Massachusetts Behavioral Health & Substance Use Licensing Guide

Substance use license

DPH Bureau of Substance Addiction Services (BSAS)105 CMR 164.000, under M.G.L. c. 111E

First step

Notice of Intent and suitability reviewYou must show need; approval is valid one year

Mental health

DPH clinic license or DMH license105 CMR 140.000; 104 CMR 27.00 and 28.00

Opioid treatment

BSAS license plus State Opioid Treatment Authority approvalStarts with a six-month provisional license

Accreditation

Required for DMH-licensed hospitals and for OTPsBSAS grants deemed status only at OTP license renewal

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

Who licenses behavioral health programs in Massachusetts?

Substance use treatment: BSAS, part of the Department of Public Health. It licenses or approves every substance use disorder treatment program under 105 CMR 164.000. That includes separate programs inside DPH-licensed hospitals and clinics and inside DMH-licensed facilities, which receive an Approval rather than a stand-alone license. Commonwealth agencies also need an approval, and federal programs are exempt.²

Outpatient mental health: a DPH clinic license under 105 CMR 140.000, with a mental health services designation. Practices wholly owned by their practitioners are generally not clinics, unless they use a name such as clinic or institute.⁷

Inpatient and residential mental health: DMH. DMH licenses hospital psychiatric units and intensive residential treatment programs (IRTPs) for adolescents.⁹ Its Community Licensing Division licenses mental health residential programs and community crisis stabilization, and it certifies PACT teams.¹¹ A psychiatric facility with a distinct substance use unit needs both DMH and BSAS licenses. One that offers only incidental care, such as medication for addiction treatment, needs only DMH.¹²

BSAS service settings

• 24-hour diversionary services: medically managed withdrawal (acute treatment services) and clinical stabilization services
• Outpatient services: counseling, outpatient withdrawal management, day treatment, acupuncture withdrawal management, office-based opioid treatment and driver alcohol programs
• Opioid treatment programs
• Residential rehabilitation: for adults, families, adolescents and transition-age youth, and second OUI offenders^{1, 2}

Partial hospitalization and intensive outpatient are not BSAS license types.¹ Day treatment, the closest BSAS service, means at least 3.5 hours a day, three to seven days a week. Running or advertising an unlicensed program can bring fines of up to $500 for a first offense and up to $1,000 after that, or up to two years in prison.²

Law and rules

105 CMR 164.000 rests on M.G.L. c. 111B, c. 111E §7 and other statutes. Its current text carries a November 11, 2022 date.² Section 7 sets two-year licenses and limits need standards to the needs of people with substance use disorders and the applicant's record of meeting them. It also directs DPH to require service to publicly insured residents without discrimination and quarterly payer-mix reports.³ Clinics follow 105 CMR 140.000, last amended in February 2025.⁷ DMH facilities follow 104 CMR 27.00 for hospitals and IRTPs and 104 CMR 28.00 for community programs.^{10, 11} BSAS can waive some requirements under 105 CMR 164.023 and publishes a waiver request form.^{2, 6}

How to apply for a BSAS license

1. Secure the siteThe Notice of Intent form asks you to have site control before you file, and asks about local zoning approval.⁴
2. File a Notice of IntentEmail a notarized NOI with resumes and CORI forms for owners and officials, organization charts, articles and bylaws, a demonstration of need and a financial plan covering at least the six-month initial license.⁴ At least one owner, board member or executive director needs substance use treatment experience.⁵
3. Suitability decisionNOIs are reviewed in the order received, with no fixed timeline. An approval is valid for one year.⁵
4. Apply in eLicensingApproved applicants get the BSAS eLicensing application through the Virtual Gateway. A regional licensing inspector handles the application and the on-site inspection.¹
5. License issuedThe license runs six months or two years. A provisional license lasts up to six months and can be renewed once.²

Changes and renewals: licenses do not transfer. A buyer files a Notice of Intent at least 90 days before the sale and a license application within two business days after it. A move needs 90 days' notice and is treated as an initial license. Renewals are due 60 days before expiration.²

Licensing fees

Commonwealth applicants pay no BSAS fee.² Clinic fees are set in 801 CMR 4.02 and refunded only if you withdraw.^{8, 7} DMH does not publish its fees in 104 CMR 27.00.¹⁰

How accreditation counts in Massachusetts

BSAS programs: there is no general deemed status. Programs subject to accreditation must keep it and send proof to DPH.² At OTP license renewal, DPH may accept non-provisional accreditation as evidence of compliance. You share the survey findings and let DPH observe the summation conference. A denial of deemed status cannot be appealed.²

DMH hospitals and IRTPs: they must be accredited by The Joint Commission or another accreditor DMH approves, or show compliance and a plan to get there. Accredited facilities can request deemed status, which narrows DMH's biennial survey to restraint and seclusion, human rights, complaints, interpreter services and clinical services.¹⁰

Clinics: deemed licensing based on accreditation under 105 CMR 140.000 is limited to ambulatory surgery centers.⁷

MassHealth CBHCs: accreditation is not an eligibility criterion. A CBHC must report any citation or loss of accreditation from bodies such as The Joint Commission or CARF within 15 days.¹⁵

Opioid treatment: OTPs need a SAMHSA-approved accreditor. Massachusetts requires accreditation by the end of the first year of operation.^{2, 14}

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

Opioid treatment programs

• Two state approvals: a BSAS license and State Opioid Treatment Authority approval. Each new or relocated site and each ownership transfer needs both again.²
• Public interest test: DPH decides whether the proposed site serves public health. If it does, DPH notifies SAMHSA and issues a six-month provisional license before considering a two-year license.²
• Controlled substances: a DEA narcotic treatment registration and a Massachusetts Controlled Substances Registration from DPH's Drug Control Program.^{2, 13} BSAS advises filing all applications at once, with DEA before the Drug Control Program. The two agencies inspect jointly.¹³
• Federal certification: SAMHSA grants provisional certification for up to one year, only after state and DEA approvals.¹⁴

Other approvals you may need

• MassHealth: substance use programs need the matching BSAS license, Medicare enrollment where eligible and a separate enrollment for each site.¹⁷
• Community behavioral health centers: a DPH clinic license with mental health and substance use designations, or a hospital license, plus a BSAS approval for outpatient counseling and withdrawal management. A CBHC also needs Medicare enrollment and a CLIA waiver. MassHealth decides within 60 days of a complete application.¹⁵ The 25 CBHCs provide 24/7 mobile crisis care under the state's behavioral health Roadmap.¹⁶
• Sober homes: no license is needed. BSAS runs a voluntary certification, and state agencies and their statewide vendors may refer people only to certified homes.¹⁸ BSAS has pointed operators to MASH for certification.¹⁹
• Determination of need: a clinic subject to Determination of Need must show need before an original license or a new satellite.⁷
• Local approvals: current building, fire and sanitary certificates.²

Recent changes

• Chapter 285 of the Acts of 2024: since July 1, 2025, treatment facilities must show patients with a history of opioid use, opioid use disorder or an overdose how to use an opioid antagonist, and give them at least two doses at discharge.^{20, 21} The act also created DPH licensing for recovery coaches and set December 31, 2026 to end the use of the Massachusetts Alcohol and Substance Abuse Center for civil commitments.²⁰
• September 2025: BSAS updated its Notice of Intent and suitability FAQ.^{4, 5}
• November 11, 2025: a DMH bulletin set substance use standards for psychiatric units and explained when BSAS dual licensure applies.¹²
• February 16, 2026: the compliance date for the federal 42 CFR Part 2 rule on substance use records.²³
• April 27, 2026: DPH held a hearing on changes to counselor licensing (105 CMR 168.000) that follow the 2024 law.²²

Confirm these with BSAS, DPH and DMH

• BSAS renewal fees and DMH license fees, which the rules do not list.
• Whether your outpatient model needs a clinic license, a BSAS license or both, and how a PHP or IOP fits BSAS day treatment.
• Whether Determination of Need applies to your project.
• Which accreditors besides The Joint Commission DMH accepts.
• When recovery coach licensure takes effect, and the status of the 105 CMR 168.000 amendments.
• For OTPs: the current State Opioid Treatment Authority process and timeline.

Sources

1. Massachusetts DPH, BSAS, Information for initial SUD program licensure. mass.gov
2. Massachusetts DPH, 105 CMR 164.000, Licensure of substance use disorder treatment programs. mass.gov
3. Massachusetts General Laws, Chapter 111E, Section 7. malegislature.gov
4. Massachusetts DPH, BSAS, Notice of Intent to apply for a SUD treatment program license (September 2025). mass.gov
5. Massachusetts DPH, BSAS, Suitability and licensure FAQ (September 2025). mass.gov
6. Massachusetts DPH, BSAS, Information for licensed substance use disorder treatment programs. mass.gov
7. Massachusetts DPH, 105 CMR 140.000, Licensure of clinics. mass.gov
8. Executive Office for Administration and Finance, 801 CMR 4.00, Rates. mass.gov
9. Massachusetts DMH, Licensing divisions. mass.gov
10. Massachusetts DMH, 104 CMR 27.00, Licensing and operational standards for mental health facilities. mass.gov
11. Massachusetts DMH, Community Licensing Division. mass.gov
12. Massachusetts DMH, Inpatient Licensing Division bulletin on co-occurring substance use disorders (November 11, 2025). mass.gov
13. Massachusetts DPH, BSAS, Opioid treatment program new applicant licensing workflow. mass.gov
14. SAMHSA, Become an opioid treatment program. samhsa.gov
15. MassHealth, 130 CMR 448.000, Community behavioral health center services. mass.gov
16. Massachusetts EOHHS, Roadmap for behavioral health reform. mass.gov
17. MassHealth, 130 CMR 418.000, Substance use disorder treatment services. mass.gov
18. Massachusetts General Laws, Chapter 17, Section 18A. malegislature.gov
19. Massachusetts DPH, BSAS, Referrals limited to certified sober homes (2016). mass.gov
20. Massachusetts Acts of 2024, Chapter 285. malegislature.gov
21. Massachusetts General Laws, Chapter 94C, Section 19D½. malegislature.gov
22. Massachusetts DPH, Proposed amendments to licensure of alcohol and drug counselors. mass.gov
23. U.S. HHS, Fact sheet: 42 CFR Part 2 final rule. hhs.gov

This guide summarizes Massachusetts statutes, regulations and agency pages as of the date above. It is general information, not legal advice. Requirements change; confirm with BSAS, DPH or DMH before you apply.