How to start an IOP in Oregon: the certificate of approval, ASAM levels and CCOs

Who wrote this, honestly

We're Texas operators: we run a licensed Texas outpatient program, PHP through outpatient, and built our own EHR to run it. When we help an owner open in another state, the first task on that client's roadmap is "apply for your state's SUD treatment program license". The work behind it is finding the state's rule and checking it against the agency's current text. This guide is that check for Oregon, and it's the same work our IOP / PHP Program Launch does for a client opening outside Texas. Where we couldn't confirm a detail, we left it out or told you who to ask.

Comparing neighbors? Read our guides for Washington, California and Nevada, or how to start an IOP or PHP in Texas.

Oregon at a glance

Question	Oregon's answer
Who approves an outpatient SUD program	Oregon Health Authority, Health Systems Division
What you get	A certificate of approval (COA), valid up to three years
Rules	OAR 309-008 (certification procedure) and OAR 309-019 (outpatient behavioral health services)
IOP	ASAM Level 2.1, OAR 309-019-0183, with co-occurring capable and co-occurring enhanced versions
ASAM designations	Since April 1, 2024, the certificate must designate each ASAM level and any enhanced designation
On-site review	Required before a COA for a substance use provider (ORS 430.637)
SUD staff	Licensed by a recognized Oregon board or certified by an OHA-approved entity (OAR 309-019-0125)
Medicaid	Oregon Health Plan; 16 CCOs operated in 2025 and manage care for most of about 1.4 million members
Brokering	SB 133 (2019) bars paying or accepting compensation for referrals for SUD, problem gambling and mental health services

The certificate of approval

Oregon doesn't call it a license. Under OAR 309-008, OHA's Health Systems Division issues a certificate of approval to providers of behavioral health treatment services. That division sets the procedures for applications, initial certification, renewal, reviews and other actions on a certificate. OAR 309-019 then says what an outpatient program must do, and requires certification under 309-008 before you provide outpatient SUD services. A certificate runs no more than three years and can be renewed, conditioned, denied, suspended or revoked under 309-008.

• An on-site review comes first. ORS 430.637 requires OHA (or another state agency) to conduct an on-site quality assessment of a substance use provider before issuing a certificate of approval. Have the site, policies, staff files and record templates ready to show.
• Fees. We didn't find the current application fee for an outpatient SUD certificate in the rules we could read. Ask OHA's licensing and certification staff for the current amount when you request the application. The state fee is small next to rent and payroll before the first claim pays; see what it costs to start an IOP.
• Mental health too? OAR 309-019 covers outpatient mental health and SUD services. If you'll treat co-occurring disorders and bill mental health services, describe the whole program in the application.

For how Level 2.1 differs from 2.5 and Level 1, see IOP vs. PHP vs. outpatient.

The rules to read

Rule or document	What it covers
OAR 309-008	Certification of behavioral health treatment services: application, initial certification, renewal, reviews, and actions on a certificate
OAR 309-019	Outpatient behavioral health services: entry and assessment, service planning, records, staff qualifications and the ASAM-level sections
OAR 309-019-0183	Intensive outpatient SUD services, ASAM Level 2.1
0182 and 0184	Outpatient (Level 1) and partial hospitalization (Level 2.5)
OAR 309-019-0125	Staff qualifications
OHA ASAM rule changes	OHA's summary of the 2023 rule changes that tied certificates to ASAM levels

Our launch package builds the policy manual as a crosswalk: every requirement in OAR 309-019, including the Level 2.1 section you'll be designated for, matched to a policy, form or record, so OHA's reviewer can find each one.

ASAM levels on your certificate

Oregon rebuilt its outpatient SUD rules around ASAM levels, each with its own section in OAR 309-019, and made the certificate say which levels you provide. According to OHA's ASAM rule changes summary, existing providers had to apply for each level by October 1, 2023, and since April 1, 2024, an outpatient program must hold a valid certificate designating each ASAM level of care, and any optional enhanced designation, it's certified to provide.

Level	Rule	What it means for an IOP owner
Level 1, outpatient	OAR 309-019-0182	The step-down most IOP clients move to; designate it too so you can keep them
Level 2.1, intensive outpatient	OAR 309-019-0183	The IOP itself. The rule has co-occurring capable and co-occurring enhanced versions; enhanced adds requirements such as mental health coordination and medical or psychiatric consultation
Level 2.5, partial hospitalization	OAR 309-019-0184	The step-up; designate it only if you'll staff for it

Decide the levels before you apply, because adding one later is a certificate change. If you want the co-occurring enhanced designation, plan the psychiatric consultation from day one; our guide to psychiatric services in an IOP covers the options. For ASAM Level 2.1 hours, ASAM describes 9 to 19 a week for adults (Pennsylvania's ASAM 2.1 summary); the IOP schedule template shows a week that fits.

Staff qualifications

• SUD treatment staff. The current text of OAR 309-019-0125 requires SUD treatment staff to be licensed in Oregon by a board the division recognizes or certified by an entity the division approves.
• SUD supervisors. Supervisors must also be licensed by a recognized Oregon board or certified by an approved entity. OHA's permanent rule text requires a psychometric exam or an approved portfolio evaluation. Earlier versions spelled out a certification path of 4,000 hours of supervised SUD counseling, 300 contact hours of education and an exam or portfolio, or a health or allied provider license plus 120 contact hours of SUD education, with experience options such as five years of full-time SUD counseling. Check which version applies when you hire.
• Mental health supervisors must meet qualified mental health professional (QMHP) requirements and have two years of post-graduate clinical experience in a mental health setting.
• Every hire gets checked against the federal OIG exclusion list; ask OHA which state background checks apply.

We build personnel files from our staff credential file checklist, documenting each 309-019-0125 qualification the way OHA's reviewer will look for it. For MAT, see adding MAT to an IOP.

The Oregon Health Plan and CCOs

• CCOs manage most Medicaid care. OHA's August 2026 release says the 16 CCOs that operated in 2025 manage care for the vast majority of about 1.4 million Oregonians enrolled in Medicaid. CCOs are regional, so contract with the ones that serve your counties.
• The map changes. OHA's CCO changes page says PacificSource Community Solutions stopped being a CCO in Lane County in early 2026, with its members moving to Trillium Community Health Plan. Check the current CCO for your service area before you contract.
• Enroll, then contract. Enroll with the Oregon Health Plan with your certificate of approval, then credential with each CCO. Ask each about its authorization rules for Level 2.1 and which codes it pays.
• Medicare pays for IOP and PHP only through hospitals, community mental health centers and a few other provider types, so most freestanding programs plan without it (CMS 2024 outpatient rule).

Our credentialing service handles Medicaid enrollment, CCO credentialing and commercial facility contracts in any state; Medicaid enrollment is $500 per clinician. Getting insurance contracts for an IOP covers the commercial packet. Before every admission, verify benefits and authorization with the prior authorization guide.

SB 133: no paying for referrals

Oregon has its own law. The enrolled text of SB 133 (2019) bars a provider from accepting or paying a fee, commission, bonus, rebate or other compensation for referring a resident for substance use, problem gambling or mental health services. It also bars advertising that falsely states or misrepresents a resident's need to get those services outside Oregon, or a resident's eligibility for a medical assistance program. The legislature's staff summary describes the same two prohibitions. Ask your attorney for the codified ORS section and any later amendments. Federal law adds EKRA (18 U.S.C. 220) and the Anti-Kickback Statute. Pay marketers a salary, never per admission, and keep advertising factual. See patient brokering laws and marketing a treatment center.

The steps, in order

1. Define the program and pick the ASAM levels for your certificate: 2.1, and usually 1 for step-down, with or without co-occurring enhanced.
2. Form the business with the Oregon Secretary of State, get the EIN and the organization NPI, and line up a health-care attorney and CPA.
3. Find a site local zoning allows, and lease it with a way out.
4. Write the policy manual from OAR 309-019 and the level sections you'll be designated for, plus 42 CFR Part 2 and HIPAA.
5. Hire the director, supervisors and SUD staff who meet 309-019-0125, and verify each license or certification.
6. Apply to OHA for a certificate of approval under 309-008, naming each level, and prepare for the on-site review.
7. Set up the EHR before the review: Cima's IOP and PHP plan keeps levels of care, group notes with each member's entry, attendance and authorizations in one place.
8. Enroll with the Oregon Health Plan, contract with the CCOs in your area, and credential with commercial plans.
9. Renew before the three years run out, and keep drills and chart reviews on a schedule with the compliance calendar.

Questions

Do you need a license to open an outpatient rehab in Oregon?

You need a certificate of approval from the Oregon Health Authority under OAR 309-008, meeting the outpatient standards in OAR 309-019. Since April 1, 2024, the certificate must designate each ASAM level you provide.

What is a certificate of approval in Oregon?

OHA's approval of a behavioral health treatment provider, issued under OAR 309-008 for up to three years. For a substance use provider, ORS 430.637 requires an on-site quality assessment before OHA issues it.

Which rule covers intensive outpatient in Oregon?

OAR 309-019-0183, intensive outpatient substance use disorder services, ASAM Level 2.1. It has co-occurring capable and co-occurring enhanced versions with added requirements for the enhanced one.

Who can provide SUD treatment in an Oregon program?

Under OAR 309-019-0125, SUD treatment staff must be licensed by an Oregon board the division recognizes or certified by an entity it approves. Supervisors must meet added requirements, including a psychometric exam or approved portfolio evaluation.

Does Oregon have a patient brokering law?

Yes. SB 133 (2019) bars providers from paying or accepting compensation for referrals for substance use, problem gambling or mental health services, and bars misleading advertising about out-of-state care or Medicaid eligibility. Federal EKRA and the Anti-Kickback Statute also apply.

Can a Texas company help with an Oregon program?

Yes, if it's honest about how. We run a Texas program, so in Oregon we work from OAR 309-008 and 309-019, OHA's guidance and the CCOs' policies, check each against the current text, and tell you where OHA, the CCOs or your attorney has the final word. We don't guarantee a certificate, contract or date.

Want accreditation for commercial contracts too? Program Launch + Accreditation is $54,500. Or book a free 30-minute call and we'll walk through what Oregon will ask of you.

Cima Consulting isn't a law firm or an accounting firm. Oregon agencies make their own decisions; we don't guarantee approvals, rates or dates. Never pay or accept anything of value for patient referrals: Oregon's SB 133 and federal law (EKRA and the Anti-Kickback Statute) apply.

Sources

• Certification: OAR 309-008-0100; on-site review, ORS 430.637: Oregon Legislature committee document
• Outpatient rules and ASAM levels: OAR 309-019-0183; 0182; 0184; OHA ASAM rule changes (May 2023)
• Staff: OAR 309-019-0125; OHA permanent rule text, 309-019-0125 and 0130
• CCOs: OHA release (August 12, 2026); OHA CCO changes
• Brokering: SB 133 (2019), enrolled; staff measure summary; EKRA, 18 U.S.C. 220: Cornell LII
• ASAM Level 2.1 hours: Pennsylvania DDAP; OIG exclusions: oig.hhs.gov; CMS, CY 2024 outpatient rule: cms.gov

Comparing states? See Texas and our guides for Alabama, Arizona, California, Colorado, Delaware, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Utah, Virginia, Washington, West Virginia and Wisconsin, or how to start an IOP for what every state has in common.