Texas Substance Use Treatment Facility License: HHSC Steps
The Texas CDTF license path for operators: who needs one, what HHSC wants in the packet, the 45-day clocks, the six-month cutoff, fees and renewal.
As of October 2026. Texas moved these rules to a new chapter in 2024 and HHSC updates its forms and guidance on its own schedule, so confirm every fee, form and deadline with HHSC before you file.
If you are opening or expanding a substance use program in Texas, the license that matters is the chemical dependency treatment facility (CDTF) license issued by the Texas Health and Human Services Commission. Texas licenses each physical location, runs three 45-day review steps, and closes the door on a slow application. Under 26 TAC 564.403, HHSC denies a CDTF application if the applicant has not shown compliance within six months of receipt, and the applicant cannot refile until six months after the denial, so a stalled application can cost up to a year.
That one rule should shape your project plan. A missing fire alarm certificate or an unsigned kitchen inspection is not a small paperwork delay in Texas; it can push a residential opening into the next fiscal year.
This guide is written for the executive director or compliance lead running a residential, withdrawal management or outpatient program, often across several sites. For the wider state picture (Medicaid, workforce and other license types), start with the Texas state guide.
Who needs a CDTF license in Texas, and who is exempt
The starting rule is broad. According to 26 TAC 564.401, a facility providing or offering chemical dependency treatment in Texas needs an HHSC license unless an exemption applies.
The exemptions that matter most for operators:
- Facilities HHSC already licenses under other chapters. Hospitals and other facilities licensed under Health and Safety Code Chapters 241, 243, 248, 466 or 577 are listed as exempt.
- Private practice. A licensed practitioner or licensed chemical dependency counselor seeing clients personally, in their own office, within their license scope.
- Registered faith-based programs. These offer only nonmedical methods and register with HHSC rather than license.
- Satellite offices. A satellite location where staff work under the supervision of a licensed outpatient facility, delivering services within that facility's licensed scope. HHSC lists Form 3214 for satellite site notification.
Two more points from the same rule drive multi-site planning. The 26 TAC 564.401 text says the facility "shall have a license for each physical location" where it provides residential or outpatient services. Under 564.401(c), a license also cannot move to a separate legal entity or to a different physical address.
In practice, that means a group with a residential campus and three outpatient clinics plans four licensed locations, unless a clinic genuinely fits the satellite exemption. Texas rules use "outpatient" as the service category, so an IOP program runs under the outpatient side of the license rather than a separate IOP license type. For how these levels fit together clinically, see our guide to ASAM levels of care.
HHSC, not DSHS: which agency and which rule chapter apply now
Older guides, including some vendor and association pages, still say DSHS licenses Texas treatment programs under 25 TAC Chapter 448. That is out of date. HHSC's Regulatory Services Division licenses CDTFs under Texas Health and Safety Code Chapter 464, and the HHSC CDTF licensing page notes that on April 30, 2024, HHSC moved the CDTF rules from 25 TAC Chapters 448 and 441 to 26 TAC Chapter 564.
Section numbers mostly carried over: 448.401 became 564.401, 448.403 became 564.403, and so on. Some official documents still cite the old numbers. HHSC's Form 3207 instructions point to 25 TAC 448, and 564.403(a) itself still refers to the operational plan rule by an old section number. The current operational plan rule is 26 TAC 564.502 (Operational Plan, Policies and Procedures). When your team builds a crosswalk of policies to rules, cite Chapter 564.
One more scoping fact. The HHSC CDTF licensing page states that CDTFs are "not certified to participate in the federal Medicare Program." The state license is a license to operate. It does not enroll you with any payer.
So, how do I get a substance abuse treatment facility license in Texas?
Here is the packet, in the order HHSC and 26 TAC 564.403(a) describe it:
- Form 3207, the license application. Legal name and FEIN have to match your IRS filing, and any DBA has to match what is filed with the Texas Secretary of State or county clerk.
- Form 3208, the initial applicant checklist. Work it line by line; it is the list HHSC reviews against.
- An operational plan written to 26 TAC 564.502.
- Proof of liability insurance.
- The application fee (see the fee section below).
- General environment documents for every site: a completed ADA checklist with corrective action timeframes for any gaps, and a certificate of occupancy reflecting current use (or proof the locality does not issue one).
- A co-location list if the site will be shared with programs that are not substance use treatment, per HHSC guidance letter GL 22-3003.
Fee timing matters more than it looks. HHSC's CDTF licensing page says the licensing unit does not process an application until HHSC Accounts Receivable has received and posted the fee. Mail the fee with the application to the Accounts Receivable address on Form 3207, and track the posting date as your real start.
If you are buying an existing program rather than starting one, the purchase does not shortcut this. The Form 3207 instructions say CDTF licenses "do not have a change of ownership application process," so when a purchase changes the legal name and federal tax ID, the seller closes its license and the buyer files as a new applicant.
Extra documents for residential and detox programs
Residential sites carry the heaviest packet. The HHSC page lists these, each tied to a section of 26 TAC Chapter 564:
| Document | Who signs off | Rule |
|---|---|---|
| Fire inspection | Local certified fire inspector or State Fire Marshal | 564.1202(1) |
| Fire alarm system inspection | Fire marshal or authorized inspector | 564.1202(2) |
| Kitchen inspection | Local health authority or HHSC | 564.1202(3) |
| Gas pipe pressure test | Local gas company or licensed plumber | 564.1202(4) |
| Fire extinguisher inspection and maintenance | Licensed or certified personnel | 564.1202(5) |
| Fire alarm installation certificate | Agent registered with the State Fire Marshal | 564.1206 |
| Floor plan with room square footage and bed count and type | Applicant | 564.1205 |
The detail that trips teams up is freshness. The HHSC CDTF licensing page says residential inspections have to be current, signed, dated and "free of outstanding corrective actions." An inspection with an open item is not a usable document, so close every finding before you file.
For a withdrawal management (detox) program, HHSC also asks for the name and license number of the Medical Director under 26 TAC 564.902. Have that person under contract before you file, since a placeholder name will not move the packet. Our detox glossary entry covers the clinical terms if your team is new to the service line.
For physical plant questions before you sign a lease, HHSC directs residential applicants to its Substance Use Disorder Compliance Unit. Call early. Changing a floor plan after inspection costs more than asking first.
The clocks: 45 days to complete, 45 to inspect, 45 to issue, and the six-month cutoff
26 TAC 564.403 sets the timeline. Read it as HHSC deadlines with your own response time in between:
- Completeness review. Within 45 days of receiving the application, HHSC tells you whether it is materially complete or lists what is missing.
- Your corrections. You submit requested materials and fix deficiencies within the time frames HHSC sets.
- On-site inspection. If one is needed, HHSC inspects within 45 days of receiving a materially complete packet, and reports deficiencies within 30 days.
- Your corrective action. You send evidence of corrective action within the time frame in the inspection report.
- Issuance. HHSC issues the license within 45 days of receiving all evidence of compliance and all fees.
The rule that sets the stakes is subsection (f). According to 26 TAC 564.403, an application "will be denied" if the applicant fails to provide evidence of compliance within six months from the date it is received. Six months after the denial, the applicant may reapply with a new application and a new fee. Put the two periods together and a stalled application can cost up to a year.
Two operating rules from the same section belong on your opening checklist:
- No treatment before approval. Under 26 TAC 564.403(g), the applicant cannot provide chemical dependency treatment before receiving written notice of licensure approval. Do not schedule admissions against an expected date.
- Post the certificate. Under 26 TAC 564.403(h), the certificate is displayed at each outpatient location and each approved residential site.
HHSC's inspection covers clinical records, personnel records, policies and procedures, quality assurance activities, staff interviews and a facility tour. Treat "ready for inspection" as policies approved, personnel files complete and record templates built, not just a finished building.
What it costs: base, per-site and per-bed fees
The fee schedule is short. According to 26 TAC 564.408, the base fee for initial and renewal licenses "includes application and review fees" and is $1,200.
| Fee | Amount | Rule |
|---|---|---|
| Base fee, initial and renewal | $1,200 | 564.408(c)(1) |
| Each outpatient or residential site at a separate physical address | $125 | 564.408(c)(2) |
| Per bed | $35 | 564.408(c)(3) |
| Printed list, mailing labels or replacement certificate | $25 | 564.408(d) |
The rule does not say whether the first site counts toward the $125 per-site fee, so ask HHSC to confirm your total before you cut the check. Other terms from 26 TAC 564.408 to plan around:
- Payment method. Fees are paid in full by cashier's check or money order.
- No refunds. Licensure fees are not refundable, including when an application is denied.
- Closing does not end the bill. A facility owes the full fee for any licensure period in which it provides treatment, and failing to tell HHSC about a closure does not excuse the fee.
Two-year term and the 60-day renewal deadline
A Texas CDTF license runs two years from issuance. The 26 TAC 564.404 text says the licensee files for renewal and pays the fee "at least 60 days before the license expires." Under 564.404(c), the facility cannot provide services after the expiration date unless it submitted the application update and fee by that date.
For a multi-site group, licenses issued at different times expire at different times. Build one renewal calendar with a 90-day reminder per license and one owner for all of them.
Growth also triggers licensing work between renewals. Under 26 TAC 564.405, adding detoxification services, adding or moving a residential site, or increasing residential beds needs an application, fees and written HHSC approval before you start. Adding an outpatient site or a new service needs written notice. Plan those steps with the same six-month logic as an initial application, and use the multi-location operations checklist when you are adding sites in sequence. Each added site is also a new location in your EHR, with its own staff and records. Before it opens, run these multi-location EHR permission tests to check who can see and act on each site's work.
The Texas market at a glance
Texas has a large and fragmented facility base. An Ease analysis of HHSC's CDTF directory spreadsheet dated 10/21/2026 counts 407 headquarters records and 650 site locations, with 546 sites listing outpatient treatment and 188 listing residential treatment across 8,678 residential beds. Counted by legal name, most licensees run a single site, but 108 run two or more and 18 run five or more. Sites cluster in the large metro counties: Harris County alone has 103 of the 650, followed by Tarrant, Dallas, Bexar and Travis. HHSC points readers to its online license search for current status, so verify any individual license there.
Where Ease fits for a licensed Texas program
Licensing gets the doors open; running each licensed site is daily census and documentation. Ease gives a residential operator a per-location bed board, so each licensed site shows its own beds, who is assigned to them and projected availability based on estimated discharge dates. A multi-site group runs every location on one instance, with each site carrying its own state, NPI and billing provider, and admins configure which levels of care each site offers so clinicians see the relevant options. More on census workflows is in our post on bed management and census for residential behavioral health, and on running many sites in EHR for multi-state behavioral health groups. You can also see how Ease approaches residential treatment.
Next steps after your Texas license is approved
A CDTF license lets you operate. It does not enroll you with Texas Medicaid, managed care plans or commercial payers, and each of those runs its own credentialing clock. Start payer enrollment in parallel with licensing so revenue does not lag your opening date by months. The Texas state guide covers the Medicaid and managed care side.
Frequently Asked Questions
Which Texas agency licenses substance use treatment facilities?
The Texas Health and Human Services Commission (HHSC), through its Regulatory Services Division and Health Facility Licensing Unit, licenses chemical dependency treatment facilities under Health and Safety Code Chapter 464. The rules moved from 25 TAC Chapter 448 to 26 TAC Chapter 564 on April 30, 2024, so older references to DSHS and Chapter 448 are out of date.
How long does HHSC take to issue a CDTF license?
26 TAC 564.403 sets three 45-day steps: HHSC tells you within 45 days whether the application is materially complete, inspects within 45 days of a materially complete packet if an inspection is needed, and issues the license within 45 days of receiving all evidence of compliance and fees. Your own response time sits between those steps, so the real calendar depends on how fast you close gaps.
What happens if my Texas CDTF application stalls?
Under 26 TAC 564.403(f), HHSC denies the application if you have not provided evidence of compliance within six months of the date it was received. You may reapply six months after the denial date with a new application and a new fee, so a stall can cost up to a year.
How much does a Texas CDTF license cost?
26 TAC 564.408 sets a $1,200 base fee for initial and renewal licenses, $125 for each outpatient or residential site at a separate physical address, and $35 per bed. Fees are paid by cashier's check or money order and are not refundable. Confirm the amount with HHSC before you pay.
Do I need a separate Texas license for each location?
Yes. 26 TAC 564.401(b) says a facility needs a license for each physical location where it provides residential or outpatient services, and a license does not transfer to a different legal entity or a different address. A satellite office working under a licensed outpatient facility's supervision and scope is listed as an exemption.
