South Carolina Behavioral Health & Substance Use Licensing Guide

Licensing agency

Department of Public Health (DPH)Took over DHEC's health facility licensing on July 1, 2024

Main license

Facility for chemically dependent or addicted personsRegulation 60-93; outpatient and residential licensed separately

License fee

$75 outpatient; $10 per bed (minimum $75) residentialPlus inspection fees starting at $350 or $450

Opioid treatment

Opioid treatment program within an outpatient licensePlus a Board of Pharmacy permit, SAMHSA and DEA; no certificate of need since 2023

Accreditation

Not required for the DPH licenseRequired by Medicaid: CARF, COA or The Joint Commission for each service billed

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

Who licenses substance use treatment in South Carolina?

The Department of Public Health. Act 60 of 2023 split the Department of Health and Environmental Control (DHEC) into DPH and the Department of Environmental Services on July 1, 2024. DPH kept health facility licensing, and DHEC licenses stayed valid until renewal.⁵ DPH's Bureau of Health Facilities Licensing handles substance use facility applications.^{1, 8}

The Department of Behavioral Health and Developmental Disabilities (BHDD) was created by Act 3 of 2025, which merged the Department of Mental Health, the Department of Disabilities and Special Needs and the Department of Alcohol and Other Drug Abuse Services (DAODAS). Its Office of Substance Use Services (OSUS) replaces DAODAS.⁶ OSUS is SAMHSA's single state agency for the substance use block grant and funds most treatment through county alcohol and drug abuse authorities and contracted providers such as OTPs.⁷ Facility licensing stays with DPH.¹

The Department of Health and Human Services (SCDHHS) runs Healthy Connections Medicaid and sets its own enrollment and accreditation rules.¹⁷

License types

DPH licenses any facility that treats substance abuse or dependence for two or more unrelated people, in five service types:¹

• Outpatient: non-residential services. Satellites must be in the main site's county or a neighboring one.²
• Residential treatment program: a 24-hour clinical program, including programs for parents with children.²
• Medical withdrawal management: medically supervised detox in a residential facility.²
• Social withdrawal management: supervised detox without medication, with medical backup.²
• Opioid treatment program (OTP): a program in an outpatient facility using methadone or another opioid treatment medication.²

Outpatient and residential services on the same premises need separate licenses, as do sites on separate, non-adjoining properties.²

Law and rules

Chapter 7 of Title 44, the State Health Facility Licensure Act, requires a license for facilities for chemically dependent or addicted persons. It leaves fees to regulation, allows inspection fees, and permits fines of $100 to $5,000 per violation plus denial, suspension or revocation.³ Act 146 of 2026 updated the statute to name DPH.^{3, 21}

The standards are in Regulation 60-93.^{1, 2} It was Regulation 61-93 until State Register Document No. 5352 moved DPH's rules to chapter 60, effective May 23, 2025.⁴ Sections 44-53-710 to 44-53-760 give DPH exclusive control of methadone.¹²

How to apply for a DPH license

1. Choose the license and siteDecide between outpatient (with or without an OTP) and residential services. DPH needs assurance that local zoning and building officials have approved the facility, which must meet Building Codes Council and State Fire Marshal codes.²
2. Get plans approvedFor new construction, renovations or a building licensed for the first time, submit plans sealed by a South Carolina architect or engineer in three stages. Work cannot start until DPH approves them.²
3. Staff up and write policiesHire a full-time administrator with at least a related bachelor's degree and at least one fully certified or licensed counselor. Write the policies the rule requires, from staffing and records to medications and discharge.²
4. Submit the applicationUse DPH form 3295 for outpatient sites and OTPs or form 3293 for residential and detox. Email is preferred. Include proof you own or lease the property, the administrator's qualifications, an evacuation plan for residential sites, ownership papers, a notarized signature page and proof of payment.^{8, 9}
5. Pass the initial inspectionDPH inspects before the first license and requires substantial compliance. No patients may be admitted before the license takes effect.²

Renewals and changes: renew before the license expires. Changes in beds, location, name or service type need an amended license first; a change in controlling interest or legal entity type needs a new license.²

Licensing fees

Fees are non-refundable and go in with the application. Renewals include any unpaid inspection fees.²

How accreditation counts in South Carolina

Deemed status, survey waivers and fee breaks: none. Regulation 60-93 does not deem accredited facilities, DPH inspects every facility before licensing and may inspect at any time without notice, and fees are the same for everyone.²

Medicaid: this is where accreditation matters. SCDHHS requires rehabilitative behavioral health services (RBHS) organizations to be accredited by CARF, the Council on Accreditation (COA, part of Social Current) or The Joint Commission. Each service must be accredited before you bill it. Losing accreditation ends enrollment, with a one-year wait to reapply, and status changes must be reported within five business days. Providers enrolled only for Assertive Community Treatment, Multisystemic Therapy or Homebuilders are exempt.¹⁷

Opioid treatment: federal rules require accreditation within the first year. SAMHSA's approved bodies are CARF International, Social Current (formerly COA), The Joint Commission, the National Commission on Correctional Health Care and the Washington State Department of Health.^{14, 15}

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

Opioid treatment programs

• DPH license: an OTP is licensed with its outpatient facility on form 3295.⁸ It needs a physician available during dosing, a pharmacist or other licensed dispenser, a licensed nurse whenever medication is given and one full-time counselor per 50 patients.²
• No certificate of need: Act 20 of 2023 removed OTPs from certificate of need review on May 16, 2023.¹¹ DPH's CON program issues rulings on whether a project needs review only in writing.¹⁰
• Pharmacy permit: the Board of Pharmacy must issue a narcotic treatment program permit before dosing begins. The program needs a pharmacist-in-charge, who can serve no more than two permit holders; mobile and satellite units need a satellite permit.¹³
• Medication units: these may only dose and drug-test. Each must sit 45 to 90 miles from the main OTP, hold its own Bureau of Drug Control and DEA registrations and get DPH approval, with either a certificate of need or a DPH finding that none is required.²
• Methadone law: patients under 18 need written consent from a parent or guardian, and an autopsy is required if a patient dies while enrolled.^{12, 2}
• Federal steps: SAMHSA grants provisional certification for up to a year after state licensure and DEA registration, and the program must be accredited within that year.¹⁴ SAMHSA's directory still lists DAODAS as the State Opioid Treatment Authority.¹⁶
• Medicaid: from October 1, 2025, SCDHHS pays $193.60 for the weekly methadone bundle and $213.03 for weekly oral buprenorphine, in DEA-approved, SAMHSA-accredited clinics. Managed care plans authorize services for their members.¹⁸

Other approvals you may need

• Medicaid enrollment: RBHS organizations are high-risk providers. The organization and its 5% or greater owners need FBI and SLED fingerprint checks, and SCDHHS visits the site before enrollment. The office must be commercially zoned, and residential settings must be licensed by DPH or DSS with 16 beds or fewer.¹⁷ The manual's substance use services section covers only OSUS-affiliated providers, mainly county authorities.¹⁷
• Recovery residences: certification is voluntary under Act 160 of 2024, and uncertified homes may still operate. Since November 20, 2025, state agencies and state-funded treatment vendors may refer only to certified homes, and courts and probation may require residence only in them. Falsely claiming certification costs $100 to $500 per occurrence.¹⁹ OSUS approved the S.C. Alliance for Recovery Residences (SCARR) to certify homes, and state recovery housing assistance pays only for Oxford Houses and SCARR-certified homes.²⁰
• Controlled substances: stock controlled substances need DPH Bureau of Drug Control and DEA registrations.²
• Related licenses: residential treatment facilities for children and adolescents and crisis stabilization units are separate DPH license types.³

Recent changes

• 2025: Act 3 of 2025 created BHDD; DAODAS became its Office of Substance Use Services.⁶
• May 23, 2025: Regulation 61-93 became 60-93, with DHEC references changed to DPH.⁴
• October 1, 2025: Medicaid OTP bundle rates rose.¹⁸
• November 20, 2025: referral and court limits on uncertified recovery housing took effect.¹⁹
• May 15, 2026: Act 146 of 2026 made conforming changes for the DHEC split.²¹
• July 1, 2026: SCDHHS issued a new RBHS provider manual.¹⁷

Confirm these with DPH

• The current fee schedule; DPH's posted schedule is a scanned image we could not read.
• What CON paperwork DPH expects for a new medication unit now that OTPs are exempt.
• Review and inspection timelines, which DPH does not publish.
• Whether an amendment to Regulation 60-93 is in progress.
• For OTPs: BHDD's current State Opioid Treatment Authority process.
• For Medicaid: which services your accreditation must cover under the RBHS accreditation crosswalk.

Sources

1. South Carolina DPH, Facilities for chemically dependent or addicted persons. dph.sc.gov
2. South Carolina DPH, Regulation 60-93. dph.sc.gov
3. South Carolina Code, Title 44, Chapter 7, State Health Facility Licensure Act. scstatehouse.gov
4. South Carolina State Register, Document No. 5352 (2025). scstatehouse.gov
5. South Carolina DPH, DHEC restructuring. dph.sc.gov
6. South Carolina General Assembly, S.2 (2025), Act No. 3. scstatehouse.gov
7. South Carolina BHDD, About OSUS. bhdd.sc.gov
8. South Carolina DPH, Form 3295, outpatient application (07/2025). dph.sc.gov
9. South Carolina DPH, Form 3293, residential application (07/2025). dph.sc.gov
10. South Carolina DPH, Certificate of Need. dph.sc.gov
11. South Carolina DHEC, 2023 Act No. 20 FAQ. dph.sc.gov
12. South Carolina Code, sections 44-53-710 to 44-53-760, Methadone. scstatehouse.gov
13. South Carolina Code, section 40-43-72, Narcotic treatment programs. scstatehouse.gov
14. SAMHSA, Become an opioid treatment program. samhsa.gov
15. SAMHSA, Approved accreditation bodies. samhsa.gov
16. SAMHSA, State opioid treatment authorities. samhsa.gov
17. SCDHHS, RBHS provider manual (July 1, 2026). scdhhs.gov
18. SCDHHS, Update to OTP service rates (September 11, 2025). scdhhs.gov
19. South Carolina Code, sections 44-49-310 to 44-49-370, Certification of recovery housing. scstatehouse.gov
20. South Carolina BHDD, Recovery services. bhdd.sc.gov
21. South Carolina General Assembly, H.4189 (2026), Act No. 146. scstatehouse.gov

This guide summarizes South Carolina statutes, regulations and DPH, BHDD and SCDHHS materials as of the date above. It is general information, not legal advice. Requirements change; confirm with DPH before you apply.