Alabama Behavioral Health & Substance Use Licensing Guide

Certifying agency

Alabama Department of Mental Health (ADMH)Office of Certification Administration processes applications

Main credential

ADMH certificate for each site and serviceChapter 580-3-23; issued for up to two years

Before you apply

ADMH prospective provider orientation$125 online course; certificate needed to apply in ACAP

Opioid treatment

Level I-O OTP certificationPlus a SHPDA certificate of need, SAMHSA and DEA

Accreditation

Accepted at ADMH's discretionThe rules set no automatic deemed status or fee discount

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

Who certifies behavioral health providers in Alabama?

The Alabama Department of Mental Health. No one may run a facility that treats mental illness or substance use without ADMH certification or a State Board of Health license.¹ State law lets ADMH set minimum standards, inspect and certify facilities, and charge reasonable fees for inspections tied to certification.²

Within ADMH, the Office of Certification Administration (OCA) takes in applications, routes them to the service division and issues reports and certificates.³ The Mental Health and Substance Use Office of Certification runs the on-site reviews and gives technical assistance.⁴ Life Safety and Technical Services inspects buildings (initial, routine and complaint visits) and reviews construction plans.⁵

Two other agencies matter. The State Health Planning and Development Agency (SHPDA) issues the certificate of need a methadone clinic must have.^{1, 6} The Alabama Medicaid Agency pays for rehabilitative services only from providers ADMH has certified.⁷

Exempt: hospitals licensed by the Board of Health (unless they ask to be a designated mental health facility), federal and state agencies, schools, licensed professionals in their own private practice, self-help groups, and groups that do not hold themselves out as offering treatment.¹

ADMH certificate types

Chapter 580-3-23 sorts certification into agency-level and location-level types:¹

• Community mental health center (CMHC): must provide emergency, outpatient, consultation and education, and partial hospitalization or day services with its own staff, plus residential care directly or by agreement.
• Mental health or substance use services provider: offers some, but not all, of the CMHC services, such as outpatient, prevention, day or residential services.
• 310 boards: public corporations formed under state law to build and run mental health programs under contract with ADMH.
• Location-specific certificates for residential, day and outpatient services. ADMH issues a separate certificate for each site, program or service.

Substance use levels of care in chapter 580-9-44 follow ASAM-style levels: early intervention (0.5), outpatient (I), ambulatory detoxification (I-D and II-D), intensive outpatient (II.1), partial hospitalization (II.5), transitional and low-intensity residential (III.01 and III.1), residential detoxification (III.2-D and 3.7-D), medium- and high-intensity residential for adults and adolescents (III.3, III.5 and III.7), and opioid maintenance therapy (I-O).⁸

Mental illness services (outpatient, outreach, day and residential) sit in chapter 580-2-20.⁹

Law and rules

• Code of Ala. 1975, section 22-50-11: ADMH's standard-setting, certification and fee powers.²
• Chapter 580-3-23: the certification process: application, temporary operating authority, site visits, plans of action, appeals, decertification and renewal.¹
• Chapter 580-2-20: shared operating standards (governing body, personnel, recipient protection, incidents, records, clinical practice) plus mental illness services.⁹ Most older mental illness service rules in chapter 580-2-9 were repealed in 2023.¹⁰
• Chapter 580-9-44: substance use program rules by level of care, including opioid treatment.⁸
• Chapter 580-3-22: life safety minimum standards for physical facilities.⁵
• SHPDA rules: the State Health Plan's substance use section (410-2-4-.11) and certificate of need filing rules (chapter 410-1-7).^{6, 14}
• Medicaid: rehabilitative services rules in chapter 560-X-47.⁷

How to get ADMH certification

1. Pick your population and build the teamDecide whether you will serve mental illness, substance use or both; each has its own standards. Set up your business through the Secretary of State. ADMH expects a full-time executive director (a master's degree and five years of management experience, or a bachelor's and ten), a full-time clinical director, and a qualified finance lead.¹¹
2. Complete the orientationPhase 1 and Phase 2 orientation is now one self-paced online course through ADMH's Relias Academy. You need its certificate of completion to apply.^{12, 13}
3. Apply in ACAPSince October 31, 2025, applications go through the Alabama Certification Automation Program. Register, wait for the confirmation email, then submit through the ACAP launcher.^{12, 3} File at least 60 days before you plan to start services; a methadone clinic must also include its SHPDA certificate of need.¹
4. Review and inspectionsThe service division reviews the application, and ADMH runs criminal background checks on new operators. Initial life safety and program reviews follow where they apply. An application stays open for six months.¹ Depending on the service, your building may need to pass a life safety inspection before certification.¹¹
5. Temporary operating authority and site visitYou may not start services until the commissioner grants temporary operating authority, which lasts up to six months. ADMH makes a certification visit before it expires. It may then certify you, extend the authority, place you on provisional status or withdraw it.¹

After the visit: ADMH sends its report within 30 days. If you receive a provisional or one-year certificate, your plan of action is due 30 days after you get the report. The plan must show life safety fixes within 30 days and program fixes within 60 days of the visit.¹

Renewals and changes: certificates last up to two years, and a provisional certificate lasts no more than 60 days. Renewal visits happen in the 60 days before expiration, and later visits may be unannounced. Tell ADMH in writing before adding a program or service. If a site stops services for more than 30 days, the certificate goes back to ADMH and you must apply again.¹

Fees

The orientation price is on ADMH's Relias course page.¹³ ADMH's certification pages and chapter 580-3-23 do not list an application fee, although state law lets ADMH charge for inspections.^{3, 1, 2} The certificate of need fee comes from SHPDA rule 410-1-7-.06.¹⁴ CMS sets the Medicaid enrollment fee each year, and the 2026 amount applies to applications filed during 2026.¹⁵

How accreditation counts in Alabama

Deemed status: Alabama has no automatic deemed status. ADMH may accept, in whole or in part, a license, certificate or accreditation from another state or national body in place of its own review. ADMH can still apply its own standards where the accreditor's fall short, and it can visit accredited programs that show serious deficiencies. The rules do not name CARF, The Joint Commission or COA.¹

Survey waivers and fee breaks: any reduction in ADMH review is case by case, and we found no accreditation discount in ADMH's rules or certification pages.^{1, 4}

Medicaid: to bill substance use rehabilitative services, an organization must hold ADMH certification under chapter 580 and get ADMH approval for the Medicaid Rehabilitative Option. The Medicaid rule does not require national accreditation.⁷

Opioid treatment: federal rules require accreditation. 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.¹⁶ Alabama's residential detoxification NTP rule also points to SAMHSA-approved accreditation standards.⁸

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

Opioid treatment programs

• ADMH certification: OTPs are certified as Level I-O opioid maintenance therapy under rule 580-9-44-.29. They must document compliance with 42 CFR Part 8, DEA rules and the certificate of need.⁸ ADMH lists 21 certified OTPs, and its substance use division houses the State Opioid Treatment Authority.¹⁷
• Certificate of need: SHPDA's State Health Plan uses four multi-county regions. A region shows need for a new clinic when projected treatment seekers exceed current clinic census by more than 10%. SHPDA may approve only one new clinic per region in each cycle and no more for 18 months after one is approved. No new clinic may sit within 50 linear miles of an existing one, though relocations within a region are allowed.⁶
• Need adjustments: the Statewide Health Coordinating Council can add need where opioid harm indicators exceed the national average and no clinic is within 50 miles. Applicants that serve patients regardless of ability to pay get preference.⁶
• Operations: dosing and counseling at least five days a week, with clinical staff reachable 24/7. Take-home doses are capped at 7 days in the first 14 days of treatment, 14 days from day 15 and 28 days from day 31. Programs check the central registry for dual enrollment and keep counselor caseloads at 50 or fewer. Interim treatment of up to 180 days needs SOTA approval.⁸
• Residential detox NTPs: a Level 3.7-D NTP may use buprenorphine, but it may dispense methadone only if it is also a certified OTP with a certificate of need.⁸
• Federal steps: SAMHSA grants one-year provisional certification only after state approval and DEA registration. The program must be accredited within that year.¹⁸

Other approvals you may need

• Life safety: ADMH classifies facilities under the NFPA Life Safety Code by type and size; for example, residential substance use rehabilitation and crisis facilities with four or more residents are board and care occupancies. Life Safety and Technical Services reviews plans for new construction and renovation.^{1, 5}
• Recovery residences: since July 2021 the Alabama Alliance for Recovery Residences (AARR) has been the state affiliate of the National Alliance for Recovery Residences (NARR). It works with ADMH and certifies homes to NARR standards. ADMH presented this certification as something homes can earn, not a requirement.¹⁹
• Medicaid enrollment: rehabilitative services providers must follow the Medicaid provider manual (Chapter 105), have their compliance approved in advance, and sign a non-institutional provider agreement. A CMHC route requires 310-board certification.⁷ ADMH posts a Medicaid performing provider application for substance use providers.²⁰

Recent changes

• June 14, 2024: SHPDA replaced the State Health Plan's substance use section. It told SHPDA to work with ADMH on defining which substance use treatment beds need a certificate of need, and to report within a year.⁶
• September 14, 2025: amendments to the chapter 580-2-20 personnel rule and its mental illness outpatient, outreach, day and residential rules took effect.⁹
• October 31, 2025: mental health, substance use and DD certification applications moved to ACAP.¹²
• January 1, 2026: prospective provider orientation became online-only through Relias, with both phases in one course.¹¹
• February 14, 2026: amendments to the OTP rule (580-9-44-.29) and the recipient protection rule (580-2-20-.04) took effect.^{8, 9}

Confirm these with ADMH and SHPDA

• Whether ADMH currently charges a certification application or inspection fee, and how much.
• Whether ADMH will accept your CARF, Joint Commission or COA accreditation in place of any part of its review.
• SHPDA's latest regional methadone need figures, and whether any residential substance use beds now need a certificate of need.
• Whether any state law, registry or funding rule now applies to recovery residences beyond voluntary AARR certification.
• Which Medicaid enrollment steps and fees apply to your provider type under Chapter 105 of the provider manual.
• The occupancy classification and life safety items for your building before you sign a lease.

Sources

1. Alabama Administrative Code, Chapter 580-3-23, Certification of community programs. admincode.legislature.state.al.us
2. Code of Alabama 1975, Section 22-50-11, Department powers. alison.legislature.state.al.us
3. Alabama Department of Mental Health, Certification administration. mh.alabama.gov
4. Alabama Department of Mental Health, Mental health and substance use certification. mh.alabama.gov
5. Alabama Department of Mental Health, Life safety and technical services. mh.alabama.gov
6. Alabama Administrative Code, Rule 410-2-4-.11, State Health Plan: substance use. admincode.legislature.state.al.us
7. Alabama Administrative Code, Chapter 560-X-47, Medicaid rehabilitative services. admincode.legislature.state.al.us
8. Alabama Administrative Code, Chapter 580-9-44, Substance use services program operations. admincode.legislature.state.al.us
9. Alabama Administrative Code, Chapter 580-2-20, Mental health and substance use program operation. admincode.legislature.state.al.us
10. Alabama Administrative Code, Chapter 580-2-9, Mental illness community programs. admincode.legislature.state.al.us
11. Alabama Department of Mental Health, Prospective community provider information and FAQs. share.articulate.com
12. Alabama Department of Mental Health, Becoming a community service provider. mh.alabama.gov
13. ADMH Relias Academy, Prospective provider orientation training (MHSU). admh.academy.reliaslearning.com
14. Alabama Administrative Code, Rule 410-1-7-.06, Filing of a certificate of need application. admincode.legislature.state.al.us
15. CMS, Federal Register notice CMS-6096-N, Provider enrollment application fee for calendar year 2026. govinfo.gov
16. SAMHSA, Approved accreditation bodies. samhsa.gov
17. Alabama Department of Mental Health, Substance use treatment services. mh.alabama.gov
18. SAMHSA, Become an opioid treatment program. samhsa.gov
19. Alabama Department of Mental Health, National certification achieved for recovery residences in Alabama (July 2021). mh.alabama.gov
20. Alabama Department of Mental Health, Medicaid performing provider application. mh.alabama.gov

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