Texas Behavioral Health & Substance Use Licensing Guide

Licensing agency

Health and Human Services Commission (HHSC)Health Care Regulation

Substance use license

Chemical dependency treatment facility (CDTF)One license per location; residential or outpatient

Rules

26 TAC Chapter 564Moved from former 25 TAC rules on April 30, 2024

Opioid treatment

Narcotic treatment program license26 TAC Chapter 563

Accreditation

Never required for a CDTF licenseCan replace HHSC’s inspection at renewal, when conditions are met

Who licenses behavioral health programs in Texas?

Substance use treatment facilities are licensed by HHSC as chemical dependency treatment facilities (CDTFs). HHSC’s Health Facility Licensing Unit processes applications, and its SUD Compliance Unit handles pre-licensure and physical plant questions.¹

Opioid treatment is licensed separately as a narcotic treatment program.²

Mental health: HHSC licenses private psychiatric hospitals and crisis stabilization units.³ HHSC describes community mental health centers as not state licensed or accredited; they are Medicare-certified.⁴ HHSC’s facility index has no separate outpatient mental health clinic license, so confirm the requirements for your model.

Co-located services: a CDTF applicant at a shared site must list its non-SUD services and review HHSC guidance letter GL 22-3003.¹

License types

• CDTF license, one per physical location, for residential or outpatient services. Detoxification programs must name a medical director.¹
• Faith-based programs using only nonmedical methods are exempt but must register with HHSC (Form 3202).¹
• Narcotic treatment program license, with medication units listed separately.²
• Private psychiatric hospital and crisis stabilization unit licenses.³
• Recovery housing is accredited voluntarily rather than licensed.⁵

Intensive outpatient and partial hospitalization are not named as separate license types on HHSC’s pages, so confirm how your levels of care fit the rules.

Law and rules

CDTFs are governed by Texas Health and Safety Code Chapter 464 and 26 TAC Chapter 564; narcotic treatment programs by Chapter 466 and 26 TAC Chapter 563; and psychiatric hospitals and crisis stabilization units by Chapter 577.^{1, 2, 6} The CDTF rules moved from former 25 TAC Chapters 441 and 448 on April 30, 2024, and the narcotic treatment program rules moved to 26 TAC Chapter 563 on November 29, 2024.^{1, 2}

How to apply for a CDTF license

1. Submit Form 3207 with the feeInclude the Form 3208 checklist. HHSC does not process the application until Accounts Receivable posts your fee.^{1, 7}
2. Add site documentsAn ADA checklist and a certificate of occupancy, or proof that your locality does not issue one.¹
3. Residential extrasFire, alarm, kitchen, gas-pressure and extinguisher inspections plus a bed floor plan. Detoxification adds the medical director.¹
4. On-site inspectionHHSC reviews records, interviews staff and tours the facility.¹
5. Watch the clockAn application left incomplete for six months is denied, and you must wait six months to reapply.¹

Licenses are not transferable; a sale means closure and a new application.¹ HHSC’s pages do not publish CDTF fee amounts or processing times, so confirm them with HHSC.

Narcotic treatment programs: HHSC requires SAMHSA certification and DEA registration before it considers your application (Form 3203), and it may inspect applicants unannounced.²

How accreditation counts in Texas

Accreditation is never required for a CDTF license, but it can replace an inspection. Health and Safety Code § 464.0055, added in 2011, directs HHSC at license renewal to accept a review by CARF, The Joint Commission or another recognized national accreditor in place of its own inspection, if the accreditor’s program meets HHSC’s minimums, it conducts regular on-site reviews and you file your latest review with the renewal.⁸ It applies at renewal, not initial licensure. Confirm the current list of recognized accreditors with HHSC.

Narcotic treatment programs are different: federal rules require current accreditation from a SAMHSA-designated body.⁹

Other approvals you may need

• Medicaid: enroll through TMHP’s Provider Enrollment and Management System (PEMS).¹⁰
• DEA and SAMHSA for narcotic treatment programs.²
• Local approvals: a certificate of occupancy, plus fire and kitchen approvals for residential sites.¹

Recent changes

• SB 437 (effective September 1, 2025): CDTF civil and administrative penalties must consider a provider’s ability to pay, and abuse and neglect training may be delivered live online.¹¹ HHSC proposed implementing rules on July 10, 2026.¹²
• Texas Certified Community Behavioral Health Clinic rules (26 TAC Chapter 306, Subchapter C) were proposed November 28, 2025, including Medicaid enrollment and managed care contract requirements and a three- to four-year certification term.¹³
• Open HHSC proposals on licensed chemical dependency counselor telehealth records (26R015) and transport standards for mental health facilities (26R095), with comment periods closing in late October and early November 2026.¹⁴
• 2026 guidance letters on registry searches (GL 26-2002), itemized billing (GL 23-2002-A) and incident reporting (GL 27-0001).¹⁵

Confirm these with the agency

• Fee amounts, processing time and whether the pre-licensure inspection must come before opening.
• Form 3207 still cites old 25 TAC 448 sections, so confirm the current checklists.
• How your levels of care and counselor credentials fit the rules.
• Which accreditors HHSC recognizes under § 464.0055 and what to file at renewal.
• The sequence of SAMHSA, DEA and HHSC approvals for opioid treatment programs.

Sources

1. Texas HHSC, Chemical dependency treatment facilities. hhs.texas.gov
2. Texas HHSC, Narcotic treatment programs and medication units. hhs.texas.gov
3. Texas HHSC, Hospitals, private psychiatric hospitals and crisis stabilization units. hhs.texas.gov
4. Texas HHSC, Community mental health centers. hhs.texas.gov
5. Texas HHSC, Substance use disorder services. hhs.texas.gov
6. Texas Health and Safety Code, Chapter 464. statutes.capitol.texas.gov
7. Texas HHSC, Form 3207, CDTF license application. hhs.texas.gov
8. Texas SB 1449 (82nd Legislature, 2011), enrolled text adding Health and Safety Code § 464.0055. capitol.texas.gov
9. 42 CFR Part 8 (eCFR). ecfr.gov
10. TMHP, Provider enrollment. tmhp.com
11. Texas Legislature, SB 437 (89th Legislature) bill analysis. capitol.texas.gov
12. Texas Register, Proposed rules (July 10, 2026). sos.state.tx.us
13. Texas Register, Proposed rules (November 28, 2025). sos.state.tx.us
14. Texas HHSC, Comment on proposed and draft rules. hhs.texas.gov
15. Texas HHSC, Health care facility regulation guidance letters. hhs.texas.gov

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