Maryland Behavioral Health Program License: COMAR 10.63

How Maryland BHA licenses behavioral health programs under COMAR 10.63: prerequisites, accreditation, renewal deadlines, penalties and the proposed rewrite.

As of October 2026. Maryland has proposed a full rewrite of COMAR 10.63 that is not yet final, so confirm the current text with the Behavioral Health Administration before you file.

If you run or are opening a residential, withdrawal management, PHP, IOP or crisis program in Maryland, your license comes from one place: the Behavioral Health Administration (BHA) inside the Maryland Department of Health. Many older guides, including some still in circulation, point operators to the Alcohol and Drug Abuse Administration. That agency is not the licensing body today.

Maryland licenses community behavioral health programs program by program and site by site under COMAR 10.63, and a renewal received less than 60 days before expiration suspends the license on its expiration date. Those two facts drive most of the planning work for a multi-site operator. On top of them sits a proposed repeal-and-replace of the entire subtitle, published in August 2026, that would change renewal windows, review clocks and incident reporting.

This guide covers what the rules require today, what the proposal would change, and a checklist you can hand to your compliance lead. For the wider state picture, see our Maryland behavioral health hub.

Who needs a license from BHA, and who is exempt

The statute is short. Health-General Article 7.5-401(a) says a behavioral health program "shall be licensed by the Secretary before program services may be provided" in Maryland (Md. Code, Health-General 7.5-401).

The same section lets the Secretary exempt five groups:

• Licensed health professionals in solo or group practice, working under their own professional board.
• Alcoholics Anonymous, Narcotics Anonymous, recovery residences, and peer or family support organizations that do not provide treatment.
• A business's employee assistance program.
• Hospital outpatient behavioral health services in a regulated hospital space, when accredited under behavioral health standards.
• Private therapeutic group homes.

If you are a facility-level operator with clinical staff delivering treatment, none of those exemptions is likely to fit. BHA also offers a short screening survey on its licensing page for programs unsure whether they need a license or a certificate.

The scale is worth knowing. BHA says it "Licenses 1,096 provider organizations at 5,326 provider sites" across the state (BHA Licensed and Certified Providers and Programs). That count excludes individual practitioners and hospitals, so it is a fair picture of the community program market you are entering.

How do I get a substance abuse treatment facility license in Maryland?

The short answer: complete BHA's prerequisites, get accredited if your level of care calls for it, then apply through BHA's online portal with a full documentation package. BHA moved to an online-only application in February 2025, and its current licensing page links an Online Application Guide alongside the portal.

BHA's COMAR 10.63 Programs page lays out the sequence in six steps (BHA COMAR 10.63 Programs):

1. Register the business with the State Department of Assessments and Taxation (SDAT).
2. Secure a physical location and include the lease or rental agreement if you lease.
3. Complete local inspections and permits, including a fire inspection report and permit and a use and occupancy permit (state and local government buildings are excepted).
4. Obtain accreditation and include the survey report and quality improvement plan, for accreditation-based licenses.
5. Get an Agreement to Cooperate from the local behavioral health authority, local addictions authority or core service agency in each jurisdiction where you will operate.
6. Assemble the supporting documentation.

Two level-of-care prerequisites catch operators off guard. BHA's licensing page says a SUD Residential 3.7 applicant is required to complete the Certificate of Need process with the Maryland Health Care Commission. In Maryland, a Residential Rehabilitation Program applicant is required by BHA to hold a Certificate of Approval from the local behavioral health authority or core service agency where the property sits. Both can take longer than the license application itself, so start them first.

Prerequisites and documents BHA lists today

BHA's page lists the documentation a Maryland license application has to include. For a residential, PHP, IOP or crisis program, the core items are:

• SDAT record showing good standing.
• A business plan covering staffing for the first six months, a sustainability model and corporate compliance information.
• An organizational chart with each person's name, credentials, title and supervisory relationships.
• Copies of all clinical and medical staff licenses.
• A floor plan.
• A criminal background check policy and a patient safety plan policy.
• A community relations policy (residential providers).
• A training plan (crisis stabilization centers and mobile crisis teams).
• The Certificate of Need (Residential 3.7) or Certificate of Approval (Residential Rehabilitation Program), where applicable.
• Completed Agreements to Cooperate for every jurisdiction.

For a multi-site organization, the Agreement to Cooperate is the item that multiplies. Each county or city where you open a site means another local authority conversation, and that runs on its own calendar.

Accreditation-based versus non-accreditation-based licenses

Maryland sorts programs into two license types. COMAR 10.63.02.02 lists the programs that need an accreditation-based license, and the list covers most of the facility levels of care: Intensive Outpatient Level 2.1, Partial Hospitalization Level 2.5, Residential Levels 3.1 through 3.7, Residential Crisis Services, Mobile Crisis Teams and Behavioral Health Crisis Stabilization Centers. Withdrawal management and opioid treatment are written as services a licensed program may add when its license specifically authorizes them.

Duration follows the type. Under COMAR 10.63.06.05B, an accreditation-based license lasts "the accreditation period plus 3 months" (COMAR 10.63.06.05). A non-accreditation-based license may not exceed three years.

That link to accreditation matters for scheduling. If your accreditation cycle ends, your license clock ends three months later, so the two calendars should be managed together. If you need a primer on how the ASAM levels map to program types, our guide to ASAM levels of care covers the clinical side.

The renewal deadline today, and what a missed deadline does

This is the rule most likely to hurt an established operator. COMAR 10.63.06.05E says the renewal application and supporting documentation have to be received at least 60 days before the current license expires.

Miss it and the consequence is automatic. Under 10.63.06.05F, "the program's license shall be suspended from the license expiration date" until BHA issues a new license (COMAR 10.63.06.05). There is no grace period written into the current rule.

Three other current rules shape day-to-day licensing for multi-site groups:

• No transfers. BHA states that its licenses are "site specific, and service specific, and are not transferable" (BHA COMAR 10.63 Programs). Under COMAR 10.63.06.09, a change in ownership means applying for a new license.
• Site changes need prior approval. COMAR 10.63.06.07 bars adding, closing or moving a location without approval from BHA's approval unit.
• Incident reports. COMAR 10.63.01.05G sets a 5 calendar day window to report critical incidents to the Department.

Penalties already exist. COMAR 10.63.08.03 lets the Department impose a civil money penalty "up to $500 per day not to exceed $15,000 in one month" for material violations, and counts each location and each service as a separate violation (COMAR 10.63.08.03). The next regulation, COMAR 10.63.08.04, allows a penalty of $1,000 per day per location site or service for operating without a license that the subtitle requires.

What the proposed COMAR 10.63.01 to 10.63.39 rewrite would change

On August 21, 2026, the Maryland Department of Health published a proposal to "repeal existing regulations and adopt new regulations" across COMAR 10.63 (BHA proposed regulations announcement). Comments closed September 21, 2026, and BHA's announcement page notes that "A public hearing has not been scheduled." As of this writing, no final adoption notice has appeared, so every item below is proposed, not in force.

The proposed structure puts general requirements in 10.63.01 to 10.63.06, program-specific chapters in 10.63.08 to 10.63.37, civil money penalties in 10.63.38 and corrective actions in 10.63.39. The changes that matter most for licensing, per the proposed text in the August 21, 2026 Maryland Register:

• Renewal window (proposed). The complete renewal application would be due "at least 40 business days, but no more than 120 business days" before expiration (Maryland Register, Vol. 53, Issue 17). If BHA does not decide within 60 business days, it would issue a letter of good standing extending the current license. A late filer could have the license suspended at the end of the license period.
• Review clocks (proposed). BHA would respond within 120 calendar days for new programs, 60 business days for renewals and 45 business days for relocating a licensed site. A relocation not decided in 45 business days would get a conditional license extension.
• Incident reporting (proposed). Critical incidents would move from 5 calendar days to 3 business days, with failure to report subject to a civil money penalty under proposed 10.63.38.
• Financial condition reporting (proposed). Changes such as a bankruptcy filing, tax lien, foreclosure or utility shut-off would also be reported within 3 business days.
• Staff vacancies (proposed). Under the proposed COMAR 10.63 text, vacancies in required positions would be reported to BHA and the local authority within 40 business days.

On penalties, the dollar amounts are not new. The proposal carries the existing $500 per day and $15,000 per month cap into 10.63.38 and ties it to the new reporting duties. The published text would also make BHA give an organization a chance to correct deficiencies, except in cases of fraud.

The Department's own economic impact statement is candid: "The proposed action has a meaningful economic impact on small businesses." (Maryland Register, Vol. 53, Issue 17). Budget for that, especially if you operate several sites.

What happens after BHA issues the license

Licensure triggers notifications you do not have to send yourself but should confirm. Under current COMAR 10.63.06.05C, BHA's approval unit notifies the Administration, the local CSA, LAA or LBHA, the Medical Assistance Program and the administrative services organization (ASO) for the Maryland Department of Health.

That last notice matters for revenue. Specialty behavioral health in Maryland Medicaid runs through the state ASO rather than the HealthChoice managed care plans, so the license record needs to be in place before you can bill those services. Check that the license, the site addresses and the authorized services all line up across those systems before your first admission.

A licensing checklist for multi-site Maryland operators

Use this as a working list for each program and each site:

1. Confirm the program is not exempt under Health-General 7.5-401(b).
2. Map each site to its license type (accreditation-based or not) under COMAR 10.63.02.
3. Start long-lead items first: Certificate of Need for Residential 3.7, Certificate of Approval for a Residential Rehabilitation Program, accreditation survey.
4. Get an Agreement to Cooperate in every jurisdiction where you will operate.
5. Collect fire, use and occupancy, and SDAT good standing documents per site.
6. Build the business plan, organizational chart, floor plans and the policies BHA lists.
7. Calendar every license expiration, and set the renewal target at least 60 days ahead under current rule, with a note to reset it if the proposed 40 to 120 business day window is adopted.
8. Treat every add, close or move of a site as a prior-approval event under COMAR 10.63.06.07.
9. Plan for a new license on any change of ownership.
10. Set incident reporting to the current 5 calendar day rule, and prepare for 3 business days if the proposal is finalized.

For a broader operating view across sites, our multi-location operations checklist pairs well with this list. If you are also choosing an EHR for several licensed sites, these multi-location EHR permission test cases help you check what staff at each site can see and do before you sign.

Where Ease fits

Licensing is a state process, and no software files it for you. What helps is having the program and site structure in one place. In Ease, multi-state and multi-location groups run every site and level of care on one instance, and admins configure which levels of care each site offers so clinicians see the relevant options. Ease also reports census by location, so you can review each licensed site on its own. Read more about running an EHR for multi-state behavioral health groups or see how Ease supports residential treatment programs.

Frequently Asked Questions

Which Maryland agency licenses substance use and mental health treatment programs?

The Behavioral Health Administration (BHA) within the Maryland Department of Health. Health-General Article 7.5-401 requires a behavioral health program to be licensed by the Secretary of Health before it provides services, and BHA issues those licenses under COMAR 10.63. The older Alcohol and Drug Abuse Administration is not the current licensing body.

Does a Maryland residential SUD program need to be accredited to get a license?

Yes, for most levels of care. COMAR 10.63.02.02 lists the programs that need an accreditation-based license, including Intensive Outpatient Level 2.1, Partial Hospitalization Level 2.5, Residential Levels 3.1, 3.3, 3.5 and 3.7, Residential Crisis Services, Mobile Crisis Teams and Behavioral Health Crisis Stabilization Centers. BHA asks for the accreditation survey report and quality improvement plan with the application.

When is a Maryland behavioral health license renewal due?

Under current COMAR 10.63.06.05E, the renewal application and supporting documents have to be received at least 60 days before the license expires. If they are late, 10.63.06.05F suspends the license from the expiration date until a new license is issued. The proposed 2026 rewrite would change the window to 40 to 120 business days before expiration.

Can a Maryland BHA license be transferred when a program is sold?

No. BHA states that its licenses are site specific, service specific and not transferable, and COMAR 10.63.06.09 says a change in ownership requires the program to apply for and receive a new license.

Has the proposed 2026 COMAR 10.63 rewrite taken effect?

Not as of October 2026. The Maryland Department of Health published the proposed repeal-and-replace of COMAR 10.63 in the August 21, 2026 Maryland Register, and comments closed September 21, 2026. The current rules stay in force until a final adoption notice is published.