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South Carolina 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: Form 3295-ENG-DPH, Outpatient Facility application (PDF) | Questions: CDAP@dph.sc.gov or 803-545-4370 (Bureau of Health Facilities Licensing)

A South Carolina outpatient addiction clinic can open a second location for $50 a year in license fees, but only within reach of home. Regulation 60-93 lets an outpatient facility operate satellites, and §102.D authorizes them only in the main facility’s county or a county next to it. So a satellite one county over can ride on the main license, while a site three counties away needs a separate license on a separate application, with its own inspection fee.

The licensing agency is the South Carolina Department of Public Health (DPH), which took over health facility licensing on July 1, 2024. Its rule for addiction treatment, R.60-93, was renumbered from R.61-93 in May 2025. This guide covers outpatient programs and the stand-alone ketamine clinic. Residential treatment and withdrawal management are in South Carolina Drug and Alcohol Inpatient Treatment Licensing, and the overview of every DPH track sits on South Carolina Behavioral Health Licensing.

One Outpatient License, With Satellites Close to Home

The rule provisions in this section were read in DPH’s posted copy of R.60-93, checked against the official Chapter 60 text on the Legislature’s site. How they apply to a given clinic design is our reading.

R.60-93 sorts facilities into two kinds, outpatient and residential, and the outpatient license is a single category. We found no separate IOP license, no partial hospitalization license and no level numbering, and the rule never refers to ASAM at all. In our reading, a clinic offering weekly counseling, an intensive outpatient schedule, or both holds the same Outpatient Facility license, and what it offers is described in its program description and policies. Opioid treatment programs are also licensed through the outpatient side, but they follow their own sections of the rule and a methadone statute, and this guide doesn’t cover them.

The statute defines the facility by what it does: one “organized to provide outpatient or residential services to chemically dependent or addicted persons and their families based on an individual treatment plan” (S.C. Code 44-7-130). Put residential beds in the same building and the outpatient program still carries its own license, since §102.H treats the two as separately licensed even under one owner. Adding a satellite later counts as a service modification. DPH must authorize new services before they start (§102.O), and the inspection for that change costs $250.

Fees on the Outpatient Side

For outpatient facilities, the rule says “The initial and annual License fee shall be seventy-five dollars ($75.00),” and the application form adds $50 per satellite. Inspection fees are billed separately. The initial, relocation or routine inspection of an outpatient facility is $450, and a service modification or follow-up inspection is $250 (§202.E). A main clinic with two satellites therefore pays $175 in license fees and $450 for its first inspection, $625 in all before any return visit (our arithmetic from the rule’s figures). Renewal takes an application, the fee, and a clean enforcement record, meaning no DPH action under consideration or underway (§102.N). A renewal paid late carries a late fee of $75 or 25 percent of the license fee, whichever is greater, and once 30 days pass after expiration without payment, the facility counts as unlicensed (§102.M).

Offices That Sit Outside R.60-93

A licensed counselor’s or physician’s private office does not appear anywhere on the S.C. Code 44-7-260 list of facilities DPH licenses. Our reading is that a solo LAC, LPC or psychiatrist seeing patients with substance use disorders in an office practice works under a professional license, with no facility license. The line moves once the practice becomes an organized program built on individual treatment plans with its own staff, which is what the statutory definition describes. If your practice is growing toward a group schedule with several counselors, ask the Bureau of Health Facilities Licensing before you assume you are still an office.

Mental health outpatient clinics are a different story. We found no DPH license category for them, and the details are in South Carolina Mental Health Outpatient Licensing. No outpatient program needs a Certificate of Need. Since May 16, 2023, S.C. Code 44-7-160 has reached only nursing homes and hospitals, and the hospital part is set to repeal on January 1, 2027.

Buprenorphine and Methadone Coordination

R.60-93 does not require an outpatient facility to offer medication for opioid use disorder, and our search of the rule found no mention of buprenorphine or naltrexone. Most clinics we see add office-based buprenorphine anyway, and the federal barrier is gone. DEA’s registrant letter of January 12, 2023 confirms that the DATA-Waiver registration is no longer required. What South Carolina adds is a state Controlled Substances Registration from the Bureau of Drug Control, required by S.C. Code 44-53-290 for anyone who dispenses or administers controlled substances, alongside the DEA registration. If the clinic stores controlled substances and any go missing, §606 gives it 72 hours from discovery to notify local law enforcement and the Bureau.

Methadone maintenance is its own setup. A practitioner dispensing narcotics for maintenance or detoxification needs a separate annual state registration under S.C. Code 44-53-290(i), and R.60-93 licenses that service as an opioid treatment program. An outpatient clinic that isn’t one should keep a signed coordination agreement with the OTP its patients attend, and record the arrangement in each affected patient’s plan. Section 601.B of the rule also makes a naloxone overdose reversal a reportable incident, due to DPH within 24 hours, so the clinic’s emergency procedure should cover both the response and the report.

Setting Up a Ketamine Practice in South Carolina

South Carolina has no statute or DPH rule on ketamine clinics. The facility and ownership conclusions below are our interpretation of the licensing statute, the professional corporation code and two advisory opinions. Board positions and drug registration rules are quoted from the sources linked.

A practice that gives ketamine or Spravato for depression does not appear on the 44-7-260 list of licensed facilities, and in our reading it needs no DPH facility license. That changes if the same practice also runs an organized addiction treatment program, which would bring it under R.60-93 as an outpatient facility. The regulated parts of a stand-alone clinic are the people, the drug registrations and the ownership structure.

Ownership Without a Corporate Practice Statute

We found no South Carolina statute or binding rule that prohibits a non-physician from owning a medical practice. The Board of Medical Examiners’ Advisory Opinion on Corporate Practice of Medicine (November 21, 2022) says the Board “does not license or regulate corporations” and puts the weight on the licensee, who “must control the exercise and practice of his or her clinical judgment at all times.” Older authority leans the other way. A 1982 Attorney General opinion says “a corporation cannot lawfully engage in the practice of law, nor in the practice of medicine, surgery or dentistry,” citing early South Carolina cases we have not read. With the question unsettled, we would not build a ketamine clinic on lay ownership of the medical practice.

The structure we recommend is a physician-owned professional corporation under South Carolina’s Professional Corporation Supplement (Title 33, Chapter 19). Section 33-19-130 says a corporation “may render professional services in this State only through individuals licensed or otherwise authorized in this State to render the services,” and the same chapter lets shares go only to licensed individuals, qualified partnerships or other professional corporations. A separate management services company, which can have lay investors, leases the space, employs the front desk, handles billing and marketing, and charges a fixed fee set at fair market value rather than a cut of treatment revenue. Clinical decisions, medical records and every controlled substance registration stay with the professional corporation.

Nurse Practitioners, RNs and the Anesthetic Question

South Carolina APRNs cannot run a ketamine practice on their own. Under S.C. Code 40-33-34, an NP performing medical acts must do so “pursuant to a practice agreement with a physician who must be readily available for consultation,” and prescribing in Schedules II through V happens only under that agreement. The Board of Nursing’s Advisory Opinion #25 limits RN administration too. RNs who are not qualified anesthesia providers “may NOT administer agents that are primarily used as anesthetics,” and ketamine is named. The joint low dose ketamine opinion opens a door only for pain management by infusion in acute care hospitals. An office clinic giving IV ketamine for depression fits neither opinion, so we would plan for a physician at the bedside for administration, with nurses handling monitoring and vital signs.

Registrations, SCRIPTS and Spravato Certification

The federal schedules put ketamine among the Schedule III depressants (21 CFR 1308.13(c)(7)). Each prescriber needs a DEA registration covering the clinic and a South Carolina Controlled Substances Registration from the Bureau of Drug Control, (803) 896-0636. South Carolina’s prescription monitoring statute, S.C. Code 44-53-1630, leaves out of its dispenser definition “a practitioner or other authorized person who administers these controlled substances.” In our reading, in-office infusions are not reported to SCRIPTS, while any prescription the clinic sends home with a patient is reported by the dispensing pharmacy. For Spravato, the SPRAVATO REMS requires certification of the setting, enrollment of every patient in the registry, and at least two hours of observation by a healthcare provider after each session. Plan chair time around that two-hour window.

Some patients will start ketamine during a residential stay and finish it with you. That starting point, along with the federal and state anti-kickback rules that apply to referrals between a residence and a clinic, is covered in the ketamine section of South Carolina Drug and Alcohol Inpatient Treatment Licensing.

Counselors, the Administrator and an Outpatient Payroll

Section 508 of R.60-93 puts a clock on every uncredentialed counselor. Every facility needs one fully certified or licensed counselor on staff at minimum, and a counselor hired while still in the certification process or holding an associate license works under direct on-site supervision and has three years from the date of hire to finish. The rule accepts several routes: certification by NAADAC, by an IC&RC-approved board or by the South Carolina Association of Alcohol and Drug Abuse Counselors Certification Commission, licensure as a Licensed Addiction Counselor, or licensure as a psychiatrist, psychologist, social worker, LPC or marriage and family therapist. Someone has to run the clinic full time, and §502.A requires that Administrator to hold a bachelor’s degree or more in a related field.

Counselor pay in South Carolina runs under the national rate. For substance abuse, behavioral disorder, and mental health counselors, BLS reports a state median of $52,370 (BLS OEWS, May 2025), compared with $59,350 nationally, and a 25th to 75th percentile spread of $43,070 to $65,070. A four-person clinical team at the median, a clinical director and three counselors, costs roughly $209,480 a year in salary before benefits and the administrator (4 x $52,370, our estimate). An outpatient clinic in South Carolina can open with one fully credentialed counselor and grow the rest of its team from people still earning their credentials. The counselor board’s statute builds that path in. A master’s-level graduate who has passed the exam can hold an addiction counselor associate license under S.C. Code 40-75-240 while completing supervised experience toward the full LAC, and the clinical director who supervises them typically holds the supervisor license, which requires five years in practice (40-75-230). Paying associates and §508 trainees below the credentialed rate while they accrue hours usually brings clinical payroll down by 40 to 60 percent against a roster made up entirely of fully licensed counselors. Clinics that keep medication services in house can also staff them with one RN supervising LPNs rather than RNs on every shift. How many groups run each week, and how full each caseload gets, will decide the real number.

No Deemed Status for Accredited Clinics

CARF, Joint Commission or COA accreditation does not change anything in the DPH licensing process for an outpatient clinic. Nowhere in R.60-93 does an accredited program get deemed status, a skipped inspection or a lower fee, and DPH keeps the right to inspect before licensure and at any later time, announced or not (§202). Accreditation is still worth weighing for its own reasons. It gives referral partners an outside measure of the program, and its standards reach clinical areas the state rule only touches. It just isn’t a licensing shortcut here.

How to Submit Your Outpatient Application to DPH

Use form 3295-ENG-DPH (07/2025), the outpatient version of the application for a facility for chemically dependent or addicted persons, which also lists any satellites. All DPH facility forms are on the Applications for Licensure page. The application is filed under oath (S.C. Code 44-7-270), so the signature page must be notarized, and it has to disclose every owner holding 5 percent or more. Attach the deed or lease for the site, the emergency evacuation plan that §102.K lists, documentation that the Administrator qualifies, and a receipt showing the fee was paid. DPH prefers email to CDAP@dph.sc.gov, with mail accepted at the Bureau of Health Facilities Licensing, P.O. Box 2046, West Columbia, SC 29171. The phone line for questions is 803-545-4370.

No published processing time exists in the rule or on DPH’s pages. Based on the steps the rule requires, an application review, the pre-licensure inspection and any plan of correction cycle, we plan on three to five months for an outpatient clinic. That is our estimate, not a DPH commitment. Patients cannot be admitted until the license issues.

Outpatient Paperwork Problems We Watch For

A satellite placed two counties away is the mistake we see most in early planning, since it turns a $50 add-on into a second full license. Close behind is a counselor roster with no fully credentialed member, which fails §508.A on the first inspection. Policy manuals carried over from another state are the third, especially ones that describe licensed ASAM levels South Carolina doesn’t use or cite R.61-93 and DHEC. The Office of Substance Use Services, now part of the Department of Behavioral Health and Developmental Disabilities, partners with county authorities and a network of licensed providers, and any funding relationship with it is separate from the DPH license and outside our work.

Frequently Asked Questions

Can a South Carolina outpatient SUD clinic open a satellite office under its existing license?

Yes, within limits. R.60-93 allows satellites of an outpatient facility only in the main facility county or a contiguous county, each adds $50 to the $75 annual license fee, and DPH must authorize the new site before it opens. A site farther away needs its own license.

Does South Carolina license intensive outpatient programs separately?

We found no separate IOP license. R.60-93 has one Outpatient Facility license and does not use ASAM levels, so in our reading a clinic running both standard outpatient and IOP services holds that single license and describes its services in its program description and policies.

Can a nurse practitioner own and run a ketamine clinic in South Carolina?

Not on their own. Under S.C. Code 40-33-34 an NP performs medical acts and prescribes controlled substances only under a practice agreement with a physician, and the Board of Nursing’s Advisory Opinion #25 keeps nurses without anesthesia credentials from giving agents primarily used as anesthetics, a list that names ketamine. We recommend a physician-owned professional corporation with a separate management company.

Mapping out satellites or a ketamine clinic in South Carolina? Talk it through with us.

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