Support Equal Access to Outdoor Healthcare

Due to current insurance policies, only the most affluent in the United States are able to access the substantial benefits of Outdoor Behavioral Healthcare (OBH). The federal Center for Medicare and Medicaid Services honors OBH as a safe and highly regulated Evidence-Based Practice, but state governments are looking away. Knowing that Nature demands the best of us, Montana intends to lead the way for outdoor mental health services, and graduate beyond the 1950's model of institutionalizing those in need of treatment.

The Problem:  
Montana has yet to adopt the Federal Revenue Code 1006 to reimburse its own DPHHS Outdoor Behavioral Programs for licensed therapeutic services, despite the following occurrences:

a) Extensive Rules and Regulations for the DPHHS Outdoor Behavioral Program
License, requiring state-licensed physical and mental healthcare professionals and overseen by the Children's Mental Health Bureau.

b) The lack of required effectiveness of current PRTF's, Psychiatric Hospitals, or any other service, as evidenced by the empty column of “Evidence Based Practice Services provided to Youth” in the 2018 Required Report to the Montana State Legislature

c) An available cost-effective and less restrictive alternative to hospitalization and long-term residential care

d) Severe budget cuts to available Behavioral Health Services

e) Extraordinarily high suicide rates in Montana

f) The surge of research showing the effectiveness of Outdoor Behavioral Healthcare in reducing anxiety, depression, trauma, substance abuse, detention, and family dysfunction, recognizing this treatment model as an Evidence-Based Practice (NOT experimental) for SUD and Mood Disorders.

g) A Federal establishment of Revenue Code 1006 for Outdoor Behavioral Healthcare with the Center of Medicare and Medicaid Services (CMS)

h) The adoption of the Parity Act at the state level requiring equal access to mental and physical health services, such as allowing for intermediate levels of care, and disallowing blanket exclusions (such as “outdoor programs”)

i) Reimbursement currently provided at a level of “SUD Clinically Managed Medium-Intensity Residential (ASAM 3.5) Adolescent,” which is a direct parallel to the Outdoor Behavioral Program level of care, but requires the adolescent to have a Substance Use Disorder in addition to their mental health diagnosis in order to access this level of care (contradicting the value of preventative care).

j) Reimbursement is provided for Illness Management and Recovery Services (IMR), which focuses on “a strong emphasis on assisting members to set and pursue personal goals and converting strategy into action in their daily lives. The goals are reviewed on an ongoing basis by the provider, behavioral aide, and member.” This model is intrinsic to Outdoor Behavioral Healthcare.

The Result: 
Denying Medicaid patients access to Outdoor Behavioral Healthcare (CMS Revenue code 1006) markedly reduces access to a least restrictive model of care for SED youth, ineffectively allocates state funds by disregarding both intermediate and cost-effective treatment models for youth, and ignores the role of Evidence-Based Practices in the health industry, resulting in high-cost, unmonitored treatment models and failure to utilize currently available services.

The Solution:
In alignment with the State's interest in cost-effective health interventions, suicide prevention, licensing oversight of Outdoor Behavioral Programs, least-restrictive and community-focused care, and the Mental Health Parity Act, DPHHS Licensed Healthcare providers of Outdoor Behavioral Healthcare and Outdoor Behavioral Programs should be integrated into state funded Children's Behavioral Health services and added as a reimbursable Provider Type within Montana's Medicaid rules.

For additional information, please review Figures and Facts.

Quick Facts:
1. From the National Institute of Health Public Access:
“Evidence-based practices or treatments (EBPs) and residential care are usually not mentioned in the same sentence. In fact, EBPs are a direct response or alternative to what are considered to be costly and ineffective treatment modalities such as residential care.” (Child Youth Serv Rev. 2013 April 1; 35(4): 642–656. doi:10.1016/j.childyouth.2013.01.007)

2. Residential care represents the highest level of care in the child welfare system's continuum of care. In the late 90's, it was considered the most restrictive and most expensive form of child welfare services (Bates, Engligh, and &Kuoidou-Gilles, 1997). No research has been identified to suggest that this has changed over time.

3. According to the 2017 and 2018 Required Reports to the Legislature, NO state funding was reported to go to Evidence-Based Practices for Children's mental health services in Montana.

4. Adolescents in Outdoor Behavioral Healthcare are at less risk than adolescents not participating in these programs (Gass, Michael & Gillis, H. L. Lee & Russell, Keith. [2012]. Adventure therapy: Theory, Practice, & Research.) "Program injury rates are substantially lower than many common activities teens and young adults participate in. Most notably, injuries during high school football games are over 328 times more common than injuries experienced in OBH Council programs. Teen backpacking is 20 times more likely to produce an injury than comparable activities in an OBH Council program.” (https://obhcouncil.com/research/obh-is-safer/, retrieved Sept. 8th, 2019).