South Dakota Drug and Alcohol Outpatient 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: DSS Office of Licensing and Accreditation, “Become a Provider” inquiry | Questions: 605.773.3165, dssbh@state.sd.us

South Dakota writes the national accreditors into its addiction treatment statute by name. SDCL 34-20A-2 treats a program surveyed and accredited by The Joint Commission, CARF, the Council on Accreditation or an Indian Health Service quality assurance review as an “accredited prevention or treatment facility,” as long as the proof reaches the Department of Social Services. SDCL 34-20A-44 then says the department’s duty to inspect “does not apply” to those programs. For an outpatient operator choosing between a state survey and a national one, that statute is the first thing to read.

There is no state license for outpatient addiction treatment in South Dakota. DSS accredits outpatient programs rather than licensing them, and the rest of this guide explains what that means in practice. Residential care, which does need a Department of Health license, is in South Dakota Drug and Alcohol Inpatient Treatment Licensing. Mental health programs and the state’s other categories are on South Dakota Behavioral Health Licensing.

Accredited, Not Licensed

Quoted wording here is from the official ARSD and SDCL text on the Legislature’s site. Where we say “voluntary,” that word is ours.

The DSS Office of Licensing and Accreditation accredits substance use disorder programs under ARSD 67:61. The rule’s opening line is permissive: “An agency that provides substance use disorder services may apply for accreditation by the department” (67:61:02:03). The application rule is written for an agency “seeking to operate an accredited alcohol, other drug, or gambling program” (67:61:02:04). We read the whole of SDCL 34-20A and found no section that forbids running an outpatient program without accreditation or that sets a penalty for doing so. Our reading is that DSS accreditation of an outpatient program is voluntary.

Voluntary on paper still leaves good reasons to get it. Under SDCL 34-20A-2.1, accreditation means the facility “is deemed to be approved by the state” whenever the insurance statute, SDCL 58-18-7.1, asks about state approval. Commitment orders under 34-20A-77 go to an “appropriate accredited treatment facility.” Public funding generally follows accreditation as well, a question that sits outside the license and that we leave to others. And once you are accredited, the counselor rule applies to everyone on the clinical roster: “An addiction counselor must obtain certification and an addiction counselor supervisee or trainee must obtain recognition before performing any addiction counseling functions” (67:61:05:03, as amended in 2026).

Outpatient Classes DSS Accredits

Under 67:61:02:03 the outpatient class covers “early intervention programs, outpatient treatment programs, and intensive outpatient treatment programs,” and day treatment is its own class. Each has its own chapter.

Program	Rule chapter	Staff coverage under 67:61:04:09
Early intervention	67:61:12	Counseling staff on duty or available by phone at all times during scheduled hours
Outpatient treatment	67:61:13	Same as early intervention
Intensive outpatient	67:61:14	Same as early intervention
Day treatment	67:61:15	Without residential services, counseling staff on duty at all times during scheduled hours. With residential services, open 24 hours a day, 7 days a week

One caution on day treatment. If the program houses clients overnight, DSS rule 67:61:10:03 requires “Each residential facility seeking accreditation or providing services” to hold a Department of Health license under ARSD 44:78. Whether DOH treats a day treatment program with residential services as a 44:78 facility is something we’d confirm with DOH before planning beds.

What National Accreditation Changes Under SDCL 34-20A

The statute gives Joint Commission, CARF, COA and IHS-reviewed programs two things. They count as accredited under the definition in 34-20A-2, provided “proof of the accreditation, with accompanying recommendations, progress reports, and related correspondence are submitted to the department in a timely manner.” And DSS’s inspection duty in 34-20A-44 doesn’t reach them. DSS doesn’t lose sight of them completely. Section 34-20A-44.1 keeps “the right of access to all facility premises and relevant records to monitor compliance or investigate complaints.”

Here is the gap. DSS’s own accreditation chapter, 67:61:02, never mentions national accreditation. It doesn’t say whether a CARF-accredited outpatient program gets a DSS certificate, whether the state’s policy approval under 67:61:02:05 still applies to it, or what “timely” means. We’d put those questions to the Office of Licensing and Accreditation in writing before choosing a route.

The state route is a scored survey. A new agency first gets provisional accreditation, which “expires after six months” and can be extended up to three more months with department approval (67:61:02:06). The comprehensive survey happens before it runs out, and a new agency that passes gets a one-year certificate. DSS reports its findings within 30 days of the survey, and the agency has 30 days from that report to submit a plan of correction (67:61:02:09). From then on, renewals are scored under 67:61:02:08: 90 percent compliance or better earns three years, 70 to 89 percent earns two, and below 70 means probation. DSS sends renewal forms at least sixty days before a certificate expires (67:61:02:04).

Changes After You Open

Under 67:61:02:20, an accredited agency must tell DSS before a change in agency director, a reduction in services or an impending closure, and a closing agency owes DSS “thirty days’ written notice of closure.” Adding a level of care is a new application, since 67:61:02:04 covers an agency “seeking to add a new level of care to a current accreditation.” A change of ownership, facility or program also needs a new application under 67:61:02:19, so a move across town is more than a change-of-address letter.

Medication for Opioid Use Disorder in Outpatient Care

We found no South Dakota rule that requires an outpatient program to provide or allow medications for opioid use disorder, at least in the 67:61 sections we read. Buprenorphine is the practical option for most outpatient programs. 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,” and the South Dakota Department of Health requires practitioners who prescribe, dispense or administer controlled substances to hold a state controlled substance registration as well. Methadone for OUD is dispensed only by federally certified opioid treatment programs, and ARSD 67:61 has no chapter for them, so an outpatient clinic should keep a working referral arrangement with one rather than try to provide it.

Opening a Ketamine Clinic in South Dakota

We found no South Dakota statute or rule written for ketamine. The facility-license and ownership points below apply the statutes cited to an office ketamine practice, and they are our conclusions, so run them past South Dakota health care counsel.

Start with what the clinic doesn’t need. The Department of Health licenses hospitals, nursing facilities, assisted living centers, ambulatory surgery centers, inpatient chemical dependency treatment facilities and a handful of other types, and none of them describes a physician office giving ketamine for depression. DSS accreditation is built for addiction programs and community mental health centers, not a depression practice. Our reading is that a stand-alone ketamine clinic needs no facility license or accreditation in South Dakota. The obligations attach to the people and the drug.

Corporate Practice: Statute, Not Case Law

South Dakota’s limit on corporate medicine sits in the code itself, at SDCL 36-4-8.1: “it is the public policy of this state that a corporation may not practice medicine or osteopathy,” except as provided for medical corporations in chapter 47-11. The same section carves out employment. A corporation can employ a physician without practicing medicine if the contract meets three conditions. It may not control the physician’s independent judgment on diagnosis and treatment. It may not profit from the physician’s medical services beyond reasonable facility, equipment and administrative charges, though it “may make additional charges reasonably associated with the services rendered.” And the contract can’t run longer than three years, after which the parties may renew it each year.

That gives investors two possible structures. One is the familiar split: a physician-owned medical corporation holds the practice, the prescriptions and the patient records, and a management services organization owned by investors provides space, staff, billing and marketing for a fee that doesn’t move with the number of infusions. The other is a lay-owned corporation that employs its physicians under contracts written to the three 36-4-8.1 conditions. Investors can’t simply buy into the medical corporation. SDCL 47-11-3 requires every officer, director and shareholder to be licensed under the Medical Practice Act, and under 47-11-7 the corporation needs a certificate of registration from the Board of Medical and Osteopathic Examiners before it opens. The statute speaks only to physicians and osteopaths, and we haven’t confirmed whether a nurse practitioner may own a ketamine practice outright.

Prescribers, Registrations and the PDMP

A Board of Nursing instruction sheet dated April 2022 says certified nurse practitioners “may prescribe, procure, furnish, and administer over-the-counter, legend, and controlled substance drugs,” and that an NP must practice at least 1,040 hours as a licensed NP before working without a collaborative agreement. We haven’t read the current statute behind that sheet, so confirm the hours before staffing a clinic around an NP.

Ketamine is Schedule III under 21 CFR 1308.13(c)(7). The prescriber needs a DEA registration and a South Dakota controlled substance registration, which DOH issues online. Its fees “are non-refundable and may not be prorated.” The PDMP statute, SDCL 34-20E-2, requires dispensers to submit information on “each prescription dispensed.” Doses given in the clinic aren’t dispensed prescriptions in our reading, but any take-home prescription will show up in the system. For Spravato, the FDA medication guide says it “can only be administered at healthcare settings certified in the SPRAVATO REMS program,” that patients treated in outpatient settings “must be enrolled in the program,” and that the patient must be monitored for at least two hours after each dose. Build the room schedule around that two-hour window.

A residential program that starts a series before discharge runs into different limits, mainly the residential medication-administration rule and on-call nursing. South Dakota Drug and Alcohol Inpatient Treatment Licensing takes those up under its ketamine heading, together with referral cautions.

Staffing an Outpatient Program

South Dakota’s counselor pay sits below the national figure. BLS puts the state median for substance abuse, behavioral disorder, and mental health counselors at $53,650 (OEWS, May 2025), with the middle half earning between $45,650 and $62,660, against a national median of $59,350. A clinical director and three counselors paid at the median would cost roughly $214,600 a year before benefits. You can open with a far smaller payroll than that number implies. Under the 2026 counselor law (HB 1029, signed February 17, 2026, and in force since July 1, 2026 under the default date in SDCL 2-14-16, since the act sets none), the Board of Addiction and Prevention Professionals now recognizes supervisees alongside Addiction Counselor Trainees, and DSS’s rules now let a supervisee or trainee complete a client’s integrated assessment (67:61:07:05). Reaching LAC takes a master’s degree and, under ARSD 20:80:16:03 (effective October 11, 2026), 2,000 hours of related work, of which 100 or more are supervised under a plan and 100 or more fall in every one of the twelve core functions. Many applicants are still working through those hours, and an LAC clinical director who supervises them at trainee or supervisee pay can bring clinical payroll down 40 to 60% from what a fully licensed roster would cost. If the program adds medication services, one RN overseeing LPNs costs less than an all-RN medical team. SDCL 36-34-13 now caps a CAC, CPS or LAC renewal at $400 and an application at $50, ceilings worth budgeting against if the program covers its staff’s credential costs. Your service mix and client volume decide the final numbers.

How to Submit Your DSS Accreditation Application

DSS doesn’t post a numbered outpatient application. The first step is the Become a Provider inquiry form on the Office of Licensing and Accreditation portal, which describes itself as the place to “inquire about becoming a licensed or accredited program.” After that, 67:61:02:04 says the department makes “accreditation application forms available upon request,” and it sends back an incomplete application without reviewing it. Assemble policies early, because 67:61:02:05 makes them “subject to the approval of the department as part of the accreditation process.” Mail goes to the office at 700 Governors Drive in Pierre (SD 57501), and its phone is 605.773.3165. The Division of Behavioral Health also takes email at dssbh@state.sd.us. If you plan to rely on Joint Commission, CARF or COA accreditation instead, ask the same office how and when it wants the proof that SDCL 34-20A-2 describes.

Frequently Asked Questions

Weighing a CARF survey against the DSS route for a South Dakota outpatient program? We can talk it through.

Sources

• South Dakota Codified Laws, SDCL 34-20A (34-20A-2, 2.1, 44, 44.1, 77): Treatment and Prevention of Alcohol and Drug Abuse (checked October 15, 2026)
• ARSD 67:61:02: Accreditation of substance use disorder agencies (checked October 15, 2026)
• ARSD 67:61:04:09: Staffing, training, and hours of operation (checked October 15, 2026)
• ARSD 67:61:05: Personnel, qualifications of addiction counselors (checked October 15, 2026)
• ARSD 67:61:07:05: Clinical processes, integrated assessment (checked October 15, 2026)
• ARSD 67:61:10:03: Residential facility licensure under article 44:78 (checked October 15, 2026)
• ARSD article 67:61: Substance Use Disorders, chapter list (checked October 15, 2026)
• DSS Office of Licensing and Accreditation: Behavioral Health and Become a Provider inquiry (checked October 15, 2026)
• DSS Division of Behavioral Health: Staff directory, February 2026 (PDF) (checked October 15, 2026)
• South Dakota Department of Health: Health Facility Licensure (checked October 15, 2026)
• DEA Diversion Control Division: Dear Registrant letter on the DATA-Waiver, January 12, 2023 (PDF) (checked October 15, 2026)
• South Dakota Department of Health: Controlled Substance Registration (checked October 15, 2026)
• SDCL 36-4-8.1: Corporation prohibited from practice of medicine or osteopathy (checked October 15, 2026)
• SDCL 47-11 (47-11-3, 47-11-7): Medical Corporations (checked October 15, 2026)
• South Dakota Board of Nursing: CNP licensure instructions, April 2022 (PDF) (checked October 15, 2026)
• 21 CFR 1308.13(c)(7), via Cornell LII: Schedule III, ketamine (checked October 15, 2026)
• SDCL 34-20E-2: Prescription drug monitoring program reporting (checked October 15, 2026)
• U.S. FDA: Spravato prescribing information and Medication Guide (checked October 15, 2026)
• BLS OEWS, May 2025, SOC 21-1018: South Dakota and national estimates (checked October 15, 2026)
• Board of Addiction and Prevention Professionals: Licensing requirements (checked October 15, 2026)
• SDCL 36-34 (36-34-13 fees): Addiction and Prevention Professionals, and HB 1029 (2026): bill history, signed February 17, 2026, with SDCL 2-14-16: effective date of acts (checked October 15, 2026)
• ARSD article 20:80, including 20:80:16:03 (LAC work experience, as amended 53 SDR 40, effective October 11, 2026): ARSD 20:80 (checked October 15, 2026)