South Carolina Mental Health Inpatient 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.

South Carolina has a date circled for psychiatric hospital projects. Since 2023 Act No. 20, S.C. Code 44-7-160 has required a Certificate of Need for just two kinds of projects, nursing homes and hospitals, and subsection (C) reads “Effective January 1, 2027, Section 44-7-160(B) is repealed.” Psychiatric hospitals sit on the statute’s list of health care facilities, so until that date a new psychiatric hospital, added beds or a change in how beds are classified still goes through the DPH Certificate of Need Program. After it, by our reading, only the licensing side remains. That side runs through DPH hospital licensure under R.60-16, the same rule that governs general hospitals, last amended effective May 22, 2026.

Inpatient Mental Health Settings and Their DPH Licenses

Every cell repeats what the cited rule or statute says, except the third row, which is our reading of a gap in DPH’s list of licensed facility types.

What R.60-16 Expects From a Psychiatric Hospital

Drawn from DPH’s published copy of R.60-16, its May 2026 update notice, the hospital licensure page and form 3292-ENG-DPH.

We found no separate South Carolina rule for psychiatric hospitals. By our reading a freestanding psychiatric hospital is what R.60-16 calls a specialized hospital, one with an organized medical staff that “provides a specialized service for one type of care.” The same definition goes on to say it “must provide on-campus emergency services,” a line that tends to catch planners after the floor plan is already drawn. Ask DPH’s hospital licensing staff early how it applies that line to a facility offering psychiatric care alone.

The psychiatric services section of the rule fills in the clinical structure. “A physician, preferably a board-certified psychiatrist, shall be designated as physician-in-charge (or chief) of the psychiatric service,” the rule calls for a registered nurse with psychiatric experience, and “At least one registered nurse shall be on duty in each nursing unit at all times.” Each patient’s psychiatric evaluation has to be completed within 60 hours of admission, and a specialized hospital “shall provide physician and registered nurse coverage 24 hours per day.”

Applications go on form 3292-ENG-DPH (08/2026) to the Bureau of Health Facilities Licensing, preferably by email at HTL@dph.sc.gov, or by mail to P.O. Box 2046, West Columbia, SC 29171, with questions to 803-545-4370. The license fee is $10 per licensed bed, initial and annual. Adding beds later takes an inspection before DPH issues the amended license.

Incident reporting sits in section 701, which has carried its current timing since an amendment effective June 28, 2024 (State Register Doc. No. 5265). A hospital sends its initial report to DPH, and to the patient or the patient’s responsible party, “within twenty-four (24) hours or by the next regular business day from when the facility had reasonable cause to believe an incident occurred.” The list covers an elopement that ends in death or serious injury, suicide, attempted suicide or self-harm with serious injury, death or serious injury involving restraints or bedrails, abduction, and impersonation of a licensed provider, among others. A written investigation report follows within seven business days. Until DPH updates its electronic system, its hospital page tells facilities to file the first report as a “24-hour Report” and the follow-up as a “10 Day Report.”

Timing a Project Around the 2027 CON Repeal

Our reading of S.C. Code 44-7-160 and 44-7-170, with the statute quoted where the wording matters.

For the rest of 2026, 44-7-160(B) requires a Certificate of Need before “the construction or other establishment of a hospital” and before “a change in the existing bed complement of a hospital,” including a change in the licensed classification of beds. Section 44-7-170 softens that in a few places. Acquiring a hospital or relocating one within the same county qualifies for a written exemption, a new hospital of up to 50 beds in a county that has none falls outside the article, and hospitals owned by DBHDD and operated by its Office of Mental Health or Office of Intellectual and Developmental Disabilities sit outside it, except for beds added beyond the predecessor departments’ July 1, 1988 total.

The sunset itself held through the 2026 session. 2026 Act No. 146 amended many sections of Chapter 7, but 44-7-160 is not among them, and the 2026 ratification lists we reviewed showed no other act aimed at it. That leaves a planning choice. A project that will not begin construction or change its bed count until January 2027 may never need CON, by our reading, while one that has to break ground in 2026 still does. Put the dates in front of the program at CONInfo@dph.sc.gov and your own counsel before deciding to wait. Either way, any building work at a licensed facility still needs DPH plan and specification approval before it starts, handled by Health Facilities Construction at (803) 545-4215.

Crisis Stabilization Units and Residential Care Outside a Hospital

A crisis stabilization unit holds its own DPH license under R.60-125, and 44-7-170 exempts it from CON without even a written exemption. The rule and the statute read differently, though. R.60-125 still defines the facility as one “operated by the Department of Mental Health, or operated in partnership with the Department of Mental Health,” while S.C. Code 44-7-130, as amended in 2023, describes “a short-term residential program, offering psychiatric stabilization services and brief, intensive crisis services” and no longer names that department. Before a private operator invests in a unit, we would get DPH’s position on whether the rule’s operator language still controls.

For a longer-term adult residence that is neither a hospital nor a CSU, we found no DPH license category built for psychiatric treatment. The 44-7-260 licensing trigger is caring for two or more unrelated people, and the categories that exist near this ground were designed for other purposes, so the model has to be checked against DPH’s list before a lease is signed. If the residents are also being treated for addiction on individual treatment plans, the program is a Residential Facility under R.60-93, which South Carolina Drug and Alcohol Inpatient Treatment Licensing walks through.

Ketamine on a South Carolina Psychiatric Unit

No South Carolina statute or rule we read names ketamine as a treatment for depression. This section is our reading of two nursing board opinions, the federal hospital pharmacy rule, the Spravato label and the state’s controlled substance statute.

Of the settings above, a psychiatric hospital is the one with enough medical staff, pharmacy support and nursing coverage to start ketamine or esketamine treatment in house. A CSU stay is brief crisis care, and we would not plan a dosing schedule around it. In a hospital that participates in Medicare, the work starts with the formulary, because 42 CFR 482.25 says “A formulary system must be established by the medical staff to assure quality pharmaceuticals at reasonable costs” and calls for “Current and accurate records” covering each scheduled drug the hospital receives and gives out. Ketamine appears on the federal Schedule III list at 21 CFR 1308.13(c)(7). On top of the DEA registration, South Carolina requires its own Controlled Substances Registration, issued by the DPH Bureau of Drug Control under S.C. Code 44-53-290.

Nursing is where South Carolina gets specific. The Board of Nursing’s Advisory Opinion #25, last reviewed in January 2026, deals with sedation, and in that setting it keeps “agents that are primarily used as anesthetics” away from RNs who are not qualified anesthesia providers, listing ketamine by name. The medical, nursing and pharmacy boards opened one narrow door in a joint advisory opinion, last revised July 10, 2020, for low dose ketamine in pain care: an RN may give and monitor a continuous infusion in an acute care hospital, up to 5 mcg/kg/min or 24 mg an hour, with IV push allowed “in ED and PACU ONLY” and orders from a credentialed attending physician. Neither opinion speaks to depression or a psychiatric unit. Our reading is that an IV ketamine protocol for depression falls outside the joint opinion, so a physician or qualified anesthesia provider would give each dose, and a hospital should ask the Board of Nursing before handing RNs any role in it.

Spravato fits more easily into many units. Under its FDA labeling (revised 09/2026), the drug “can only be administered at healthcare settings certified in the SPRAVATO REMS program,” so the hospital enrolls first, and the patient stays under observation for at least two hours after every dose. Whichever route a hospital picks, we would open it first to voluntary adults consenting for themselves and leave committed patients out of the protocol until hospital counsel has reviewed how consent would work for them.

Choosing the Outpatient Prescriber Early

A series almost always runs past discharge. Settle on the outpatient prescriber during the first week of the stay. With the patient’s written authorization, pass along the dose log and a few lines on how each session went, attached to the discharge summary. That practice will often be a professional corporation, which under S.C. Code Title 33, Chapter 19 may render professional services only through licensed individuals and may issue shares only to licensed individuals and a few qualified entities. The Board of Medical Examiners’ 2022 advisory opinion on corporate practice adds that the Board “does not license or regulate corporations.” For how such a clinic can be owned and structured, see the ketamine section of South Carolina Drug and Alcohol Outpatient Treatment Licensing.

Payroll on a South Carolina Psychiatric Unit

R.60-16 sets the nursing floor at one RN on duty in each nursing unit at all times, with physician and RN coverage around the clock in a specialized hospital and a physician in charge of the psychiatric service. Therapists and counselors come on top of that. BLS (OEWS, May 2025) reports $52,370 as South Carolina’s median for the substance abuse, behavioral disorder and mental health counselor occupation. The 25th percentile is $43,070, the 75th is $65,070, and the national median is $59,350. By our arithmetic, six clinicians at the state median cost about $314,220 in annual base salary, benefits not included. Not every one of those clinical salaries has to be paid at the fully licensed rate. South Carolina’s counselor board issues an associate license to addiction counselors who have finished their education and exam but not their supervised experience (S.C. Code 40-75-240), so a unit can pair one fully licensed clinical lead with several associates working toward full licensure at an earlier-career wage, and a unit staffed that way commonly spends 40 to 60 percent less on that part of the budget than it would with every clinician fully licensed. Because the rule fixes one RN per unit as the minimum, an RN can lead each shift while LPNs fill the remaining nursing positions where the hospital’s own nursing plan allows, which is our reading of R.60-16. Bed count, acuity and the services on the license set the final roster.

What Slows South Carolina Psychiatric Projects

Bad timing against January 1, 2027 is the newest risk, whether that means a CON filed in late 2026 for beds that could have waited a few weeks, or a project that waits and then has to break ground in December. The on-campus emergency services line in the specialized hospital definition is the next. A quieter problem is an incident policy nobody has compared with the current section 701 list, which DPH’s May 2026 copy of the rule shows in a shorter form than the Code of State Regulations printed in March, along with the seven business day written report.

Frequently Asked Questions

Working out whether your South Carolina psychiatric project should file for CON now or after January 1? Let’s compare notes.

Sources

• DPH, Certificate of Need Program and 2023 Act No. 20 FAQ: Certificate of Need and Act 20 FAQ (PDF) (checked October 18, 2026)
• DPH, Hospital Licensure (incident reporting notice): Hospital Licensure (checked October 18, 2026)
• DPH, Applications for Licensure and form 3292-ENG-DPH (08/2026): Applications and Form 3292 (PDF) (checked October 18, 2026)
• DPH copy of R.60-16 and its May 2026 update: R.60-16 (PDF) and Updates for R.60-16 (PDF) (checked October 18, 2026)
• DPH copies of R.60-125 and R.60-93: R.60-125 (PDF) and R.60-93 (PDF) (checked October 18, 2026)
• S.C. Code of State Regulations, Chapter 60 (official text): Chapter 60 (PDF) (checked October 18, 2026)
• S.C. Code Title 44, Chapter 7 (44-7-130, 44-7-160, 44-7-170, 44-7-260): Chapter 7 (checked October 18, 2026)
• 2026 ratification sheets, S.C. General Assembly: Ratifications (checked October 18, 2026)
• DPH, Health Facilities Construction: Construction contacts (checked October 18, 2026)
• DPH, Bureau of Drug Control, and S.C. Code 44-53-290: Drug Control and Chapter 53 (checked October 18, 2026)
• S.C. Board of Nursing, Advisory Opinion #25: AO #25 (PDF) (checked October 18, 2026)
• Boards of Medical Examiners, Nursing and Pharmacy, joint advisory opinion on low dose ketamine (July 2020): Joint opinion (PDF) (checked October 18, 2026)
• 42 CFR 482.25, via Cornell LII: Pharmaceutical services (checked October 18, 2026)
• 21 CFR 1308.13(c)(7), via Cornell LII: Schedule III (checked October 18, 2026)
• FDA, Spravato prescribing information and Medication Guide (revised 09/2026): Spravato label (PDF) (checked October 18, 2026)
• S.C. Code Title 33, Chapter 19, Professional Corporation Supplement: Chapter 19 (checked October 18, 2026)
• S.C. Board of Medical Examiners, Advisory Opinion on Corporate Practice of Medicine: Corporate practice opinion (PDF) (checked October 18, 2026)
• S.C. Code Title 40, Chapter 75 (40-75-240, associate licenses): Chapter 75 (checked October 18, 2026)
• 2025 Act No. 3 (S.2) and 2026 Act No. 146 (H.4189): Act 3 and Act 146 (checked October 18, 2026)
• U.S. Bureau of Labor Statistics, OEWS May 2025, SOC 21-1018: South Carolina and National (checked October 18, 2026)