Home Providers & Partners Applications, Forms, and Fees

Applications, Forms, and Fees

New Application Types Added to the Behavioral Health Licensing and Certification Portal

The Behavioral Health Licensing and Certification Portal will now accept amendment applications, making all four DHCS-administered substance use disorder (SUD) licensing and certification application types available online. Alcohol and other drug providers can now submit initial, level of care designation, amendment, and renewal applications for licensed and/or certified programs. Active program providers are encouraged to sign in to set up their organization and verify their profile.

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The Department of Health Care Services (DHCS) has the sole authority to license adult alcoholism or drug abuse recovery or treatment facilities, also known as residential substance use disorder (SUD) treatment facilities. DHCS also has the sole authority to certify and monitor all outpatient alcohol and other drug programs, also known as outpatient SUD treatment programs that offer treatment, recovery, detoxification, or Medication for Addiction Treatment (MAT) services. Any SUD program operating in a setting that is exempt from the DHCS mandatory certification under the Health and Safety Code, subdivision (b) of Section 11832.3, and meet the requirements outlined in the Certification for Alcohol and Other Programs (revised February 2025) may voluntarily apply for certification.  

Applications

Please note: If you are interested in applying for both licensure and certification, we encourage you to complete this application through the DHCS Licensing and Certification Portal. 

If you do not use the Licensing and Certification Portal, submit all application forms together by email to LCDSUDApplication@dhcs.ca.gov. For first-time licensing and certification, include DHCS 6002 and DHCS 6040 forms. For renewal applications, include DHCS 5999 and DHCS 6043 forms. All applications should be submitted as part of the same package. There is no need to submit duplicate supporting documents.

DHCS Level of Care Designation

Please note: If you are interested in applying for both licensure and certification, you can be guided to complete this application in the DHCS Licensing and Certification Portal.

If you choose not to use the Licensing and Certification Portal and instead submit by email, you must complete and submit all applicable forms together. For initial applications, this includes DHCS 6002, DHCS 6040, DHCS 4022, and DHCS 4030, as applicable. 

All applications should be submitted as part of the same application package. Duplicate supporting documents do not need to be submitted. 

Submitting the initial applications and the level of care applications concurrently helps ensure timely and coordinated review of your licensure and level of care request.

Supplemental Forms

Incidental Medical Services Certification Form – Health Care Practitioner Client Assessment (DHCS 4026)
Staff and Health Care Practitioner (HCP) Information (DHCS 5050)
Health Screening Report (DHCS 5077)
Program Director Information (DHCS 5082)
Administrative Organization – Corporation, Nonprofit Corporation Limited Liability Company, General Partnership or Limited Partnership (DHCS 5083)
Administrative Organization – Public Agency or Sole Proprietor (DHCS 5084)
Administrative Responsibility (DHCS 5085)
Schedule of Recovery and Treatment Services (DHCS 5086)
Client Health Questionnaire and Initial Screening Questions (DHCS 5103)
Cuestionario de Salud y Preguntas Iniciales de Evaluación del Cliente (DHCS 5103 SP)
Staff Health Questionnaire (DHCS 5105)
Health Care Practitioner Incidental Medical Services Acknowledgement (DHCS 5256)

Miscellaneous Forms

Fees