Kentucky Behavioral Health & Substance Use Licensing Guide

Licensing agencies

DBHDID for substance use, OIG for mental healthAODE licensing moved to DBHDID on April 5, 2023

Substance use license

Outpatient or residential AODE license908 KAR 1:370, 1:372 and 1:374

Applications

AODE system in the Kentucky Online Gateway (KOG)$500 a year, plus $80 per outpatient extension site

Opioid treatment

Narcotic treatment program (NTP) licensed as an outpatient AODEDBHDID is the state opioid treatment authority

Accreditation

Required within a year for BHSOs and for Medicaid billingState law lets accredited agencies be inspected every two years instead of yearly

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

Who licenses behavioral health programs in Kentucky?

Two agencies, split by service. The Cabinet for Health and Family Services (CHFS) licenses nonhospital substance use programs as alcohol and other drug treatment entities (AODEs). Since April 5, 2023, this has been the job of the Substance Use Disorder Program Licensure Branch in the Department for Behavioral Health, Developmental and Intellectual Disabilities (DBHDID), which also oversees narcotic treatment and DUI programs.¹

Mental health programs outside hospitals are licensed by the CHFS Office of Inspector General (OIG) as behavioral health services organizations (BHSOs).⁵ OIG also handles residential crisis stabilization units, psychiatric residential treatment facilities and chemical dependency treatment services.¹² Medicaid is run by the Department for Medicaid Services (DMS).⁹

License types

• Outpatient AODE: ambulatory withdrawal management, outpatient, intensive outpatient, partial hospitalization, NTPs, and office-based opioid treatment at sites not owned by a Kentucky-licensed physician where at least half of patients get opioid use disorder medication.⁴
• Residential AODE: clinically managed withdrawal management, residential treatment, family residential, transitional living and adolescent programs.³
• BHSO: outpatient mental health care, or co-occurring care where mental illness is the primary diagnosis.⁵
• Residential crisis stabilization unit (RCSU): a separate OIG license.⁶

An AODE may not admit clients to a modality until it is licensed for it. Federally qualified health centers, rural health clinics, private practitioner offices and RCSUs are exempt.² For Medicaid, DMS calls these BHSO tiers: Tier I mental health (BHSO license), Tier II outpatient substance use (outpatient AODE) and Tier III residential substance use (residential AODE).⁹

Law and rules

KRS 222.231 sets a one-year AODE license, requires each agency to be licensed separately and requires NTPs to be licensed before they operate.⁷ The rules are 908 KAR 1:370 (procedures and fees), 1:372 (residential) and 1:374 (outpatient and NTPs).^{2, 3, 4} BHSOs and RCSUs fall under 902 KAR 20:430 and 20:440, and Medicaid substance use coverage under 907 KAR 15:022.^{5, 6, 10} Recovery residences are covered by KRS 222.500 to 222.510 and 908 KAR 1:410.^{13, 15}

How to apply for an AODE license

1. Choose license and servicesEach residential facility needs its own license. Extension sites are allowed only for outpatient programs, not for NTPs or office-based opioid treatment.^{2, 9}
2. Prepare the siteMeet local building codes and get State Fire Marshal approval before initial licensure.^{3, 4}
3. Apply onlineCreate a KOG account, enroll in the AODE system and file the AODE Initial Licensure Application⁸ with $500, plus $80 per outpatient extension site.²
4. InspectionThe cabinet must inspect each agency before licensing it.⁷
5. Renew yearlyRefile with the same fees each year. Current licensees first complete an AODE Verification Form in the system.^{2, 8}

Changes: report a name change within 10 days, apply before relocating, and have a new owner apply within 10 days when more than 25% changes hands.² BHSOs apply to OIG and need fire marshal approval first; OIG asks applicants to check with it on certificate of need and fire marshal requirements.^{5, 12}

Licensing fees

Licenses renew yearly. BHSO and RCSU renewals are due at least 60 days ahead, payable to the Kentucky State Treasurer.^{2, 5, 6} The recovery housing rule sets no state certification fee.¹⁵

How accreditation counts in Kentucky

Fewer inspections: under KRS 222.231, nonaccredited agencies are inspected at least yearly, while agencies fully accredited by The Joint Commission, CARF, the Council on Accreditation (COA) or a comparable body are inspected at least every two years.⁷ 908 KAR 1:370 still calls for an annual AODE survey and gives no fee break.²

Required by rule: outpatient AODEs offering partial hospitalization must be accredited by one of those bodies.⁴ BHSOs and RCSUs must be accredited within a year of licensure, with one extension if requested 60 days before renewal; a BHSO that fails loses its license.^{5, 6}

Medicaid: all BHSO tiers, including AODEs, must be accredited by The Joint Commission, CARF, COA or another national body within a year of enrollment, with one extension if requested 90 days before enrollment expires. Residential programs also need ASAM level of care certification, or DMS provisional certification, for levels 3.1 and 3.5.^{9, 10}

Opioid treatment: federal rules require accreditation from a SAMHSA-approved body such as CARF, The Joint Commission or Social Current (formerly COA).^{18, 19}

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

Narcotic treatment programs

• State license: an NTP holds an outpatient AODE license, follows 42 CFR Part 8 and reports to the state Central Registry and KASPER.^{4, 7}
• State authority: DBHDID is the state opioid treatment authority (SOTA) and approves labs, exceptions and waivers.⁴ Medicaid enrollment needs a SOTA certification letter.⁹
• Medication stations: no separate license; apply to DBHDID on the AODE form. Stations offer dosing and drug screens only.⁴
• Medical director: a board-eligible psychiatrist with three years of substance use experience, or a physician board certified in addiction medicine.⁷
• Federal steps: state licensing and DEA registration precede SAMHSA's provisional certification, which lasts up to a year, and accreditation must follow within it.¹⁸ DBHDID lists 48 NTPs statewide.¹⁷

Other approvals you may need

• Medicaid enrollment: apply in the KY Medicaid Partner Portal Application (KY MPPA) with your license, plus a DBHDID approval letter for AODEs. You need a permanent Kentucky location, and every site must be registered with DMS.⁹
• Recovery residences: since July 1, 2024, running or advertising one requires certification from an approved certifying organization and proof filed with the cabinet, with exemptions for Recovery Kentucky and some religious residences.¹³ Certification follows NARR standards, lasting 12 months at first and two years on renewal.¹⁵ Violators face fines and closure actions.¹⁴ The Kentucky Recovery Housing Network certifies residences.¹⁶
• Certificate of need: KRS 216B.020 exempts outpatient behavioral health treatment other than partial hospitalization, and freestanding residential substance use programs with 16 or fewer beds.¹¹

Recent changes

• January 22, 2026: an amended 907 KAR 15:022, the Medicaid rule for substance use BHSOs, took effect.¹⁰
• HB 470 (signed April 10, 2026): from January 1, 2027, AODEs, BHSOs and similar entities may employ only peer support specialists registered under KRS 309.0831, and peers may not provide psychoeducational services.²¹
• July 1, 2026: the Kentucky Recovery Housing Network opened an online certification portal.¹⁶
• 908 KAR 1:370 amendment (proposed July 13, 2026): adds AODE peer support requirements under HB 470, with no fee changes.²⁰

Confirm these with DBHDID

• Whether an accredited AODE is surveyed every two years, as KRS 222.231 allows, or yearly, as 908 KAR 1:370 says.
• The final text and effective date of the 908 KAR 1:370 peer support amendment.
• How long initial review and inspection take; no timeline is published.
• Whether you need a certificate of need, for example for residential programs over 16 beds, partial hospitalization or an NTP.
• For recovery residences: the approved certifying organizations and their fees.
• For NTPs: the SOTA steps to complete before applying to SAMHSA.

Sources

1. Kentucky DBHDID, Division of Program Integrity. chfs.ky.gov
2. Kentucky LRC, 908 KAR 1:370, AODE licensing procedures and fees. legislature.ky.gov
3. Kentucky LRC, 908 KAR 1:372, Residential AODEs. legislature.ky.gov
4. Kentucky LRC, 908 KAR 1:374, Outpatient AODEs. legislature.ky.gov
5. Kentucky LRC, 902 KAR 20:430, Behavioral health services organizations. legislature.ky.gov
6. Kentucky LRC, 902 KAR 20:440, Residential crisis stabilization units. legislature.ky.gov
7. Kentucky LRC, KRS 222.231, Licensing of treatment programs. legislature.ky.gov
8. Kentucky DBHDID, Online AODE system flyer. chfs.ky.gov
9. Kentucky DMS, Provider type 03 BHSO summary (September 2026). chfs.ky.gov
10. Kentucky LRC, 907 KAR 15:022, Substance use BHSO services. legislature.ky.gov
11. Kentucky LRC, KRS 216B.020, Certificate of need exemptions. legislature.ky.gov
12. Kentucky OIG, Applications for health care facilities. chfs.ky.gov
13. Kentucky LRC, KRS 222.502, Recovery residence certification. legislature.ky.gov
14. Kentucky LRC, KRS 222.504, Cabinet powers and fines. legislature.ky.gov
15. Kentucky LRC, 908 KAR 1:410, Recovery housing. legislature.ky.gov
16. Kentucky DBHDID, Kentucky Recovery Housing Network. chfs.ky.gov
17. Kentucky DBHDID, Medication-assisted treatment for opiates. chfs.ky.gov
18. SAMHSA, Become an opioid treatment program. samhsa.gov
19. SAMHSA, Approved OTP accreditation bodies. samhsa.gov
20. Kentucky LRC, 908 KAR 1:370 proposed amendment (July 2026). legislature.ky.gov
21. Kentucky General Assembly, HB 470 (2026). legislature.ky.gov

This guide summarizes Kentucky statutes, regulations and CHFS pages as of the date above. It is general information, not legal advice. Requirements change; confirm with DBHDID or OIG before you apply.