1. Licensure and Legal Standing

• Must hold a valid, current Residential Treatment Facility (RTC) license or Residential Program license appropriate to its level of care (e.g., SUD, MH, Dual Diagnosis).

• Must provide evidence of full compliance with:

  • Local building codes (fire, zoning, occupancy).

  • State DHHS/DSS regulations.

  • Federal guidelines (HIPAA, ADA, CFR 42 Part 2).

• Must maintain minimum accreditation (Joint Commission, CARF, or similar) before applying for Commissioned status.

2. Clinical Leadership Requirements

• Clinical Director must have:

  • Master’s degree or higher in behavioral health field.

  • Independent licensure (LCSW, LMFT, LPCC, PsyD, MD, etc.).

  • Minimum 7 years post-licensure experience, with 3 years specifically in residential care leadership.

• Medical Director (if applicable):

  • Must be a board-certified physician (preferably psychiatrist or addictionologist).

3. Program Composition and Services

• Program must provide:

  • 24/7 awake staff coverage.

  • Clinical services minimum 5 days per week (can include IOP/OP services onsite).

  • Access to individual therapy weekly.

  • Family engagement as standard practice.

  • Structured Life Skills Programming (budgeting, cooking, hygiene, job prep) minimum 3 hours/week.

  • Medication management by licensed clinicians if medications are prescribed.

4. Facility and Environment Standards

• Private or semi-private bedrooms — no more than two beds per bedroom unless state-licensed for higher occupancy.

• Living space must include:

  • Separate recreational space.

  • Quiet spaces for therapy and reflection.

  • Secure medication storage.

  • Emergency evacuation plan posted and practiced quarterly.

• Facility must maintain:

  • Annual fire inspection clearance.

  • Annual health department inspection.

  • Quarterly safety and cleanliness inspections (internal).

5. Staffing Requirements

• Minimum 80% of all direct care staff must be:

  • Licensed/certified OR

  • Bachelor's level with at least 2 years direct residential experience.

• Clinical supervision required monthly for all staff.

• Staff-to-client ratio must meet or exceed:

  • 1:6 during awake hours, 1:10 overnight.

6. Outcome and Quality Assurance Requirements

• Use validated outcome measures (e.g., BASIS-24, ASAM).

• Track and report admission, completion, relapse, and readmission rates.

• Must maintain:

  • Minimum 65% program completion rate.

  • Self-reported improvement in quality of life/symptoms (minimum 50% success rate).

• Submit a written Quality Improvement Plan (QIP) annually.

7. Ethics, Client Rights, and Transparency

• Written Client Rights Policy — posted visibly and distributed at admission.

• Ethical Marketing Policy banning:

  • Patient brokering

  • Kickbacks

  • Deceptive advertising

• Full disclosure of:

  • Ownership interests.

  • Referral relationships.

  • Financial affiliations.

8. Safety, Emergency Preparedness, and Risk Management

• Emergency Operations Plan (natural disaster, fire, elopement, overdose, suicide crisis).

• Annual safety drills documented (fire, medical emergency, etc.).

• Staff must be trained annually in:

  • First Aid/CPR

  • Naloxone administration (opioid reversal)

  • Suicide risk assessment

• Maintain:

  • $2M/$4M professional liability insurance.

  • $1M minimum property insurance.

9. Cultural Competency and Client-Centered Care

• Cultural competency training mandatory annually for all staff.

• Commitment to serve clients without discrimination based on:

  • Race

  • Gender

  • Religion

  • Sexual orientation

  • Disability

• Translation/interpretation services or accessible materials for non-English speakers.

10. External Peer Review and Oversight

• Peer chart reviews required annually.

• Anonymized quarterly outcome reports submitted to BHSO.

• Subject to random site inspections without prior notice.

• Executive team and Clinical Director must pass BHSO Executive Interview:

  • Organizational philosophy

  • Ethical compliance

  • Incident management policies