The Virginia Association of Recovery Residences (VARR) supports the first draft of the proposed recovery residence regulations. VARR appreciates the Department’s work establishing this framework for the certification and oversight of recovery residences in Virginia. We are confident that this continued work will provide more recovery residence options for Virginians and strong guidance for those already operating recovery residences.
VARR has identified items that we believe should be amended or added to the first draft of the regulations. Additionally, we have identified areas where we think additional clarification and further development would be necessary to strengthen the regulations. These are referenced in the comments below, organized by section headers.
Overall, the first draft is foundationally strong. We wish to offer our expertise to help strengthen the draft guidelines and address some gaps we identified.
Reporting non-certified recovery residences - Virginia contains recovery residences that are operational and are not certified nor pursuing certification. What is the process for reporting a recovery residence that is operating without the required state certification and/or is out of compliance with state code?
VARR recommends that the regulations address:
What is the Department’s responsibility for responding to non-certified recovery residences?
Who should non-certified recovery residences be reported to?
What is a credentialing entity's process for reporting non-certified recovery residences?
Will there be a publicly accessible reporting process for members of the community?
Recovery Residences and Licensed Clinical Services - The draft regulations defines and addresses “resident brokering”, but does not include some key terms and practices related to other relevant ethical risks.
VARR recommends that the regulations on resident brokering also address:
Inducement - Incentive to consume or to make a referral that is influenced or predicated on reward rather than individual’s needs.
Kickback - The exchange (or offer to exchange), especially illicitly, anything of value in an effort to induce (or reward) the referral of programs and/or services (i.e. bribe, inducement, payment, an undercover or indirect payment for a favor).
Complaints regarding the Department - The draft regulations outlines the oversight of the credentialing entities as well as the complaint process for stakeholders.
VARR recommends that the regulations also address:
If a certified recovery residence, credentialing entity or a citizen needs to submit a complaint regarding the department, where is that submitted and what is the process?
VARR appreciates the opportunity to review and provide public comments on the first draft of the recovery resilience regulations. VARR supports the overall direction of the draft and believes it provides a foundation for improving the recovery residence space over the coming years.
12VAC35-260-30. List of recovery residences.
Section A. “A. DBHDS shall maintain a list of certified and conditionally certified recovery residences on its website.
VARR Comment: VARR supports transparency and accountability and recognizes the value of maintaining a publicly accessible list of certified recovery residences. VARR believes at a minimum there should be an exemption process available for recovery residences serving at-risk populations such as recovery residences serving women and children, victims of human trafficking, victims of domestic violence, court witnesses, etc. It’s important to consider balancing transparency and accountability with safety and privacy.
Consideration should be given to how recovery residences are treated in comparison with other shared living environments serving similar or overlapping populations including ASAM 3.1 setting, group homes, and transitional housing. VARR has not been able to locate another publicly available, comprehensive state list for other supportive housing and shared living environments that provide the exact address of each residence.
Other states, such as Kentucky and Ohio, have adopted approaches in which the exact address of a certified recovery residence is not publicly disclosed, while the information remains available to appropriate personnel such as local governments, law enforcement and emergency personnel.
VARR Recommendation: Create an exemption process through which a recovery residence that serves a defined at-risk population may apply for an exemption from the public disclosure of its exact address.
12VAC35-260-40. Disclosures, restrictions, and violations.
Section B. 1. “1. If the credentialing entity is the National Alliance for Recovery Residences, the recovery residence shall disclose the level of support provided by the recovery residence.”
VARR Comment: The National Alliance for Recovery Residences is not a credentialing entity. NARR utilizes a state affiliate model in which state affiliates do the credentialing, so in Virginia, the Virginia Association of Recovery Residences (VARR) is the credentialing entity.
VARR Recommendation: A technical change of “National Alliance for Recovery Residences” to “the Virginia Association of Recovery Residences”.
Proposed Language: If the credentialing entity is the Virginia Association of Recovery Residences, the recovery residence shall disclose the level of support provided by the recovery residence.
12VAC35-260-110. Required reporting.
Each recovery residence shall report the following information concerning deaths and serious injuries to the department in a manner prescribed by the department within 48 hours of discovery. All deaths that occur as a result of illness or injury occurring when the resident was in a recovery residence shall be reported regardless of the location where the death occurs. All reports of death and serious injuries shall include:
1. Date and place of the death or serious injury;
2. Nature of the injuries;
3. Circumstances of the death or serious injury.
VARR Comment: Required reporting to the Department for a death or serious injury is a longstanding requirement and there is precedent with the current reporting process. Currently, the reporting process utilizes a Microsoft form link to access and submit the required report. The reporting form is not publicly accessible through the Department's website.
Additionally, operators who have submitted reports have provided feedback that they do not receive a copy of the report submitted.
VARR Recommendation: Require the Department to maintain the reporting form on its public facing website and provide the operator a confirmation copy of the submitted report.
Proposed Language: Add - “The department shall maintain the required reporting form on its public facing website. Upon submission of a report, the department shall provide the operator with a confirmation copy of the submitted report.”
12VAC35-260-140. Complaint process.
Section D, 3. Complaints involving injury, abuse or exploitation:
iii. The recovery residence operator shall notify the department of any injuries or allegation of abuse or exploitation within 24 hours of discovery;
iv. A credentialing entity shall notify the department of any injuries or allegation of abuse or exploitation within 24 hours of receiving the complaint.
VARR Comment: There are two conflicting time frames related to the reporting of injuries and serious injuries with no clear delineation between the two. In 12VAC35-260-110. Required reporting., it states that “Each recovery residence shall report the following information concerning deaths and serious injuries to the department in a manner prescribed by the department within 48 hours of discovery”.
VARR Recommendation: Align the 24-hour reporting time frame referenced in 12VAC35-260-140. Complaint process, with the 48-hour reporting time frame outlined in 12VAC35-260-110. Required reporting
Proposed Language:
iii. The recovery residence operator shall notify the department of any injuries or allegation of abuse or exploitation within 48 hours of discovery;
iv. A credentialing entity shall notify the department of any injuries or allegation of abuse or exploitation within 48 hours of receiving the complaint.
Section G. “Recovery residences and recovery residence operators are prohibited from creating, using or pressuring a resident to enter into a non-disclosure agreement which would interfere with the resident’s right to submit a complaint regarding the recovery residence or recovery residence operator.”
VARR Comment: This should include potential residents and former residents. Considering how residents are treated should include the application process, residency and post-residency.
Proposed Language: “Recovery residences and recovery residence operators are prohibited from creating, using or pressuring a resident to enter into a non-disclosure agreement which would interfere with a potential, active, or former resident’s right to submit a complaint regarding the recovery residence or recovery residence operator.”
12VAC35-260-190. Resident’s handbook.
Section C. “Each resident shall be provided a copy of the resident’s handbook for future reference.”
VARR Comment: The phrase “shall be provided” may be interpreted to require that each resident receive an individual physical copy of the resident handbook. This may create an unnecessary administrative burden for operators. Many operators maintain a physical copy of the handbook at the residence for anyone in the residence to access and/or provide a digital copy.
VARR Recommendation: Clarify if this is referring to a physical copy of the resident handbook. Consider accommodating modern practices of relaying information via digital formats, with the understanding that a physical copy can always be provided upon request.
Proposed Language: “Each resident shall have access to a physical copy or a digital version of the resident’s handbook for future reference.”
12VAC35-260-220. Physical environment requirements.
Section A. B. C. D. E. F.
A. Each resident shall be provided their own bed.
B. Each bedroom shall have no less than 50 square feet of floor space per resident.
C. Each recovery residence shall have a minimum of one sink, toilet and shower per six residents. D. Each resident shall have adequate private storage space accessible to the bedroom for clothing and personal belongings.
E. Each resident shall have adequate storage space accessible to the kitchen for storage of food.
F. The interior and exterior of all recovery residences shall be safe, properly maintained, clean, and in good repair.
VARR Comment: The physical environment requirements section is missing key elements of a recovery residence, notably around safety and the general living environment. Additionally, the square feet requirement should be amended to align with industry standards and Virginia Uniform Statewide Building Code - § 36-105.4. Occupancy standards for residential dwelling units.
VARR Recommendation: We believe this needs to address fire safety, naloxone accessibility, appliances and furnishing within the recovery residence.
Proposed Language:
Amend B to read - B. Each multi-occupancy bedroom shall have no less than 50 square feet of floor space per resident. (A minimum of 70 square feet for any single occupancy bedroom)
Amend F to read - F. The interior and exterior of all recovery residences shall be safe, properly maintained, clean, furnished and in good repair.
Add:
Each residence shall have fire extinguishers, smoke detectors, carbon monoxide detectors(when applicable) and evacuation maps.
Each residence shall have naloxone available and accessible at the residence.
Each residence shall provide access to a washer and dryer on site for laundry.