Virginia Behavioral Health & Substance Use Licensing Guide

Licensing agency

DBHDS Office of LicensingRules in 12VAC35-105

Substance use licenses

One license per service, by ASAM levelLevels 1.0 to 4.0, plus opioid use disorder treatment

Applications

CONNECT Provider PortalTraining and an exam first for priority services

License fee

None set in 12VAC35-105Children’s residential: $500 initial, $100 renewal

Accreditation

Required for opioid treatment programsNo deemed status for other licenses; inspections are annual and unannounced

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

Who licenses behavioral health programs in Virginia?

The DBHDS Office of Licensing. The Commissioner of the Department of Behavioral Health and Developmental Services issues licenses under State Board rules, and no provider may operate a service without one.⁹ Hospitals, community services boards and private organizations all count as providers; individual practitioners licensed by a Department of Health Professions board do not.³ DBHDS also certifies recovery residences and is the state opioid treatment authority (SOTA).^{7, 9} The Department of Medical Assistance Services (DMAS) runs Medicaid, including Addiction and Recovery Treatment Services (ARTS).²²

Services DBHDS licenses

Each service is licensed separately, and the license addendum lists the services, populations, locations and residential capacity.⁹ Substance use services follow the ASAM levels of care:

• Outpatient (1.0), intensive outpatient (2.1) and partial hospitalization (2.5)
• Clinically managed residential: low-intensity (3.1), population-specific high-intensity (3.3) and high-intensity (3.5)
• Medically monitored (3.7) and medically managed (4.0) intensive inpatient
• Medication for opioid use disorder treatment and case management⁹

The same chapter covers mental health outpatient, intensive outpatient and partial hospitalization, crisis services and assertive community treatment.⁹ Adolescent residential treatment at Levels 3.1 and 3.5 and psychiatric residential treatment facilities fall under the children’s residential rules.^{12, 10}

Law and rules

Licensing rests on Code of Virginia section 37.2-403 et seq.³ The main rule is 12VAC35-105;⁹ children’s residential facilities follow 12VAC35-46¹⁰ and recovery residences 12VAC35-260.¹¹ Medicaid ARTS coverage is in 12VAC30-130-5000 onward, based on the third edition of the ASAM Criteria.²² DBHDS has begun a standard rulemaking to split 12VAC35-105 into a general chapter and five service chapters, a process it said usually takes up to two years.¹⁷

How to apply for a DBHDS license

1. Check the priority levelDBHDS ranks services as Priority 1, Priority 2 or non-priority, and does not always review in date order. Opioid treatment and adult Level 3.3 are Priority 1; adult Levels 1.0 and 3.5 are Priority 2; adult Level 2.1 is non-priority.^{12, 2}
2. Finish the orientationSince November 7, 2025, Priority 1 and 2 applicants must complete a 16-module orientation, now in the TRAIN system, and score 85% or better on a proctored exam first. Otherwise the application joins the non-priority waitlist.^{13, 2}
3. Build the packageA first-year budget, funds or credit for 90 days of operating expenses, authority to do business in Virginia, disclosure of other licenses and sanctions, and per service a staffing plan, job descriptions, service description and records policy. New sites need a certificate of use and occupancy.⁹
4. Apply in CONNECTSubmit within 90 days of creating the application, or it is closed.²
5. Onsite review and conditional licenseNew services are reviewed on site and start on a conditional license of up to six months, 12 months at most with renewals, with no new services or locations meanwhile.⁹ A January 2026 memo limits providers to one active conditional license, with case-by-case exceptions.¹⁴
6. Full licenseOne year, or up to three years for providers that show sustained compliance.^{9, 5}

Changes and ownership: modifications need an application at least 30 days ahead and approval before they take effect. Licenses do not transfer; a new owner files a new application.⁹

Licensing fees

The Code lets the State Board set a reasonable fee.⁵ Children’s residential fees are nonrefundable, are charged again after a closed, denied or withdrawn application, and do not apply to government facilities.¹⁰

How accreditation counts in Virginia

Licensing: 12VAC35-105 gives accredited programs no deemed status or survey waiver, and DBHDS inspects every service unannounced at least once a year.⁹ With no general license fee, there is no fee discount.

Opioid treatment: programs must stay accredited by a federally approved body.⁹ SAMHSA’s list includes CARF, Social Current (formerly COA) and The Joint Commission.²³

Medicaid: the DMAS enrollment vendor and health plans may ask for Joint Commission or CARF accreditation during credentialing.²¹

Recovery residences: certification relies on a credential from the Virginia Association of Recovery Residences (VARR), which uses NARR standards, or an Oxford House charter.^{19, 7}

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

Opioid treatment programs

• Local notice: for a methadone program, the Commissioner notifies the local government and community services board within 15 days. They have 30 days to comment, the locality confirms ordinance compliance, and no license issues before then.⁴
• Site and staff: zoning, building and fire code compliance, parking, a medication security plan meeting DEA and Board of Pharmacy rules, a program sponsor, program director, Virginia-licensed medical director, prescriber, nurses, counselors and a community liaison.⁹
• Registrations: DEA, federal HHS certification and the Virginia Board of Pharmacy, plus accreditation.⁹
• Hours: daily-dosing programs open seven days a week except state holidays; Sunday closing needs SOTA approval.⁹
• Mobile units: must operate as part of a licensed location and appear on its addendum.⁹ A further change adopting federal mobile rules is pending.¹
• Certificate of public need: the COPN law does not list opioid treatment programs, but it does cover DBHDS-licensed hospitals and substance use intermediate care facilities.²⁴

Other approvals you may need

• Medicaid ARTS: Levels 2.1 to 4.0 and opioid treatment programs send their DBHDS license to the DMAS enrollment vendor and each of the five health plans. Levels 0.5 and 1.0 need Department of Health Professions licensure, though a DBHDS Level 1.0 license is allowed. Since July 2026, new office-based addiction treatment providers enroll with an attestation letter.^{21, 20}
• Recovery residences: each location needs DBHDS certification to operate. Conditional certification lasts up to six months, plus one renewal of up to three. Deaths and serious injuries are reported within 48 hours. Operating uncertified is a Class 1 misdemeanor.^{7, 11, 19}
• Background checks: fingerprint checks for direct care staff in adult substance use and mental health services.⁶

Recent changes

• November 7, 2025: mandatory orientation and exam for priority applicants.¹³
• December 1, 2025: opioid treatment rules aligned with federal changes, dropping the one-year addiction history rule for adults, allowing a take-home dose in week one and telehealth screening, and cutting minimum drug screens from 12 to 8 a year.¹⁸
• 2026 legislation: section 37.2-405.3 requires rules on emergency medical drills and a CPR-trained employee on duty at each location.⁸ The recovery residence law was amended in 2025 and again in 2026.⁷
• Behavioral health redesign: emergency rules effective September 28, 2026 to March 27, 2028 add Community Psychiatric Support and Treatment, Coordinated Specialty Care and Recovery and Empowerment Centers.¹⁶ Applications are due January 15, 2027, and licenses for therapeutic day treatment, intensive in-home, mental health skill-building and psychosocial rehabilitation close July 1, 2027.¹⁵

Confirm these with DBHDS

• Whether any fee applies; the Code allows one even though 12VAC35-105 sets none.
• Your service’s priority level and current waitlist.
• The status of the regulation overhaul, the permanent redesign rules, the CPR and drill rules, and the mobile unit change.
• For opioid treatment programs: zoning and the local comment process.
• For residential projects: whether COPN review applies (Virginia Department of Health).
• With DMAS: any move past the third edition of the ASAM Criteria, and health plan credentialing deadlines.

Sources

1. Virginia DBHDS, Office of Licensing. dbhds.virginia.gov
2. Virginia DBHDS, Licensing information for applicants and providers. dbhds.virginia.gov
3. Code of Virginia, 37.2-403, Definitions. law.lis.virginia.gov
4. Code of Virginia, 37.2-406, Conditions for initial licensure. law.lis.virginia.gov
5. Code of Virginia, 37.2-410, License renewal and fees. law.lis.virginia.gov
6. Code of Virginia, 37.2-416.1, Background checks. law.lis.virginia.gov
7. Code of Virginia, 37.2-431.1, Recovery residences. law.lis.virginia.gov
8. Code of Virginia, 37.2-405.3, Emergency medical simulations; CPR. law.lis.virginia.gov
9. Virginia Administrative Code, 12VAC35-105, Licensing providers. law.lis.virginia.gov
10. Virginia Administrative Code, 12VAC35-46, Children’s residential facilities. law.lis.virginia.gov
11. Virginia Administrative Code, 12VAC35-260, Certified recovery residences. law.lis.virginia.gov
12. Virginia DBHDS, Prioritization list for initial applications. dbhds.virginia.gov
13. Virginia DBHDS, Initial applicant orientation memo (October 2025). dbhds.virginia.gov
14. Virginia DBHDS, One active conditional license memo (January 2026). dbhds.virginia.gov
15. Virginia DBHDS, Pre-application training and legacy service closure memo (August 2026). dbhds.virginia.gov
16. Virginia DBHDS, Emergency regulations memo (October 2026). dbhds.virginia.gov
17. Virginia DBHDS, Overhaul of licensing regulations memo (August 2025). dbhds.virginia.gov
18. Virginia Register of Regulations, 12VAC35-105 opioid use disorder amendments (42:3). register.dls.virginia.gov
19. Virginia DBHDS, Information for providers about recovery residences. dbhds.virginia.gov
20. Virginia DMAS, ARTS credentialing and resources for providers. dmas.virginia.gov
21. Virginia DMAS, Pathways to becoming an ARTS Medicaid provider (July 2026). dmas.virginia.gov
22. Virginia Administrative Code, 12VAC30-130, Part XX, Addiction and recovery treatment services. law.lis.virginia.gov
23. SAMHSA, Approved accreditation bodies for opioid treatment programs. samhsa.gov
24. Code of Virginia, 32.1-102.1:3, Facilities requiring a certificate of public need. law.lis.virginia.gov

This guide summarizes Virginia statutes, regulations and DBHDS and DMAS publications as of the date above. It is general information, not legal advice. Requirements change; confirm with DBHDS before you apply.