Virginia 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: DBHDS Office of Licensing | Questions: (804) 786-1747

Residential substance use disorder treatment in Virginia is licensed by the Department of Behavioral Health and Developmental Services (DBHDS) under 12VAC35-105. DBHDS licenses services rather than buildings. The organization holds a provider license, and each service it runs carries its own service license with its own expiration date (12VAC35-105-50), so a site offering residential care and outpatient counseling answers to two separate sets of standards.

Licensed by Service, Inspected Every Year

There is no generic “residential” license for addiction care in Virginia. The Office of Licensing licenses residential substance use treatment by ASAM level (12VAC35-105-30), so the application names the exact level you plan to run. Once licensed, Code of Virginia § 37.2-411 calls for “at least one annual unannounced inspection of each service offered by each licensed provider,” and 12VAC35-105-70 repeats that DBHDS reviews each service “at least annually.” Neither section gives relief for CARF, Joint Commission, or COA accreditation. Lawmakers did raise the question. Chapter 491 of the 2023 Acts of Assembly (HB 2255), along with the identical Senate bill enacted as chapter 492 (SB 1155), told DBHDS to consider “how relief from licensing requirements may be authorized for providers that are accredited by recognized national accreditation bodies” and to report by November 1, 2023. The workgroup report that followed (RD621) leaned toward more study, and it flagged that the settlement agreement Virginia entered with the U.S. Department of Justice in 2012 still requires annual inspections. The inspection language in 12VAC35-105-70 is unchanged, so plan on a full unannounced visit every year.

Which Residential Levels DBHDS Licenses

The service list in 12VAC35-105-30 has five residential and inpatient addiction services: Level 3.1 (clinically managed low-intensity residential), Level 3.3 (clinically managed population-specific high-intensity residential), Level 3.5 (clinically managed high-intensity residential), Level 3.7 (medically monitored intensive inpatient) and Level 4.0 (medically managed intensive inpatient). “Residential treatment” is a different line on that list and is not one of the ASAM-numbered addiction services, so don’t apply under it for an SUD program. Each level has its own staff, program, admission and discharge sections in Part VII of the regulation. At Level 3.7, 12VAC35-105-1480 requires 24-hour nursing care, a physician, nurse practitioner, or physician assistant available around the clock in person or by phone, and MAT available “for all individuals with opioid use disorder or alcohol use disorder.” Under 12VAC35-105-1500, every 3.7 admission must meet ASAM’s Level 3.7 admission criteria.

Don’t go looking for a separate detox license. Part VI, Article 2 of the regulation, “Medically Managed Withdrawal Services,” was repealed effective June 19, 2025, and the current service list has no withdrawal management line at all. The one definition of “withdrawal management” left in 12VAC35-105-20 is about tapering doses of MOUD. Our reading is that residential withdrawal management now has to be delivered inside a Level 3.7 or 4.0 license. That is our interpretation, not a DBHDS statement, so confirm it with your licensing specialist before you build a detox unit into the plan.

The level you pick also sets your place in line. An Office of Licensing memo dated July 18, 2025 (effective July 30, 2025) put adult Level 3.3 in Priority 1 and adult Levels 3.1, 3.5, 3.7 and 4.0 in Priority 2. Priority 1 applications are assigned within 5 to 10 business days and Priority 2 within 21 business days, while non-priority services come off the waitlist at a rate of at least one applicant a month.

CARF adds a layer DBHDS doesn’t offer. Its ASAM Level of Care Certification, which CARF describes as the only program approved by the American Society of Addiction Medicine for certifying residential SUD services, has an outside surveyor check whether a program actually delivers a residential level the way The ASAM Criteria describe it, and CARF says “Certification is available for adult Levels of Care 3.1, 3.5, and 3.7.” For a Virginia 3.7 program it would sit on top of the DBHDS Level 3.7 license, never in place of it, and it won’t appear on the DBHDS license itself. Anyone checking your claim can look it up in CARF’s provider search with the “ASAM Level of Care 3.7” filter. We found nothing in 12VAC35-105 that requires it.

Certificate of Public Need and the Inpatient Tier

Virginia’s Certificate of Public Need (COPN) program is run by the Virginia Department of Health under Article 1.1 of Title 32.1, Chapter 4. Section 32.1-102.1:3 lists the facilities it reaches, and two of them matter here: “any hospital licensed as a provider by the Department of Behavioral Health and Developmental Services,” and “any intermediate care facility established primarily for the medical, psychiatric, or psychological treatment and rehabilitation of individuals with substance abuse” that DBHDS licenses. Establishing one of those, adding beds to one, or introducing substance abuse treatment at a covered facility that hasn’t offered it in the previous 12 months is a reviewable project. The Code never defines “intermediate care facility” for addiction treatment, so which ASAM levels it captures is a judgment call. We read a medically monitored 3.7 or a 4.0 inpatient program as the likeliest fit and clinically managed 3.1, 3.3 and 3.5 residences as less likely, but that is our interpretation. VDH says the application and review “can take six to seven months to complete,” so put the question to copn@vdh.virginia.gov before you sign a lease or a construction contract.

The License, the Level of Care and the Staffing Plan Must Match

A reviewer only needs to find one inconsistency between these three documents to stall the whole file. Virginia licenses by service, so DBHDS reads your program description, the level of care you name and your staffing documentation as one picture. Keep all three consistent before you submit, since a mismatch between them is the easiest thing for a reviewer to question. Payer enrollment sits outside the license, and we don’t handle it.

Medication for Opioid Use Disorder in a Residential Setting

Virginia’s opioid treatment rules changed on December 1, 2025. An Office of Licensing memo dated October 9, 2025 explains that the fast-track amendments replace older terms such as “medication-assisted opioid treatment” and “detoxification” with “medication for opioid use disorder” and “withdrawal management,” and the licensed service is now called “Medication for opioid use disorder treatment” (12VAC35-105-30). Policies written before that date probably use the old vocabulary and should be updated. Mobile MAT has its own article (12VAC35-105-1821 and following, effective December 5, 2024), and each mobile unit must “operate as a component of a licensed MAT location,” so it hangs off an MOUD license, not a residential one.

Apart from narrow exceptions such as a three-day emergency supply and hospital care, methadone for maintenance or withdrawal can only be dispensed by a practitioner “separately registered with DEA as a narcotic treatment program” (21 CFR 1306.07). In Virginia that program also holds a DBHDS MOUD service license and must keep registration or certification with DEA, HHS and the Virginia Board of Pharmacy plus accreditation from a federally approved body (12VAC35-105-930). A residential program without that license needs a real working arrangement with a licensed OTP. The 3.7 staffing rule says only that the program must “make MAT available,” and the 3.7 program criteria (12VAC35-105-1490) allow “close coordination through referral” to other services. We read that as room for a coordinated OTP arrangement, but that is our interpretation, so confirm it with your licensing specialist. Naming the specific OTP partner and spelling out transport and dose continuity holds up better than a generic referral line. Buprenorphine is simpler. Since Congress ended the DATA-waiver program, DEA says “all prescriptions for buprenorphine only require a standard DEA registration number.”

Ketamine Inside a Virginia Residential Service

The DBHDS regulation doesn’t name ketamine. We applied its medication and modification rules, the Board of Pharmacy’s registration rule and the federal DEA rules to it, so the fit described here is our reading to confirm with your licensing specialist.

Virginia licenses the service, not the drug, so the real question is whether your residential service can carry a ketamine protocol safely. Level 3.7 can. 12VAC35-105-1480 already requires 24-hour nursing care and a physician, nurse practitioner, or physician assistant available 24 hours a day, in person or by phone. For the clinically managed levels we would use an outside prescriber with monitoring capacity rather than build the medical side into the residence.

Whatever the level, the medication management rule in 12VAC35-105-770 governs. Medications may be given only by people the Drug Control Act authorizes, the provider needs written policies covering safe handling, storage, disposal and medication orders, and a current order for every medication a resident receives has to be kept on site. A ketamine protocol slots into those policies rather than sitting beside them.

The open question is paperwork. 12VAC35-105-60 calls for a written service modification application at least 30 days before any change to “the services offered,” and the change can’t be put in place until the commissioner approves it. A new medication inside an already licensed 3.7 service may not count as a change in services, but that is DBHDS’s call, so get the Office of Licensing’s answer in writing before you schedule a first dose.

Registrations and Reporting

Ketamine is a Schedule III drug (21 CFR 1308.13(c)(7)), and DEA wants a separate registration for each place where controlled substances are dispensed, exempting only an office where a practitioner prescribes, administers nothing and keeps no supply (21 CFR 1301.12). On the state side, 18VAC110-20-690 lets an entity that keeps a supply of Schedule II through VI drugs apply to the Board of Pharmacy for a controlled substances registration, and lets the Board require one where several practitioners draw on a common stock and warning signs such as unusual purchases or diversion appear. Ask the Board whether your facility should hold one before the first order arrives.

Virginia’s Prescription Monitoring Program barely touches this. Code § 54.1-2522 exempts the administering of covered substances from reporting, so doses given on site aren’t reported. The prescriber lookup in § 54.1-2522.1 is aimed at opioid courses expected to run longer than seven consecutive days, and the version taking effect July 1, 2027 shifts it to benzodiazepines and opiates expected to run more than 90 days, so ketamine alone triggers neither. Spravato carries federal strings of its own. Its REMS limits treatment to certified settings and has a healthcare provider monitor the patient for at least 2 hours after every dose. None of it ever goes home with the patient.

The Board of Nursing’s closest guidance is Guidance Document 90-63, “Registered Nurses and Procedural Sedation” (revised May 18, 2021). It doesn’t mention ketamine, but it lets RNs give mild to moderate sedation on a prescriber’s order, in the presence of a prescriber credentialed for sedation, with continuous monitoring of heart rate, respiration, blood pressure and EKG. We found no Board position aimed at ketamine for depression, and if a protocol’s doses are meant to sedate, we would treat 90-63 as the minimum. Nurse practitioners with at least three years of full-time clinical experience and an attestation can practice without a practice agreement (Code § 54.1-2957). Everyone else works under a practice agreement, and we would have it name ketamine.

Choosing the Residents

Candidacy in our protocols comes down to a short sequence of questions. Is the resident medically stable now that withdrawal is over? Has depression or PTSD stalled recovery even after adequate medication trials? Has the resident ever misused ketamine or another dissociative? A yes to that last one ends the discussion. Because ketamine sits outside the MOUD pathway described above, a resident who takes buprenorphine or methadone keeps taking it.

When the Resident Steps Down

Under 24-hour nursing a resident can start a series with closer observation than any outpatient clinic offers, and the continuation should be lined up before the first dose. Virginia’s ownership law points two ways. Code § 13.1-542.1 lets a corporation that isn’t a professional corporation render professional services “unless otherwise prohibited by law or regulation,” though the Supreme Court of Virginia held in Parikh v. Family Care Center (2007) that “a non-professional corporation cannot engage in the practice of medicine in Virginia,” so we still usually pair a physician-owned professional corporation with a management company. The catch is DBHDS. Its licensing statute carves individual licensed practitioners, not companies, out of the definition of a provider (Code § 37.2-403), so a company-run clinic treating depression should ask DBHDS whether it needs a license of its own. That question is worked through in the ketamine section of Virginia Drug and Alcohol Outpatient Treatment Licensing.

Referrals into a clinic your own clinicians invest in raise two problems at once. Virginia’s Practitioner Self-Referral Act (Code § 54.1-2411) bars a practitioner from referring a patient to an outside entity the practitioner or an immediate family member invests in, unless the practitioner provides services there and is personally involved in that patient’s care or holds a Department exception. Federally, 18 U.S.C. § 220 reaches payments tied to referrals to a licensed clinical treatment facility, so have counsel review any money that moves between the program and the clinic.

Staffing a Residential Program

Virginia’s counselor tiers give operators real flexibility on how a residential roster gets built. The regulation doesn’t create a “clinical director” title. What it asks for depends on the level: at 3.5, for instance, 12VAC35-105-1530 requires “onsite 24-hour-a-day clinical staffing by credentialed addiction treatment professionals,” and each level requires clinical staff who are appropriately licensed, certified, or registered. We usually advise putting a Licensed Substance Abuse Treatment Practitioner (LSATP) in the lead clinical seat, though that is our recommendation rather than a rule. The Virginia Board of Counseling licenses the LSATP, a graduate-degree credential that Code § 54.1-3500 ties to “independent, direct, and unsupervised treatment.” Under it, the Board certifies the Certified Substance Abuse Counselor (CSAC) and the Certified Substance Abuse Counseling Assistant (CSAC-A). Two in-training statuses round out the roster. People working toward the CSAC register their supervision with the Board and use the title “supervisee,” and LSATP candidates practice on a temporary resident license under the title “Resident in Substance Abuse Treatment.”

Round-the-clock coverage adds real cost. Virginia’s substance abuse, behavioral disorder, and mental health counselors earn a median of $59,880 a year statewide (BLS OEWS, May 2025), essentially even with the $59,350 national median, with the middle half earning between $47,390 and $77,870, so a residential program with a clinical director, several counselors, and 24-hour direct-care staff commonly runs past $420,000 a year in payroll before nursing coverage. The number is real, but so is the way most Virginia operators bring it down. Many Virginia residential programs fill counseling roles with CSACs, CSAC supervisees and Residents in Substance Abuse Treatment working under an LSATP, at meaningfully lower wages than an all-independently-licensed roster, and pair one RN with several LPNs for medical oversight rather than staffing every shift with a registered nurse. At Level 3.7 the nursing piece still has to add up to the 24-hour nursing care 12VAC35-105-1480 requires. The actual matrix comes down to census and level of care once those are confirmed.

How to Submit Your DBHDS Application

There is no paper packet to request. Applications go through the DBHDS CONNECT Provider Portal, and the training comes first. Every adult residential SUD level sits in Priority 1 or Priority 2, so since November 7, 2025 a first-time applicant has to finish the 16-module Initial Applicant Orientation and pass the proctored Comprehensive Knowledge Exam with a score of 85% or better. You may also see DBHDS’s August 26, 2026 pre-application training memo mentioned. It does not reach residential addiction services: by its own terms it covers applicants for Community Psychiatric Support and Treatment, Coordinated Specialty Care and Mental Health Center-Based Recovery and Empowerment Center services only. After you begin an application you have 90 days to submit it, or DBHDS closes it administratively and you start over.

Code § 37.2-405.2 sets what the file must contain, including a first-year working budget and funds or a line of credit “sufficient to cover at least 90 days of operating expenses,” along with your service description, staffing plan and policies. The priority memo sets when an application gets assigned for review, but we found no DBHDS deadline for the licensing decision itself. A new service starts on a conditional license of no more than six months, renewable to 12 successive months at most (12VAC35-105-50 and § 37.2-415), and a full license after that runs one year or three successive years (§ 37.2-410). Whichever license you hold, each licensed service gets at least one unannounced inspection a year. Questions go to the Office of Licensing at (804) 786-1747.

What Delays Virginia Residential Applications

A few mistakes come up more than anything else in Virginia residential applications. One is assuming accreditation buys inspection relief that Virginia has studied but never adopted, then being surprised by the full annual inspection cycle. Another is an opioid treatment policy still written in the vocabulary that the December 1, 2025 MOUD amendments replaced. A third is submitting before the orientation and knowledge exam are done, which on a priority service costs you the priority timeline.

Frequently Asked Questions

Working through DBHDS’s per-service licensing for a Virginia residential program? Reach out here.

Sources

• Code of Virginia § 37.2-411: Inspections (checked October 7, 2026)
• Code of Virginia § 37.2-405.2: Application requirements (checked October 7, 2026)
• 12VAC35-105-30: Licenses (checked October 7, 2026)
• 12VAC35-105-20: Definitions (checked October 7, 2026)
• 12VAC35-105-50: Issuance of licenses (checked October 7, 2026)
• 12VAC35-105-70: Onsite reviews (checked October 7, 2026)
• 12VAC35-105-930: Registration, certification, or accreditation (checked October 7, 2026)
• 12VAC35-105-1055: Medically Managed Withdrawal Services (repealed) (checked October 7, 2026)
• 12VAC35-105-1480: Level 3.7 staff criteria (checked October 9, 2026)
• 12VAC35-105-1490: Level 3.7 program criteria (checked October 7, 2026)
• 12VAC35-105-1430, -1580 and -1630: Level 4.0, Level 3.3 and Level 3.1 staff criteria (checked October 7, 2026)
• 12VAC35-105-1500: Level 3.7 admission criteria (checked October 7, 2026)
• 12VAC35-105-1530: Level 3.5 staff criteria (checked October 7, 2026)
• 12VAC35-105-1821: Application for operation of a mobile medication-assisted treatment program (checked October 7, 2026)
• 2023 Acts of Assembly, Chapter 491 (HB 2255): DBHDS regulatory review (checked October 7, 2026)
• 2023 Acts of Assembly, Chapter 492 (SB 1155): Senate companion act (checked October 7, 2026)
• Code of Virginia § 37.2-410: License term and renewal (checked October 7, 2026)
• Code of Virginia § 37.2-415: Conditional and provisional licenses (checked October 7, 2026)
• DBHDS report RD621: 2023 Combined Study Workgroup, November 1, 2023 (checked October 7, 2026)
• DBHDS: Licensing Information for Providers and Applicants (checked October 7, 2026)
• DBHDS memo, July 18, 2025: Priority Service Categories and Review Timelines (checked October 7, 2026)
• DBHDS memo, October 9, 2025: Fast-Track Amendments to MOUD Licensing Regulations (checked October 7, 2026)
• DBHDS memo, October 23, 2025: Initial Applicant Orientation for Priority 1 and 2 Services (checked October 7, 2026)
• DBHDS memo, August 26, 2026: Mandatory Pre-Application Training (checked October 7, 2026)
• Code of Virginia § 32.1-102.1:3: COPN-covered facilities and projects (checked October 7, 2026)
• VDH: Certificate of Public Need Program (checked October 7, 2026)
• Code of Virginia § 54.1-3500: Board of Counseling definitions (checked October 7, 2026)
• Virginia Department of Health Professions: Virginia Board of Counseling (checked October 7, 2026)
• 18VAC115-30-60: CSAC experience requirements (checked October 7, 2026)
• 18VAC115-60-60 and -80: LSATP degree requirements and resident license (checked October 7, 2026)
• 21 CFR 1306.07: Administering or dispensing narcotic drugs (checked October 7, 2026)
• DEA Dear Registrant letter, January 12, 2023: Elimination of the DATA-Waiver Program (checked October 7, 2026)
• CARF: ASAM Level of Care Certification and Find a Provider (checked October 7, 2026)
• ASAM: Level of Care Certification (checked October 7, 2026)
• 12VAC35-105-60: Modification (checked October 9, 2026)
• 12VAC35-105-770: Medication management (checked October 9, 2026)
• 18VAC110-20-690: Controlled substances registration (checked October 9, 2026)
• Code of Virginia §§ 54.1-2522 and 54.1-2522.1: PMP reporting exemptions and Prescriber requirements (checked October 9, 2026)
• Code of Virginia § 54.1-2957: Nurse practitioner practice agreements and autonomous practice (checked October 9, 2026)
• Virginia Board of Nursing: Guidance Document 90-63, Registered Nurses and Procedural Sedation (checked October 9, 2026)
• 21 CFR 1308.13 and 1301.12 (Cornell LII mirror of the official text): Schedule III, ketamine and Separate registrations for separate locations (checked October 9, 2026)
• SPRAVATO REMS: Program requirements for healthcare settings (checked October 9, 2026)
• Code of Virginia § 13.1-542.1: Practice of certain professions by corporations (checked October 9, 2026)
• Supreme Court of Virginia: Parikh v. Family Care Center, Inc., Record No. 060934 (March 2, 2007) (checked October 9, 2026)
• Code of Virginia § 37.2-403: Definition of provider (checked October 9, 2026)
• Code of Virginia § 54.1-2411: Practitioner Self-Referral Act, prohibited referrals (checked October 9, 2026)
• 18 U.S.C. § 220 (Cornell LII mirror of the official text): Illegal remunerations for referrals (checked October 9, 2026)