Provider Certification and Licensure
In order to expedite your paperwork or if you have any questions, please email DMHA-CL@fssa.in.gov.
For compliment, questions or concerns about services, treatments, procedures, rights and/or policies, please refer to the consumer service line flyer linked here.
Addiction Certifications
Addiction Treatment Services Provider (outpatient) - an agency of 10 or fewer direct service staff/volunteers/contract workers
- Required attachments for addiction services providers - outpatient certification
- Application for certification of addiction providers - State form 55376
- Documentation of direct services providers - State form 52810
- Statement of understanding
- Facility facts record - State form 48160
- Article 4.4: Addiction treatment services provider certification
Addiction Treatment Services Provider (regular) - an agency of 11 or more direct service staff (requires accreditation)
- Required attachments for addiction services providers - regular certification
- Application for certification of addiction providers - State form 55376
- Documentation of direct services providers - State form 52810
- Statement of understanding
- Facility facts record - State form 48160
- Article 4.4: Addiction treatment services provider certification
Community Mental Health Centers *Currently not accepting new applicants - all areas of Indiana are designated*
- Required attachments for CMHC renewal
- Application for certification/licensure of CMHC - State form 48161
- Summary sheet of contracted services - State form 53365
- Chart of providers sites and services - State form 53360
- Request for approval to subcontract with for profit - State form 53366
- Direct care staff report - State form 53359
- Facility facts record - State form 48160
- Article 4.1: Community mental health centers certification
- Article 9: Minimum standards for the provision of services by community mental health centers and managed care providers
Opioid Treatment Program *Currently not accepting new applicants - all areas of Indiana are designated*
- Required attachments for OTP renewal
- OTP: Application for certification as an addiction services provider
- Article 10: Minimum standards for the provision of services by opioid treatment facilities and programs
Private Mental Health Institution
- Private Mental Health Institution required attachments
- Application for certification/licensure of Private Mental Health Institution - State Form 52871
- Private Mental Health Institution annual attestation
- Facility facts record - State form 48160
- Article 1.5: Licensure of private mental health institutions
Certifying a Residential Facility
If your organization is not already certified as an Addiction Treatment Services Provider with Regular Certification or Community Mental Health Center, you need to be certified as a Residential Care Provider before applying to be certified as a supervised group living facility or sub-acute stabilization facility.
- Application for certification as a Residential Care Provider - state form 56914
- Interested in opening a sub-acute stabilization facility?
- Interested in opening a supervised group living facility?
- Facility facts record - State form 48160
- Information required for bed waiver request
- Zoning Code Information Affidavit of Application – Marion County Only
- Article 7.5: Residential living facilities for individuals with psychiatric disorders or addictions
Residential Care Provider
Additional Certification Forms
- Indiana Division of Mental Health and Addiction approved addictions counseling credentials
- Indiana Division of Mental Health and Addiction approved accreditation
Additional Rules
- 42 CFR Part 2 -- Confidentiality of Substance Use Disorder Patient Records
- Article 27 Human services
- Article 39 Health records
You may access rules and regulations through the State of Indiana website: http://iga.in.gov/legislative/. Click on "Administrative Code" in the publications column, then click on "Title 440".