DBH Heard Recovery Housing Providers. Now the Rules Are Changing.

Ohio’s recovery housing rules are changing again.

This time, we have a much clearer picture of how the Ohio Department of Behavioral Health is responding to the concerns raised by recovery housing providers and other stakeholders over the past several weeks.

DBH has now described significant revisions to the permanent recovery housing rules it is developing.

Some of those changes address major concerns providers raised about staffing, medications, building requirements, resident independence, incident reporting, and the differences between recovery housing models.

That is meaningful progress.

But the process is not finished.

Providers still have not seen the complete revised rule language, the emergency rules remain in effect today, and several important policy and implementation questions remain unresolved.

The next major date to watch is September 22, 2026, when DBH has indicated it plans to file the permanent rule package with the Joint Committee on Agency Rule Review, commonly known as JCARR.

That filing should give providers their first real opportunity to compare DBH’s description of the changes with the actual language of the revised rules.

DBH Made Significant Changes After Stakeholder Feedback

The update from DBH confirms something important.

Provider input has had an impact.

Several provisions that generated significant concern have been revised or removed.

Building and Inspection Requirements

DBH says it removed the majority of the additional building and health inspection requirements contained in proposed Rule 5122 31 09 and will instead rely, where appropriate, on other applicable state, local, and federal requirements.

DBH also says it removed the proposed fire suppression system requirement from Rule 5122 31 10 after stakeholders raised concerns about cost.

That is a significant change.

Recovery housing providers should absolutely be held to appropriate health and safety standards. But unnecessary duplication and requirements designed for other types of facilities can create substantial costs without necessarily improving resident safety.

Major Medication and Staffing Requirements Are Being Removed

Some of the most concerning provisions in the original proposal involved medications and staffing.

DBH now says it revised Rule 5122 31 18 and removed paragraphs F, G, and H.

Those provisions included requirements that raised questions about staffing levels, medication observation, and whether the presence of certain prescriptions could effectively create an onsite staffing requirement.

DBH also says it removed medication management requirements from the proposed permanent rules, rescinded the proposed medication rule, and removed medication log requirements from proposed Rule 5122 31 20.

These changes matter because recovery housing is not a clinical medication management program.

Residents can receive treatment and use prescribed medications without turning recovery housing staff into medical providers.

There will still need to be clear expectations around medication storage, resident safety, and the boundaries of provider responsibility, but DBH appears to have responded substantially to the concern that the proposed rules were becoming too clinical.

DBH Is Recognizing That Different Recovery Housing Models Operate Differently

Another major concern involved the failure to adequately distinguish between different recovery housing models.

DBH now says the rules have been revised to better distinguish peer run, monitored, and supervised recovery residences.

The Department also says that responsibility for compliance may rest with the operator or the residence itself in a peer run model rather than assuming that staff are always responsible.

DBH specifically acknowledged stakeholder feedback that recovery housing residents are developing responsibility and independence and that staff are not always the people responsible for day to day operation of the home.

This is an important policy shift.

A peer run recovery residence should not be regulated as though it operates like a staffed residential treatment program.

Ohio has different recovery housing models because residents have different needs and because recovery can happen in different environments.

The final rules need to preserve those distinctions.

Resident Independence and Privacy Are Also Being Addressed

DBH says it has removed several requirements involving confidential resident information, including medication log requirements.

The Department also reports changes to bedroom and bathroom requirements, resident agreements, resident rights, and daily living provisions.

Some requirements that DBH determined were more appropriately addressed through residence agreements have also been removed from the proposed rules.

The Department says these changes are intended to better support resident independence rather than supervising ordinary daily living activities.

That is consistent with one of the most important principles providers have been raising throughout this process.

Recovery housing is a home and recovery community.

It is not residential treatment.

DBH also reports that Rule 5122 31 13 was revised to better reflect a home rather than a residential facility.

Incident Reporting Is Being Revised

DBH says Rule 5122 31 14 and its incident reporting appendix have also been revised to reduce burden.

The Department has indicated that a complaint portal is also forthcoming.

We will need to review the revised language carefully once it is available to understand what incidents must be reported, when reporting is required, and what process providers will be expected to follow.

The Most Important Limitation: We Still Have Not Seen the Revised Rules

This is where providers need to be careful.

DBH has told us what it intends to change.

We have not yet seen the complete revised language.

That means we should acknowledge the progress without assuming every concern has been resolved.

A summary can tell us that a requirement was revised.

Only the actual rule tells us exactly what remains.

When the revised rules are released, providers need to look at the chapter as a whole.

A staffing requirement may disappear from one section and appear somewhere else.

A medication requirement may be removed but replaced with a different responsibility.

A provision may sound reasonable by itself but create a significant burden when combined with twenty other requirements.

The details matter.

Several Important Questions Still Need Answers

Even with the announced revisions, several significant issues remain.

Recurrence of Use and Maintaining a Recovery Environment

Recovery housing providers need the ability to maintain the alcohol and drug free environment residents entered the home to receive.

That does not mean every recurrence of use must automatically result in discharge.

A written recurrence policy might require assessment, detoxification, treatment, additional support, transfer to another setting, or another appropriate intervention.

But providers need to know that they can meaningfully enforce those policies when necessary to protect the recovery environment.

The final rules need to balance resident rights with the provider’s responsibility to maintain a safe and recovery focused home.

Medication Policies and Different Recovery Pathways

DBH appears to have made substantial improvements to the operational medication requirements.

A separate policy question remains.

What discretion will individual recovery residences have to establish medication related admission and residency policies that are consistent with their recovery model?

Some providers specifically support medication assisted treatment.

Other providers want to preserve abstinence based or MAT free environments.

This is an area where recovery philosophy, resident choice, medically appropriate treatment, provider choice, and disability protections can intersect.

Providers need clear guidance about what DBH requires and what discretion individual residences retain.

Background Checks and the Recovery Workforce

DBH continues to reference multiple databases as part of the background review process.

Providers still need clear answers about what happens when someone appears in a criminal justice database, how community supervision is treated, how sealed convictions are handled, and what findings actually disqualify someone from working in recovery housing.

Recovery housing depends heavily on people with lived experience.

For many people, justice system involvement is part of that experience.

Resident safety must be protected without unnecessarily excluding qualified people who have rebuilt their lives and now use that experience to help others recover.

Cost and Operational Impact

The changes DBH has announced may significantly reduce some of the cost concerns contained in the original proposal.

That is encouraging.

But providers still cannot assess the full financial impact until we see the complete revised chapter.

Staffing, training, certification, building requirements, documentation, inspections, administrative responsibilities, and compliance obligations have to be evaluated together.

This is especially important for smaller and independent providers.

September 22 Is the Next Major Date

DBH has reported that it completed its initial stakeholder engagement, submitted the revised permanent rule package for Common Sense Initiative review, and plans to file the rules with JCARR by September 22, 2026.

That filing matters because providers should finally be able to evaluate the actual revised rules.

It will allow us to answer questions that cannot be answered from a summary.

Were the provisions DBH said it removed actually removed?

Do the distinctions between peer run, monitored, and supervised residences work in practice?

Are there still staffing obligations that create problems for peer run models?

What medication requirements remain?

How do resident rights and termination requirements interact with recurrence of use policies?

What is the total operational impact of the chapter?

Those are the questions I will be looking at when the revised language becomes available.

The September 22 filing is not the end of the process.

DBH has explained that stakeholder input continues throughout the permanent rulemaking process, including through CSI and later through JCARR.

There will still be opportunities for providers to participate.

The Stakeholder Advisory Group May Be Just as Important as the Rules

There is another development that deserves attention.

DBH says it is actively planning a recovery housing residence advisory committee made up of stakeholders representing diverse perspectives.

The Department describes this as part of a longer term, iterative process and says the group will provide recommendations as the work continues.

I think this could become one of the most important outcomes of the current rulemaking process.

Rules matter.

But implementation matters too.

Questions will continue after permanent rules are adopted.

Providers will have questions about certification.

DBH will issue guidance.

New operational issues will emerge.

Some requirements may create consequences that were not obvious when the rules were written.

Future legislative and regulatory changes will occur.

An effective stakeholder group could create an ongoing channel between DBH and the people who actually operate and live in recovery housing.

But the success of that group will depend heavily on representation.

Ohio does not have one type of recovery housing.

The stakeholder group should include operators of peer run, monitored, and supervised residences.

It should include smaller independent providers and larger organizations.

It should include people with lived experience in recovery housing.

It should include different recovery philosophies.

It should include peer recovery, behavioral health treatment, medication expertise, justice and reentry perspectives, fair housing expertise, local systems, accreditation perspectives, and the state officials responsible for implementing the rules.

Most importantly, people who understand what these requirements look like inside an actual recovery residence need a meaningful voice at the table.

A large stakeholder group is not necessarily a diverse stakeholder group.

The goal should be representation that reflects the real variety of recovery housing operating across Ohio.

Where ORRPA Goes From Here

This process is exactly why I created the Ohio Recovery Residence Provider Association.

Small and independent recovery housing providers often do not have dedicated regulatory staff, government affairs teams, compliance departments, or attorneys reviewing every new rule.

But decisions made at the state level can fundamentally affect how those providers operate, what they can afford, who they can serve, and whether they can continue providing housing at all.

ORRPA exists to help providers understand what is changing, prepare for what comes next, connect with other providers, and have a stronger collective voice in the decisions affecting recovery housing.

Our first statewide ORRPA provider meeting will be held September 18 at 12:30 p.m.

We will discuss DBH’s announced changes, the issues providers still believe need attention, the upcoming September 22 filing, and what meaningful representation should look like in the stakeholder advisory process.

I also want to hear directly from providers about the issues they want carried forward.

One house or twenty.

Peer run, monitored, or supervised.

New provider or established organization.

Your operational experience matters.

Provider Input Is Working

There is a reason for cautious optimism.

Providers identified concerns.

Stakeholders participated.

DBH responded.

Several provisions that could have significantly changed the nature and cost of recovery housing are now being revised or removed.

That is meaningful.

But this is not the point where providers disengage.

It is the point where we review the actual language, identify what has truly been resolved, raise the issues that remain, and build a stronger process for ongoing communication between providers and the state.

September 22 is the next major checkpoint.

When the revised rules become available, ORRPA will review them carefully, compare them with what DBH has announced, update our provider resources, and continue sharing what providers need to know.

The rules are moving forward.

Providers need to stay in the conversation.