Adolescent IOP in Texas: the rules, who consents, school and coverage

The short answer: an adolescent substance use IOP in Texas needs HHSC's chemical dependency treatment facility license and must meet 26 TAC 564.905: serve ages 13 to 17 (exceptions approved in writing by a QCC), keep adolescents separate from adults, involve the family or document why not, and arrange access to education when a stay is expected to pass 14 days. Under the facility rules a parent or guardian consents for clients under 16, and 16- and 17-year-olds may consent to their own treatment; the Texas Family Code also lets minors consent to SUD treatment and counseling. When a minor consents alone, 42 CFR Part 2 generally means only the minor can authorize disclosures, even to a parent. Medicaid members under 21 can get IOP and PHP through Texas Health Steps, and CHIP plans cover outpatient SUD treatment.

1. The license

A Texas program that treats substance use disorders, at any age, must be licensed by HHSC as a chemical dependency treatment facility (CDTF) under Health and Safety Code chapter 464 and 26 TAC chapter 564. There's no separate teen license for outpatient care: the adolescent rules are additional requirements inside chapter 564. Describe the adolescent program in your operational plan and policies (ages, schedule, family involvement, school access), and ask HHSC during licensing what it wants to see. How to get the Texas CDTF license covers the application, and how to start an IOP in Texas covers everything around it.

Treating teens for depression, anxiety or trauma without a substance use disorder is a mental health program, which the CDTF license doesn't fit; see licensing a mental health IOP or PHP in Texas. Many teens have both; see running a dual diagnosis program.

2. The adolescent rules in 26 TAC 564

These are the adolescent items we check in every teen chart, with the citation a surveyor would use. HHSC moved the chapter from 25 TAC 448 in April 2024 without changing the text, so a few cross-references still use old numbers.

Rule	Citation	Proof a surveyor looks for
Adolescent means 13 through 17 and not emancipated; an adult is 18 or older, or emancipated	564.1	Date of birth matches the program's age band
Age exceptions: an adolescent program may admit 18- to 21-year-olds whose needs are similar to adolescents'; an adult program may admit a 17-year-old referred by adult criminal justice or with adult-like needs. Each exception is clinically justified, documented and approved in writing by a QCC	564.905(e)–(g)	A signed QCC exception in the chart
Adolescents kept separate from adults in outpatient services, including by telehealth	564.905(b)(1); 564.911(w)	Group rosters with no adults in teen groups
Access to TEA-approved education within 3 school days of admission when treatment is expected to last more than 14 days, if required by law	564.905(b)(2)	An education-access note when the projected stay is over 14 days
Age-appropriate services and materials	564.905(d)(1)	A curriculum written for teens
Family or an alternate support system involved in treatment, or the reason it isn't possible documented	564.905(d)(2)	Family sessions in the chart, or a dated note explaining why not
No tobacco use by adolescent clients on site	564.20(12)	Program rules and the posted policy
Consent, rights and grievance to both the client and the consenter	564.802(b), (d); 564.702(b)	Signatures of client and consenter on the consent and bill of rights; grievance procedure given to both
Records kept at least 5 years after the client turns 18 (6 years minimum for adults)	564.508(h)	Retention policy and destruction log

The rest of chapter 564 applies to teens as it does to adults: the assessment within 3 individual service days, the treatment plan within 5, the education topics (TB, HIV, hepatitis, STDs and tobacco), group-size limits and discharge follow-up. Our plain-English map of 26 TAC 564 has every deadline.

3. Hours: IOP, PHP and day treatment

• Day treatment for adolescents must provide at least 15 hours of services a week: at least 1 hour of individual counseling and 14 hours of other counseling, chemical dependency education, life skills training and relapse prevention education. School attendance can't be counted (564.905(c)). If you run a full-day adolescent program or an adolescent PHP, ask HHSC whether it treats your schedule as day treatment, and build to 15 hours if so.
• Adolescent IOP has no weekly hour minimum in chapter 564, which asks only for enough intensity to meet plan goals. Payers usually apply the ASAM Criteria, where adolescent intensive outpatient (level 2.1) means 6 or more hours a week rather than the adult 9, as state Medicaid manuals that adopt ASAM spell out (for example Montana's). Each plan's medical policy decides what it pays for, so check every contract.
• After school. Schedule teen IOP groups after the school day so clients don't miss class. Our IOP schedule templates include an evening track you can shift earlier.

4. Who consents to treatment

Three sources answer this, and a program's consent form has to satisfy all of them:

Source	What it says	What to do
26 TAC 564.1, "consenter"	For an adolescent, the consenter is the parent, guardian or conservator, but the rule notes that Texas law lets a 16- or 17-year-old consent to their own treatment	Ages 13–15: the parent or guardian signs the consent to treatment. Ages 16–17: the teen may sign as consenter
Texas Family Code 32.003	A child may consent to examination and treatment by a licensed physician for drug or chemical addiction or dependency, or a condition directly related to drug or chemical use, and the consent can't be undone because of age	Relevant to the medical side: physician or psychiatric visits, MOUD
Texas Family Code 32.004	A child may consent to counseling for chemical addiction or dependency (and for suicide prevention and abuse) from a licensed or certified physician, psychologist, counselor or social worker. The professional may tell the parents, with or without the child's consent, and a parent who didn't consent isn't obligated to pay	Counseling a younger teen without a parent is lawful under this section, but read it with chapter 564 and Part 2

In practice, involve a parent or guardian whenever you can: 564.905(d)(2) expects family involvement, the payer is usually a parent's plan, and our chart audit treats an adolescent under 16 with no parent or guardian consent on file as a critical finding (564.1 and 564.802(b)). When a teen 16 or older consents alone, record why, who the consenter is, and how family involvement will happen or why it won't.

5. Part 2 and what you can tell parents

A federally assisted SUD program is covered by 42 CFR 2.14, the Part 2 rule for minors, and chapter 564 makes Part 2 a licensing requirement (564.508(f)).

• When the minor may lawfully consent to treatment alone, only the minor can sign a Part 2 consent to disclose their records, including to a parent or guardian, and including to get reimbursement from a parent's insurance. The program may decline to treat until the minor agrees to the disclosure needed for payment, unless state or local law requires the service regardless of ability to pay.
• When state law requires a parent's consent to treatment, a disclosure consent needs both the minor and the parent or guardian.
• Safety exception: the program director may share facts with a parent to reduce a substantial threat to the life or physical well-being of the minor or someone else, when the minor lacks capacity for a rational decision about it.
• The Family Code permission isn't a Part 2 consent. 32.004 lets a counselor tell parents without the child's consent, but a Part 2 program still needs a Part 2 basis to disclose. Have your attorney reconcile the two in your release policy.
• Insurance leaks. A teen on a parent's plan generates explanations of benefits mailed to the policyholder. Tell a self-consenting teen this at intake, before you bill.

Our sister site's Part 2 guide covers consents and the 2024 rule; the consent form needs every element of 42 CFR 2.31.

6. School coordination

• Education access. When a stay is expected to pass 14 days and the law requires it, arrange access to TEA-approved education within 3 school days of admission (564.905(b)(2)). For an after-school IOP, the client usually stays in their own school; document that.
• Every school contact needs a Part 2 consent naming the school or district, what may be shared and why: attendance letters, a return-to-school plan, coordination with a counselor, a 504 coordinator or an alternative program. Share the minimum the purpose needs.
• School referrals. Schools are a common source of teen referrals. Build the relationship on fast assessments and clear communication, never on anything of value: the Texas Patient Solicitation Act and EKRA apply. See patient brokering laws.
• Drug testing of teens is a clinical tool, not a report to the school. Your drug testing policy should say who sees results and under what consent.

7. Staffing and safety

• Counselors. Counseling is provided by QCCs (LCDCs, or other licensees with 1,000 hours of documented SUD experience), graduates or supervised counselor interns, the same as in an adult program (564.901(p)). Staff serving clients with co-occurring disorders need the competencies in 564.908, including age-appropriate assessment and the higher risk of self-harm, suicide and violence. See IOP staffing requirements in Texas.
• Child abuse reporting. Texas professionals must report suspected abuse or neglect of a child within 48 hours of first suspecting it (Family Code 261.101), and Part 2 allows reports of suspected child abuse and neglect required by state law. Abuse, neglect or exploitation by staff also goes to HHSC under 564.703.
• Suicide risk. Screen every teen at admission and on a schedule with a validated tool, with a same-day path for a positive screen. Chapter 564 doesn't name an instrument; it sits in the assessment's mental and emotional functioning area and the mental health referral duty (564.803).
• Separate groups, separate spaces. Plan the building and the schedule so teens and adults don't share group rooms at the same time, including waiting areas where you can manage it.

8. The family program

Family involvement is a licensing rule for adolescents, not an extra. Plan family sessions on a schedule (with the teen's consent where Part 2 requires it), a parent education group, and a written reason in the chart whenever family can't take part. Our guide to building an IOP family program has a curriculum and the documentation.

9. Medicaid, CHIP and commercial coverage

Coverage	What applies
Texas Medicaid, under 21	PHP and IOP may be covered through Texas Health Steps (EPSDT), the benefit for medically necessary care for members under 21. Aetna Better Health of Texas says PHP and IOP are covered for members 20 and younger under EPSDT and aren't treated as in-lieu-of services (Aetna Better Health notice)
CHIP	A separate program with its own benefits. Molina's CHIP coverage lists outpatient SUD services including assessment and intensive outpatient (Molina CHIP behavioral health), and Aetna's notice says PHP and IOP are CHIP benefits except for CHIP Perinate
The CDTF requirement	Medicaid SUD treatment must be delivered in a licensed CDTF, since January 1, 2019 (TMHP)
Which plans	Children's plans matter more to a teen program: Texas Children's Health Plan, Cook Children's Health Plan and Driscoll Health Plan serve Medicaid and CHIP members in their areas. See Texas Medicaid plans by service area
Commercial	Most teens are dependents on a parent's plan. Verify the benefit, the authorization rules and whether a behavioral health company manages it before admission; see behavioral health carve-outs

HHSC asked Medicaid plans to track IOP and PHP by HCPCS code, so put H0015 on SUD IOP claims. Texas Medicaid for IOP and PHP programs covers the codes, prior authorization and the contract steps, and our credentialing service files each plan.

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10. The adolescent program opening checklist

• Operational plan describing the adolescent program: ages, levels, schedule, family involvement, school access.
• Admission policy with the 13–17 age band and the written QCC exception process for 18–21 or a 17-year-old in adult care.
• Consent to treatment with all 16 elements of 564.802(b), signature lines for client, consenter and staff, and a rule for who the consenter is by age.
• Part 2 release forms that a minor can sign, a policy on disclosures to parents, and the safety exception written down.
• Separate adolescent groups and rooms (and separate video groups), with rosters that prove it.
• A teen curriculum, including the required health and tobacco education, in age-appropriate materials.
• Family program schedule and a note template for "family not involved because…".
• Education-access procedure for stays over 14 days; school consent template.
• Child abuse reporting procedure (48 hours) and ANE reporting to HHSC.
• Suicide-risk screening with a same-day path; crisis contacts for parents.
• Records retention set to 5 years after age 18.
• Contracts with the children's Medicaid and CHIP plans in your area, and commercial plans.

Running some sessions by video? How to run a virtual IOP covers 564.911, which also requires teens to be served separately from adults online.

Questions

Can a minor consent to substance abuse treatment in Texas?

Yes. Texas Family Code 32.003 lets a minor consent to examination and treatment by a physician for drug or chemical addiction or dependency, and 32.004 lets a minor consent to counseling for chemical addiction or dependency from a licensed professional. In a licensed CDTF, the facility rules treat a parent or guardian as the consenter for clients under 16, while 16- and 17-year-olds may consent to their own treatment.

Can parents see their teen's substance use treatment records?

It depends on who consented. Under 42 CFR 2.14, when a minor may lawfully consent to treatment alone, only the minor can authorize disclosure, including to a parent. When a parent's consent to treatment is required, a disclosure needs both the minor's and the parent's consent. There's a narrow safety exception for a substantial threat to life or physical well-being.

What ages can an adolescent program serve in Texas?

Ages 13 through 17 under 26 TAC 564. An adolescent program may admit someone 18 to 21 whose needs are similar to an adolescent's, and an adult program may admit a 17-year-old in limited cases, each with a written, QCC-approved clinical justification.

How many hours a week is an adolescent IOP?

Chapter 564 sets no IOP minimum. Payers usually follow the ASAM Criteria, where adolescent intensive outpatient is 6 or more hours a week. Adolescent day treatment under 564.905(c) is at least 15 hours a week, including 1 hour of individual counseling, and school time doesn't count.

Does Texas Medicaid cover adolescent IOP?

For members under 21, PHP and IOP may be covered through Texas Health Steps (EPSDT), and CHIP plans cover outpatient SUD treatment including intensive outpatient. The program must be a licensed CDTF, and plans require prior authorization. Confirm each plan's rules in your contract.

Does an adolescent program have to provide school?

Not in every case. Under 564.905(b)(2), when treatment is expected to last more than 14 days and the law requires it, the program provides access to TEA-approved education within 3 school days of admission. For an after-school IOP where the teen keeps attending their own school, document that their education continues.

Sources

• 26 TAC 564.905, 564.1 and chapter 564 (Cornell LII); Texas Health and Safety Code ch. 464
• Texas Family Code chapter 32 (32.003, 32.004) and chapter 261 (261.101); Texas Occupations Code ch. 102
• 42 CFR 2.14, minor patients (Cornell LII)
• TMHP, SUD benefit change, January 1, 2019; Aetna Better Health of Texas, PHP and IOP notice; Molina Healthcare of Texas, CHIP behavioral health benefits
• Montana DPHHS, ASAM 2.1 intensive outpatient manual (adolescent hours, as an example of ASAM's levels)

Cima Consulting isn't a law firm and doesn't give legal advice. This page paraphrases the rules; the official text controls.