How to start an IOP in South Carolina: the DPH license, the new BHDD and Medicaid

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 South Carolina, 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 North Carolina and Georgia, or how to start an IOP or PHP in Texas.

South Carolina at a glance

Question	South Carolina's answer
Who licenses an outpatient SUD program	The Department of Public Health (DPH), successor to DHEC's health regulation
Regulation	Standards for Licensing Facilities for Chemically Dependent or Addicted Persons: R. 60-93, formerly R. 61-93 (transferred May 23, 2025)
License fee	$75 initial and annual for an outpatient facility, plus $50 per satellite
Late renewal	$75 or 25% of the license fee, whichever is greater
State substance use agency	Office of Substance Use Services, Department of Behavioral Health and Developmental Disabilities (formerly DAODAS)
Counselor licenses	LLR's Board of Examiners for Licensure of Professional Counselors, Marriage and Family Therapists, Addiction Counselors and Psycho-Educational Specialists
Medicaid	SCDHHS (Healthy Connections); MCOs Absolute Total Care, Healthy Blue, Humana Healthy Horizons, Molina and Select Health (First Choice)

Who does what after the reorganizations

Older guides, forms and payer checklists still say "DHEC licensed" and "DAODAS". Here's how those map today:

You'll see	What it is now	What it does for an IOP
DHEC (health regulation)	Department of Public Health (DPH)	Licenses your facility under R. 60-93, inspects it and collects the fee. DPH's FY2025 fees and fines report lists the outpatient license
DAODAS	Office of Substance Use Services, within BHDD	The state substance use authority, working with the county alcohol and drug authorities; public funding and planning, not your facility license
Department of Mental Health; DDSN	Also merged into BHDD	Public mental health and disability services

The merger was signed in June 2025; the state's BHDD page says the department replaces DAODAS, the Department of Disabilities and Special Needs and the Department of Mental Health, and a June 2025 report describes it as the largest restructuring of state government in more than 30 years. Facility licensing for chemically dependent or addicted persons stayed with DPH. If an older document tells you to send something to DHEC or DAODAS, find out which successor office takes it now.

The regulation to read

South Carolina's licensing standard covers inpatient, residential and outpatient facilities for people with substance use disorders. The State Library's record notes that R. 61-93 was transferred by State Register Document No. 5352 (SCSR 49-5), effective May 23, 2025, and is now R. 60-93. The text most people still read is the unofficial DHEC-hosted copy of R. 61-93; the official text is the latest publication in the State Register, so check that the copy you're working from matches.

Map these topics from the copy you use; section numbers can shift between versions, and only the 100-series licensing sections are cited below by number.

Look for	What to build from it
Licensing (the 100-series sections; fees in 102)	The license application, fees, satellites, renewals, and what changes need DPH approval
Enforcement and inspections	Expect DPH inspections; keep a survey-ready binder from day one
Staffing and training	Job descriptions, staff qualifications, orientation and annual training records
Client rights, assessment, treatment planning, records	Your intake packet, assessment, individualized plans and record-keeping policies
Physical plant and fire safety	The site, the fire marshal's approval and your drills

Our launch package builds the policy manual as a crosswalk: every requirement in the regulation matched to a policy, form or record, so a DPH inspector can find each one. For how intensive outpatient differs from partial hospitalization and outpatient, see IOP vs. PHP vs. outpatient, and for a typical week, the IOP schedule template.

Fees and renewals

From section 102 of the regulation (text current through September 2024) and DPH's FY2025 fee report:

Item	Fee	Our notes
Outpatient facility license, initial and annual	$75	Paid before the license is issued
Each outpatient satellite	$50	Plan satellite locations into the application
Late renewal	$75 or 25% of the license fee, whichever is greater	Put the renewal date on the compliance calendar the day the license arrives

The DPH fee report notes the department may also charge an inspection fee; ask DPH what applies to a new outpatient facility. At $75, the license is the smallest line in your budget. Rent, staff and build-out before your first claim pays are the big ones; what it costs to start an IOP walks through them. Want the license work done for you? It's part of the program launch package, or $7,500 on its own as our state facility license application service.

Counselors and staffing

• The board. South Carolina licenses addiction counselors through a combined board at the Department of Labor, Licensing and Regulation (LLR): the Board of Examiners for Licensure of Professional Counselors, Marriage and Family Therapists, Addiction Counselors and Psycho-Educational Specialists. The license is the licensed addiction counselor (LAC), with an associate stage first.
• Associates and supervision. LLR's supervision procedures say supervision for licensed associates lasts at least two years. Plan who will supervise each associate before you hire them.
• Supervisors. LLR's LAC supervisor application requires a current, unrestricted South Carolina addiction counselor license, at least three years of continuous practice, and either a qualifying certification or documented supervision training and experience.
• Licensed clinicians. Professional counselors, marriage and family therapists and social workers carry their own licenses; plan one for diagnosis and co-occurring care, and check the regulation's staffing section for which roles it requires.
• Every hire gets checked against the federal OIG exclusion list.

We build personnel files from our staff credential file checklist and add each state's items. For prescribers and MAT, see psychiatric services in an IOP and adding MAT to an IOP.

Healthy Connections Medicaid

• Five MCOs. SCDHHS's managed care page lists Absolute Total Care, BlueChoice (Healthy Blue), Humana Healthy Horizons, Molina and Select Health (First Choice). SCDHHS notes the participating plans can change.
• More members in managed care. Effective January 1, 2026, SCDHHS moved more adults into managed care for medical services, including dually eligible members, certain waiver enrollees and nursing facility residents; waiver services stay fee-for-service.
• The county authorities. South Carolina's public substance use system runs through county alcohol and drug authorities. A 2024 SCDHHS bulletin (extending DAODAS providers' coverage) let them enroll as physician group providers, and says the MCOs handle authorizations, coverage and payment for their members.
• Ask SCDHHS which provider type fits. We didn't find a public SCDHHS document that spells out how a private, DPH-licensed outpatient SUD program enrolls for intensive outpatient. Ask SCDHHS provider enrollment, and each MCO, what license, accreditation and provider type they require, and get it in writing before you count on Medicaid revenue.
• 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, MCO credentialing and facility contracts in any state; Medicaid enrollment is $500 per clinician. Commercial plans are often the bigger door for a private IOP, and getting insurance contracts for an IOP explains the facility packet. Before every admission, verify benefits and authorization with the VOB checklist.

Referrals and marketing

Federal law applies to every South Carolina program: the Eliminating Kickbacks in Recovery Act (18 U.S.C. 220) bars paying or receiving anything for referrals to a treatment facility whatever the payer, and the Anti-Kickback Statute covers Medicaid. We didn't research South Carolina's own statutes on referral payments for this guide, so ask your attorney. Pay marketers a salary, never per admission. Our guides to patient brokering laws and marketing a treatment center explain where the lines are.

The steps, in order

1. Define the program: intensive outpatient and any other outpatient services, adults or adolescents, and any satellites.
2. Form the business with the South Carolina 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, line up the fire marshal, and lease it with a way out.
4. Write the policy manual from R. 60-93, plus 42 CFR Part 2 and HIPAA.
5. Hire the director, clinical supervisor and counselors, and verify each LLR license and associate's supervision plan.
6. Apply to DPH for the outpatient facility license, with the $75 fee and $50 for each satellite.
7. Set up the EHR before the inspection: 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 SCDHHS and contract with the MCOs your clients carry, and credential with commercial plans.
9. Consider accreditation once you're operating; many commercial plans want it. See accreditation for new programs.
10. Renew every year, on time, 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 South Carolina?

Yes. An outpatient substance use program is a facility licensed by the Department of Public Health under the Standards for Licensing Facilities for Chemically Dependent or Addicted Persons, now R. 60-93 (formerly R. 61-93).

Is R. 61-93 still the right citation?

It was transferred to R. 60-93 effective May 23, 2025, by State Register Document No. 5352. Many forms and guides still say 61-93. Check that your copy of the text matches the latest State Register publication.

How much is an outpatient treatment license in South Carolina?

$75 for the initial and each annual license, plus $50 for each satellite location, paid before the license is issued. A late renewal costs $75 or 25% of the license fee, whichever is greater.

What happened to DAODAS?

A 2025 law merged DAODAS, the Department of Mental Health and the Department of Disabilities and Special Needs into the Department of Behavioral Health and Developmental Disabilities. DAODAS became its Office of Substance Use Services. Facility licensing stayed with the Department of Public Health.

Which Medicaid plans operate in South Carolina?

Absolute Total Care, BlueChoice (Healthy Blue), Humana Healthy Horizons, Molina and Select Health (First Choice), per SCDHHS. Plans can change, so check SCDHHS before you contract.

Can a Texas company help with a South Carolina program?

Yes, if it's honest about how. We run a Texas program, so in South Carolina we work from R. 60-93, SCDHHS's policies and the MCOs' rules, check each against the current text, and tell you where DPH, SCDHHS, the MCOs or your attorney has the final word. We don't guarantee a license, contract or date.

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

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

Sources

• The regulation: R. 61-93, unofficial copy; transfer to R. 60-93: South Carolina State Library; fees, section 102: Justia
• DPH fees: FY2025 DPH fees and fines report
• BHDD: SC.gov, Department of Behavioral Health and Developmental Disabilities; The Woodruff Times (June 30, 2025)
• Counselors: LLR LAC supervision procedures; LAC supervisor application
• Medicaid: SCDHHS managed care; Healthy Connections managed care; SCDHHS bulletin on county authorities
• EKRA, 18 U.S.C. 220: Cornell LII; 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, Oregon, Pennsylvania, Tennessee, Utah, Virginia, Washington, West Virginia and Wisconsin, or how to start an IOP for what every state has in common.