Behavioral health designation and licensing

 

Program designation and licensing for mental health and substance use disorder treatment

The Colorado Department of Human Services, Office of Behavioral Health (OBH) is responsible for licensing substance use disorder treatment programs and designating mental health treatment programs that receive public funding.

About substance use disorder treatment licenses

The substance use disorder treatment license identifies the level of intensity of the services provided, including residential, outpatient or withdrawal management (detox), and any specialized populations an agency serves. Specialized populations include individuals referred for treatment following a Driving Under the Influence (DUI) conviction, individuals required through their involvement in the criminal justice system to complete treatment as a part of a court sentence, or mothers receiving treatment tailored to meet their needs. Intensity of service ranges from once per week outpatient treatment all the way to residential services.

Licensed substance use treatment programs may include:

Outpatient counseling, residential treatment, withdrawal management ("detox") programs, intensive outpatient (IOP)services, residential programs for pregnant women, and opioid treatment programs that provide methadone, buprenorphine and naltrexone.

Licensed substance use treatment programs do NOT include:

Private substance use treatment programs that do not accept public funding including outpatient and residential programs, sober living homes, recovery services, non-clinical groups such as AA, sports or physical therapy programs for individuals in recovery.

About mental health designations

The Office of Behavioral Health oversees the mental health programs that provide mental health services to children, adolescents and/or adults. Community mental health centers and community mental health clinics require a facility license from the Colorado Department of Public Health and designation (program approval) from the Office of Behavioral Health. OBH designation is based on state rules and regulations from the Code of Colorado Regulations and is required to receive OBH funding to provide mental health treatment.

Designated mental health programs may include: Community mental health centers, community mental health clinics, and residential child care facilities.
Designated mental health programs do NOT include: Hospital emergency rooms, private psychologists or psychiatrist offices (outpatient), primary care offices that provide mental health services, wellness or mindfulness programs, prisons, or jails.
About 27-65 designations for involuntary/mental health holds

A facility that places individuals on involuntary holds or into involuntary treatment for mental health must be designated by the Office of Behavioral Health to provide services as specified under 27-65 C.R.S., Care and Treatment of Persons with Mental Health Disorders. This process may also be called a "72-hour hold", an "M-1 hold" a "mental health hold." These agencies must verify that they are in compliance with the conditions set forth in statute, and that they have proper clinical and infrastructure support to protect the rights of individuals whose mental health disorders render them a danger to themselves or others.

Programs designated under 27-65 may include: Psychiatric units within hospitals, psychiatric hospitals, crisis stabilization units, acute treatment units and psychiatric residential treatment facilities.
Programs designated under 27-65 do NOT include: Community mental health clinics, outpatient substance use disorder programs, hospital emergency rooms, private psychologists or psychiatrist offices (outpatient), primary care offices that provide mental health services, wellness or mindfulness programs, prisons, or jails.
Frequently asked questions

Frequently asked questions about licensing and designation through the Office of Behavioral Health
(Print PDF)

What is the difference between licensing and designation?

OBH licenses agencies to provide substance use disorder (SUD) treatment. A license from the Office of Behavioral Health is needed to provide treatment to people who have received Driving Under the Influence (DUI) charges, to people involved with the criminal justice system, or to receive public funding to provide SUD treatment. OBH also licenses all programs that use controlled substances to treat substance use disorder, including medically-managed withdrawal management (detox) and opioid treatment programs, regardless of public or private funding.

OBH designates mental health programs to provide mental health services. Community mental health centers and community mental health clinics require a health facility license from the Colorado Department of Public Health and Environment and a designation from the Office of Behavioral health in order to operate with public funds.

Can you point me toward the licensing standards or requirements that substance use providers would have to meet in order to obtain a license?

All requirements for licensing are contained in 2 CCR 502-1. The licensing standards for substance use treatment facilities are located in multiple locations. They include standards on staffing, admissions, data collection and reporting, quality improvement, application and revocation of a license, license expiration, background checks for staff, use of records, service plans, type of care provided, and rules specific to special populations such as adolescents.

  • Licensing standards differ based on the type of service provided and are found primarily in Code of Colorado Regulations, Volume 21:

    • Section 21.100 through Section 21.190 are rule sections that all licensed substance use disorder providers must follow, which includes the general licensing procedures (21.120).

    • Rule Section 21.200 covers the care and treatment of children, youth and families,

    • Section 21.210 is specific to agencies licensed to provide substance use disorder services,

    • Section 21.220 covers gender-responsive women's treatment for substance use disorder programs,

    • Section 21.230 covers substance use disorder education and treatment for person involved in the criminal justice system, Section 21.240 covers DUI/DWAI, BUI, and FUI education and treatment,

    • Section 21.250 covers non-hospital residential withdrawal management,

    • Section 21.300 covers licensing of addiction programs using controlled substances, Section 21.310 covers medically monitored inpatient detoxification, and,

    • Section 21.320 covers opioid medication assisted treatment.

How do I know if I need a license? Are both private/commercial-pay providers and publicly funded providers required to be licensed?

Providers are required to be licensed under the following conditions:

  • A license from the Office of Behavioral Health is needed in order to:

    • Provide treatment to people who have received Driving Under the Influence (DUI) charges,

    • Provide treatment to people involved with the criminal justice system, or

    • Receive public funding to provide SUD treatment.

    • Operate a program the uses controlled substances to treat substance use disorder, including medically-managed withdrawal management (detox) and opiate treatment programs, regardless of public or private funding.

  • Some providers choose to be licensed even though they do not meet the above criteria, but it is not a condition of operation outside of the above described circumstances.

  • Colorado has state laws and regulations that set these standards.

Do I need to have a mental health designation to bill for services provided in my agency by a non-licensed person?

A designation is intended only as approval for those programs with whom OBH contracts for services. OBH does not determine which services are reimbursed by insurance companies or third party payers, including Colorado Health First (Medicaid).

Will I have to have a facility inspection for an SUD license or a mental health designation?

Yes. OBH staff will conduct a site visit once the initial application is approved to determine that the agency location and facility is appropriate for the provision of behavioral health services.

What are the steps in the initial licensing or designation process if an agency does not yet have an OBH license or designation?

  1. Prospective applicants should review the OBH treatment rules to determine whether the services they wish to provide are regulated by OBH.
  2. Applicant should complete the appropriate application through the LADDERS website, and include their program policies and procedures, which should be uploaded in electronic form through the application website.

  3. Once the application has been submitted and the appropriate fee paid, the application will be assigned to a program staff member to review.

  4. The program staff member will contact the applicant to schedule and conduct a site visit once he or she has determined that the agency is in compliance with the OBH treatment rules.

  5. OBH grants the applicant a provisional license or designation for 90 days if the agency is in substantial compliance with rules and needs a small amount of time to verify full compliance.

  6. Once OBH can verify by reviewing records that the entity is in full compliance, OBH grants a 2 year designation or license. The license must be renewed prior to expiration if the provider wishes to continue to operation without interruption.

We are a medical practice and want to become licensed as a substance use disorder treatment program so that we can provide medication-assisted treatment for opiate addiction. What do we need to do?

Physicians, nurse practitioners and physician's assistants can provide office-based medication for opioid addiction (with the appropriate training) without being licensed through OBH as an SUD program unless you wish to provide methadone. Primary care providers prescribing and administering depo-naltrexone or buprenorphine are not regulated by OBH. However, if a provider wanted to prescribe or administer methadone FOR SUBSTANCE USE TREATMENT (not for pain or other approved use), they are required to apply for a controlled substance license through LADDERS and to register with SAMHSA, the Center for Substance Abuse Treatment and the Drug Enforcement Administration as an Opioid Treatment Program.(see questions 13-14).

We have a set of policies and procedures from an agency we own in another state. Can we submit those for our agency in Colorado?

Many of Colorado's requirements are specific to our state, and your policies and procedures are needed to document what you will do to assure compliance with Colorado's treatment rules. You should review your existing policies and procedures to determine what needs to be modified to meet Colorado's requirements, and then tailor the documents you submit to these specifications.

We are applying for an SUD license. Many of our staff are medical, or have mental health licenses. We would like to request a waiver of the 50% certified addiction counselor (CAC) requirement (rule 21.210.1) so that our current staff can be considered sufficient to provide services under the license we want.

Please consider whether a substance use disorder treatment license is what you want. OBH treatment rules require that SUD treatment programs be staffed with professionals with training and experience in addiction treatment as evidenced by current CAC or licensed addiction counselor (LAC) certification.

I am concerned our facility can not meet one or two requirements in rule. How do we request rule waivers so that we can operate the programs we want to?

21.120.7 WAIVERS [Eff. 11/1/13] Every licensed and designated agency shall comply in all respects with applicable rules. Upon application to the Department, a waiver of the specific requirements of these rules may be granted in accordance with this section, unless the requirements are otherwise required by state or federal law, and individual rights shall not be waived. 

Can I get technical assistance to assist me in completing the application process?

OBH has limited capacity to assist in the application process, however, once an application is submitted and a program staff member has been assigned, more specific questions about your program and application can be addressed.

I am planning to sell my substance use disorder treatment agency to another company-can I sell my license along with other assets?

No. When an agency changes ownership, the new owner has to apply for a new license. Licenses are not transferable from one business to another.

What is a controlled substance license and why would I need one?

Controlled substance licenses allow approved agencies to dispense, compound, or administer a controlled substance in order to treat an addiction or to treat the withdrawal symptoms of an addiction. A controlled substance license is not required for a physician or prescriber in an office-based opioid treatment program setting whose patients obtain their medication from a pharmacy.

How is methadone different from other medications for addiction? Why can't our doctor simply prescribe methadone to our patients?

In order to use methadone to treat addiction, an agency must be licensed as an opioid medication assisted treatment program (OMAT). Because the doses used to treat addiction could be lethal to a person who obtains the drug by accident, access to methadone is highly regulated at both state and federal levels. A doctor who is unaffiliated with a licensed OMAT program may not prescribe or dispense methadone to any patients for the purpose of treating addiction, although methadone at lower doses may be used to treat pain and can be prescribed by a physician without an OMAT license.

What is LADDERS?

LADDERS is the State of Colorado's online portal that allows mental health and substance use disorder treatment providers to apply electronically for a designation or license. Paper applications are no longer accepted. Provider user names and passwords may be requested through the website. With a user name and password, a provider may sign in, update a directory profile and submit license and designation applications. For more information, check out the LADDERS fact sheet.