, at 50%, 80% and 100% completion	§202.F
Late renewal fee	$75 or 25% of the license fee, whichever is greater	§102.M

Plan review is priced by the project’s total estimated cost, not by beds: $750 under $10,001, $1,500 up to $100,000, $2,000 up to $500,000, and $2,500 plus $100 for each additional $100,000 beyond that. Take a 20-bed house with a $250,000 renovation (our example, using the rule’s figures): $200 license fee, $850 initial inspection, $2,000 plan review and $1,500 for the three site visits, or $4,550 in state fees before a single staff member is hired. A follow-up inspection after a failed visit adds another $700 at that bed count. DPH also posts a fee schedule on its applications page, but the file is a scanned image we could not read, so the rule is our source for every figure here.

Construction review is not optional. In its Act 20 FAQ, DPH reminds licensees that building or altering a licensed facility “still requires plan and specification approval prior to beginning the construction or alteration.” Questions about plans go to Health Facilities Construction at (803) 545-4215.

No Certificate of Need, and a Hospital Exception That Ends in 2027

Ever since 2023 Act No. 20 (S.164) became effective on May 16, 2023, section 44-7-160 of the S.C. Code has required a Certificate of Need only for nursing home projects and for hospitals: building or establishing one, or changing its bed complement or bed classification. A freestanding residential program licensed under R.60-93 is not a hospital, so in our reading it needs no CON. The hospital piece has an end date written into the statute itself: “(C) Effective January 1, 2027, Section 44-7-160(B) is repealed.” Until then, a residential program that grows into an alcohol and substance abuse hospital, which the CON definitions list by name, would still go through CON review. After December 31, 2026, that review disappears as well, and only licensing remains.

Opioid Use Disorder Medications Under R.60-93

R.60-93 is silent on MOUD. We searched the rule for buprenorphine, naltrexone and medication-assisted treatment and found no requirement that a residential program offer or permit any of them. That silence leaves the decision with the operator, and we would write the policy anyway, covering how a resident who arrives on buprenorphine keeps getting it, who prescribes, and how doses are stored and counted.

The federal piece is simple. 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,” so a prescriber with an ordinary DEA registration can treat. South Carolina adds a state registration on top. Under S.C. Code 44-53-290, anyone who dispenses or administers a controlled substance needs a South Carolina Controlled Substances Registration from the DPH Bureau of Drug Control as well as DEA registration. If controlled substances go missing from a facility holding those registrations, §606 requires a report to the local police and to the Bureau of Drug Control “within seventy-two (72) hours of the discovery of the loss and/or theft.”

Methadone maintenance runs on a different track. S.C. Code 44-53-290(i) requires a separate annual registration for practitioners who dispense narcotic drugs for maintenance or detoxification treatment, and R.60-93 places opioid treatment programs on the outpatient side of licensing, not the residential side. A residence whose patients need methadone should hold a written coordination agreement with a licensed OTP nearby. One more line in the rule touches overdose care directly. Section 601.B lists an overdose reversal with naloxone among the incidents a facility must report to DPH within 24 hours, so stock naloxone, train on it, and build the reporting step into the same procedure.

Ketamine Inside a DPH-Licensed Residential Program

R.60-93 never mentions ketamine, and we found no DPH guidance on it. What follows applies the rule, two South Carolina licensing board opinions and the statutes cited, and the licensing conclusions are our interpretation.

Nothing we read bars a licensed residence from treating a resident’s co-occurring depression or PTSD with ketamine, but the rule asks for permission first. Section 102.O says “No facility shall establish new care or services or occupy additional beds or renovated space without first obtaining authorization from the Department.” Ketamine infusions or Spravato sessions are, in our view, new care, so we would send DPH a written description of the service and wait for an amended license or a written answer before the first dose. Expect the $200 plus $25 per bed service change inspection to apply.

Which residential program you hold matters for monitoring. A Residential Treatment Program only has to keep a physician available during operating hours, in person or by phone. A Medical Withdrawal Management program must have “a Physician, Licensed Nurse, or other Authorized Healthcare Provider” present at all times. The second is far better suited to watching someone through the hours after a dose.

The Nursing Board Draws a Line at Anesthetic Agents

The South Carolina Board of Nursing has addressed ketamine directly, and the answer limits what a residential nurse can do. Advisory Opinion #25 says nurses without anesthesia credentials “may NOT administer agents that are primarily used as anesthetics,” and ketamine is in the opinion’s own list of examples. The medical, nursing and pharmacy boards also issued a joint advisory opinion on low dose ketamine (revised July 10, 2020) that permits RNs to administer and monitor low dose ketamine by continuous infusion, but only for pain management in acute care hospitals, with IV push limited to the emergency department and PACU. Neither opinion reaches a residential treatment setting or a psychiatric indication. Our reading is that IV ketamine in a South Carolina residence should be given by the physician, with nurses monitoring rather than administering, until the boards say otherwise.

Two Registrations and the SCRIPTS Database

On the drug side, ketamine is a federal Schedule III controlled substance, listed at 21 CFR 1308.13(c)(7). The prescriber needs a DEA registration for the site and the state Controlled Substances Registration from the Bureau of Drug Control, reachable at (803) 896-0636 or bdc@dph.sc.gov. South Carolina’s monitoring program, SCRIPTS, collects Schedule II to IV dispensing, and S.C. Code 44-53-1630 excludes from the definition of dispenser “a practitioner or other authorized person who administers these controlled substances.” We take that to mean doses given on the unit stay out of SCRIPTS, while a prescription a resident carries out the door shows up there once a pharmacy dispenses it. Nurse practitioners can prescribe Schedule II to V drugs only under a physician practice agreement (S.C. Code 40-33-34), so an APRN’s role in a ketamine protocol runs through that agreement. Spravato adds its own rules. The SPRAVATO REMS requires the setting to be certified, every patient to be enrolled, and observation by a healthcare provider “for at least 2 hours” after each dose.

Residents We Would Consider

We found no FDA approval of ketamine for treating addiction itself, which in our view keeps it outside MOUD and leaves the buprenorphine or naltrexone plan above in place. We would reserve it for residents whose withdrawal is well behind them, who have stayed depressed or symptomatic after an adequate trial of standard treatment, and whose history shows no misuse of ketamine, PCP or other dissociatives. The program physician writes the actual criteria. Put them in the consent form.

After Discharge: a Separate Outpatient Practice

Starting a series in a supervised residence makes sense, but most series outlast a residential stay, and the remaining sessions belong in an outpatient ketamine practice. Nothing we read in South Carolina’s statutes or binding rules stops a lay investor from owning a medical practice. In a 2022 advisory opinion, the Board of Medical Examiners stated that it “does not license or regulate corporations” and focused on keeping clinical judgment with the licensee, while the Attorney General wrote in 1982 that a corporation cannot lawfully practice medicine. Given that mix, we favor a physician-owned professional corporation contracting with a management services company. The full structure, including the professional corporation rules in Title 33, Chapter 19, is in the ketamine clinic section of South Carolina Drug and Alcohol Outpatient Treatment Licensing.

Money changing hands around referrals is where this model gets operators in trouble, so counsel should review the arrangement before it starts. Because a DPH-licensed residence operates under state licensure, it falls within 18 U.S.C. 220, the Eliminating Kickbacks in Recovery Act, where each prohibited payment can draw a fine as high as $200,000, a prison term as long as 10 years, or both. South Carolina’s own Provider Self-Referral Act, S.C. Code 44-113-60, separately makes it unlawful for a provider “to offer, pay, solicit, or receive a kickback” for referring patients. We did not find a South Carolina statute aimed specifically at addiction treatment patient brokering.

Staffing Ratios and Payroll for a South Carolina Residence

R.60-93 sets the minimums by the clock. Between 7 a.m. and 7 p.m., a Residential Treatment Program keeps one staff member or volunteer on duty per 10 patients in each building, overnight that loosens to one per 20, and everyone on duty must be “present, awake, and dressed at all times when Patients are present” (§503). Withdrawal management programs need one direct care or counselor staff member for every 10 patients around the clock, and medical withdrawal management adds a physician, licensed nurse or other authorized provider on site at all times under the general supervision of a physician or RN. The rule also calls for a full-time Administrator holding a bachelor’s degree or higher in a related field (§502.A) and “at least one (1) Staff Counselor who is fully-certified or licensed” (§508.A). Annual training covers CPR, with one certified person present whenever patients are in the building, along with first aid, vital signs, medication management and seizure response.

BLS puts South Carolina’s median annual wage for substance abuse, behavioral disorder, and mental health counselors at $52,370 (OEWS, May 2025), below the $59,350 national figure, and the middle half of the state’s counselors earn between $43,070 and $65,070. Six salaried clinical positions at the state median, an administrator, a clinical lead and four counselors, come to about $314,220 a year (6 x $52,370, our estimate), and overnight direct care staff, nursing for any medical withdrawal management beds and benefits are extra. That figure assumes every counselor arrives fully credentialed, and South Carolina’s own rule says they don’t have to. Section 508 lets a facility hire counselors who are not yet certified or licensed, working under direct on-site supervision, as long as each one is either in the certification process run by the South Carolina Association of Alcohol and Drug Abuse Counselors Certification Commission or holds a Licensed Addiction Counselor Associate license, and reaches the full credential inside three years from the hire date. Miss that deadline and §508.E takes the person off counseling duties until the credential arrives. The associate license itself comes from the counselor board under S.C. Code 40-75-240 once education and the exam are done. A clinical lead who holds a full credential can supervise several of those counselors at below-credentialed pay while they log their hours, which commonly trims clinical payroll by 40 to 60 percent next to an all-credentialed team. On the medical side, one RN supervising LPNs on the withdrawal management shifts usually costs less than an all-RN roster and fits the rule’s general supervision language, in our reading. Your census and which of the three programs you run will set the final schedule.

Incident Reports DPH Expects Within 24 Hours

Section 601 of R.60-93 sets one of the tighter reporting clocks we see in residential rules. A facility must report listed incidents to DPH “immediately, not to exceed twenty-four (24) hours,” through the Department’s electronic reporting system, then send a separate written investigation report within five days. The list, which the rule says is not limited to these, includes abuse, neglect or exploitation by staff, whether confirmed or suspected, crimes against patients, a death in the facility or on its grounds, an overdose reversed with naloxone, elopement, fractures, hospitalization after an accident, medication errors, attempted suicide and severe injury involving restraint. The next of kin or responsible party gets notice within the same 24 hours. A fire means an immediate call, email or fax to DPH and a full written account no later than 48 hours afterward (§602), and an administrator change must be reported within 72 hours (§604). Keep each incident record for six years past the date that patient’s services end.

Accreditation Earns No Inspection Credit Here

We read every page of the DPH copy of R.60-93 looking for deemed status, an inspection waiver or a fee reduction tied to CARF, The Joint Commission or COA. There is none. The only accreditation language concerns counselor credentialing bodies in §508. DPH inspects before the first license (§202.A) and afterward as it deems appropriate, and it may show up unannounced. Accreditation still has value for a South Carolina residence, mainly with referral sources and as an outside check on clinical quality, and the CARF level of care certification described above is the one outside credential we found that puts an ASAM level on record. It simply does nothing for the state license.

How to Submit Your Residential Application to DPH

The residential form is 3293-ENG-DPH (07/2025), the Application for Licensure as a Facility for Chemically Dependent or Addicted Persons for a Residential Facility. It covers all three residential programs. The signature page must be notarized, signed by the individual owner, the head of an LLC, or two officers of a corporation, and Part C asks for “the name, address, and percentage of all owners that possess 5% or more ownership.” Attach proof of property ownership or a lease, an emergency evacuation plan, verification of the Administrator’s qualifications, and proof that the fee was paid, since “Proof of payment is required for all applications submitted.”

Email is DPH’s preferred route, to CDAP@dph.sc.gov. The mailing address is Bureau of Health Facilities Licensing, P.O. Box 2046, West Columbia, SC 29171, and questions go to 803-545-4370. No admissions are allowed before the license issues, and DPH will not issue it until the facility has shown substantial compliance at the initial inspection (§102.A and B). Neither the rule nor the DPH page states a processing time. Our planning range for a residential file is five to nine months, longer when construction review is involved. If you want a variance from a specific standard, DPH’s applications page links the Request for Exception to Licensing Standard form.

One funding note. The Office of Substance Use Services, part of the new Department of Behavioral Health and Developmental Disabilities since 2025 Act No. 3, works with the county alcohol and drug abuse authorities to deliver services through licensed providers, but any funding relationship with it sits outside the DPH license and we don’t handle it.

Snags We Expect in a South Carolina Residential File

Policies that still cite R.61-93 and DHEC are the easiest fix and the most common. A second is checking only Residential Treatment Program on form 3293 when the building will also run social or medical withdrawal management beds, which leads to an amended license and another inspection fee later. The third is the counselor roster: if no one on staff is fully certified or licensed on opening day, the facility fails §508.A no matter how many trainees it has hired. Construction projects stall most often when work starts before DPH has approved the plans.

Frequently Asked Questions

Planning a South Carolina residence and want the R.60-93 file checked before DPH sees it? Get in touch.

Sources

• DPH: Facilities for Chemically Dependent or Addicted Persons (checked October 18, 2026)
• DPH, Regulation 60-93, sections 101 to 608: Standards for Licensing Facilities for Chemically Dependent or Addicted Persons, unofficial copy (PDF) (checked October 18, 2026)
• S.C. Code of State Regulations, Chapter 60 (official): Chapter 60, including R.60-93 history note (PDF) (checked October 18, 2026)
• State Register Vol. 49, Issue 5, Doc. No. 5352: Transfer of R.61-93 to R.60-93 (PDF) (checked October 18, 2026)
• S.C. Code Title 44, Chapter 7, sections 44-7-130, 44-7-160, 44-7-260 and 44-7-270: State Certification of Need and Health Facility Licensure Act (checked October 18, 2026)
• S.C. Code Title 44, Chapter 1, section 44-1-20: Department of Public Health (checked October 18, 2026)
• DPH: 2023 Act No. 20 (S.164) FAQ (PDF) (checked October 18, 2026)
• DPH: Certificate of Need (checked October 18, 2026)
• DPH: Health Facilities Construction contacts (checked October 18, 2026)
• DPH: Applications for Licensure (checked October 18, 2026)
• DPH, form 3293-ENG-DPH (07/2025): Residential Facility licensure application (PDF) (checked October 18, 2026)
• DEA Diversion Control Division: Dear Registrant letter, January 12, 2023 (PDF) (checked October 18, 2026)
• DPH, Bureau of Drug Control: Drug Control, register and verify (checked October 18, 2026)
• S.C. Code Title 44, Chapter 53, sections 44-53-290 and 44-53-1630: Controlled substances and prescription monitoring (checked October 18, 2026)
• S.C. Board of Nursing, Advisory Opinion #25: Administration of anesthetic agents (PDF) (checked October 18, 2026)
• S.C. Boards of Medical Examiners, Nursing and Pharmacy: Joint advisory opinion on low dose ketamine infusions, revised July 10, 2020 (PDF) (checked October 18, 2026)
• 21 CFR 1308.13(c)(7), via Cornell LII: Schedule III, ketamine (checked October 18, 2026)
• S.C. Code 40-33-34: APRN practice agreements and prescriptive authority (checked October 18, 2026)
• Janssen: SPRAVATO REMS (checked October 18, 2026)
• S.C. Board of Medical Examiners: Advisory Opinion on Corporate Practice of Medicine (PDF) (checked October 18, 2026)
• S.C. Attorney General, opinion of September 8, 1982: Corporate practice opinion (PDF) (checked October 18, 2026)
• S.C. Code Title 33, Chapter 19: Professional Corporation Supplement (checked October 18, 2026)
• 18 U.S.C. 220, via Cornell LII: Illegal remunerations for referrals to recovery homes, clinical treatment facilities, and laboratories (checked October 18, 2026)
• S.C. Code 44-113-60: Provider Self-Referral Act (checked October 18, 2026)
• S.C. Code Title 40, Chapter 75, sections 40-75-220 to 40-75-240: Counselor, addiction counselor and associate licensure (checked October 18, 2026)
• 2025 Act No. 3 (S.2): Department of Behavioral Health and Developmental Disabilities (checked October 18, 2026)
• BHDD, Office of Substance Use Services: Services (checked October 18, 2026)
• CARF: ASAM Level of Care Certification (checked October 18, 2026)
• ASAM: Level of Care Certification (checked October 18, 2026)
• CARF: Find a Provider (checked October 18, 2026)
• U.S. Bureau of Labor Statistics, OEWS May 2025, SOC 21-1018: South Carolina estimates (checked October 18, 2026)
• U.S. Bureau of Labor Statistics, OEWS May 2025, SOC 21-1018: National estimates (checked October 18, 2026)