Here you will find out how to apply for a state license to provide all other services—with the exception of children's residential services—for individuals who have or who are at risk of mental illness, serious emotional disturbance, intellectual disabilities, substance use disorders, or brain injury. This includes applicants wanting to become licensed under the Rules and Regulations for the licensing of providers of mental health, mental retardation, and substance abuse services, the Individual and Family Developmental Disabilities Support Waiver and Brain Injury Residential Services.
(Please click here if you are applying for a license to provide children’s residential services.)
(Click here if applying for a license to provide children’s residential services.)
To be licensed by DBHDS to provide all other services—with the exception of children's residential services—the applicant must:
- Submit and receive preliminary approval of the Initial Provider Application [and required attachments].
- Submit, receive approval of, and demonstrate knowledge of required licensing policies, procedures and forms.
- Submit and receive approval of required Human Rights Policies and Procedures.
- Affiliate with a Local Human Rights Committee, (LHRC).
- Request the LHRC to approve their Human Rights Policies and Procedures.
- Set up an account and request criminal history and central registry background investigations for identified staff as required by Virginia Code §37.2-405 and submit Child Protective Services reference checks.
- Have an on-site review of the physical plant, to include interviews with applicants over the content of their service description and policies and procedures, as well as compliance with other regulations, and copies of forms and sample client and personnel records.
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Initial Provider Licensing Application
The Initial Provider Licensing Application packet is for applicants interested in becoming providers of all other services—with the exception of children's residential services. In the packet, the new provider applicant will find necessary forms and information needed to successfully apply for a license and manage your program. Obtain your initial application packet in one of three ways:
- Download for free the Initial Provider Application packet documents; or
- Send a completed order form and $35.00 for just the application packet; or
- Order the New Applicant Training DVD for $75.00–the application packet is included.
New Applicant Training is strongly encouraged prior to submitting your application. The training will provide you with information that will help you to successfully apply for a license and manage your program.
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Initial Provider Application Packet - (Download the entire application packet or click on the following individual forms as needed.)
- Licensing Process Overview
- DBHDS Process for Licensing
- Initial Provider Application
- CHAPTER 105 RULES AND REGULATIONS FOR LICENSING PROVIDERS BY THE DEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES
- Human Rights Rules and Regulations
- Licensing Regulation Matrix
- QMHP/QMRP Qualifications
- Direct Care Staff Qualifications
- College of Direct Support
- Staff Information Sheet
- Policy and Procedure Review Checklist
- Background Investigation Unit
- Contact central registry background investigations through the Department of Social Services. Required forms can be obtained from their Web site, www.dss.state.va.us.
- Annual Operating Budget Form
- Physical Environment Review Checklist
- Non-Resident Physical Environment Review Checklist
- Personnel Review Checklist
- Individual Review Checklist
- Rate Sheet
- Human Rights Provider Verification
Licensing Tools:
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Note! Due to budget reductions, the Office of Licensing is no longer able to offer live training for applicants interested in becoming providers of all other services – with the exception of children's residential services. We highly recommend our new training DVD that will provide you with the information you need to successfully apply for a license and manage your program.
The DVD
includes a recording of the actual training, plus comments by the offices of
Human Rights and Intellectual Disabilities. Also included is the entire
application packet containing regulatory information, application materials and
management tools. Once purchased, you will own the DVD, be able to refer back
to it repeatedly and share it with your staff at a time convenient for you.
To order the DVD — plus the entire application packet — please send
your payment of $75.00 along with the completed
order form.
(If you only want the application packet, you may send $35.00 and the completed order form–or you may click to download the application packet materials for free.)
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Renewal Application (Word) - Please use this form to renew a license.[ top of page ]
Service Modification Application (Word) - Please use this form when you are already licensed and want to want to modify the license or add a service or location. Please submit the completed form 30-60 days prior to implementation of the modification.
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The Department can only accept payments in the form of a check or money order. The following licensing services are available to providers and provider-applicants:
- There is a $35.00 fee if you opt to receive the Initial Provider Application packet
through the mail; or choose to download the packet for free.
- The cost of the Initial Provider Training DVD — plus the entire
application packet — is $75.00
Please mail the completed order form with a CHECK or MONEY ORDER to the following address. If you have any questions, you may phone (804) 786-9302.
DBHDS, Office of Licensing
Attention: Office of Licensing
P.O. Box 1797
Richmond, VA 23218-1797
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