This article contains one update.

Will the recovery housing workgroup make any progress toward protecting residents’ rights to choose their own healthcare providers? As with protections from arbitrary evictions, the answer is unclear.

This is the fifth in a series of updates on the SB838 workgroup, which is still deliberating on recommendations — due to the General Assembly by Nov. 1 — to strengthen oversight, transparency and resident rights in Virginia’s recovery housing sector. 

Today’s focus: protecting freedom of choice in treatment

Among other tasks, SB838 directs the workgroup to recommend “protocols to ensure resident and patient choice in receiving treatment and that the recovery residence operator, the house manager, or anyone in leadership with the recovery residence is not determining the treatment received.”

That language is responsive to accounts from dozens of former residents and employees of Richmond-area recovery homes who report operators steering residents into specific outpatient programs — with some described as low quality — that generate financial benefit for the operators. 

It also aligns with findings from a regional, Virginia Commonwealth University-led study on the needs of pregnant and parenting individuals with substance use disorders¹:

Lack of standards and oversight. Residents of some recovery housing facilities are reportedly told from which clinicians they must seek treatment, are evicted for minor conduct violations (e.g., bringing food into a residence), and lack tenant housing rights. Such issues reportedly reflect a culture of control (and, at times, abuse) in some recovery residences, rather than any therapeutic value. …

SB838 makes clear that recovery house operators should not dictate residents’ clinical care, at minimum ensuring that residents retain the right to choose their own providers. What remains uncertain is the workgroup’s response, which to date has been limited and vague.

“Freedom of choice” and “self-directed care” have been presented at workgroup meetings as broad values, without any discussion of concrete mechanisms to ensure these principles in practice.

At the July 29 workgroup meeting, DBHDS introduced draft proposals related to the state certification process. The first bullet point on an early slide read: 

Establish minimum standards for DBHDS certification to ensure residents living in recovery residences are in a safe and supportive environment that foster [sic] self-directed care and freedom of choice

Bob de Triquet, interim executive director of the Virginia Association of Recovery Residences (VARR), commented at the meeting:

The first bullet point, I think that’s a great one, you know, resident freedom of choice. And that’s a very big deal, but also it seems like we almost need a full workgroup dedicated to the topic. That’s a very complex issue. We also see it, like, throughout the country as well, too, with other NARR (National Alliance for Recovery Residences) affiliates trying to tackle that. But also it involves parts of, like, licensure and DMAS (the Department of Medical Assistance Services), so that’s all these different components into it that make it very complex.

The SB838 workgroup, however, is tasked with developing standards for non-clinical recovery residences. That means licensing and DMAS (which governs Medicaid-funded clinical care) fall outside its scope. 

When I asked about his statement in light of the workgroup’s focus, de Triquet responded:

I was bringing attention to the fact that this issue straddles multiple parts of the system and that communication between all referenced entities is necessary to establish a holistic solution to a holistic issue. In regards to the system of care as a whole, I believe this topic would result in better outcomes through agencies working together and not in silos.

While some operators conflate their housing programs with treatment services — presenting them as a single package — they are, in fact, legally distinct. That separation exists for a reason: Having a place to live should never be contingent on a resident’s choice of treatment provider.

Client autonomy is also a basic tenet across the spectrum of addiction recovery services.² According to NARR policy, resident choice is a straight-forward principle:

• “A resident’s right to accept or reject recommended services … is an essential component of the Social Model of Recovery.” 
• Recovery house operators “shall promote choice in all recommendations for external services and/or providers. Residents must always be empowered to choose or reject the external services and/or providers suggested by the residence’s owners/operators.”

Yet in Metro Richmond, housing is often tied to specific outpatient programs in ways that undermine resident autonomy.

I raised this issue with de Triquet in the context of NARR standards. He provided a detailed written response:

In regards to the NARR Standard, it is clear – resident choice is a core principle of the social model and should be upheld at all times. We are working diligently to ensure our policies and procedures stay up to date with current practices in the recovery residence ecosystem. Our application for accreditation has always included the questions: does the applicant own and/or partner with a licensed alcohol & drug or mental health program or facility.”

Starting in early 2025, we added another layer to that – anytime an applicant answers yes to owning and/or partnering with a licensed facility, we have a series of follow up questions we ask and document – see below. We recently shared these questions with the DBHDS RRQA to solicit feedback and will be sending them to others on the clinical side for feedback as well.

1. What role does XXXXX have in the service delivery at recovery residences seeking accreditation?
2. Do any of your residents use the licensed services at XXXXX??
   1. If no, please stop here.
   2. If yes, please answer the following questions:
      1. Please provide an estimated percentage of current residents residing in the recovery residences seeking accreditation who access licensed services with:
         1. XXXXXX
      2. Is entering XXXXXX clinical services ever a requirement to enter and/or remain in the recovery residence?
      3. What does your organization do to ensure residents have Freedom of Choice for any licensed services they access?
      4. Do residents at the recovery residences seeking accreditation receive any type of compensation including, but not limited to paid bed fees, for accessing XXXXXX?
3. Does your organization have an understanding of the Eliminating Kickback in Recovery Act (EKRA) Law and Federal Anti-Kickback Statute?
   1. If no, we recommend educating yourselves on these as you have been identified as an applicant that operates recovery residences, and that owns, operates and/or partners with a licensed alcohol & drug or mental health program or facility.
   2. Responsibility for meeting local, state, and federal laws and codes lies with the owner/operator. The owner/operator seeking accreditation with VARR assumes all liabilities for any misrepresentations. In our effort to acknowledge trends in Virginia’s recovery housing landscape and deliver relevant information to operators, we recommend that any recovery residence provider who owns, operates or partners with a licensed alcohol & drug or mental health program or facility exercise the due diligence to inform themselves about these and other laws that pertain to those relationships, or contact an expert to educate them.

Amongst other things, these questions help to:

• Understand the nature of the relationship between the RR operator and licensed service.
• Determine if participation in clinical services is a requirement for accessing a recovery residence bed
• Assess if the appropriate NARR support level has been identified or recommend that this organization seek licensure
• This also documents the applicants’ answers for future reference should a situation arise where an operator’s practice contradicts the answers provided during the accreditation process.

If there are allegations that resident choice is being violated, I would ask that this gets submitted to VARR so that we can initiate the grievance process. Additionally, if any allegations towards a VARR accredited operator include a licensed facility that is in violation of their regulations, we encourage individuals to also submit a complaint to DBHDS licensure:

VARR Complaint Link:
https://varronline.org/accredited-residences-search/formal-grievance-2/

DBHDS Licensure Complaint Link:
https://vadhbdsv7prod.glsuite.us/GLSuiteWeb/Clients/vadhbds/Public/Complaints/ComplaintInformation.aspx

From VARR’s revitalization around 2017 until earlier this year, the organization’s leadership included individuals who, according to former residents and staff, were either directly involved in — or married to someone involved in — steering residents to specific providers. Among them was former Executive Director Anthony Grimes, now vice president of NARR. 

Jimmy Christmas, owner of River City Comprehensive Counseling Services and former VARR vice chairman, has been described by many as a central figure, partnering with VARR-accredited operators to direct residents into outpatient programs he owns or co-owns. Given the entanglement, residents consistently said they saw no point in raising concerns with VARR.

While none of the implicated individuals remain in VARR leadership today, VARR still occupies the Parham Road office with River City and two of the organizations named in steering allegations — WAR Foundation (owned by Grimes’ wife) and True Recovery RVA (formerly owned by VARR past president David Rook). 

The shared history and ongoing proximity between VARR and these organizations raise questions about whether residents’ past reservations remain relevant today.

At the July 29 workgroup meeting, no one responded when de Triquet raised the idea of a separate workgroup dedicated to resident choice, and the group moved on to other topics. Whether this subject will receive detailed attention in future sessions remains uncertain.

If this issue is important to you or someone you care about, you can weigh in:

• Attend a workgroup meeting and make a statement during the public comment period; or
• Email your comments with the bill number (SB838) to workgroups@dbhds.virginia.gov.

As previously announced, the next round of subgroup meetings will be held virtually tomorrow, Aug. 26. See the bill tracker page for details.

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Update: At the Aug. 26 subgroup meeting, DBHDS introduced draft language that would bar non-clinical recovery house operators from dictating residents’ treatment:

If adopted, the measure could be a game changer for operators whose business models depend on restricting resident choice. But it remains to be seen whether the provision will make it into the final recommendations to the General Assembly.

In the next and final update in the SB838 mini-series, I’ll cover complaints and investigations.

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Have a correction, update, or tip to share? Email christa@investigate-rva.com or get in touch with me here.

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1. Disclosure: I was among the many people interviewed for this study. Return to article.

2. See, for example, the Substance Abuse and Mental Health Services Administration’s Recovery-Oriented Systems of Care (ROSC) Resource Guide. Return to article.