RECOVERY RESIDENCES IN HENRICO COUNTY

2024 Henrico Board of Supervisors Retreat

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Michael Y. Feinmel

Deputy County Manager

What is a Recovery Residence?

What is a Recovery Residence?

Virginia Code Definition of Recovery Residence

Virginia Code Definition of Recovery Residence

C. No person shall operate a recovery residence or otherwise imply to the public that a recovery residence or other housing facility is certified by the Department unless such recovery residence … has been certified by the Department in accordance with regulations adopted by the Board.

Oversight Delegated to VARR

Oversight Delegated to VARR

DSS Guidelines for Providers for Individuals with Developmental Disabilities�

• https://law.lis.virginia.gov/admincode/title12/agency30/chapter122/section120/
• On a monthly basis, screen and document the names of all new and existing employees and contractors to determine whether any are excluded from eligibility for payment from federal health care programs
• Assure the individual's freedom to refuse medical care, treatment, and services and document that potential adverse outcomes that may result from refusal of services were discussed with the individual.
• Participate in the completion of Quality Service Reviews conducted by DBHDS or its contractor.

Dept of Juvenile Justice Regulations for Group Homes

• Virginia Administrative Code - Title 6. Criminal Justice And Corrections - Agency 35. Department (Board) of Juvenile Justice - Chapter 41. Regulation Governing Juvenile Group Homes and Halfway Houses

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Regulations for Assisted Living Homes

• final_alf_reg.pdf (virginia.gov)

NARR Standard 3.0

• NARR (National Association of Recovery Residences) has a 15-page listing of standards with 10 Principles:
• Operate with Integrity
• Uphold Residents’ Rights
• Create a culture of empowerment where residents engage in governance and leadership
• Develop staff abilities to apply the Social Model
• Provide a home-like environment
• Promote a safe and healthy environment
• Facilitate active recovery and community engagement
• Model Prosocial behaviors and relationship enhancement skills
• Cultivate the resident’s sense of belonging and responsibility for community
• Be a good neighbor

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What Happens when a Recovery Residence is not credentialed?

VARR Website 99 Certified Residences

A Large Number of Recovery Residences Exist in Henrico County that Are Not VARR Accredited

• Department of Corrections provided a list of Recovery Homes that they refer to:
• 17 listed Recovery Residences were not VARR credentialed
• 8 were apartments with no listed operators
• 8 were sober living homes owned by approved Operators that were not VARR approved
• 3 were Oxford House
• 2 were listed as “Program Unknown”

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National Association of Recovery Residences

* Richmond, VA 28, Chesterfield 3, Hanover 1, Total 72 or 73% of VA

“Tens of millions of tax dollars have flowed to Evergreen Recovery to reimburse the program for addiction treatment ostensibly provided to low-income individuals… However, both former employees and clients have raised concerns that the services provided … do not match the submitted Medicaid billing claims”

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“A review of social media accounts for [the] owners, … reveals a lifestyle of wealth and success. Photos … show the [owners] traveling by private jet, staying at luxury hotels, wearing designer clothing, and showing off extravagant purchases like a new boat and their $200,000 Mercedes-Benz G Wagon SUV.”

“Starting in late 2019, scammers began targeting the state’s Medicaid agency. … The fraudsters hit the program in multiple directions: by luring people with addiction into rehab programs that provided little, if any, actual treatment; by generating fake bills for drug and alcohol rehab services …”

“However, there are also unscrupulous actors running sober living homes who profit off the misery of their occupants. Landlords exploit individuals with substance use disorders for money or sex, and even encourage relapse over recovery. There is rampant abuse of the system, including patient brokering, devious marketing practices, kickbacks from treatment providers and insurance fraud”

“We see not only the benefits of these facilities but also the problems that flow from a lack of regulation and oversight – a shortcoming that local governments have little power to rectify.”

“Many times the sober living home has a deal worked out with the treatment centers where they will get the referral from the treatment center (i.e., money as long as the sober house mandates that the resident go to that treatment center’s IOP program (i.e., money)”

“[T]he resident of the home has to make a decision. Do they waste 3 hrs a day – 3 days a week in a program they know they are not getting anything out of, or do they leave the IOP program and subsequently [lose] their housing?”

Legislative Change?? SB190 (2023)

In the 2024 VA Gen Assembly session, Sen Subramanyam proposed SB 190:

• Requires DBHDS to promulgate regulations that require recovery residences to
1. Optionally be accredited by or be a member of a credentialing agency
2. Comply with uniform health and safety requirements established by DBHDS including minimum square footage requirements related to beds and sleeping rooms
3. Report death or serious injury to DBHDS

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Legislative Change?? SB190 (2023)

Unaddressed Issues by Current Legislation

1. Standards of Management: No requirement of credentials or length of time of verified sobriety before becoming a leader or house manager
2. Patient Choice: Some statutory protections for Patient Choice, but no guardrails on Recovery Residences preventing them from ordering residents to specific providers
3. Unregulated Residences: Minimal sanctions for non-credentialed Recovery Residences. Not a lot of reason for Recovery Residences to credential
4. Effects on Communities: unsupervised residents
5. Reporting requirements do what?

Model Recovery Residence Certification Act

• In February 2021, Legislative Analysis and Public Policy Association utilized a grant from the Office of National Drug Control Policy to develop “a voluntary certification process for recovery residences in a state”
• Purpose: to allow for greater oversight of recovery residences and greater protection of residents
• The Model act allows either a state agency designated by the state or an approved certifying agency to certify recovery residences

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Model Recovery Residence Certification Act

• The Model Act seeks to limit localities’ ability to monitor activities of Recovery Residences
• The Act also makes participation voluntary, with no contemplation of behaviors of non-participating residences – specifically exempts residences that aren’t credentialed
• Some focus on patient brokering and resident rights, such as eviction
• Makes assumptions about the credentialing agency
• Does not comprehensively address the NARR standards

Ideas for Potential Legislation��Credentialing

Make credentialing by DBHDS mandatory to operate as a Recovery Residence

• Can create a carve out for Oxford Houses from VARR
• Remove VARR as the credentialing agency and place this authority with DBHDS – can still require VARR accreditation as the Code currently does, but create more robust requirements to be met by DBHDS
• Class 1 misdemeanor to operate Recovery Residence unless credentialed/ certified by DBHDS

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Ideas for Potential Legislation��Workgroup

Renew Sen Subramanyam’s workgroup proposal.

• Include representatives from localities, including 5 localities in the Commonwealth with most Recovery Residences- allow locality to designate representative on this workgroup
• Include representatives of the community, including families who have loved ones affected by recovery residences

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Ideas for Potential Legislation��Workgroup

Work Group should develop guidelines for DBHDS to require in credentialing, including, but not limited to:

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• Ensure Patient Choice
• Codify Standards for Management, including verifiable period of sobriety for house manager and external checks on ability of house manager to sanction residents
• Create Residents’ Bill of Rights and mandate Recovery Residences to adhere to Bill of Rights
• Develop protocols for Termination of Residency
• Mandate uniform Data collection for Recovery Residences with transparent platform maintained by DBHDS
• Require Recovery Residences to publicly state services offered and levels of support
• Uniform occupancy requirements and baseline house safety requirements

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Ideas for Potential Legislation��Hotline

Create Hotline for Complaints against Recovery Residences:

• Make information of complaint available to locality
• Allow Locality to conduct investigation into complaint, in conjunction with or in lieu of DBHDS, with all information shared between locality and DBHDS
• Require DBHDS and locality to report findings of violation to locality and Circuit and District Courts
• Develop Protocols for Sanctions, including de-certifying Recovery Residences when findings of violation occur

Ideas for Potential Legislation��Authority of Locality

• Allow locality to prevent operation of a Recovery Residence when operator is not credentialed by DBHDS (will be a Class 1 Misd)
• Locality (Fire Marshal, Building Inspector, Community Revitalization) allowed semi-annual inspections as well as inspections in response to complaints

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