Oregon Residential Treatment Facility License: RTH, RTF and SRTF

Oregon's adult mental health residential programs are licensed by the Oregon Health Authority under OAR chapter 309, division 35. The division covers three settings, and the one you build decides the license you apply for. This guide walks through the three types, what OHA's application asks for, the staffing and safety rules that changed in 2026, and the order that keeps an opening date intact.

One boundary first. Residential substance use disorder programs are a different license with different standards (OAR chapter 309, division 18), covered in our Oregon residential SUD licensing guide. Outpatient programs work through the Certificate of Approval. The overview of every Oregon license type is in our Oregon treatment facility licensing hub.

What are RTH, RTF and SRTF licenses in Oregon?

The definitions sit in OAR 309-035-0105 and follow the statute, ORS 443.400. All three provide services and supports on a 24 hour basis to adults; the difference is size and whether residents can leave.

The fees are in OAR 309-035-0115 and apply to initial and renewal applications alike; a program run by a government entity pays none. Adult foster homes for people with mental health conditions are a separate license again, under division 40, and OHA licenses those every year rather than every two.

Choosing the type is a building decision before it is a paperwork decision. A sixth bed moves a home into facility territory, with the occupancy classification and fire review that follow. A secure setting means locking hardware, approvals and policies that an unlocked RTF never needs. Settle the census and the security model before you sign a lease; our site selection guide covers the zoning side.

Which 2026 rules govern an Oregon residential license right now?

Division 35 has changed more in 2026 than in any recent year, so check the date on anything you read about it, including this page. As of October 27, 2026, the main steps on OHA's behavioral health rulemaking page are:

• January 1, 2026. Temporary rules (order BHS 32-2025) took effect through June 27, 2026 to align division 35 with three 2025 laws: HB 2015, HB 2024 and SB 739.
• May 1, 2026. Permanent rules took effect (order BHS 6-2026, filed April 30), amending 24 rules, including administrator qualifications, training, medication and civil penalties.
• June 1, 2026. A second set of temporary rules (order BHS 13-2026) took effect through November 25, 2026 to align the rules with four 2026 laws: HB 4016, HB 4068, HB 4069 and HB 4115. A companion order suspended the suspension of license rule, OAR 309-035-0275. Shorter temporary orders since then revised the waitlist rule, OAR 309-035-0158 (from July 3), and, on October 23, the rule on when a provider may give less than 30 days' notice of a move, OAR 309-035-0170 (order BHS 25-2026), both through November 25.
• October 19, 2026. Comments closed on the proposed permanent version of those 2026 changes, which would also repeal 0275. As of October 27 no permanent order for it is posted.

Because the June temporary rules end on November 25, 2026, expect a permanent filing or a further temporary order before then. OHA's May 2026 memo to adult mental health residential providers also says further changes are intended for January 1, 2027. Build policies against the rules in effect, then recheck the week you submit.

What do the 2025 and 2026 laws change for residential operators?

• Safety plan (HB 4069). The provider must develop and implement a comprehensive safety plan to identify, prevent and respond to hazards, including protocols for the physical safety of lone workers (OAR 309-035-0145 in the June temporary rules).
• Weapons and knives. Since May 15, 2026, temporary rules add a weapon definition and require locked storage for all kitchen knives, with policies on weapons and on searches for reasonable cause.
• Background checks (HB 4115). Check approvals now last three years instead of two.
• Tax compliance (HB 4016). Each owner with a 20 percent or greater interest submits a tax compliance certification issued by the Department of Revenue with the application.
• Transition aged youth homes (HB 2015 and HB 4068). HB 2015 directed OHA to create a separate licensing process for transition aged youth residential treatment homes, and HB 4068 defines that group as young adults from 17 to 25. Check the bill text on the Legislature's site before you plan a program for that age group.
• Inspections. Since January 1, 2026 (made permanent May 1), OHA must inspect every program in person between 90 and 120 days after initial licensure and at least once every two years after that.

What does OHA's residential license application include?

OHA's Guide to Applying for a Mental Health Residential License in Oregon (dated September 2026) lists 34 named attachments. The rule, OAR 309-035-0115, sets the core of the package:

• Ownership. Every person or entity with 5 percent or more ownership, plus the tax compliance certification for owners at 20 percent or more.
• Administrator. A resume showing the qualifications in the next section.
• Budget. A proposed annual budget. The guide recommends cash reserves equal to at least three months of operating costs.
• Background checks. For owners, the administrator and staff, through OHA's background check unit.
• Policies and procedures. The full set the division requires, written for your setting, not a template with the name changed.
• Local acknowledgement. A signed letter of acknowledgement from the Local Mental Health Authority or its designee.
• Building and fire. A certificate of occupancy based on the change of use, issued by the city or county building codes authority, and a fire inspection report from the State Fire Marshal or the local fire jurisdiction. OAR 309-035-0140 requires the setting to meet its occupancy classification under the Oregon Building Code and Oregon Fire Code before initial licensure.
• Floor plan. Showing the rooms, their uses and the beds you are asking OHA to license.

Applications go in through OHA's online portal, which takes the fee, or by email to the address in the guide. The guide is blunt about timing: submit at least 60 days before you plan to open.

How long does Oregon residential licensing take?

The rule and the guide set the clock once a complete application is in. Everything before that, the building, the hiring and the policies, runs on your schedule.

In our experience the certificate of occupancy sets the real opening date far more often than OHA's review does. A change of use can mean sprinklers, fire alarms, egress work or accessibility upgrades, and none of that is quick. Our OHA licensing timeline covers the sequencing, and the cost to open a treatment center in Oregon covers the budget around it. A program cannot take residents until the license issues.

What staffing does an Oregon RTH or RTF need?

• Administrator. Since May 1, 2026, the administrator needs one year or more of clinical experience in a setting that treats people diagnosed with serious mental illness, or two years or more of experience in a residential setting licensed to serve them (OAR 309-035-0125). The administrator must be available at the setting at least 20 hours a week. OHA's guide says experience with intellectual or developmental disabilities is not accepted, and the September 2026 proposal would also accept a current Qualified Mental Health Associate or Qualified Mental Health Professional credential held for at least one year.
• Around the clock coverage. At least one direct care staff member on duty at all times, and night staff must be awake, dressed and observant of program operations (OAR 309-035-0135). Missing 24 hour coverage carries a mandatory $250 penalty per occurrence.
• Orientation. At least 16 hours of pre-service orientation within 60 days of hire and before anyone works alone with residents, then at least 8 hours of in-service training every year.
• Medication. Staff who assist with medication must be trained by a licensed medical professional, registered nurse or licensed pharmacist (OAR 309-035-0215). Unused, discontinued, outdated or recalled medications must be disposed of, and disposal of Schedule I to V controlled substances must be witnessed by a second staff person who signs the disposal record.

In our experience the staffing model drives the budget more than any other line. Night awake coverage for a five bed home costs nearly what it costs for a larger facility, which is why census and license type belong in the same conversation.

What are the civil penalties under OAR 309-035?

OAR 309-035-0220, as amended May 1, 2026, sets the amounts. General violations carry penalties up to $250 per violation, to a maximum of $1,000. Falsifying individual service records or program records carries a mandatory penalty up to $500. Failing to have direct care staff on duty 24 hours a day carries a mandatory $250 per occurrence. Substantiated abuse carries up to $1,000 per occurrence. The amounts are modest; the findings behind them are what put a renewal or a payer contract at risk.

How do Oregon residential programs get paid?

A license is not a payer contract. OHA's guide says that to be paid for Medicaid eligible residents you must also apply through Medicaid provider enrollment, and every facility or home needs its own Medicaid ID number. OHA sets adult mental health residential rates in its fee for service behavioral health fee schedule; its most recent update to these rates we found took effect January 1, 2025. Plan provider enrollment and any coordinated care organization contracts alongside the license, not after it; our Oregon Medicaid billing guide covers how OHP claims work.

Operators in both states can compare this process with Washington's residential treatment facility license, which runs through the Washington Department of Health.

Frequently asked questions

What is the difference between an RTH, an RTF and an SRTF in Oregon?

Size and exits. Under OAR 309-035-0105, a residential treatment home serves up to five residents and a residential treatment facility serves six to 16. A secure residential treatment facility is an RTF, or part of one, that OHA has approved to restrict residents from leaving with locking devices on exit doors.

How much does an Oregon residential treatment facility license cost?

The application fee is $60 for a residential treatment facility and $30 for a residential treatment home, for an initial license or a renewal, with no fee for a program run by a government entity (OAR 309-035-0115). The license fee is the smallest cost of opening; the building, staff and reserves are the real budget.

How long does an Oregon mental health residential license last?

Two years from the date issued unless it is revoked or suspended sooner. A complete renewal application filed at least 60 days before expiration keeps the current license in effect while OHA reviews it.

Do I still need to send OHA a letter of intent?

OHA suspended the letter of intent rule (OAR 309-035-0114) from January 1 to June 27, 2026 and proposed repealing it, but the May 2026 permanent rules did not repeal it, and OHA's September 2026 application guide has no letter of intent step. Ask OHA's licensing unit whether it applies before you sign a lease or buy a building.

Does an Oregon residential license let me bill Medicaid?

No. OHA's guide says you must also apply through Medicaid provider enrollment, and every facility or home needs its own Medicaid ID number. OHA's application form adds that state approval does not guarantee eligibility to participate as an OHP provider.

Opening a residential program in Oregon

Saint Health Group takes a residential program from site selection to license as one accountable partner. We write the division 35 policies and the safety plan, build the application package, coordinate the building and fire approvals, train staff before the first resident arrives and run the mock inspection before OHA's. See our OHA licensing consulting or talk with us about your site.