The Patient Protection and Affordable Care Act (PPACA) aims to provide affordable health insurance and expanded health care coverage for some 32 million Americans. The PPACA makes provisions for modernizing the delivery of health care services using technology, evidence-based treatments, and integrated and patient-centered care to ensure effectiveness, efficiency and cost-savings within the health care system.To gauge the addiction treatment field’s readiness for health reform, the authors developed a Health Reform Readiness Index (HRRI) survey for substance use disorder (SUD) treatment agencies. Addiction treatment administrators and providers from around the United States were invited to complete the survey. Respondents self-assessed their agency based on thirteen conditions pertinent to health reform readiness, and received a confidential score and instant feedback.Overall, agencies (n=276) indicated, on a scale of "Needs to Begin," "Early Stages," "On the Way," and "Advanced", that they were in the Early Stages of health reform preparation for eleven of thirteen conditions. Of greater concern was organizations that had budgets of < $5 million (n = 193) were less likely than those with > $5 million budgets to have information technology, evidence based practices, quality management systems, a continuum of care, good financial health, or a board of directors informed about PPACA.Based on the findings of the HRRI, it is clear that the SUD field, and in particular smaller organizations, have much to do to prepare for a future environment that has greater health information technology, credentialed workforce, quality of care, and continuum of care expectations.