This is a manual revised and intended for OTP staff in manuevering the paradigm shift towards patient centered care in SUD treatment. This manual includes changes based on current events of the past few years (Covid-19) and provides information on the substansive changes to the prior regulations in over 20 years. While the primary audience is OTP staff, the range of information is still valuable to a variety of stakeholders. This report is from SAMHSA.