Language intended to protect patient choice was significantly altered before Senate Bill 270 was heard Friday in committee.
As introduced, the bill explicitly prohibited recovery residences from mandating clinical services as a condition of housing:
[State regulations] shall require that no recovery residence, or operator, employee, or agent of a recovery residence, require a resident to participate in medical or psychological services, including clinical substance use treatment, as a condition of entering or continuing residence at a recovery residence.
The revised version substantially narrowed the scope of that prohibition:
[State regulations] shall require that no recovery residence, or operator, employee, or agent of a recovery residence, require a resident to participate in medical or psychological services, including clinical substance use treatment, that such recovery residence receives financial benefit from, either directly or indirectly, as a condition of entering or continuing residence at such recovery residence.
At the hearing, Sen. Schuyler VanValkenburg (D-Henrico), the bill’s patron, said the revision was intended to clarify that operators may send residents to treatment so long as they do not financially benefit.
“So if someone’s tapering off or something and they want to make sure they have access to treatment, it can’t be, ‘But you have to go to mine,’” he said.
The scenario VanValkenburg described — a resident in withdrawal requiring medical detox — would generally involve a level of clinical care inconsistent with a nonclinical recovery residence. It’s unclear why such circumstances could not have been addressed through narrower language specific to emergency or medically imperative situations.
Instead, the revised provision grants recovery residence operators broad discretion. As written, it places no limits on the type or extent of clinical services operators may require, and it does not safeguard residents’ ability to choose their own providers — so long as the operator does not explicitly mandate services with a provider from which it derives a financial benefit.
In a follow-up interview, VanValkenburg acknowledged that part of the bill’s intent was to prevent recovery residence operators from steering residents into their own intensive outpatient (IOP) and partial hospitalization (PHP) programs.
Despite the economic-benefit caveat, the revised language’s broad flexibility appears to preserve the same power dynamics that have allowed these practices to persist in the Richmond area — even though they already conflict with NARR policy and widely accepted clinical standards emphasizing patient autonomy and person-centered care.
Over multiple years, reporting for this project has documented this form of patient steering among several operators accredited by the Virginia Association of Recovery Residences (VARR), including recent former leaders of the organization. One of them, Anthony Grimes — a 50 percent owner of WAR Foundation with his wife, according to DBHDS records — is now president of the National Alliance for Recovery Residences (NARR).
While multiple stakeholders participated in revising the bill language, VanValkenburg confirmed that VARR brought a request to narrow the scope of the restriction on treatment requirements.
A loophole preserved
While SB 270’s revised language aims to prevent treatment coercion for economic benefit, its practical effect is best understood by examining how recovery housing tied to outpatient treatment already functions on the ground in Richmond.
As previously reported, residents and employees have consistently described a model in which sober home operators retain control over outpatient care, even as some maintain the appearance of resident choice on paper. According to dozens of interviews, that model typically includes:
- screening prospective residents for Medicaid billing eligibility;
- requiring assessments with affiliated providers;
- enforcing participation in the predetermined level of care (IOP/PHP), which the assessment predictably confirms; and
- structuring rules, transportation, and other logistics in ways that leave residents with no viable alternatives.
Under this system — particularly in the absence of tenant rights, following legislation advanced on VARR’s behalf in 2022 — residents have no meaningful choice, even if they have signed “patient choice” acknowledgments.
The result is a de facto residential treatment model operating without licensure — and therefore without the required staffing levels, background checks, or resident protections licensure requires — while generating millions of dollars in Medicaid revenue through a captive resident population.
With substantial operator discretion left intact, it’s unclear how the revised provision in SB 270 would meaningfully alter these dynamics.
Asked who would enforce the provision, VanValkenburg pointed to the Virginia Department of Behavioral Health and Developmental Services (DBHDS) and credentialing entities.
“I would assume you would lose your credentialing,” he said. “Like if you were credentialed by VARR, you would lose that for breaking the law. So you would have the credentialing authority, also you would have possible DBHDS sanctions. So I think it’s kind of twofold there.”
Unlike VARR, DBHDS advocated for language that would have required licensure for recovery homes mandating clinical treatment — a step that would have expanded its oversight authority and barred nonclinical recovery homes from dictating any aspect of residents’ clinical care.
Because that language was not included in the version of the bill that advanced, credentialing entities such as VARR remain central to enforcement.
VARR’s role in overseeing recovery house operators, however, raises ongoing questions — particularly around enforcing resident choice. Numerous residents report that coercive practices have long persisted despite NARR policy prohibiting such conduct.
While the operators directly implicated in patient-steering allegations have stepped down from VARR leadership, personal ties to Richmond’s sober home and outpatient treatment network remain within the organization.
VARR Executive Director Bob de Triquet is married to the senior vice president of operations at River City Comprehensive Counseling Services, the primary outpatient program owned by former VARR Vice Chairman Jimmy Christmas — a central figure in Richmond’s recovery-house-to-outpatient ecosystem.
VARR Chief Operating Officer Matthew Conner is married to the therapy coordinator for Dr. Peter Breslin, an addiction medicine physician, former VARR board member and part owner of River City Residential Services. He was seated next to Conner at the SB 270 hearing.
Former recovery-house residents and employees report that Breslin’s practice has, for years, received mandated referrals from multiple VARR-accredited operators. Support for their claims was found in various documents and operator statements.
In an email provided by the parent of a WAR Foundation participant, the program’s former director outlined the requirements the participant would need to follow upon entering the program. The email stated that the participant would be enrolled in IOP “at our day center on Parham Rd,” which at the time meant attending IOP with River City. It added: “We meet any and all needs of mental health services and partner with Dr. Peter Breslin for the needs of any services.” The parent, who said she was closely involved in communications with WAR Foundation, confirmed that the participant was not given other provider options.
In a 2022 interview, David Rook, then a VARR board member and owner of True Recovery RVA, told me:
…part of what we do is, you do what we say you do. So, if we say you go to River City, you go to River City. If we say you see Dr. Breslin, you see Dr. Breslin, as part of the program.
A previous McShin Foundation policy relating to Medication Assisted Treatment (MAT) similarly identified Breslin as the required provider for initial consults. The policy stated:
Individuals who are currently at McShin and request MAT must go through addiction specialist, Dr. Peter Breslin, for an initial consult. If there is a financial barrier and/or the individual has private insurance and would like to see an outside specialist those cases will be reviewed individually.
McShin Chief Operating Officer Jesse Wysocki said he could not recall when the policy was revised but stated that, at the time, there were limited MAT options in the area beyond Breslin, who also served as a McShin board member and medical advisor.
Wysocki also provided McShin’s current MAT policy, which allows residents to select providers of their choosing. He said McShin’s updated policy is intended to address “situations in which participants display observable signs of intoxication or impairment that may pose safety concerns for themselves or others in the recovery environment” — not to require participation in clinical treatment as a condition of residency.
He added: “As a recovery residence, we believe there must be a reasonable and lawful mechanism for responding to such situations while remaining compliant with certification standards and applicable law.” (Read Wysocki’s full statement.)
Breslin told me that aside from providing input with River City Residential Services, he does not “manage how any business is run” other than his own office, Verity Mental Health.
“My office provides mental/physical/addiction treatment to patients in these programs, if they would like and are willing to be seen by our providers,” he said in an email. “That is the extent of my relationship.”
Breslin added: “I am in support of SB270. I agree that people should not be forced into treatment (there are exceptions in the Psychiatric realm such as if a patients is at imminent danger to self or others; at which point a TDO process is initiated).”
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Publicly, VARR has presented a united front in supporting efforts to prevent abuses in recovery housing.
Commenting on the bill for a previous article, de Triquet said: “VARR commends Senator VanValkenburg for his ongoing efforts to strengthen recovery residences and protect individuals seeking recovery by ensuring irresponsible operators are removed from this space.”
At the hearing, de Triquet was the first to speak in favor of the bill, offering a brief statement of support.
Responding to a request for comment on the SB 270 revisions, de Triquet wrote:
The original language of the bill was meant to prevent both IOP and PHP coercion, which we support. However, in the way it was drafted by DLS, there could have been the unintended consequence of prohibiting the requirement of medical or psychological services entirely. There are instances when a resident may need medical or psychological services due to health and safety concerns. The way the bill was initially written did not reference already established laws, like EKRA and Anti-Kickback provisions and we provided that context to the Senator. We expressed those concerns to the patron as well as our continued support for freedom of choice. We did not provide the specific language that was used in the bill amendment.
We were pleased the Senator heard our concerns about the unintended consequences in the initial draft and worked on language to help address them. We look forward to continuing this engagement and serving as a valued stakeholder moving forward.
Ensuring resident choice is taking place within recovery residences is a priority for VARR. If residents are restricted of choice or if there are concerns related to unethical or illegal practices that conflict with established laws, like EKRA and Anti-Kickback provisions, then those matters should be reported to the appropriate authorities, including DBHDS Licensure, Virginia Medicaid Fraud, law enforcement, and VARR. I have attached appropriate links below:
De Triquet did not initially respond to follow-up questions about whether VARR supports operators mandating IOP or PHP — outpatient treatment programs not tied to an immediate health or safety risk — even when residents retain provider choice, or whether the organization requested bill language to address those practices.
Several hours after publication, he responded:
We do not support required IOP/PHP services to access a recovery residence, except within a NARR Level 4 / Type C recovery residence. We do support the integration of clinical services with non-clinical recovery residences to support recovery from SUD – through person-centered, individualized recovery planning that incorporates linkages to clinical services with resident choice. VARR emphasized to the Senator that we want to address IOP/PHP coercion without negative unintended consequences (i.e. health and safety).
De Triquet also said VARR is developing a notice that residences will be required to post, informing residents of the distinction between licensed clinical treatment and recovery housing and providing contact information for those who believe they are being required or coerced into clinical services. He said the document will be finalized after the legislative session to reflect any statutory changes.
I have asked de Triquet to clarify how VARR defines a level 4 recovery residence and whether levels 1 through 3 may require participation in IOP or PHP at any point during a resident’s stay as a condition of continued residency, as his response only addressed requirements to “access” a residence.
I will update this article when I receive a response.
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VARR and NARR affiliates across the country have long positioned accreditation as the solution for states seeking to regulate recovery housing without licensure.
But responsibility for identifying and reporting coercion largely rests with residents themselves — within a system where such practices are widely described as normalized, and where, in Virginia, residents can be removed from housing without notice or cause, making reporting a high risk endeavor.
While VARR has emphasized resident choice as a priority, the organization has sought greater flexibility for recovery residence operators over multiple legislative cycles — including through the removal of tenant protections and the narrowing of restrictions on mandating clinical care. Taken together, those positions support a policy framework that preserves broad operator authority and the conditions under which coercive practices have long been reported.
In a Friday interview, VanValkenburg acknowledged the potential for operators to circumvent the revised provision in SB 270, but he said stakeholders believed the bill retained sufficient enforcement capacity and that later adjustments could be made if necessary.
“This bill is the first step in what will be a multi-year process,” he said. “If that language doesn’t work, we can always come back and tighten it.”
Second provision introduces potential conflict with federal law
The revised bill includes an additional provision:
[State regulations] shall prohibit a provider of clinical treatment services from offering housing to individuals receiving treatment unless such housing is either licensed as a residential treatment program or certified as a recovery residence.
If “offering housing to individuals receiving treatment” is intended to mean offering free or subsidized housing in exchange for participation in clinical treatment services, the provision appears to conflict with existing federal law.
As previously reported, the federal Anti-Kickback Statute and the Eliminating Kickbacks in Recovery Act make it a crime to offer anything of value in exchange for participation in clinical treatment services. Housing assistance tied to enrollment in PHP or IOP has been a recurring issue across the country and the subject of recent enforcement actions in other states.
In Massachusetts, Bournewood Health Systems settled allegations that it violated federal anti-kickback and False Claims Act statutes by providing free recovery housing to induce participation in its PHP. Just last year, the Minnesota-based NUWAY Alliance agreed to an $18.5 million settlement after the Department of Justice alleged it offered free housing in exchange for participation in clinical services, among other violations.
Against that enforcement backdrop, SB 270 as drafted could be read as implicitly permitting conduct that federal law already prohibits.
I raised this issue to VanValkenburg’s legislative aide, Emmaline Herring. As of publication, she had not responded to questions regarding this potential conflict.
Other revisions address NDAs and credentialing conflicts
Not all of the revisions to SB 270 weakened oversight.
Following questions raised last month about the absence of protections against non-disclosure agreements (NDAs) in recovery housing — an issue VanValkenburg had previously indicated would be addressed — the revised bill now directs the State Board of Behavioral Health and Developmental Services to develop regulations prohibiting NDAs that interfere with complaint reporting or investigations involving recovery residences.
The revisions also close a conflict-of-interest gap related to credentialing entities.
As originally drafted, the bill barred credentialing organizations from accrediting recovery residences owned or operated by individuals employed by the credentialing entity. But the language did not explicitly address conflicts involving board members.
The revised language removed the employment limitation, extending the prohibition to anyone “in a position of authority” within the entity. As Herring explained, the change was made “to ensure board members will not be able to receive credentialing from the same entity on which they serve.”
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SB 270 passed the Senate Rehabilitation and Social Services Committee 15 to 0. The full hearing on the bill is available below.
(Clip from Virginia Senate Youtube)
Next, the bill will be considered by the Senate Finance and Appropriations Committee, though it has not yet been officially scheduled for a hearing. Public comment is not allowed at this stage, but members of the public may still reach out to their legislators or VanValkenburg’s office to share feedback as the bill moves through the legislative process.
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