Tennessee Behavioral Health & Substance Use Licensing Guide

Licensing agency

TDMHSAS Office of LicensureRegional offices in Memphis, Nashville and Knoxville

Rules

Tenn. Comp. R. & Regs. Chapter 0940-05One license per site, listing each category offered there

Applications

Four forms to your regional officeInitial license lasts up to 12 months

Opioid treatment

OTP license plus a certificate of needRule 0940-05-42; CON from the Health Facilities Commission

Accreditation

The Joint Commission, CARF or COA can support deemed complianceLife safety rules and unannounced inspections still apply

Licensing or accrediting a program here? Book a free consultation or call 561-396-0813.

Who licenses behavioral health programs in Tennessee?

TDMHSAS, through its Office of Licensure. State law (T.C.A. Title 33, Chapter 2, Part 4) authorizes the department to license facilities and services providing mental health, substance abuse and personal support services.⁵ Applications go to the regional office nearest the site, in Memphis, Nashville or Knoxville.^{1, 3} It is unlawful to begin delivering services before the license is issued.⁵

Other agencies: facilities licensed by the Department of Health whose main purpose is not behavioral health are excluded from TDMHSAS licensing.⁵ The Health Facilities Commission issues certificates of need, which opioid treatment programs require.¹⁰ TennCare, the state Medicaid program, works through managed care organizations (MCOs) that credential providers.¹⁵

License categories

The rules define distinct categories of facilities and services. Each licensee gets one license per site, and the license lists every category authorized there.⁵ Each category has its own minimum program requirements chapter:⁴

• Substance use: non-residential rehabilitation treatment, residential rehabilitation treatment, residential detoxification, outpatient detoxification, halfway house treatment, residential treatment for children and youth, DUI school services and non-residential opioid treatment programs.⁴
• Office-based opioid treatment: nonresidential office-based opiate treatment facilities (OBOTs), with or without dispensing authorization.⁴
• Mental health: outpatient, adult day treatment, hospital, adult residential treatment, crisis stabilization units, supportive living, psychosocial rehabilitation, intensive day treatment for children and adolescents, partial hospitalization and residential treatment for children and youth.⁴
• Other: personal support services agencies and adult supportive residential facilities.⁴

Halfway houses and recovery residences differ. A halfway house is a licensed residential treatment facility that provides clinical services. A recovery residence is a substance-free home with peer support and no on-site clinical services, and it is certified through organizations TDMHSAS approves (see Other approvals).^{12, 13}

Law and rules

The licensure rules are Chapter 0940-05: administration, procedures and fees (0940-05-02), life safety (0940-05-04), facility environment (0940-05-05) and requirements for all services (0940-05-06), then one chapter per category, such as 0940-05-42 for opioid treatment programs and 0940-05-43 to 0940-05-47 for alcohol and drug facilities.⁴ Life safety follows the codes the State Fire Marshal uses.⁸

How to apply for a TDMHSAS license

1. Choose your categoriesRead the licensure rules for each service and facility category you plan to offer at each site.¹
2. Submit four formsSend the initial application, fact sheet, background check and privacy statement form, and financial statement to your regional office.^{1, 2}
3. Pay the invoiceThe Office of Licensure invoices the fee once it has your forms. Fees are non-refundable.^{1, 5}
4. Pass a life safety inspectionResidential sites and sites clients visit need an inspection by the State Fire Marshal, a local fire marshal or a private certified codes inspector. Personal support services agencies, DUI schools and OBOTs are currently exempt.¹
5. Licensure inspection and initial licenseA licensure surveyor inspects the site, or runs an electronic desk audit for personal support services agencies, DUI schools and OBOTs. Once any deficiencies are fixed, you get an initial license for up to one year.¹

After licensing: a full license runs up to 12 months, with at least one unannounced inspection a year. Licenses do not transfer: a change of ownership or location needs a new license before services start.⁵ A fact sheet adds a site or category.³

Licensing fees

The fee is due with every initial and renewal application.⁵ Other on-site inspections can cost up to $50 each, and an OBOT found non-compliant pays a $500 reinspection fee. The department can withhold or suspend a license until fees are paid.⁵

How accreditation counts in Tennessee

Deemed compliance: the department may treat a facility accredited by The Joint Commission, CARF or the Council on Accreditation (COA, named in the rule as the Council on Accreditation for Children and Family Services) as meeting the licensure program requirements. To ask for it, send official proof of accreditation with any cited deficiencies and your plan of correction.⁵

What it does not replace: deemed facilities must still meet the life safety and environmental rules, fix deficiencies found during unannounced inspections and cooperate with complaint investigations.⁵ The fee rule has no accreditation discount.⁵

TennCare: psychiatric inpatient facilities must be accredited by The Joint Commission, and psychiatric residential treatment facilities by a state-recognized accreditor under 42 CFR 441.151.¹⁵

Opioid treatment: federal rules require accreditation by a SAMHSA-approved body. The list includes CARF International, The Joint Commission and Social Current (formerly COA).^{16, 17}

Getting accredited? See our CARF accreditation consultants and Joint Commission consultants, available nationwide.

Opioid treatment programs

• Certificate of need first: a nonresidential substitution-based treatment center for opiate addiction needs a CON from the Health Facilities Commission. A hospital opening one on its own campus is exempt.¹⁰ The license application must include the CON, or proof that none was needed, and any CON condition is carried onto the license.⁶
• CON timing: file and publish a letter of intent between the 1st and 15th of a month. The application and fee are due on the 1st of the next month, and review typically takes 30 days before a commission vote.¹¹
• State license: Rule 0940-05-42 sets OTP standards. File the state application at the same time as your SAMHSA and DEA applications, and admit no one until you are licensed and active in the state central registry.⁶
• State Opioid Treatment Authority: the SOTA sits within TDMHSAS and makes unannounced inspections. OTPs must offer dosing and counseling at least six hours a day on weekdays and three hours on Saturday.⁶
• Federal steps: SAMHSA grants a one-year provisional certification only after state and DEA approvals, and the program must become accredited during that year.¹⁶
• TennCare: each MCO must meet with every TDMHSAS-licensed OTP and offer it a contract for medications for opioid use disorder.¹⁵
• OBOTs: a practice prescribing buprenorphine or similar medication to 25% or more of its patients, or to 150 or more patients, needs an OBOT license under 0940-05-35. Its ownership structure must include a physician with an unrestricted Tennessee license.⁷

Other approvals you may need

• TennCare credentialing: MCOs check that each behavioral health site has the licenses and any accreditation state rules require, credential individual practitioners under NCQA standards and must decide a complete application within 30 days. You need an active Medicaid ID, and TennCare urges providers to apply at least 120 days before they start serving members.¹⁵
• Recovery residence certification: since January 1, 2026, TDMHSAS approves the organizations that certify recovery residences, for three-year terms. Its approved list names the Tennessee Alliance of Recovery Residences (TN-ARR) and Recovery is the New High (RITNH).¹² Certifiers must apply statutory minimum standards, certify for at most three years and inspect each residence at least once a year. These rules do not apply to TDMHSAS-licensed facilities.¹³

Recent changes

• Public Chapter 406 (signed May 13, 2025): set minimum standards for recovery residence certifiers from January 1, 2026. Residences certified earlier keep their old standards until renewal on or after July 1, 2026, or January 1, 2027, whichever is first.^{14, 13}
• September 4, 2025: amended OTP rules took effect, including a new rule for mobile units. A mobile unit needs written approval from the SOTA and the Office of Licensure, plus a CON if one is required.⁶
• September 25, 2025: amended OBOT rules (0940-05-35) took effect.⁷
• May 25, 2026: the life safety rules and the minimum program requirements for all services were amended, adding a rule on minors living with a parent or guardian at a facility.^{8, 9}

Confirm these with TDMHSAS

• How an OTP is charged; the fee rule does not list OTPs separately from other non-residential categories.
• Which categories your program needs at each site, and whether combining them changes the life safety occupancy class.
• How long deemed compliance review takes, and whether it reduces the scope of your licensure survey.
• For OTPs: whether your project needs a CON, and the current HFC filing fee.
• For recovery residences: whether any referral source or funder requires certification.

Sources

1. Tennessee TDMHSAS, Become a licensed provider. tn.gov
2. Tennessee TDMHSAS, Licensing forms. tn.gov
3. Tennessee TDMHSAS, Licensed provider FAQs. tn.gov
4. Tennessee Secretary of State, Rules of the Department of Mental Health and Substance Abuse Services (Chapter 0940 index). tnsosfiles.com
5. Tenn. Comp. R. & Regs. 0940-05-02, Licensure administration and procedures. tnsosfiles.com
6. Tenn. Comp. R. & Regs. 0940-05-42, Non-residential opioid treatment program facilities (September 2025). tnsosfiles.com
7. Tenn. Comp. R. & Regs. 0940-05-35, Nonresidential office-based opiate treatment facilities (September 2025). tnsosfiles.com
8. Tenn. Comp. R. & Regs. 0940-05-04, Life safety licensure rules (May 2026). tnsosfiles.com
9. Tenn. Comp. R. & Regs. 0940-05-06, Minimum program requirements for all services and facilities (May 2026). tnsosfiles.com
10. Tennessee Health Facilities Commission, Certificate of need basics. tn.gov
11. Tennessee Health Facilities Commission, CON process and how to apply. tn.gov
12. Tennessee TDMHSAS, Recovery residences. tn.gov
13. Tennessee Public Chapter 406 (2025), SB 1240, recovery residences. tnsosfiles.com
14. Tennessee General Assembly, SB 1240 bill history (114th General Assembly). capitol.tn.gov
15. Division of TennCare, Statewide MCO contractor risk agreement (Amendment 25, July 1, 2026). tn.gov
16. SAMHSA, Become an opioid treatment program. samhsa.gov
17. SAMHSA, Approved accreditation bodies for opioid treatment programs. samhsa.gov

This guide summarizes Tennessee statutes, rules and agency pages as of the date above. It is general information, not legal advice. Requirements change; confirm with TDMHSAS before you apply.