Maryland Behavioral Health & Substance Use Licensing Guide

Licensing agency

Behavioral Health Administration (BHA)Office of Licensing, within the Maryland Department of Health

Main license

Accreditation-based license under COMAR 10.63Lasts the accreditation period plus 3 months

State license fee

None set in COMAR 10.63Your main cost is national accreditation

Opioid treatment

Opioid treatment service added to a BHA licensePlus SAMHSA certification and DEA registration

Accreditation

Required before licensure for most programsApproved bodies: ACHC, CARF, COA and The Joint Commission (NCCHC for correctional facilities)

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

Who licenses behavioral health providers in Maryland?

The Behavioral Health Administration. State law says a behavioral health program must be licensed by the Secretary of Health before it serves anyone in Maryland.³ BHA's Office of Licensing licenses mental health programs and substance use programs at every ASAM level, including withdrawal management and opioid treatment.²

The Office of Health Care Quality (OHCQ) does not license community programs. It licenses youth residential treatment centers and limited private inpatient facilities and handles CMS certification of community mental health centers, whose IOP or PHP lines may still need a BHA license.¹

Local behavioral health authorities plan and monitor public services in each county; you need an agreement to cooperate with yours before applying.^{6, 8} Maryland Medicaid and its administrative services organization, Carelon Behavioral Health, run the Public Behavioral Health System.²⁹

License types

COMAR 10.63 has two kinds of license.^{5, 6}

• Accreditation-based licenses (20 program types): outpatient mental health centers; SUD outpatient, intensive outpatient and partial hospitalization; integrated behavioral health; psychiatric rehabilitation and day treatment; mobile treatment; supported employment; respite; residential Levels 3.1 to 3.7; residential rehabilitation and crisis services; adult group homes; mobile crisis teams; and crisis stabilization centers.⁹
• Add-on services: withdrawal management and opioid treatment, offered by outpatient, intensive outpatient, partial hospitalization, integrated or residential programs only when the license names the service.⁹
• Non-accreditation-based licenses: DUI education, substance-related disorder assessment and referral, and early intervention Level 0.5.^{5, 19}

Exempt: licensed professionals in solo or group practice (except DUI education and residential Levels 3.1 to 3.7), AA and NA, recovery residences, peer and family support, employee assistance programs, accredited hospital outpatient services and therapeutic group homes.⁷

Law and rules

Health-General Article §7.5-401 requires the license and lists who may be exempted. §7.5-402 lets the Secretary require accreditation for licensure and allows licensing fees by regulation.^{3, 4} The detailed rules are COMAR 10.63, in force since July 1, 2016. Chapter 01 covers all programs, 02 to 05 cover program types, 06 covers applications and sanctions, and 08 sets civil money penalties.⁵ Recovery residence certification falls under Health-General §§19-2501 to 19-2504.²⁷

How to apply for a BHA license

1. Set up the businessRegister the entity with the State Department of Assessments and Taxation (SDAT). The application asks for proof of good standing, and the business name must match SDAT records exactly.¹⁹
2. Get accredited firstFor an accreditation-based license, you upload the latest accreditation survey report, any required corrective action plan and the final accreditation letter or certificate.^{13, 19}
3. Sign the local agreementBefore applying, sign an agreement to cooperate with the local authority for each county you will serve.^{8, 19}
4. Assemble site documentsFor each site: lease or deed, floor plan, fire inspection report from the last 12 months, use and occupancy permit, criminal background policy, safety plan and organizational chart. New businesses add a business plan; all applicants add an insurance policy and disclose any licensing actions or convictions from the past 10 years.^{12, 19}
5. Apply onlineBHA moved to an online application on February 10, 2025. File one application per site. A saved draft link expires after 21 days.^{20, 19}
6. Review and licenseBHA reviews applications in the order received and returns incomplete ones. The form asks whether each site is ready for an on-site or virtual inspection. The license lists every program and site, and BHA notifies Medicaid, the ASO and your local authority.^{21, 12, 19, 14}

Renewals and changes: the renewal application must reach BHA at least 60 days before the license expires, or the license is suspended from its expiration date until a new one is issued.¹⁴ Adding, closing or moving a site needs prior approval, with notice to your accreditor, local authority and clients; non-accredited programs and residential sites are inspected first.¹⁵ A license cannot be sold or transferred, so a change of ownership needs a new license.¹⁶ Critical incidents go to the Department within 5 calendar days.⁸

Licensing fees

The application rule and BHA's online application guide list no state license fee, though the statute lets MDH adopt one.^{12, 19, 4} DEA renews narcotic treatment program registrations every year.²⁶ Civil money penalties count each site, and each service with a violation, separately.¹⁷

How accreditation counts in Maryland

Required, not optional: for the 20 program types above, accreditation is a condition of the license. The term runs for the accreditation period plus 3 months, so lapsed accreditation means a lapsed license.^{9, 14} MDH approves the Accreditation Commission for Health Care (ACHC), CARF, the Council on Accreditation (COA) and The Joint Commission, plus NCCHC for correctional facilities. Not every body covers every program type; BHA publishes crosswalks for each.¹⁸

Survey waivers: the rules lean on the accreditor's survey. BHA's pre-license site review and extra inspections of accredited programs are tied to significant concerns about the program or its accreditor, and BHA may enforce the accreditor's standards.^{13, 10} The online application still asks whether each site is ready for an on-site or virtual inspection.¹⁹

Fee breaks: none apply, because COMAR 10.63 sets no license fee.¹²

Medicaid: the Medicaid program and the ASO are notified of each license BHA issues.¹⁴ If your accreditor requires a community relations plan, you must also give it to BHA.⁴

Opioid treatment: SAMHSA accepts CARF, Social Current (formerly COA), The Joint Commission, NCCHC and the Washington State Department of Health. ACHC, though approved by Maryland, is not on SAMHSA's list.^{24, 18}

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

Opioid treatment programs

• State license: opioid treatment is licensed as a service at an outpatient, intensive outpatient, partial hospitalization, integrated or residential program site, and must follow 42 CFR Part 8.^{9, 11}
• Medical director: a physician with either 3 years of addiction experience (1 year in opioid maintenance treatment) plus board certification in addiction medicine or addiction psychiatry, or ABPN certification in addiction psychiatry.¹¹
• Operations: a program-wide average of no more than 50 patients per counselor; random drug testing at least monthly for a set panel; proof of locked storage before any take-home dose; tapers of at least 21 days with daily cuts under 5%; and involuntary tapers only for listed reasons.¹¹
• State Opioid Treatment Authority: BHA's SOTA advises SAMHSA on new and renewing OTP and medication unit applications, rules on exception requests and oversees closures.²²
• Federal steps: state licensure and DEA registration come before SAMHSA provisional certification, which lasts up to one year while the program gets accredited.²³
• Federal rule changes: the revised 42 CFR Part 8 took effect April 2, 2024, with compliance by October 2, 2024.²⁵ Maryland's OTP regulation was last amended in 2017; the pending rewrite moves OTPs to a new chapter, COMAR 10.63.35.^{34, 33}

Other approvals you may need

• Certified recovery residences: residences are exempt from licensure, but they must be certified if they receive state funds or call themselves certified.^{7, 1} BHA's Maryland Certification of Recovery Residences (MCORR) office certifies them statewide.²⁷ Under the statute, the approved credentialing entity inspects before certifying and at least once each renewal period, and a certificate lasts one year.²⁸
• Housing tied to treatment: licensing applicants that offer housing upload their housing policy or certification, a list of affiliated organizations that receive referrals and a community relations plan.¹⁹
• Medicaid and the PBHS: specialty behavioral health is carved out of HealthChoice and paid fee-for-service. You enroll with Medicaid, then register with Carelon for authorizations.²⁹ Carelon replaced Optum as ASO on January 1, 2025.³⁰
• MPRIME enrollment: Medicaid paused new ePREP applications from July 1, 2026 (moderate and high risk) and August 1, 2026 (limited risk) ahead of its new MPRIME portal, scheduled for October 2026. Unenrolled behavioral health providers can ask Carelon for courtesy authorizations meanwhile.³¹

Recent changes

• January 1, 2025: Carelon became the Public Behavioral Health System ASO.³⁰
• February 10, 2025: online licensing applications replaced paper.²⁰
• August 22, 2025: MDH withdrew its May 2025 proposal to revise COMAR 10.63.³²
• April 17, 2026: BHA warned that it never expedites applications for a fee.²¹
• July to October 2026: Medicaid enrollment holds and the move from ePREP to MPRIME.³¹
• August 21, 2026: MDH proposed replacing COMAR 10.63 with general chapters plus separate program chapters, including a recovery residence program chapter. Renewals would be filed 40 to 120 business days before expiration, BHA could inspect before licensing, and MDH expects to certify and oversee all recovery residences. Comments closed September 21, 2026; no final rule has been adopted.^{33, 32}

Confirm these with BHA

• The final text and effective date of the COMAR 10.63 rewrite, and how existing licensees transition.
• Whether your accreditor is approved for each program type you want, using BHA's crosswalks.
• Whether any state licensing fee is adopted.
• Whether recovery residence certification becomes mandatory for all residences under the new rules.
• MPRIME go-live status and whether your Medicaid effective date can be backdated.
• For OTPs: the Maryland controlled dangerous substances registration, local zoning and SOTA expectations for new sites and medication units.

Sources

1. Maryland Department of Health, MDH care provider licensing overview. health.maryland.gov
2. Maryland BHA, Office of Licensing and Certification. health.maryland.gov
3. Maryland Code, Health-General §7.5-401, License required. mgaleg.maryland.gov
4. Maryland Code, Health-General §7.5-402, Regulations and accreditation. mgaleg.maryland.gov
5. COMAR 10.63, Community-based behavioral health programs and services. regs.maryland.gov
6. COMAR 10.63.01.02, Definitions. regs.maryland.gov
7. COMAR 10.63.01.04, Exempt providers. regs.maryland.gov
8. COMAR 10.63.01.05, Requirements for licensed programs. regs.maryland.gov
9. COMAR 10.63.02.02, Covered programs and services. regs.maryland.gov
10. COMAR 10.63.02.03, Programs with an accreditation-based license. regs.maryland.gov
11. COMAR 10.63.03.19, Opioid treatment service. regs.maryland.gov
12. COMAR 10.63.06.02, License application process. regs.maryland.gov
13. COMAR 10.63.06.03, Applications for licenses requiring accreditation. regs.maryland.gov
14. COMAR 10.63.06.05, Issuance and duration of licenses. regs.maryland.gov
15. COMAR 10.63.06.07, License modification. regs.maryland.gov
16. COMAR 10.63.06.09, Sale or transfer of license. regs.maryland.gov
17. COMAR 10.63.08.03, Civil money penalty. regs.maryland.gov
18. Maryland BHA, Accreditation based licensing. health.maryland.gov
19. Maryland BHA, COMAR 10.63 online application guide. health.maryland.gov
20. Maryland Department of Health, MDH implements new behavioral health licensing process (February 6, 2025). health.maryland.gov
21. Maryland BHA, Alert regarding licensing misinformation (April 17, 2026). health.maryland.gov
22. Maryland BHA, State Opioid Treatment Authority. health.maryland.gov
23. SAMHSA, Become an opioid treatment program. samhsa.gov
24. SAMHSA, Approved accreditation bodies. samhsa.gov
25. SAMHSA, 42 CFR Part 8 final rule. samhsa.gov
26. Code of Federal Regulations, 21 CFR 1301.13, DEA registration fees (2025 edition). govinfo.gov
27. Maryland BHA, Maryland Certification of Recovery Residences. health.maryland.gov
28. Maryland Code, Health-General §19-2502, Recovery residence certification. mgaleg.maryland.gov
29. Maryland Medicaid, HealthChoice and behavioral health coverage. health.maryland.gov
30. Maryland Department of Health, Update on the behavioral health ASO transition (2025 Joint Chairmen's Report). health.maryland.gov
31. Maryland Medicaid, MPRIME provider enrollment transition. health.maryland.gov
32. Maryland Department of Health, BHA COMAR 10.63 revisions. health.maryland.gov
33. Maryland Register, Vol. 53, Issue 17 (August 21, 2026), proposed action 26-079-P on COMAR 10.63. dsd.maryland.gov
34. COMAR 10.63.03, Programs requiring an accreditation-based license (history note). regs.maryland.gov

This guide summarizes Maryland statutes, COMAR and Maryland Department of Health pages as of the date above. It is general information, not legal advice. Requirements change, and a new COMAR 10.63 is pending; confirm with BHA before you apply.