Department of Mental Health Community Licensing Division

DMH Community Licensing Division

A program license is required for any program including private programs operated or contracted by the Department which operates a residential site and is organized primarily to provide treatment, rehabilitation, support and supervision for mentally ill persons

Community Licensing Guidelines, Regulations, and Documents

Regulations

• 104 CMR 28.00: Licensing and Operational Standards for Community Programs
• 104 CMR 32.00: Investigation and Reporting Responsibilities

Residential Licensing Forms

• Site Feasibility Assessment
• Pre-placement Survey Requirements
• Physical Facility Pre-placement Survey
• Affidavit for Local Building Official
• Instructions for Completing Application
• Application For Licensure
• Waiver Petition
• Pool Policy  

PACT Certification Documents

• PACT Certification Procedures
• PACT Provider Application

Community Crisis Stabilization Licensing Forms

• Community Crisis Stabilization Site Feasibility Assessment Tool
• Community Crisis Stabilization Licensing Application
• Community Crisis Stabilization Instructions for Licensing Application
• Community Crisis Stabilization Waiver Petition/Determination Form
• Community Crisis Stabilization Pre-Placement Survey

Person Served Rights/Report a Complaint

If you wish to submit a complaint concerning a licensed private or residential program in the Commonwealth of Massachusetts, complete the complaint form and email to [e-mail] or mail to:

Director of Community Licensing
Department of Mental Health
167 Lyman St. Westborough, MA 01581

• Complaint Form  
• Appeal Form  

Contact Us

Kim Clougherty
Director of Community Services
617-626-8164
[e-mail]

Jennifer Evans
Director of Community Licensing/ Program Evaluation
508 977-3420
[e-mail]