Prepared for lenders, CDCs, and federal agencies to SBA SOP 50 10 8, USDA 7 CFR Part 5001, and conventional underwriting standards. Fiduciary duty runs to the lender and the agency, never the borrower. 4,000+ engagements since 1998 covering $41.2 billion in evaluated project value. So far in 2026: 41 engagements and $1.54 billion evaluated — 17 SBA, 11 USDA.
Behavioral health spans inpatient psychiatric beds, residential treatment, crisis stabilization, and the partial-hospitalization and intensive-outpatient continuum — and feasibility turns on documented unmet demand, licensure pathway, and payer access. The study quantifies the bed and slot deficit from prevalence data and existing capacity, documents the licensure and accreditation path level of care by level of care, and builds the revenue case from the payer contracts the operator can actually reach, since parity law on paper and network access in practice are different facts.
Demand modeling from prevalence and capacity-gap analysis, census ramp against referral-source development, per-diem and per-session yields by payer with authorization and length-of-stay patterns stated, staffing at required clinical ratios, and the operator's licensure track record weighed as the management dimension it is.
Every Wert-Berater financial model is fully linked with no hardcoded values, so any reviewer can stress any input. Deliverables comprise a complete narrative report and the linked Excel model, with ten-year pro forma, sensitivity analysis at ±5, 10, and 15 percent, interest-rate stress from +0.5 to +3.0 percent, and ratio analysis benchmarked against RMA and IBISWorld data.
SBA engagements are prepared to SOP 50 10 8, including its debt-service-coverage minimums of 1.15x operating and 1.00x global. USDA engagements follow RD Staff Instruction 5001 across the Business & Industry, Community Facilities, REAP, and Value-Added Producer Grant programs. Conventional engagements are built to the lender's stated coverage standard, typically 1.20x. Community-serving facilities reach USDA Community Facilities in eligible areas; for-profit operators fit B&I and SBA structures; the regulatory dimension is decisive in every framework.
The firm's senior-care and residential-facility record supplies the census-and-staffing underwriting architecture the category requires. Independence is non-negotiable: determinations follow the evidence and are not revised under pressure, and studies are built to pass lender, agency, and third-party review without exception items.
A feasibility study for a behavioral health facility (psychiatric, residential, PHP/IOP) is not a single document applied uniformly across levels of care. Each level of care — acute inpatient psychiatric, residential treatment, crisis stabilization, partial hospitalization, and intensive outpatient — carries its own licensure trigger, staffing ratio, reimbursement mechanism, and authorization pattern. The study addresses each level of care as a discrete operating unit, then models the facility as an integrated whole where census at one level feeds referral flow to another.
The bound narrative report and the fully linked Excel model are delivered together, with no hardcoded values, so any reviewer can independently stress any input.
Demand analysis for a behavioral health facility begins with prevalence, not with population headcounts alone. The study draws on published epidemiological prevalence rates for the specific diagnoses the facility will treat — major depressive disorder, substance use disorders, serious mental illness, co-occurring conditions — and applies those rates to the defined service area population to produce a diagnosed-population estimate. That estimate is then discounted for treatment-seeking rates, which behavioral health literature consistently shows are well below prevalence, producing a realistic addressable population.
Existing licensed capacity is inventoried from state behavioral health licensing registries, certificate-of-need filings where the state maintains a CON program, Medicaid managed care network directories, and SAMHSA facility locator data. Each competitor is assessed not only for licensed bed or slot count but for actual operating census where that information is available through cost reports, state utilization filings, or payer network disclosures. A licensed bed that is unstaffed or delicensed in practice does not constrain demand.
Referral-source mapping identifies the hospitals, emergency departments, courts, schools, employee assistance programs, and primary care networks within the service area whose discharge and referral patterns would direct patients to the proposed facility. Geographic access barriers — drive time, public transit availability, and rural designation — are documented because they affect both the realistic catchment area and the USDA eligibility determination. The result is a supply-demand gap stated in beds or slots by level of care, not a single aggregate figure.
Four inputs move the debt-service-coverage ratio for a behavioral health facility more than any others. Understanding how each is tested is the core of the underwriting conversation.
Sponsors evaluating a licensed acute-care or specialty inpatient facility rather than a behavioral health programme should refer to the firm’s hospital feasibility study consultant practice, where service-line demand and CMS certification are analyzed directly.
Each assumption is sourced and disclosed in the narrative so a lender or agency reviewer can evaluate the basis, not just the output.
Lenders and agencies financing behavioral health facilities raise concerns that are specific to this asset class and are not resolved by generic healthcare underwriting.
SBA engagements prepared to SOP 50 10 8 must demonstrate 1.15x operating debt-service coverage and 1.00x global coverage. For behavioral health, the SBA reviewer will scrutinize the payer-mix assumption because Medicaid and Medicare reimbursement rates are set by state plan and fee schedule, not by negotiation, and the study must document those rates rather than estimate them. The operator’s licensure history is treated as a management-quality dimension: a sponsor without a prior license in the proposed state faces a longer credentialing timeline, which the census ramp must reflect.
USDA engagements under 7 CFR Part 5001 differ by program. Community Facilities financing applies to nonprofit and public behavioral health providers in eligible rural areas and requires documentation of community need that aligns directly with the demand analysis. Business & Industry financing for for-profit operators requires the same coverage discipline but applies commercial underwriting logic to the payer-mix and contract assumptions. In both cases, the regulatory dimension — state licensure, Medicaid enrollment, network participation — is a condition of revenue, not a background fact.
Conventional lenders typically require 1.20x coverage and place additional weight on the operator’s existing network contracts, because a facility without executed payer agreements at opening has no demonstrated revenue floor. The study documents which contracts are executed, which are in negotiation, and which are assumed, and the sensitivity analysis isolates the coverage impact of the assumed contracts not materializing.
The fee for a behavioral health facility feasibility study is fixed and quoted in writing within one business day of the initial inquiry. No portion of the fee is contingent on the finding, and the determination is not revised under pressure. That structure is not a policy preference; it is the condition under which a study can be submitted to SBA, USDA, or a conventional lender as an independent third-party analysis. A contingent fee or a finding revised to satisfy a sponsor would disqualify the study from the lending process it is meant to support.
The standard delivery window is ten to fifteen business days from receipt of a complete data room. The data room for a behavioral health facility engagement typically includes the operator’s existing license and accreditation documents, executed or draft payer contracts with fee schedules, three years of historical financials if the operator has an operating history, the proposed facility’s construction or lease cost documentation, and the staffing plan with wage assumptions. Rush delivery is available when the lending timeline requires it.
Every engagement is published to a secure client portal where the Excel model stays live and recalculates when inputs change. This matters for behavioral health facilities because payer contracts are frequently renegotiated and state Medicaid rates are updated on a schedule; a lender who needs to re-run coverage under a revised rate assumption can do so without requesting a new engagement. The portal access remains available through the closing process. The deliverable set — bound narrative, ten-year pro forma, sensitivity tables, ratio analysis benchmarked against RMA and IBISWorld data, and explicit statement of conditions — is standard across all engagements regardless of loan program.
The fee is fixed, quoted in writing within one business day of inquiry, and does not vary with the finding. Because behavioral health facilities require level-of-care-specific demand analysis, payer-contract review, and licensure-pathway documentation, the scope is more involved than a single-use commercial property study. Contact Wert-Berater directly for a quote tied to your specific project structure and loan program.
Standard delivery is ten to fifteen business days from receipt of a complete data room. For behavioral health facilities, the data room must include payer contracts or draft agreements, the operator’s licensure documents, and the staffing plan with wage assumptions. Incomplete data rooms restart the clock. Rush delivery is available when a lender or SBA closing deadline requires it.
Three factors distinguish this asset class. First, parity law and actual network access are different facts — a payer may be legally required to cover a service but exclude the facility from its network. Second, revenue does not begin until state licensure and payer credentialing are complete, so the census ramp is tied to regulatory milestones, not just marketing. Third, staffing ratios are fixed by regulation, so cost cannot be reduced below a floor without losing licensure.
No study guarantees loan approval, and any firm that implies otherwise is misrepresenting the process. An independent feasibility study documents whether the evidence supports the project’s financial projections under the applicable lending standard. The credit decision belongs to the lender and, where applicable, to SBA or USDA. The study’s value is that it is built to survive agency and third-party review without exception items.
The core data room includes: the operator’s existing state behavioral health licenses and any accreditation certificates; executed or draft payer contracts with fee schedules; three years of historical financial statements if the operator has operating history; the proposed facility’s construction budget or lease terms; the proposed staffing plan with wage and benefit assumptions; and the service area definition. Gaps in payer contracts or licensure documentation are identified as conditions in the study.
The analytical methodology is consistent across loan programs, but SBA SOP 50 10 8 and USDA 7 CFR Part 5001 have different coverage standards, eligibility tests, and documentation requirements. If the loan program changes after delivery, the study may require a program-specific supplement or revision. Because the Excel model is fully linked with no hardcoded values and remains live in the client portal, coverage recalculation under a different standard is straightforward.
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Wert-Berater, Inc. is an independent provider of feasibility studies and other related services. The firm does not provide financing or equity investment advice, and does not arrange, broker, or place debt or equity capital of any kind.
All appraisal assignments are performed by Bruce E. Jones, MAI, ASA-GC, BCA, CMEA, a member of the Appraisal Institute since 2006, a staff member of Wert-Berater, Inc. and owner of Special Purpose Realty Valuation.