How to start a behavioral health clinic in Virginia

Virginia requires a DBHDS provider license for behavioral health services (e.g., Mental Health Outpatient, Substance Abuse Outpatient, intensive outpatient, partial hospitalization) from Virginia Department of Behavioral Health and Developmental Services (DBHDS) — Office of Licensing to operate a behavioral health clinic. Processing time: DBHDS prioritizes the Commonwealth's most needed services. Priority applications are pulled from the waitlist within 10 business days; non-priority services may take a year or longer to be licensed. After policy review, the on-site inspection and license must happen within 45 calendar days (priority) or 90 calendar days (non-priority) for the application to stay open.

License required

Yes

License

DBHDS provider license for behavioral health services (e.g., Mental Health Outpatient, Substance Abuse Outpatient, intensive outpatient, partial hospitalization)

Issuing agency

Virginia Department of Behavioral Health and Developmental Services (DBHDS) — Office of Licensing

Processing time

DBHDS prioritizes the Commonwealth's most needed services. Priority applications are pulled from the waitlist within 10 business days; non-priority services may take a year or longer to be licensed. After policy review, the on-site inspection and license must happen within 45 calendar days (priority) or 90 calendar days (non-priority) for the application to stay open.

Accreditation

Not required for DBHDS licensure. Virginia is not among the federal CCBHC demonstration states named by Medicaid.gov.

Survey and inspection

On-site inspection before licensure, scheduled by the assigned Licensing Specialist.

Regulation

12VAC35-105 (Rules and Regulations for Licensing Providers by DBHDS); Code of Virginia 37.2-400 et seq.

1. Complete DBHDS's required Initial Applicant Orientation training
2. Register in the DBHDS CONNECT portal and submit a complete initial application with attachments, including policies and procedures and a sworn statement that they meet the regulations
3. Show evidence of financial resources to operate for 90 days (statement current within 30 days)
4. Wait for policy review (priority services within 10 business days; non-priority services from a waitlist); submit revisions within 30 days (priority) or 90 days (non-priority)
5. Complete background checks and the on-site inspection by the assigned Licensing Specialist
6. Receive a conditional (provisional) license, then a full license after demonstrating compliance

Program

Virginia Medicaid / Cardinal Care (Department of Medical Assistance Services, DMAS)

Enrollment portal

Medicaid Enterprise System (MES) Provider Services Solution (PRSS), the 'Provider Portal'

Fiscal agent

Gainwell Technologies (PRSS enrollment and revalidation support and notices)

Application fee

Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts. DMAS's revalidation plan says every revalidation includes collecting the application fee. The enrollment page does not list a separate state fee.

Fingerprinting

DMAS designates nursing facilities, DME, hospice, home health, prosthetic devices and doula services as high categorical risk. Its revalidation plan includes background checks for these providers. Under federal rules (42 CFR 455.434 and 455.450), the state places provider types in 'limited', 'moderate' or 'high' risk levels. High-risk providers, and anyone who owns 5% or more of one, must submit fingerprints for a criminal background check.

Site visit

DMAS's revalidation plan includes site visits for applicable provider types, including high-risk providers and the moderate-risk providers being revalidated off-cycle. Under federal rule (42 CFR 455.432), the state must visit moderate- and high-risk providers before and after enrollment. Every enrolled provider must allow unannounced on-site inspections.

Revalidation

Fee-for-service and MCO network providers enroll in PRSS and revalidate at least every five years. DMAS sends a notice at least 90 days before the enrollment period ends, with Gainwell reminder emails at 60 and 30 days. Revalidation is electronic only, through PRSS (see the Manage Revalidation panel). Missing it ends participation in both fee-for-service and MCO networks. Under DMAS's June 2026 CMS strategy, high-risk types (nursing facilities, DME, hospice, home health, prosthetic devices, doula services) move to a 3-year cycle on July 1, 2027. The 808 high-risk providers will be revalidated off-cycle from August to December 2027, and some moderate-risk providers in early 2028.

Full Virginia Medicaid enrollment guide →

CON program

Yes

Program

Certificate of Public Need (COPN)

Agency

Virginia Department of Health; the State Health Commissioner issues certificates after review by regional health planning agencies

Services covered

• hospitals, including DBHDS-licensed psychiatric hospitals
• nursing homes and new nursing home services
• intermediate care facilities for substance abuse treatment
• certain small ICFs for persons with developmental disabilities (not ICF/IID of 12 beds or fewer in need areas)
• outpatient/ambulatory surgery centers and physician-office surgery
• cardiac catheterization, CT, MRI, PET, radiation therapy, stereotactic radiotherapy (non-linear-accelerator), proton beam therapy
• bed or operating room increases and bed relocations
• new medical rehabilitation, neonatal special care, open heart surgery, psychiatric, and organ/tissue transplant services

Virginia certificate of need details →

State minimum wage

$12.77 an hour

Effective

2026-01-01

Scheduled increases

Rises to $13.75 on 2027-01-01 (Va. Code 40.1-28.10 as amended in 2026).

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Community/behavioral health agencies and mental health clinics — active organization NPIs (NPPES)

3,840 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

1,635,168 (as of Jun 1, 2026)

All Virginia Behavioral health Medicaid rates, ranked →

• VA Building Independence Waiver (1915(c))
• VA Commonwealth Coordinated Care Plus Waiver (1915(c))
• VA Community Living Waiver (1915(c))
• VA Family and Individual Support Waiver (1915(c))

Virginia waivers and waiting lists →