West Virginia Mental Health Outpatient 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.

Outpatient mental health services in West Virginia are licensed as a behavioral health center by the Office of Health Facility Licensure and Certification (OHFLAC). W. Va. Code § 27-9-1 bars any behavioral health center from providing behavioral health services until it holds an OHFLAC license, and the 2024 version of the licensing rule defined behavioral health services to include outpatient services for people with mental health or addictive challenges. That puts a mental health clinic and an outpatient SUD program under the same rule and the same application. The rule itself was renumbered this year. The version in force is 71 CSR 25, effective May 1, 2026, and the 2024 rule at 64 CSR 11 is now listed by the Secretary of State as historical. Section 27-9-1 says nothing about accreditation, and the 2026 rule has OHFLAC inspect on site before it issues an initial, renewal or provisional license (section 4.1.6), with deemed licenses limited to certain children’s programs (sections 2.6 and 2.7). We read that as no accreditation condition for an outpatient license.

Licensing Under 71 CSR 25 (Formerly 64 CSR 11)

Check the exemption list before you decide you can skip the license, because it is narrower than many clinic owners expect. The 2024 rule applied its core requirements (sections 1 through 13) to every behavioral health center, public or private, for-profit or nonprofit. Section 2.5 of the May 2026 rule carves out six groups: programs that don’t provide behavioral health services, services under a Medicaid self-directed community-based waiver, outpatient services approved by the Centers for Medicare and Medicaid Services at federally designated locations, hospitals working within the scope of their hospital license, Specialized Family Care providers, and individual practitioners or groups of practitioners working within the scope of their chapter 30 professional license. That last exemption is the one outpatient owners ask about. Our reading is that a psychologist, LPC or social worker seeing clients in a private office is practicing under a professional license, while a clinic that operates as an agency with its own program description, staff and services looks much more like a behavioral health center. If your setup sits anywhere near that line, ask OHFLAC before you open.

Applying for the License

The published sequence is a Certificate of Need or exemption from the West Virginia Health Care Authority first, then a Life Safety Program review if you’re doing new construction or renovation, then the Behavioral Health Services Application for Licensure to OHFLAC once your policies and procedures are ready. Under the 2026 rule, OHFLAC has 60 days from a complete application both to inspect and to decide, as long as the State Fire Marshal’s recommendation comes back positive (sections 4.1.5 and 4.1.6). OHFLAC’s own opening checklist says a 6-month initial license is issued once you are found in substantial compliance, followed by a full on-site licensure review.

Most Outpatient Mental Health Clinics Are Exempt From Full CON Review

W. Va. Code § 16-2D-11(b)(19) lists “providing behavioral health facilities and services” among the services the Legislature has found exempt from the certificate of need process. Exempt does not mean you skip the Health Care Authority, though. Subsection (a) says you get the exemption by filing an exemption application with a statement of which exemption applies and why, and the Authority’s CON FAQ lists a nonrefundable $1,000 filing fee. For a small outpatient clinic that is usually a paperwork step rather than a full review, but OHFLAC still expects to see the exemption before it moves your application forward.

Adding Ketamine at a Licensed West Virginia Behavioral Health Center

OHFLAC hasn’t published anything on ketamine that we could locate. Treating it as a change in services is our reading of the licensing rule, so confirm the filing with OHFLAC first.

Because an outpatient mental health clinic in West Virginia holds a behavioral health center license, ketamine or Spravato becomes part of a licensed service the moment the clinic offers it. A Cornell LII copy of 71 CSR 25 section 4, which shows no version date, says “An amended license application shall be submitted to the Director for a change in the services to be provided” (4.2.3), and it has the provider notify the Director 60 days ahead of “a significant change in the population served or type of service provided” (4.2.2). We could not match those two subsections against the May 1, 2026 final file, so ask OHFLAC whether both still apply and how much lead time it wants before you schedule the first patient.

Two registrations come before any vial arrives. W. Va. Code 60A-3-302 requires anyone who dispenses a controlled substance in the state to register annually with the Board of Pharmacy, with a separate registration at each principal place of business or professional practice, and the federal side works the same way, one DEA registration per location (21 CFR 1301.12). Spravato needs one more enrollment, the clinic’s own REMS certification as an outpatient healthcare setting, along with a provider observing each patient for no less than 2 hours.

On the Controlled Substances Monitoring Program, 60A-9-4(f) says reporting “is not required for a drug administered directly to a patient by a practitioner,” so a dose a clinician gives in the room is not reported. The mandatory lookup in 60A-9-5a(b) is triggered by first prescribing a Schedule II drug, an opioid or a benzodiazepine. Ketamine is none of those under the federal schedule, so as we read it ketamine alone doesn’t require a lookup. Physicians order the treatment. For APRNs, W. Va. Code 30-7-15b makes a written collaborative agreement the starting point for prescriptive authority, and the Board can lift that requirement on application once the nurse shows three years in a duly documented collaborative relationship.

Plenty of clinics skip the license amendment by letting a physician practice handle ketamine. As we read it, the section 2.5 exemption for practitioners working within their own chapter 30 licenses is what makes that work. West Virginia Drug and Alcohol Outpatient Treatment Licensing sets out the PLLC structure and referral limits for that arrangement where it discusses ketamine.

Staffing an Outpatient Mental Health Program

A small outpatient program typically needs a clinical director and two to three clinicians, and the credentialing path matters more here than the headcount does. Professional counselors are licensed by the West Virginia Board of Examiners in Counseling, which issues the full LPC and the associate-level LPCA. That board is unrelated to the new alcohol and drug counselor licensure in W. Va. Code § 16-68, which the Bureau for Behavioral Health has until July 1, 2027 to get fully running, and § 16-68-21 says that article does not apply to paid counselors working at a licensed behavioral health center anyway. West Virginia’s substance abuse, behavioral disorder, and mental health counselors earn a median of $49,430 a year statewide (BLS OEWS, May 2025), 17% below the $59,350 national median, with the middle half between $42,730 and $61,560, so a clinical director plus two to three clinicians commonly runs $160,000 to $210,000 a year in clinical payroll before benefits. A below-average wage line reads like bad news until it’s your budget, then it’s just breathing room. Build the clinical director role around a fully licensed clinician and staff the remaining counseling positions with clinicians completing their supervised experience requirements. Once your program model is set, the actual staffing and cost estimate follows from it.

How to Submit Your OHFLAC Application

Start with the West Virginia Health Care Authority for your CON exemption (304-558-7000, see the CON FAQ). Contact the OHFLAC Life Safety Program at 304-558-0050 for space review, then submit your Behavioral Health Services Application for Licensure to the OHFLAC Behavioral Health Program at the same number once your policies are ready.

What Delays West Virginia Outpatient Mental Health Applications

In our work with outpatient mental health clinics, three mistakes cause most of the delays. The first is skipping the CON exemption filing because the project seems too small to need it. The second is a written program description that doesn’t match the services listed on the application, which is one of the documents OHFLAC reviews at the initial survey. The third is scheduling the Fire Marshal and Life Safety reviews too late in the buildout timeline.

Frequently Asked Questions

Not sure whether your West Virginia outpatient practice falls under the behavioral health center rule or the Chapter 30 practitioner exemption? Reach out here.

Sources

• W. Va. Code § 27-9-1, license requirement: License; regulations (checked October 7, 2026)
• WV Secretary of State, 71 CSR 25 (effective May 1, 2026), sections 2.5 to 2.7, 4.1.5, 4.1.6: Behavioral Health Centers Licensure, current rule (checked October 7, 2026)
• WV Office of Inspector General: Office of Health Facility Licensure and Certification (checked October 7, 2026)
• WV Secretary of State, 64 CSR 11: Behavioral Health Centers Licensure, historical versions (checked October 7, 2026)
• 64 CSR 11 (2024), sections 1 to 4, Cornell LII mirror: scope and exemptions, definitions, licensure (checked October 7, 2026)
• OHFLAC: Steps for opening a behavioral health center (checked October 7, 2026)
• W. Va. Code § 16-2D-11: Exemptions from certificate of need (checked October 7, 2026)
• WV Health Care Authority: Certificate of Need and Certificate of Need FAQ (checked October 7, 2026)
• WV Board of Examiners in Counseling: Becoming a licensed counselor (checked October 7, 2026)
• W. Va. Code § 16-68 and § 16-68-21: Licensure and certification of alcohol and drug counselors, exception (checked October 7, 2026)
• 71 CSR 25, section 4 (Cornell LII mirror, version date not shown): Licensure, amended applications and 60-day notice (checked October 9, 2026)
• W. Va. Code § 60A-3-302: Board of Pharmacy controlled substance registration (checked October 9, 2026)
• W. Va. Code chapter 60A, article 9, including § 60A-9-4(f): Controlled Substances Monitoring and § 60A-9-5a: Practitioner lookup requirements (checked October 9, 2026)
• W. Va. Code § 30-7-15b: APRN prescriptive authority (checked October 9, 2026)
• 21 CFR 1301.12 (Cornell LII mirror of the official text): Separate registrations for separate locations (checked October 9, 2026)
• 21 CFR 1308.13(c)(7) (Cornell LII mirror of the official text): Ketamine in Schedule III (checked October 9, 2026)
• SPRAVATO REMS: Healthcare setting certification and monitoring (checked October 9, 2026)