A free guide from Cima Consulting

How to start a detox center in Texas

A detox program in Texas is a licensed chemical dependency treatment facility that offers withdrawal management. This guide covers the license, the detox rule line by line, the medical and nursing coverage, medications and the DEA, the building, and how Texas Medicaid, commercial plans and TRICARE pay. From the team that runs a licensed Texas PHP, IOP and outpatient program.

Updated October 24, 2026. Checked against 26 TAC chapter 564 as published in 2026. Not legal or medical advice: confirm the current rules with HHSC, your medical director and a health-care attorney.

The short answer: Texas has no separate "detox license." You apply to HHSC for a chemical dependency treatment facility (CDTF) license that includes detoxification services, on Form 3207, and meet 26 TAC 564.902 on top of the rest of chapter 564. The detox rule asks for a physician medical director, a history and physical within 24 hours of admission, an LVN or RN on duty at least 8 hours every day, a physician or designee on call 24 hours, services available at least 16 hours a day, 7 days a week, and, in residential detox, monitoring at least every 4 hours. The license fee is $1,200 plus $35 per residential bed (26 TAC 564.408). The two hard parts are 24-hour clinical staffing and getting paid: commercial plans usually want accreditation and authorize detox a few days at a time.

Which license a detox needs

In Texas, withdrawal management is a treatment service of a licensed CDTF, regulated by the Health and Human Services Commission under Health and Safety Code chapter 464 and 26 TAC chapter 564. The same license covers outpatient, IOP, PHP and residential services; your application says which services you'll provide at which site. What changes for detox is the extra rule in 564.902 and, if clients stay overnight, the residential rules.

Setting	What licenses it	Rules on top of chapter 564
Freestanding residential detox	HHSC CDTF license with detox and residential services	564.902 (detox), 564.903 (residential), subchapter L (residential physical plant), the $35 per bed fee
Ambulatory (outpatient) detox	HHSC CDTF license with detox services at an outpatient site	564.902; the 16-hours-a-day, 7-days-a-week access rule still applies
Detox unit inside a hospital	The hospital's license	Hospital licensing and Medicare hospital rules; ask the hospital's compliance office
Methadone for opioid withdrawal, beyond 3 days	A narcotic treatment program (OTP) license, or an approved hospital	26 TAC chapter 563 and 42 CFR Part 8. See how to start an OTP in Texas

The application itself (Form 3207, the Form 3208 checklist, the operational plan, the 6-month compliance window and the inspection) is the same for every CDTF and is laid out in our step-by-step guide to the Texas CDTF license. HHSC's CDTF provider page points residential applicants to its Substance Use Disorder Compliance Unit (512-438-4328 as of October 2026) for physical plant and pre-licensure inspection questions. Call before you sign a lease on a building you'll sleep clients in. (Planning mental health services instead? See how to open a mental health clinic in Texas.)

Pick your level of withdrawal management

Payers authorize detox by level of care, and most use the ASAM Criteria. The level you choose decides your staffing, building and payer mix, so choose it before anything else. In the 3rd edition, which many payer contracts still cite, the levels are:

ASAM 3rd edition	What it is	Fits a freestanding Texas CDTF?
1-WM	Ambulatory withdrawal management without extended on-site monitoring: office visits, the client sleeps at home	Yes, as outpatient detox; often run by a prescriber alongside an IOP
2-WM	Ambulatory withdrawal management with extended on-site monitoring during the day	Yes; pairs well with a PHP schedule
3.2-WM	Clinically managed residential withdrawal management ("social detox"), for mild to moderate withdrawal	Yes, as residential detox
3.7-WM	Medically monitored inpatient withdrawal management, with 24-hour nursing and physician availability	Yes, and the level most freestanding "medical detox" programs bill
4-WM	Medically managed intensive inpatient withdrawal management	No: this is hospital care

The 4th edition changes the labels. The ASAM Criteria, 4th edition, folds withdrawal management into each level of care instead of keeping separate WM levels: 3.2-WM's standards move into Level 3.5, and 3.7 and 3.7-WM combine into one Level 3.7 (NAATP summary of the 4th edition). Texas lets regulated group health plans use either edition: 28 TAC 3.8001 names the MCG Care Guidelines (27th edition), the ASAM Criteria 3rd edition, and the ASAM Criteria 4th edition, Volume I. Write your admission and continued-stay criteria in the edition each contract names, and map both in your policy.

For how detox fits with the rest of a program (most clients step down to residential, PHP or IOP), see IOP vs. PHP vs. outpatient and our sister guide on starting a residential treatment center in Texas.

What 26 TAC 564.902 requires

The detox rule is short. Here it is by requirement, from the text of 26 TAC 564.902 as published (Justia, current through March 2025; also on Cornell LII), and what we'd put in the binder to prove each one:

Requirement	What the rule says	What proves it
Admission eligibility	Everyone admitted meets DSM criteria for substance intoxication or withdrawal	A dated screening with the withdrawal diagnosis and a withdrawal scale (for example CIWA-Ar or COWS) in every chart
Medical director	A licensed physician, responsible for admission, diagnosis, medication management and client care	A signed agreement, the physician's Texas license and DEA registration, and their sign-off on medical policies
Designees	The medical director or a designee (physician assistant or nurse practitioner) approves all medical policies, procedures, tools and the medical content of forms, and may authorize admissions and do the examination	Written delegation; for an NP, the prescriptive authority agreement
History and physical	A face-to-face history and physical and signed admission orders within 24 hours of admission; an exam from the 24 hours before admission can count if the medical director or designee approves it and it covers the required elements	Time-stamped H&P and orders in every chart
Nursing	A licensed vocational nurse or registered nurse on duty at least 8 hours every day	The nursing schedule and time records, every day of the week
Physician coverage	A physician or designee on call 24 hours a day	The on-call calendar, with phone numbers, posted for staff
Hours	Detox services accessible at least 16 hours a day, 7 days a week	Posted hours and an admissions schedule that matches them
Monitoring	In residential detox, at least every 4 hours	Vital signs and withdrawal scores on a flowsheet, at least every 4 hours around the clock
Emergencies	Continuous access to emergency medical care	A transfer agreement or written procedure with the nearest emergency department, and drills

The rest of chapter 564 still applies: QCC-authorized admissions, the consent with all of 564.802(b)'s elements, the client bill of rights, the grievance procedure, incident reporting and staff training. Our plain-English map of 26 TAC 564 lists each one with the document that proves it. The rule sets floors. Payers, accreditors and your medical director will usually ask for more, such as nursing around the clock at the 3.7 level.

Staffing a detox

A detox is a 24-hour medical service, so its payroll looks nothing like an IOP's. The roles we'd plan for a residential detox:

Role	License and who issues it	What to plan
Medical director	Physician, Texas Medical Board; DEA registration	Addiction medicine experience; a written agreement at fair market value for hours actually worked. See hiring a medical director
NP or PA designee	APRN (Board of Nursing) with a prescriptive authority agreement, or a PA	Admissions and the 24-hour H&P, daily rounds, the on-call rotation
Nurses	RNs and LVNs, Board of Nursing	At least 8 hours on duty every day by rule; around the clock at 3.7. Medication administration, monitoring, the flowsheet
Counselors	Qualified credentialed counselors (LCDCs, or other licensees with 1,000 hours of SUD experience)	Screening, admission authorization, assessment and the discharge plan to the next level of care
Technicians	Trained staff, with the training 564.603 requires before they do the duty	Overnight observation, safety rounds, intake support

The math that surprises people: one position covered around the clock is 168 hours a week, which is about 4.2 full-time employees before anyone takes vacation or calls in sick. A 3.7 detox with one nurse and one tech on every shift needs roughly 8.4 FTEs for those two posts alone, plus the medical director, the NP or PA and counselors. Build that into the business plan before you pick a bed count. For the outpatient side of the team, see IOP staffing requirements in Texas; for each person's file, the staff credential file checklist.

Medications, the DEA and methadone

Storage and counts. A detox stores and gives medication, so 26 TAC 564 subchapter J applies: written procedures, locked storage, administration only by staff legally authorized to give it, and at least daily counts of stored Schedule II, III and IV medications, with any difference explained in a signed note. Our guide to adding MAT to a program walks through those sections.
DEA registration for the site. Storing or dispensing controlled substances (benzodiazepines for alcohol withdrawal, buprenorphine for opioid withdrawal) needs a DEA registration for that address. Register through DEA Diversion Control and confirm the current fee there.
Buprenorphine can be prescribed or given for opioid withdrawal by any practitioner whose DEA registration covers Schedule III, where state law allows; the X-waiver ended in 2022.
Methadone is different. Outside an opioid treatment program or a hospital, a practitioner may give or dispense a narcotic to relieve acute opioid withdrawal only under the narrow exception in 21 CFR 1306.07(b): no more than a 3-day period while arranging referral for treatment, and it can't be renewed or extended. A detox that wants methadone tapers is opening an OTP. Texas's rules for hospitals approved for narcotic drug detoxification are in 26 TAC 563.151.
The PMP. Texas prescribers check the prescription monitoring program before prescribing opioids or benzodiazepines (Health and Safety Code 481.0764). Ask your consultant pharmacist how it applies to doses given on site, and whether your medication model needs a pharmacy license.
Naloxone on every unit, and in every client's hand at discharge: tolerance drops after detox. Our naloxone policy guide has the policy outline.
Drug testing. On-site urine cups need a CLIA certificate of waiver; see CLIA waivers for drug testing.

The building

Zoning and occupancy first. The city decides whether people may sleep there for treatment and what occupancy class the certificate of occupancy needs. Get it in writing before you sign. 26 TAC 564.505 asks for the certificate of occupancy and an ADA checklist (HHSC CDTF page).
Residential physical plant rules are in 26 TAC 564 subchapter L (564.1201 to 564.1207). For example, 564.1203 requires fire drills on each shift at least quarterly, with evacuation procedures that cover people with disabilities. Our sister product explains fire drill requirements and the environment-of-care rounds.
Ligature and safety. People in withdrawal can be at high risk of self-harm. Walk the bedrooms and bathrooms with a ligature risk assessment before you buy furniture.
Bed count. Every residential bed adds $35 to the license fee, and more than 16 beds can make the facility an "institution for mental diseases" for Texas Medicaid adults. Read the IMD section of our residential treatment guide before you set the number.

Who pays for detox

Payer	How it works	Watch for
Texas Medicaid	The TMHP Behavioral Health handbook lists outpatient and residential withdrawal management, with prior authorization on TMHP's forms signed by a QCC. TMHP has said Medicaid SUD treatment may be given only in a licensed CDTF (TMHP notice)	Most members are in managed care, so you need each MCO's facility contract too. See Texas Medicaid credentialing
Commercial plans	Texas Insurance Code chapter 1368 says covered care in a chemical dependency treatment center is provided as if it were given in a hospital (section 1368.007), and 28 TAC 3.8001 sets the screening criteria plans use	Facility contracts usually require accreditation; authorization is often a few days at a time with concurrent review
TRICARE	Residential SUD care runs through authorized substance use disorder rehabilitation facilities, which must be accredited by the Joint Commission, CARF, COA or another body the Defense Health Agency approves (TRICARE Policy Manual, chapter 11, section 8.1)	The manual sets these facilities apart from acute treatment; ask the regional contractor how your detox is classified. See TRICARE credentialing
Out of network and single case agreements	Common in the first months, before contracts	Verify benefits and authorization before admission; never waive patient cost-sharing as a routine practice

Detox lives and dies on admission-day verification. Use the insurance verification guide for detox and residential and the prior authorization guide, and document each day's withdrawal scores, because those are what the reviewer asks for. How facility contracts are won is in our guide to insurance contracts for treatment centers; we file and follow them through our credentialing service.

Step by step

Choose the level (ambulatory, 3.2-WM, 3.7-WM or a mix) and who you'll serve. Check demand and payer rates for that level in your county.
Hire a health-care attorney and a CPA. Settle ownership and the medical director's role first: Texas has a strong corporate practice of medicine doctrine.
Sign the medical director and the NP or PA designee, and write the medical protocols with them (withdrawal scales, medication orders, transfer criteria).
Find the building and get the city's written answer on zoning and occupancy. Call HHSC's SUD Compliance Unit about the physical plant before you sign.
Form the entity with the Texas Secretary of State, get the EIN, and use the exact legal name everywhere.
Write the operational plan and policy manual against 26 TAC 564 and 564.902, including the 24-hour H&P, monitoring and emergency transfer procedures.
Build out and pass the fire inspection; get the certificate of occupancy.
Hire and train the team, with credential files and 564.603 training finished before anyone does the duty.
Register the site with the DEA and set up medication storage, counts and disposal.
File the CDTF application with HHSC when you're close to ready, because the 6-month clock starts on filing. Don't admit anyone until HHSC approves in writing.
Pass the inspection, then enroll with TMHP as a CDTF and apply for facility contracts.
Open, then pursue accreditation. Joint Commission and CARF survey programs that are serving clients; see accreditation for new programs and Joint Commission vs. CARF.

Fees you can count on

We only list fees we can source. Build-out, insurance and payroll are much larger and depend on your building and level.

Fee	Amount and source
HHSC CDTF license (two years)	$1,200 base, plus $125 per extra site and $35 per residential bed (26 TAC 564.408). A 16-bed residential detox at one site: $1,200 + 16 × $35 = $1,760
Texas certificate of formation	$300 (Texas Secretary of State)
DEA registration for the site	Set by the DEA; check the current fee when you apply
Accreditation	Joint Commission: $1,700 application deposit, on-site survey from about $3,330, annual fee from about $1,930 (Joint Commission fact sheet, as of our 2026 roadmap). CARF: ask CARF. See accreditation cost and timeline

Opening a detox, or adding one to a program?

We prepare the HHSC application and operational plan for the services you'll license, with every required policy checked against 26 TAC 564: the state facility license application is $7,500, and a full program policy and procedure manual, with the detox, medication and emergency transfer policies, is $7,500. Most detox programs also run a step-down: the IOP / PHP Program Launch is $39,500, or $54,500 carried through Joint Commission or CARF.

Book a free call

Our flat-fee launch packages are built for outpatient programs. For a residential detox we scope the work on a free 30-minute call and quote the pieces you need from the list below, so you never pay for a package that doesn't fit.

Service	Price
State facility license application Your program's state license application prepared and filed, and the inspection prepared for. Includes: Application and operational plan (Texas: HHSC forms and 26 TAC 564); Required policies checked against the rules; Inspection-readiness walkthrough.	$7,500
Program policy and procedure manual A full policy manual written for your program, organized by accreditation chapter, in Word. Includes: Every chapter: rights, care, records, medications, infection control, safety, emergency management, HR, leadership, performance improvement; Environment-of-care and emergency plans; State-rule crosswalk; Editable Word files.	$7,500
Accreditation readiness Get ready for a Joint Commission or CARF survey: a gap assessment, a fix plan and the evidence surveyors ask for. Includes: Gap assessment against the standards; Policy and chart fixes; Staff training and tracer practice; Application and survey scheduling; A full mock survey.	$16,500
Facility or group contract: one plan A program or group contract with one insurance plan: the organization application, site visit and contract. Includes: Organization application; Site visit preparation if the plan does one; Contract and rate review checklist; Effective date and billing set-up confirmed.	$950 per plan

Questions

Do you need a license to open a detox center in Texas?

Yes. Withdrawal management is a chemical dependency treatment service, so a freestanding detox needs an HHSC chemical dependency treatment facility license that includes detoxification services, and must meet 26 TAC 564.902. A detox unit inside a hospital operates under the hospital's license.

What staff does a Texas detox need?

Under 26 TAC 564.902: a physician medical director, an LVN or RN on duty at least 8 hours every day, and a physician or designee (NP or PA) on call 24 hours a day, with a history and physical within 24 hours of admission. Counselors and trained technicians round out the team, and medically monitored programs usually staff nurses around the clock.

Can a detox be outpatient?

Yes. Ambulatory withdrawal management (ASAM 1-WM and 2-WM) is provided by licensed CDTFs at outpatient sites, often alongside an IOP or PHP. The 564.902 requirements, including services accessible at least 16 hours a day, 7 days a week, still apply.

Does Texas Medicaid pay for detox?

Texas Medicaid lists outpatient and residential withdrawal management, with prior authorization on TMHP forms signed by a qualified credentialed counselor, delivered by licensed CDTFs. Most members are in managed care, so you also need a contract with each plan. For adults 21 to 64, a residential facility with more than 16 beds raises the federal IMD question.

Can a detox use methadone?

Only narrowly. Outside an opioid treatment program or a hospital, federal rule 21 CFR 1306.07(b) allows a practitioner to give or dispense a narcotic to relieve acute opioid withdrawal for no more than 3 days while arranging a referral. Most freestanding detox programs use buprenorphine, which any practitioner with a DEA registration covering Schedule III can provide.

How long does it take to open a detox in Texas?

HHSC has 45-day review windows for the packet, the inspection and the license, and you have 6 months from filing to show compliance. The building usually sets the pace: zoning, build-out and the fire inspection come first. Plan in months, and don't file until the site and staff are close to ready.

Do I need accreditation to open a detox?

Not for the Texas license. But TRICARE requires it for residential SUD facilities and many commercial plans want it before they'll contract, so most programs plan for Joint Commission or CARF from the start and are surveyed after they open.

Sources

26 TAC 564.902, requirements applicable to detoxification services (Justia) and Cornell LII
26 TAC chapter 564; 564.408, fees; 564.1203, fire drills
Texas Health and Safety Code chapter 464; chapter 481 (PMP checks)
HHSC: Chemical Dependency Treatment Facilities
TMHP, Texas Medicaid Provider Procedures Manual: Behavioral Health handbook; TMHP SUD benefit notice
Texas Insurance Code 1368.007; 28 TAC 3.8001 (screening criteria)
ASAM Criteria; NAATP, ASAM Criteria 4th edition key updates
21 CFR 1306.07 (the 3-day exception); DEA Diversion Control Division
TRICARE Policy Manual, chapter 11, section 8.1: substance use disorder rehabilitation facilities

Cima Consulting isn't a law firm and doesn't give legal or medical advice. HHSC decides every license, and payers decide every contract and authorization; no one can promise an approval, a rate or a date.

Staff it, license it, get it paid.

Start with a free 30-minute call about your level of care, your building and your payers.