For years, people in our industry talked about Montana’s teen treatment landscape as the “Wild West.” Limited oversight. A patchwork of licensing categories. Families navigating a system that didn’t make sense.
Some providers saw that as freedom. We saw it as a problem.
At Turning Winds, we’ve spent more than two decades building a program we’re proud of — one that holds The Joint Commission’s Gold Seal of Approval, serves families from across the globe, and operates at the highest clinical and ethical standards. We didn’t need new regulations to tell us how to treat kids well.
But we also knew that families deserved better than a system held together by hope and good intentions. They deserved clarity, real safety standards they could count on, and a pathway to access care without fighting their insurance company or sending their child hundreds of miles from home.
That’s why my brother Owen and I helped write Montana Senate Bill 191.
KEY takeaways
- SB191 creates Montana’s first RTC license for youth under 21
- Commercial insurers (BCBS, Allegiance) can now authorize in-state treatment
- Safety standards built into the license (see 5 Parents Rights)
- With the help of The Montana Group, Turning Winds created the legislation for SB191 which was sponsored by Senator Cuffe and supported by DPHHS.
- Effective October 2025
🎧Listen: How Turning Winds Helped Pass SB191 (Podcast)
The Problem No One Was Explaining
Here’s what most people — including journalists covering this legislation — didn’t fully understand:
Montana only had two licensing categories for residential youth mental health programs: Therapeutic Group Homes and Psychiatric Residential Treatment Facilities (PRTFs). That sounds reasonable until you look at what it actually meant for families.
PRTFs are designed for teens in crisis — those experiencing severe aggression, active self-harm, psychotic symptoms, or who pose an immediate danger to themselves or others. These programs provide 24-hour psychiatric supervision in a secure setting. They serve an essential role for high-acuity kids who need that level of intervention.
But what about the teen who’s struggling with depression, anxiety, and failing grades? The one who’s withdrawing from family, making risky choices, and clearly needs more than weekly outpatient therapy, but isn’t in psychiatric crisis?
That teen falls into what we call “the missing middle.”
These moderate-acuity kids needed residential treatment. Their parents often had commercial insurance that should have covered it. But Blue Cross Blue Shield of Montana — the state’s largest insurer — would only recognize the PRTF license for residential mental health coverage.
And there were only two PRTF programs in the entire state. This ‘acuity mismatch’ forced families to make impossible choices.
So families faced three impossible options:
- Pay out of pocket — often $10,000 to $15,000 per month, for as long as treatment takes.
- Send their child out of state — away from family, making it harder to participate in the therapeutic process that actually heals relationships.
- Place their moderate-needs teen in a high-acuity PRTF environment — surrounded by peers whose challenges were far more severe, in a setting designed for a different level of care.
Type of Care Comparison table
Type of Care
Who is it For?
The Problem
Insurance Reality
Therapeutic Group Home
Teens with lower-acuity needs who require structure but not intensive clinical intervention
Often lacks the clinical depth for teens with complex emotional or behavioral struggles
Inconsistent coverage
Psychiatric Facility (PRTF)
Teens in severe crisis (e.g., psychosis, active self-harm, immediate danger) requiring 24-hour secure supervision
High-security, hospital-like setting — often too intense for a teen who needs therapy, not lockdown
Covered by insurance, but often clinically inappropriate for moderate needs
Residential Treatment Center (RTC)
The “Missing Middle.” Teens with moderate needs (depression, anxiety, trauma, failing grades) who need clinical immersion but not a hospital
Didn’t Exist. Before SB191, this license category wasn’t available in Montana
Now Recognized. Insurers like Allegiance and BCBS Montana can finally authorize coverage.
SB191 creates the RTC license Montana families have been waiting for — the clinically appropriate middle ground, now recognized by insurance.Elementor Instructions:
We watched this happen for years. And we decided to do something about it.
What SB191 Actually Does
Montana Senate Bill 191 creates something that didn’t exist before: a dedicated Residential Treatment Center (RTC) license for youth under 21.
This isn’t a workaround or a loophole. It’s infrastructure.
The new license, administered by the Montana Department of Public Health and Human Services, establishes a clear framework for programs serving moderate-acuity teens. The ones who need more than outpatient care but don’t require psychiatric-hospital-level intervention.
More importantly, it’s a license that commercial insurers will recognize. When SB191 took effect in October 2025, Montana families with BCBS and other commercial coverage finally have a pathway to access residential treatment in-state, close to home, with their insurance contributing to the cost.
Owen and I co-authored this legislation alongside former DPHHS officials and state Senator Mike Cuffe. We brought what we’d learned from more than two decades of serving families — and a clear view of where the system was failing.
The bill passed with overwhelming bipartisan support. The Senate vote was 46 to 4. In a political climate where agreement is rare, this was Montana saying: We see the gap. We’re fixing it.
We Didn't Fear Oversight — We Asked for It
When we started working on this legislation, we had a choice. We could push for a license that simply expanded insurance access — a narrow fix that helped families pay for treatment.
Or we could build something better.
We chose to build something better.
Some providers look at oversight as a burden. We’ve always looked at it as accountability. Turning Winds has operated at the highest standards for over twenty years — not because regulations required it, but because families trust us with their children. That trust is sacred, and it has to be earned every single day.
So when we helped draft SB191, we made sure the safety provisions families had been asking for were built into the license itself:
Safety Checklist
- Weekly unmonitored video calls between residents and their families
- 24/7 abuse reporting hotline — available to residents without staff involvement
- Thorough background checks for all employees — no exceptions
- Staff qualification requirements and ongoing workforce training
- Unannounced site visits — real accountability, not scheduled inspections
From Patchwork to Protection
Before SB191, families faced a patchwork of licensing categories — some with meaningful oversight, some with very little. Certain programs operated outside state regulation entirely by claiming religious exemptions. Parents trying to make the right choice for their child had no reliable way to know what standards a program actually met.
SB191 creates a clear, accountable pathway. Families who choose an RTC-licensed program know exactly what they’re getting: a facility that meets Montana’s safety standards, accepts oversight, and operates within a framework designed to protect young people.
This isn’t about adding red tape. It’s about replacing confusion with clarity. It’s about giving families a baseline they can trust.
“We didn’t fear oversight — we asked for it.”
— John Baisden, Co-Founder
What This Means for Montana Families
If you’re a Montana parent with a teen who needs residential treatment, SB191 changes your options dramatically.
Starting October 2025, you’ll no longer be limited to two PRTF programs or forced to send your child out of state. RTC-licensed programs will be recognized by commercial insurers, giving you a real pathway to access care — without choosing between your child’s wellbeing and your family’s financial stability.
Your child can receive treatment closer to home. You can participate meaningfully in family therapy. And you’ll know that any RTC-licensed program meets Montana’s new safety and accountability standards.
For families with Allegiance insurance, we’ve put together specific information on coverage options.
What This Means for Out-of-State Families
If you’re considering Montana for your teen’s treatment, SB191 should give you confidence — not concern.
Montana has made a deliberate choice to raise the bar. The state now has a licensing framework specifically designed for residential treatment, with safety provisions, oversight requirements, and accountability standards built in from the beginning.
Programs operating under this license aren’t flying under the radar. They’re part of a system that demands transparency, protects residents, and answers to state regulators.
At Turning Winds, we’ve always believed Montana’s setting offers something unique for healing — 150 acres in the northern woodlands, surrounded by mountains and the South Fork Yaak River. Nature does what walls sometimes cannot. Now the state’s regulatory framework matches the standard of care families deserve.
Why We Do This Work
Turning Winds was founded in 2002, but the mission started earlier — with our family’s own tragedy.
My parents, John Sr. and Charmaine, lost my sister when she was just seventeen. No family should ever receive that phone call. In the years before her death, they’d tried everything they knew to help her find her way back. They were desperate, heartbroken, and searching for answers that didn’t come in time.
That loss changed everything. Out of grief came purpose: help other families find hope before it’s too late.
Owen, Carl, and I joined our father in building something that could make a real difference. Over two decades, we’ve served families from every state and every continent. We’ve watched teens arrive hopeless and leave transformed. We’ve seen the work that happens when clinical excellence meets genuine care.
But this mission has never been just about Turning Winds. It’s been about changing what’s possible for families everywhere.
SB191 is part of that vision. We didn’t write this legislation to benefit one program. We wrote it to fix a system that was failing families, to expand access for parents who had no good options, and to ensure that Montana’s kids — and every kid who comes here seeking help — are protected by the highest standards.
5 Rights for Parents Under sb191
- Unmonitored Video Calls — Privacy with your child, weekly
- Licensed Clinical Staff — Real clinicians, not “mentors”
- Background-Checked Staff — Every employee, no exceptions
- 24/7 Abuse Hotline Access — Your child can report directly
- Insurance Recognition — Commercial coverage pathway
Finding the Right Path Forward
If your family is navigating teen mental health challenges, you don’t need more confusion. You need someone who understands the system — because they helped build it.
SB191 represents a new chapter for Montana. Real options for families. Insurance coverage that actually works. Safety standards built into the foundation rather than left to chance.
We’re here to help you find the right path forward for your child.
To learn more about treatment options or verify your insurance coverage, call us at 800-845-1380.
