WEBVTT 00:00:00.000 --> 00:00:01.659 And there is inherent tension, I think, between 00:00:01.659 --> 00:00:04.179 the tennis and the pickleball people. There is. 00:00:04.259 --> 00:00:08.179 Right. The pickleball people are taking over 00:00:08.179 --> 00:00:10.539 the courts. And the tennis people are not happy. 00:00:12.779 --> 00:00:15.279 Welcome to County Connection, the official podcast 00:00:15.279 --> 00:00:17.579 of the Washington State Association of Counties, 00:00:17.579 --> 00:00:19.960 where we dive into the legislative issues shaping 00:00:19.960 --> 00:00:22.420 the future of our communities. From budgets to 00:00:22.420 --> 00:00:25.359 public safety, infrastructure to elections, we'll 00:00:25.359 --> 00:00:28.000 break down what's happening in Olympia and how 00:00:28.000 --> 00:00:29.980 it impacts counties from across the Evergreen 00:00:29.980 --> 00:00:33.100 State. Stay informed, stay engaged, and join 00:00:33.100 --> 00:00:35.679 us as we amplify the voice of Washington's 39 00:00:35.679 --> 00:00:40.979 counties. Welcome back, everybody, to the County 00:00:40.979 --> 00:00:43.619 Connection podcast. I'm Paul Jewell. government 00:00:43.619 --> 00:00:45.359 relations director with the Washington State 00:00:45.359 --> 00:00:48.359 Association of Counties, and your host. And I'm 00:00:48.359 --> 00:00:51.060 back in the studio on this same Tuesday afternoon, 00:00:51.420 --> 00:00:54.740 another bright, sunny, shining day here in Olympia 00:00:54.740 --> 00:00:58.579 by March standards. And today I've got Brad Banks, 00:00:58.799 --> 00:01:01.619 our contract lobbyist handling behavioral health 00:01:01.619 --> 00:01:03.780 and human services, as well as law and justice 00:01:03.780 --> 00:01:05.859 issues for us. Good to see you, Brad. Great to 00:01:05.859 --> 00:01:07.620 see you, Paul. Thanks for coming back. No, no, 00:01:07.640 --> 00:01:09.870 I'm delighted to be here. So I've been talking 00:01:09.870 --> 00:01:13.409 with everybody else for the last couple of podcasts 00:01:13.409 --> 00:01:18.079 about last week and Cut Off. Yeah. big day on 00:01:18.079 --> 00:01:21.079 Wednesday. It's kind of the really marks the 00:01:21.079 --> 00:01:24.260 halfway point process wise for all of us here 00:01:24.260 --> 00:01:26.420 in Olympia. And it's always a bit of a day of 00:01:26.420 --> 00:01:29.620 celebration. I know for that reason and because 00:01:29.620 --> 00:01:31.540 our workloads get a lot smaller. That's right. 00:01:31.640 --> 00:01:33.439 We get to focus a little more. Yeah. It's not 00:01:33.439 --> 00:01:36.680 so scattershot, but yeah. Yeah. And no one has 00:01:36.680 --> 00:01:40.519 really been shy about celebrating the demise 00:01:40.519 --> 00:01:44.400 of several pills. I wasn't too sad to see a few 00:01:44.400 --> 00:01:46.859 of them go. Let me put it that way. Yeah. Are 00:01:46.859 --> 00:01:48.840 there any in particular that you feel deserve 00:01:48.840 --> 00:01:51.760 some honorable mention here? You know, is that 00:01:51.760 --> 00:01:54.260 a good idea? Should we be calling those out publicly? 00:01:54.280 --> 00:01:57.180 I don't know if that actually is in our interest. 00:01:57.319 --> 00:02:00.060 It probably is a bad idea. So why don't we we 00:02:00.060 --> 00:02:02.640 can we can move on. I mean, yes, there were definitely 00:02:02.640 --> 00:02:06.700 some that. I just sat and watched as they sat 00:02:06.700 --> 00:02:09.139 in rules or sat on the floor. And you weren't 00:02:09.139 --> 00:02:11.979 sad to see them. I was not. I was not. And as 00:02:11.979 --> 00:02:14.919 that minute hand clicked towards 5 p .m., I was 00:02:14.919 --> 00:02:18.960 like, yeah, I'm not going to have to sign in 00:02:18.960 --> 00:02:22.319 or testify. Just get to zero, please. Just get 00:02:22.319 --> 00:02:25.330 to zero. And whatever you do, don't. don't make 00:02:25.330 --> 00:02:27.590 it unnecessary to implement the budget well of 00:02:27.590 --> 00:02:29.530 course yeah those are the magic bills right the 00:02:29.530 --> 00:02:32.090 ones which is what you have more success on than 00:02:32.090 --> 00:02:34.550 sometimes no that's impressive yeah sometimes 00:02:34.550 --> 00:02:37.870 so you know that five o 'clock that five o 'clock 00:02:37.870 --> 00:02:42.189 hour yeah on um cutoff day is a big deal yep 00:02:42.189 --> 00:02:45.169 a lot of us are you know very anxiously kind 00:02:45.169 --> 00:02:48.930 of awaiting that yeah Both for not just to see 00:02:48.930 --> 00:02:51.469 bad bills kind of go the way of the dodo, right? 00:02:51.569 --> 00:02:54.650 Right. But also because we are oftentimes running 00:02:54.650 --> 00:02:56.870 up against that clock. That's right. To try to 00:02:56.870 --> 00:02:58.750 get to our own stuff. Yeah, it's our own stuff. 00:02:58.750 --> 00:03:00.509 Keeping our own stuff from dying. Right. And 00:03:00.509 --> 00:03:04.090 that's easier said than done, right? It is. I 00:03:04.090 --> 00:03:06.729 was talking with Brian just a few hours ago. 00:03:06.889 --> 00:03:08.610 Yeah. And we were talking about the process and 00:03:08.610 --> 00:03:11.289 how it's actually designed for you to fail. Yeah. 00:03:11.289 --> 00:03:13.629 And how much easier it is to kill bills than 00:03:13.629 --> 00:03:17.610 it is to pass bills. Yep. And the one thing you 00:03:17.610 --> 00:03:19.909 definitely want to do is do everything you can 00:03:19.909 --> 00:03:21.930 to get rid of the bad bills. But at this point 00:03:21.930 --> 00:03:23.490 in the session, you also don't want to look around 00:03:23.490 --> 00:03:26.610 and go, wait a minute, all the good stuff I was 00:03:26.610 --> 00:03:28.629 trying to work on is dead too. Is also dead now 00:03:28.629 --> 00:03:31.349 too. And I've got really nothing going on. Yeah. 00:03:31.349 --> 00:03:33.830 That's kind of the death knell for a lobbyist. 00:03:33.930 --> 00:03:36.590 Totally. And yeah, I would agree. I think I like 00:03:36.590 --> 00:03:40.189 that analogy or that summary that it's designed, 00:03:40.409 --> 00:03:43.729 it is designed to... to kill bills. Ultimately. 00:03:43.810 --> 00:03:45.849 I think that is the way the system is designed 00:03:45.849 --> 00:03:48.750 to keep, to keep the deluge from continuing on. 00:03:48.870 --> 00:03:50.789 Right. And yeah, even if you're the majority 00:03:50.789 --> 00:03:52.689 party, a hundred percent, you gotta make, you 00:03:52.689 --> 00:03:54.710 gotta have self controls. Right. And that's what 00:03:54.710 --> 00:03:56.849 this is. It's a, it's a, all these cutoffs are 00:03:56.849 --> 00:03:58.750 control mechanisms, right? It's a way to kind 00:03:58.750 --> 00:04:03.349 of, you know, silo in and consolidate where really 00:04:03.349 --> 00:04:05.629 the priorities need to be for session and what, 00:04:05.650 --> 00:04:07.710 what they feel like they can handle as it relates 00:04:07.710 --> 00:04:09.909 to the budget and, you know, any of the other 00:04:09.909 --> 00:04:12.050 pieces to that. So, yeah, I mean, and I, I agree. 00:04:12.129 --> 00:04:14.050 I mean, in some ways, you know, keeping, and 00:04:14.050 --> 00:04:16.550 there are so many, so many little things that 00:04:16.550 --> 00:04:18.410 can hang a bill up. Oh, we were talking about 00:04:18.410 --> 00:04:20.649 that too. I mean, it's just like. Yeah. Even 00:04:20.649 --> 00:04:22.850 a good bill. A good, yeah. With nothing that 00:04:22.850 --> 00:04:26.730 gets out of committees unanimously. I know. And 00:04:26.730 --> 00:04:29.730 then it just, it takes one thing to just totally, 00:04:29.769 --> 00:04:31.990 and at the pace of at which things are moving, 00:04:32.110 --> 00:04:33.750 that's all it takes. All of a sudden you get 00:04:33.750 --> 00:04:36.209 blown by, by five other bills that now are, you 00:04:36.209 --> 00:04:38.149 know, somebody else's attention. And you can 00:04:38.149 --> 00:04:41.220 do everything right. everything right and just 00:04:41.220 --> 00:04:43.560 watch it wither and die right in front of your 00:04:43.560 --> 00:04:46.180 eyes exactly yeah you know it's a little demoralizing 00:04:46.180 --> 00:04:48.259 you can have everything lined up you can get 00:04:48.259 --> 00:04:51.060 you know and the the panic yeah the panic that 00:04:51.060 --> 00:04:54.300 sets in yeah i mean unless you do this work like 00:04:54.300 --> 00:04:57.839 that panic of watching your bill the days sort 00:04:57.839 --> 00:05:00.300 of you know all of a sudden the days of sessions 00:05:00.300 --> 00:05:03.100 really slow down right and it's like why can't 00:05:03.100 --> 00:05:05.600 this get out of rules why can't i get this on 00:05:05.600 --> 00:05:08.019 an order of consider why i can't yeah and it 00:05:08.019 --> 00:05:09.939 just becomes you're Processing over it every 00:05:09.939 --> 00:05:12.079 second. Yes, it's just a nightmarish process. 00:05:12.300 --> 00:05:14.740 What else can I do? What haven't I done? Who 00:05:14.740 --> 00:05:17.160 can I talk to? Who can help me? Should I leave? 00:05:17.459 --> 00:05:19.600 Would it be better if I just left the hill? Because 00:05:19.600 --> 00:05:22.779 me being here seems to not be helping. So maybe 00:05:22.779 --> 00:05:24.620 if I just walk away, this bill will have a better 00:05:24.620 --> 00:05:28.060 chance. We'll talk about sweating it. Yeah. 1813. 00:05:28.120 --> 00:05:30.759 Yeah, that was one that caused a little perspiration 00:05:30.759 --> 00:05:32.819 for me. So that's our priority bill. We've talked 00:05:32.819 --> 00:05:35.379 about that here on the podcast before. That's 00:05:35.379 --> 00:05:37.500 our behavioral health priority bill. Yeah. That 00:05:37.500 --> 00:05:41.129 one. ultimately passed. So it's alive, but you, 00:05:41.209 --> 00:05:43.670 you were sweating it pretty good. It was both 00:05:43.670 --> 00:05:47.790 at the, at the cutoff for rules to get it out 00:05:47.790 --> 00:05:50.250 of rules. Right. As well as kind of that, you 00:05:50.250 --> 00:05:52.089 know, floor cutoff. You were cutting it pretty 00:05:52.089 --> 00:05:54.069 close. We were. Yeah. Tell us what happened. 00:05:54.129 --> 00:05:56.189 Yeah. So yeah, no, it was. And again, it was 00:05:56.189 --> 00:05:57.970 one of the, I mean, this bill has not been without 00:05:57.970 --> 00:06:00.350 tension. Yeah. So remind everybody. Yeah, sure. 00:06:00.449 --> 00:06:03.550 So, so house bill 1813, uh, it is our priority 00:06:03.550 --> 00:06:05.490 legislation and really what it's designed to 00:06:05.490 --> 00:06:08.459 do is sort of two things. Um, When the bill initially 00:06:08.459 --> 00:06:13.089 was drafted, it... Called for a re -procurement 00:06:13.089 --> 00:06:15.990 of our managed care companies that operate here, 00:06:16.069 --> 00:06:18.310 the Apple Health MCOs, as they're sometimes called. 00:06:18.490 --> 00:06:19.790 MCOs are managed care organizations. Managed 00:06:19.790 --> 00:06:22.230 care organizations, right. They're kind of the 00:06:22.230 --> 00:06:23.790 insurance companies that handle all the folks 00:06:23.790 --> 00:06:28.170 on Medicaid. Right. And then really try to make 00:06:28.170 --> 00:06:31.069 some improvements through what we were calling 00:06:31.069 --> 00:06:33.810 a carve -out for our crisis system, right? So 00:06:33.810 --> 00:06:37.009 for the Medicaid dollars and the folks that were 00:06:37.009 --> 00:06:39.569 accessing the crisis system who were on Medicaid, 00:06:39.910 --> 00:06:41.870 currently that's not in the - county sort of 00:06:41.870 --> 00:06:43.490 book of business, right? I mean, we work and 00:06:43.490 --> 00:06:45.670 we provide crisis services for those folks, but 00:06:45.670 --> 00:06:47.889 that is still sort of managed and sort of financially 00:06:47.889 --> 00:06:50.769 responsible. The responsibility sits at the MCO 00:06:50.769 --> 00:06:53.050 level, the managed care organizations. We felt 00:06:53.050 --> 00:06:55.269 like it made more sense to sort of shift, realign 00:06:55.269 --> 00:06:58.540 that and shift those folks. back over to the 00:06:58.540 --> 00:07:00.600 counties through the BHA SOs, the behavioral 00:07:00.600 --> 00:07:02.040 health administrative services organizations 00:07:02.040 --> 00:07:05.060 that are responsible for the crisis side. As 00:07:05.060 --> 00:07:06.939 this bill went through the process, obviously, 00:07:07.139 --> 00:07:08.620 you know, the managed care organizations had 00:07:08.620 --> 00:07:10.420 a lot to say, the state agencies had a lot to 00:07:10.420 --> 00:07:13.680 say. And as we worked through it, it's gotten 00:07:13.680 --> 00:07:15.839 to a point now where the re -procurement language 00:07:15.839 --> 00:07:19.600 is pretty toned down. It still requires some 00:07:19.600 --> 00:07:22.300 pieces from HCA, from the healthcare authority, 00:07:22.459 --> 00:07:25.000 sorry. That's a very acronym heavy space. It 00:07:25.000 --> 00:07:27.379 is. Everything in county government. That's right. 00:07:27.540 --> 00:07:31.120 We love it. For them to continue to... prepare 00:07:31.120 --> 00:07:33.459 and take stakeholder feedback as they work towards 00:07:33.459 --> 00:07:34.920 a re -procurement. I think we've talked about 00:07:34.920 --> 00:07:36.680 before on this podcast, it's been like 14 plus 00:07:36.680 --> 00:07:38.920 years since the state has done a re -procurement. 00:07:38.980 --> 00:07:41.319 So we're definitely way overdue. And I imagine 00:07:41.319 --> 00:07:43.819 if you're an MCO, you know, you like the fact 00:07:43.819 --> 00:07:45.639 that it's been 14 years. You haven't had to change 00:07:45.639 --> 00:07:48.839 a thing. No need to see a re -procurement anytime 00:07:48.839 --> 00:07:50.939 soon. Right. No new standards to meet. Exactly. 00:07:50.939 --> 00:07:53.360 No new expectations, anything like that. It's 00:07:53.360 --> 00:07:56.199 just kind of status quo. That's right. And yeah, 00:07:56.279 --> 00:07:58.019 status quo is working. And I think that was really 00:07:58.019 --> 00:08:00.879 our, you know, works for. that works for them 00:08:00.879 --> 00:08:03.300 that's been our the biggest pushback from our 00:08:03.300 --> 00:08:04.980 end is that - It hasn't been working for us. 00:08:05.019 --> 00:08:06.379 It hasn't been working for us. And that really, 00:08:06.399 --> 00:08:09.220 we're the only ones arguing for that are, at 00:08:09.220 --> 00:08:11.160 least in our estimation at this point, are the 00:08:11.160 --> 00:08:13.420 managed care companies. That really the status 00:08:13.420 --> 00:08:15.459 quo is meeting their needs, but it's not meeting 00:08:15.459 --> 00:08:16.939 our needs. Well, let's be honest. They're the 00:08:16.939 --> 00:08:18.879 ones who profit from the system the way that 00:08:18.879 --> 00:08:20.459 it is right now. They do. And the profit is pretty 00:08:20.459 --> 00:08:22.819 modest. I mean, I don't want to say that, but 00:08:22.819 --> 00:08:24.459 it is, they wouldn't be here if they weren't 00:08:24.459 --> 00:08:26.139 making money, right? I mean, that's the whole 00:08:26.139 --> 00:08:28.300 point. And I think, back to the re -procurement 00:08:28.300 --> 00:08:30.180 point, right? I mean, we have five managed care 00:08:30.180 --> 00:08:32.370 companies that operate in - in Washington State 00:08:32.370 --> 00:08:35.850 through our managed care process. If it were 00:08:35.850 --> 00:08:37.350 to go to re -procurement, there are a number 00:08:37.350 --> 00:08:39.129 of companies out there, national, large national 00:08:39.129 --> 00:08:42.029 companies that I think would love to get in on. 00:08:42.480 --> 00:08:44.419 get in on it. Right. And so that could displace 00:08:44.419 --> 00:08:46.320 one of the current companies, for example. And 00:08:46.320 --> 00:08:49.340 so. Yeah. But from for us and for from a service 00:08:49.340 --> 00:08:51.379 model and an efficiency model, competition is 00:08:51.379 --> 00:08:53.700 a good thing. We want to encourage that. Right. 00:08:53.799 --> 00:08:56.139 And really, we don't care who I mean, I think 00:08:56.139 --> 00:08:57.740 from the county standpoint, it's not our we're 00:08:57.740 --> 00:08:59.320 not interested who the managed care companies 00:08:59.320 --> 00:09:01.500 are. We're not interested in any of that bidding 00:09:01.500 --> 00:09:03.799 process. What we're interested in is making sure 00:09:03.799 --> 00:09:06.240 that there's a clear expectation of what the 00:09:06.240 --> 00:09:08.120 responsibilities are. If you're going to provide. 00:09:08.700 --> 00:09:11.179 contracted services in this state for our Medicaid 00:09:11.179 --> 00:09:14.919 eligible folks, and that we're matching the right 00:09:14.919 --> 00:09:17.340 managed care organizations with the right populations 00:09:17.340 --> 00:09:21.059 in our regions, right? So it's also about, you 00:09:21.059 --> 00:09:23.279 know, it's about efficiencies, it's about service, 00:09:23.460 --> 00:09:25.779 but it's also about getting services in the right 00:09:25.779 --> 00:09:27.799 places, right? And making sure that there aren't 00:09:27.799 --> 00:09:30.240 deserts. That's right. And there are right now. 00:09:30.279 --> 00:09:31.720 Yeah. And that's something we're dealing with. 00:09:31.799 --> 00:09:33.639 Well, when you talk about it, it's been 14 years 00:09:33.639 --> 00:09:36.909 since a re -procurement was required. I'm trying 00:09:36.909 --> 00:09:40.350 to remember when the whole behavioral health, 00:09:40.590 --> 00:09:44.330 physical health, you know, collaboration. Yeah. 00:09:44.330 --> 00:09:48.409 The whole integration process. Because when I 00:09:48.409 --> 00:09:51.929 was a county commissioner back. in ancient times, 00:09:51.990 --> 00:09:54.769 right? Way back in 2008, 2009, it was a whole 00:09:54.769 --> 00:09:57.730 different system. It was. And it was only, you 00:09:57.730 --> 00:10:00.909 know, a few years into, I think my first or second 00:10:00.909 --> 00:10:03.629 term where this, well, it was essentially, it 00:10:03.629 --> 00:10:05.309 started under the Inslee administration, right? 00:10:05.330 --> 00:10:08.850 This was one of his signature issues was to integrate 00:10:08.850 --> 00:10:11.809 the physical health and mental health side, behavioral 00:10:11.809 --> 00:10:14.330 health side. And that must've been right around. 00:10:15.080 --> 00:10:17.840 12 or 13 years ago. It was. So there hasn't been 00:10:17.840 --> 00:10:20.039 a re -procurement since that whole process began? 00:10:20.259 --> 00:10:22.580 No. And in fact, when this system went, you know 00:10:22.580 --> 00:10:24.179 - That's actually hard to believe. It's pretty 00:10:24.179 --> 00:10:26.340 amazing, right? And when you consider that, you 00:10:26.340 --> 00:10:28.899 know, they did this initial procurement, right, 00:10:28.960 --> 00:10:31.440 14 years ago, everything that has happened since 00:10:31.440 --> 00:10:34.480 then, including going fully live. So when we 00:10:34.480 --> 00:10:37.740 did that procurement as a state, we hadn't fully 00:10:37.740 --> 00:10:39.720 integrated at that point, right? So our integrated 00:10:39.720 --> 00:10:41.860 managed care plan hadn't really been put into 00:10:41.860 --> 00:10:44.240 place. That didn't really go live until 2020. 00:10:44.549 --> 00:10:47.129 So there's no way that the current system of 00:10:47.129 --> 00:10:50.750 services in any way matches that full integration 00:10:50.750 --> 00:10:52.990 process. That's right. And you think about all 00:10:52.990 --> 00:10:55.750 the things that have changed between when that 00:10:55.750 --> 00:10:58.990 happened and where we are here now in 2025 and 00:10:58.990 --> 00:11:00.909 the demands on the system, whether it's on the 00:11:00.909 --> 00:11:03.110 criminal justice side or in the behavioral health 00:11:03.110 --> 00:11:06.789 side or the intersect in between. Right. I mean, 00:11:06.789 --> 00:11:10.509 the need and the. the outcry for services in 00:11:10.509 --> 00:11:12.549 communities, which county commissioners and council 00:11:12.549 --> 00:11:15.210 members are hearing all the time because they're 00:11:15.210 --> 00:11:18.230 in the communities hearing these needs, it continues 00:11:18.230 --> 00:11:20.029 to grow in the crisis side of the system. And 00:11:20.029 --> 00:11:22.830 so for us, we see this as something needs to 00:11:22.830 --> 00:11:24.330 happen, and that's why we're here. So I don't 00:11:24.330 --> 00:11:25.850 mean to be controversial, and I don't mean to 00:11:25.850 --> 00:11:28.950 morning quarterback this thing, but the more 00:11:28.950 --> 00:11:31.230 we talk about this, it's a great education for 00:11:31.230 --> 00:11:33.169 me because even though I was an elected official 00:11:33.169 --> 00:11:34.850 for a while and I was part of this association 00:11:34.850 --> 00:11:36.750 as a member, I never really understood that much 00:11:36.750 --> 00:11:38.929 about behavioral health. And I certainly don't 00:11:38.929 --> 00:11:40.629 have the same knowledge base that you do. And 00:11:40.629 --> 00:11:42.309 I'm sure our listeners, many of our listeners 00:11:42.309 --> 00:11:44.049 don't as well, although we have some members 00:11:44.049 --> 00:11:47.950 who are really up to speed on this. But again, 00:11:48.529 --> 00:11:50.250 not to be too controversial and not to Monday 00:11:50.250 --> 00:11:52.210 morning quarterback this too much, but if this 00:11:52.210 --> 00:11:56.529 were such an important issue. and such an important 00:11:56.529 --> 00:11:59.549 cause for the previous administration. How did 00:11:59.549 --> 00:12:02.690 this much time go by without a re -procurement, 00:12:02.710 --> 00:12:06.629 number one? That seems at best to be a major 00:12:06.629 --> 00:12:09.889 oversight, at worst, almost negligent, number 00:12:09.889 --> 00:12:12.429 one. And number two, how is it that we're now 00:12:12.429 --> 00:12:15.350 the ones who are pushing this? Yeah, I think 00:12:15.350 --> 00:12:17.330 both of those are great questions, frankly. And 00:12:17.330 --> 00:12:20.129 I think there's a few things to that, right? 00:12:20.230 --> 00:12:24.129 I mean, we did this initial re -procurement. 00:12:25.370 --> 00:12:29.149 or initial procurement. And then in 2020, when 00:12:29.149 --> 00:12:31.509 we went live on the integrated managed care model, 00:12:31.570 --> 00:12:35.159 where we set up. these two types of new systems 00:12:35.159 --> 00:12:37.860 where we got rid of the old model, the old BHOs, 00:12:37.860 --> 00:12:39.500 behavioral health organizations, if you recall, 00:12:39.759 --> 00:12:42.379 which even before then were, what were they? 00:12:42.419 --> 00:12:45.220 Regional service networks, right? The RSNs. RSNs, 00:12:45.220 --> 00:12:46.820 yeah. That's what they were called. That's right, 00:12:46.960 --> 00:12:49.480 yeah. We called them behavioral health service 00:12:49.480 --> 00:12:51.539 networks or whatever, but they were still called 00:12:51.539 --> 00:12:53.759 RSNs. Right, they were RSNs, yeah. And then, 00:12:53.840 --> 00:12:56.419 so when we did this shift, this sort of... full 00:12:56.419 --> 00:12:58.679 -on shift in 2020 where we had the managed care 00:12:58.679 --> 00:13:00.679 organizations now responsible for all the Medicaid 00:13:00.679 --> 00:13:03.860 folks in the state, including those Medicaid 00:13:03.860 --> 00:13:05.679 folks as they're accessing crisis. And then we 00:13:05.679 --> 00:13:07.120 set up the behavioral health administrative services 00:13:07.120 --> 00:13:10.019 organizations to do just the crisis side of the 00:13:10.019 --> 00:13:13.340 system, right? So just the crisis side, non -Medicaid, 00:13:13.639 --> 00:13:16.860 state general fund dollar, local dollar, responding 00:13:16.860 --> 00:13:19.899 to need within the community. It's been a real 00:13:19.899 --> 00:13:23.220 challenge, I think, that at least from our perspective 00:13:23.220 --> 00:13:25.399 at the local level, how little attention has 00:13:25.399 --> 00:13:27.230 been been paid to that side of the system over 00:13:27.230 --> 00:13:30.370 the last five plus years, right? That since we 00:13:30.370 --> 00:13:32.289 sort of went live or flipped the switch on this, 00:13:32.429 --> 00:13:34.889 it's been disheartening. And I think what we've 00:13:34.889 --> 00:13:37.210 seen is the legislature, to their credit, has 00:13:37.210 --> 00:13:39.889 tried to respond, right? They have tried to respond 00:13:39.889 --> 00:13:43.029 with bills and provisos and funding increases 00:13:43.029 --> 00:13:45.429 and rate increases for our providers and a variety 00:13:45.429 --> 00:13:48.070 of things. But the reality is, and I think if 00:13:48.070 --> 00:13:49.690 we're just going to all lay the cards on the 00:13:49.690 --> 00:13:51.529 table, it's been really frustrating to not see 00:13:51.529 --> 00:13:54.649 much of a statewide vision. being presented by 00:13:54.649 --> 00:13:59.110 our agencies, right? To really say, this is where 00:13:59.110 --> 00:14:00.970 we're going to work towards as a state and as 00:14:00.970 --> 00:14:03.590 a system. And so it's really been left to individual 00:14:03.590 --> 00:14:06.909 counties, regions, like I said, legislators to 00:14:06.909 --> 00:14:10.470 try to come up and do stop gaps, right? So here 00:14:10.470 --> 00:14:12.049 we are. And here we are. And here we are with 00:14:12.049 --> 00:14:13.570 this piece of legislation, which is designed 00:14:13.570 --> 00:14:16.370 to try to move some of this forward in a way 00:14:16.370 --> 00:14:19.049 that it needed to and provide some meaningful 00:14:19.049 --> 00:14:22.049 change. Okay. Well, that catches us up. to kind 00:14:22.049 --> 00:14:25.009 of where the bill is now. Yeah. Getting back 00:14:25.009 --> 00:14:28.090 to the process and kind of how you were sweating 00:14:28.090 --> 00:14:29.470 bullets there at the end. I was hoping we had 00:14:29.470 --> 00:14:32.289 moved on from that part. No, no. Yeah, no, we 00:14:32.289 --> 00:14:34.169 were sweating it because, like I said, it wasn't 00:14:34.169 --> 00:14:35.929 a bill that didn't have a lot of, I mean, it 00:14:35.929 --> 00:14:38.549 wasn't without controversy. On a podcast, you 00:14:38.549 --> 00:14:40.570 never get away without giving away the gritty 00:14:40.570 --> 00:14:42.710 details. I know, I know. So, you know, the bill 00:14:42.710 --> 00:14:45.110 certainly, obviously, we had a lot of negotiations 00:14:45.110 --> 00:14:46.809 happening between the managed care organizations 00:14:46.809 --> 00:14:51.269 as well as the BHASOs, the state agencies. The 00:14:51.269 --> 00:14:53.029 governor's office were also involved in these 00:14:53.029 --> 00:14:56.269 negotiations. I think when the bill – one of 00:14:56.269 --> 00:14:59.009 the issues that came up later, which really did 00:14:59.009 --> 00:15:03.230 slow the bill down, was inclusion with our partners 00:15:03.230 --> 00:15:06.470 in the tribes. It was our tribal partners. They 00:15:06.470 --> 00:15:09.629 did not – the tribes did not integrate in the 00:15:09.629 --> 00:15:11.850 same way that the rest of the state did as it 00:15:11.850 --> 00:15:13.950 relates to behavioral health. They have a slightly 00:15:13.950 --> 00:15:16.450 separate system that they negotiate directly 00:15:16.450 --> 00:15:18.950 with the state. At the ASO level, at the local 00:15:18.950 --> 00:15:20.549 BHA ASO level and the county level, level, we 00:15:20.549 --> 00:15:22.889 interact with our tribal partners all the time. 00:15:22.970 --> 00:15:25.269 And it's a big part of the work that we do is 00:15:25.269 --> 00:15:27.549 a lot of cross coordination and collaboration. 00:15:28.549 --> 00:15:30.850 But they also had some frustrations, frankly, 00:15:30.990 --> 00:15:32.769 in the way that the system was working, and I 00:15:32.769 --> 00:15:35.570 think some warranted ones. And so they felt like 00:15:35.570 --> 00:15:37.570 this was a vehicle that they could try to get 00:15:37.570 --> 00:15:40.990 some input in. But by doing so kind of late in 00:15:40.990 --> 00:15:43.330 the game, it really slowed the bill down. We 00:15:43.330 --> 00:15:45.549 had to pause so that we could try to figure out 00:15:45.549 --> 00:15:48.269 how to negotiate that in a way that made sense 00:15:48.269 --> 00:15:50.409 and make sure that what some of the concerns 00:15:50.409 --> 00:15:53.350 that they were trying to build in a fit within 00:15:53.350 --> 00:15:56.929 the bill, the scope of the bill, but also could 00:15:56.929 --> 00:15:59.529 move the ball forward for them as well. So you 00:15:59.529 --> 00:16:01.509 had some kind of late hour negotiations. So we 00:16:01.509 --> 00:16:03.610 did. And so that, that created, and that's one 00:16:03.610 --> 00:16:04.950 of those things like we were just talking about. 00:16:04.990 --> 00:16:06.879 It's like. once you have one of those little 00:16:06.879 --> 00:16:09.440 hiccups, all of a sudden your bill is now not 00:16:09.440 --> 00:16:11.440 the priority, right? Your bill is now not on 00:16:11.440 --> 00:16:13.159 the track that it was because it's off to the 00:16:13.159 --> 00:16:15.559 side being worked on and everything else is moving 00:16:15.559 --> 00:16:17.639 along and clicking along. And then you've got 00:16:17.639 --> 00:16:19.080 to find your way back to that conveyor belt. 00:16:19.240 --> 00:16:19.860 Right, you've got to bring yourself back into 00:16:19.860 --> 00:16:22.679 the stream, right? And so once we got that done, 00:16:22.840 --> 00:16:26.500 then we also did learn that there were some concerns 00:16:26.500 --> 00:16:30.220 being raised by the MCOs on the floor that were 00:16:30.220 --> 00:16:33.360 ultimately those amendments didn't get offered 00:16:33.360 --> 00:16:36.210 by the - by the sponsor who had them drafted 00:16:36.210 --> 00:16:40.830 up. But it, it was a, that's yet another negotiation 00:16:40.830 --> 00:16:42.690 that takes time. That's exactly. And, and ultimately 00:16:42.690 --> 00:16:44.970 it created, you know, I think we use the term 00:16:44.970 --> 00:16:46.350 sometimes that there was a member with their 00:16:46.350 --> 00:16:48.409 foot on it. So we had a member that had their 00:16:48.409 --> 00:16:50.450 foot on it while the, while we were kind of working 00:16:50.450 --> 00:16:52.850 this out. And, and ultimately we got to a good 00:16:52.850 --> 00:16:54.929 place. The, the prime sponsor did some really 00:16:54.929 --> 00:16:57.950 excellent work with that particular member who 00:16:57.950 --> 00:17:01.710 was, who was. expressing some concerns. And they 00:17:01.710 --> 00:17:03.149 got to a good place. They got to an agreement 00:17:03.149 --> 00:17:05.450 and were able to get it released and pulled. 00:17:05.730 --> 00:17:07.809 I think I want to say we were one of the last. 00:17:07.950 --> 00:17:11.210 Yeah. One of the last rules polls. I think you 00:17:11.210 --> 00:17:14.670 were the last rules poll. You were on that last 00:17:14.670 --> 00:17:17.309 list. I was glad to see it on there. Yeah, me 00:17:17.309 --> 00:17:20.089 too. Believe me. And then, yeah, we had a couple 00:17:20.089 --> 00:17:21.549 of late nights and then we ended up passing it. 00:17:21.589 --> 00:17:23.549 I think it passed out at like 11 p .m. on that. 00:17:23.759 --> 00:17:26.880 tuesday night so it was the day before um but 00:17:26.880 --> 00:17:30.250 it came out it came out yeah it was it was But 00:17:30.250 --> 00:17:31.950 yeah, it came out with a good vote, nice bipartisan 00:17:31.950 --> 00:17:35.569 vote, strong bipartisan vote. And so now it's 00:17:35.569 --> 00:17:37.390 over the House and we're, or I'm sorry, over 00:17:37.390 --> 00:17:39.049 in the Senate and we're working it now. And in 00:17:39.049 --> 00:17:40.490 fact, I've got some stakeholder meetings with 00:17:40.490 --> 00:17:43.250 senators on this tomorrow. So congratulations 00:17:43.250 --> 00:17:46.150 on getting it this far. No, and credit to our 00:17:46.150 --> 00:17:48.849 membership who has, you know, whether they were 00:17:48.849 --> 00:17:50.869 testifying or talking to members or working members, 00:17:51.150 --> 00:17:53.670 it's really been a push by the association to 00:17:53.670 --> 00:17:55.650 keep this moving. Yeah, it's not easy to get 00:17:55.650 --> 00:17:57.549 it even halfway through the system. That's right. 00:17:57.670 --> 00:17:59.349 The good news is, is once you get it halfway, 00:17:59.470 --> 00:18:01.569 way your odds of getting it all the way through 00:18:01.569 --> 00:18:04.750 go way up obviously right so we're feeling a 00:18:04.750 --> 00:18:06.250 little bit like the winds that are back at the 00:18:06.250 --> 00:18:08.049 moment but there's still a bottleneck at the 00:18:08.049 --> 00:18:09.450 end that you're gonna have to fight to get in 00:18:09.450 --> 00:18:11.190 line with you know and whenever you move from 00:18:11.190 --> 00:18:13.049 one chamber to the other i mean they are completely 00:18:13.049 --> 00:18:15.230 different animals right i mean i think some people 00:18:15.230 --> 00:18:17.029 assume it's like oh you move from the house of 00:18:17.029 --> 00:18:18.529 the senator senator to the house and it's just 00:18:18.529 --> 00:18:20.369 the same old thing and they are just that's you 00:18:20.369 --> 00:18:22.609 know as well as i that's they operate on totally 00:18:22.609 --> 00:18:24.890 different planes well and this year the senate 00:18:24.890 --> 00:18:26.549 is so different than what we've seen the last 00:18:26.549 --> 00:18:29.019 several years right very much so um So it'll 00:18:29.019 --> 00:18:30.640 be interesting to see kind of how things work 00:18:30.640 --> 00:18:33.039 out. Now, your bill was in the Senate. No, our 00:18:33.039 --> 00:18:34.400 bill was a House bill. Okay, it was in the House. 00:18:34.420 --> 00:18:37.180 That's right. It was 1813 is the number. So it's 00:18:37.180 --> 00:18:38.579 in the Senate now. Has it been scheduled for 00:18:38.579 --> 00:18:41.859 a hearing? No. We expect it to be scheduled probably 00:18:41.859 --> 00:18:46.019 next week is what we're thinking. Like I said, 00:18:46.039 --> 00:18:47.759 there's some stakeholder meetings happening this 00:18:47.759 --> 00:18:50.400 week with the committee chairs. Well, committee 00:18:50.400 --> 00:18:53.849 chair and... uh, ranking member. We're trying 00:18:53.849 --> 00:18:55.509 to bring everybody in to kind of have a conversation 00:18:55.509 --> 00:18:57.490 and make sure everybody's comfortable with where 00:18:57.490 --> 00:19:01.009 it's at. Um, and, and see what we can do to kind 00:19:01.009 --> 00:19:02.730 of move this forward. I anticipate, obviously 00:19:02.730 --> 00:19:04.670 it'll go through a policy committee first and 00:19:04.670 --> 00:19:06.390 then have to go to a fiscal committee as well. 00:19:06.470 --> 00:19:09.029 So the clock is ticking, but you got some time 00:19:09.029 --> 00:19:11.130 we do. And I feel good that we're at least we're, 00:19:11.130 --> 00:19:13.130 you know, we've got it lined up to where we can 00:19:13.130 --> 00:19:14.930 get it heard relatively soon. And yeah, our next 00:19:14.930 --> 00:19:17.170 committee cutoff or next policy cutoff isn't 00:19:17.170 --> 00:19:20.420 until April 2nd. Exactly. Two weeks? Yeah, two 00:19:20.420 --> 00:19:21.940 weeks. I'm feeling pretty good that we'll have 00:19:21.940 --> 00:19:24.259 this at least out of the policy committee. Good, 00:19:24.339 --> 00:19:27.200 good. Well, congratulations on that. Thanks. 00:19:27.339 --> 00:19:29.779 We have a couple minutes left. Any other important 00:19:29.779 --> 00:19:32.900 pieces that made it through so far that you are 00:19:32.900 --> 00:19:34.859 following that are important to our members? 00:19:35.079 --> 00:19:37.759 Yeah, I think, you know, interestingly, I know 00:19:37.759 --> 00:19:41.420 we've talked before on this podcast about House 00:19:41.420 --> 00:19:44.279 Bill 1218, which dealt with competency evaluations. 00:19:45.119 --> 00:19:47.299 This was a bill that we had some significant 00:19:47.299 --> 00:19:50.250 concerns about when it came. It came up initially 00:19:50.250 --> 00:19:52.569 just before session, particularly the components 00:19:52.569 --> 00:19:56.309 around essentially penalizing or fining counties 00:19:56.309 --> 00:19:59.450 that were being. determined to have too many 00:19:59.450 --> 00:20:03.930 comments evaluation requests. So we've had to 00:20:03.930 --> 00:20:07.130 do a ton of work to get this bill to a place 00:20:07.130 --> 00:20:09.390 where we feel comfortable with it. I won't say 00:20:09.390 --> 00:20:11.750 it's a perfect bill because it's not, but I think 00:20:11.750 --> 00:20:14.029 we feel at the moment that by removing, we were 00:20:14.029 --> 00:20:15.549 successful in getting the penalty components 00:20:15.549 --> 00:20:17.269 removed from the bill. So they're completely 00:20:17.269 --> 00:20:19.809 gone. They're completely gone. So that is good. 00:20:19.869 --> 00:20:22.549 That was a big win for us. And I do think we 00:20:22.549 --> 00:20:24.609 shared some of the problem statement in the bill. 00:20:24.630 --> 00:20:27.289 We shared that the concerns that the sponsor 00:20:46.420 --> 00:20:50.500 I do believe that will have a harder path in 00:20:50.500 --> 00:20:52.809 the Senate. than it did in the House, and it 00:20:52.809 --> 00:20:54.630 didn't have a totally easy run in the House. 00:20:54.829 --> 00:20:57.529 You know, that bill is an interesting one. It's 00:20:57.529 --> 00:21:00.710 kind of a lesson in what I think are some of 00:21:00.710 --> 00:21:03.230 the fundamental misconceptions about how county 00:21:03.230 --> 00:21:05.630 government actually operates, right? You know, 00:21:05.650 --> 00:21:08.450 county government has a separation of powers. 00:21:09.289 --> 00:21:11.190 unlike any other government system that's out 00:21:11.190 --> 00:21:14.130 there. You know, we have, what, eight or nine 00:21:14.130 --> 00:21:17.009 independently elected officials plus several 00:21:17.009 --> 00:21:20.049 agencies that all have individual responsibilities. 00:21:20.549 --> 00:21:23.509 And there is no clear executive versus legislative 00:21:23.509 --> 00:21:26.109 versus judicial branch. I mean, there is in some 00:21:26.109 --> 00:21:28.470 ways, but for instance, the county commissioners 00:21:28.470 --> 00:21:31.630 actually have executive. judicial and legislative 00:21:31.630 --> 00:21:36.890 powers. So it's just this kind of weird animal. 00:21:37.009 --> 00:21:39.210 I started calling it the shadow government in 00:21:39.210 --> 00:21:42.769 Washington state that no one ever really fully 00:21:42.769 --> 00:21:44.769 understands until you're part of it. It's like 00:21:44.769 --> 00:21:50.150 skull and bones. You have to be a member before 00:21:50.150 --> 00:21:52.890 they give you the secrets to how things actually 00:21:52.890 --> 00:21:57.089 operate. But I can't remember who I was talking 00:21:57.089 --> 00:21:59.569 to. It wasn't very long ago, but they were saying, 00:21:59.720 --> 00:22:02.700 that they'd been in politics for years, studied 00:22:02.700 --> 00:22:05.559 it, you know, went to school for political science, 00:22:05.799 --> 00:22:08.500 were in elective office, et cetera. And, you 00:22:08.500 --> 00:22:10.900 know, they could never remember through all their 00:22:10.900 --> 00:22:13.099 studies and everything that they'd been through 00:22:13.099 --> 00:22:16.460 anyone ever giving them a lesson on how county 00:22:16.460 --> 00:22:20.259 governments actually worked. And I think that's 00:22:20.259 --> 00:22:21.980 probably why we spend all of our time up here 00:22:21.980 --> 00:22:24.279 trying to fix things. Right, right. And 1218, 00:22:24.420 --> 00:22:25.559 I think, is a really good example. It is a great 00:22:25.559 --> 00:22:28.140 example of that. Yeah. And not only just in terms 00:22:28.140 --> 00:22:31.400 of how things work at the county level but there 00:22:31.400 --> 00:22:35.130 are other players involved that that aren't counties 00:22:35.130 --> 00:22:37.150 at all. Right. I mean, their cities are a part 00:22:37.150 --> 00:22:41.150 of this work, our judicial system. I mean, the 00:22:41.150 --> 00:22:43.730 judges. So not just the not just the prosecutors, 00:22:43.890 --> 00:22:46.130 the public defenders. Right. Which are a whole 00:22:46.130 --> 00:22:48.369 other independent group. And so, yeah, they're 00:22:48.369 --> 00:22:51.250 all independent, all independent and all have 00:22:51.250 --> 00:22:54.289 a different and different interest and a different 00:22:54.289 --> 00:22:56.430 interaction authority and authority in this and 00:22:56.430 --> 00:22:59.269 responsibility in space. And many in, for instance, 00:22:59.309 --> 00:23:00.910 the county commissioners can't tell the prosecutor 00:23:00.910 --> 00:23:03.210 what to do. They can't public defense. The prosecutor 00:23:03.210 --> 00:23:06.130 can't tell her. city exactly none of those entities 00:23:06.130 --> 00:23:08.569 can tell anybody what to do exactly once they're 00:23:08.569 --> 00:23:10.549 elected and they're in those positions they have 00:23:10.549 --> 00:23:12.230 full authority to make those decisions the only 00:23:12.230 --> 00:23:15.210 check that's on them at all other than the law 00:23:15.210 --> 00:23:17.710 is that is the voters that's right is the taxpayers 00:23:17.710 --> 00:23:21.190 that's right and 12 18 right that had a bunch 00:23:21.190 --> 00:23:24.650 of penalties that that i think assumed that county 00:23:24.650 --> 00:23:26.450 commissioners would be able to control right 00:23:26.450 --> 00:23:28.230 that we could just flip a switch or turn a dial 00:23:28.230 --> 00:23:30.190 and all of a sudden it would be fine right and 00:23:30.190 --> 00:23:33.019 it took a lot of work to try to explain that 00:23:33.019 --> 00:23:35.200 that was just that's that's not how it works 00:23:35.200 --> 00:23:37.660 and that we don't as i appreciate them thinking 00:23:37.660 --> 00:23:40.240 we had that much power right but but that we 00:23:40.240 --> 00:23:42.920 don't and that this really is a lot of independent 00:23:42.920 --> 00:23:45.740 individuals or independent entities making this 00:23:45.740 --> 00:23:48.000 part of the system work or not work frankly um 00:23:48.000 --> 00:23:50.220 so yeah it was a challenge but i think we got 00:23:50.220 --> 00:23:52.539 to a good place on it i feel good about it uh 00:23:52.539 --> 00:23:54.799 and we'll continue to engage on it in the senate 00:23:54.799 --> 00:23:58.349 as it works through Well, that's great, and that's 00:23:58.349 --> 00:24:01.630 good news to hear that the penalties are gone 00:24:01.630 --> 00:24:04.009 off of that bill. I think our members will really... 00:24:04.200 --> 00:24:06.160 appreciate that. So good work, Brad. Well, thanks. 00:24:06.200 --> 00:24:07.559 Appreciate it. Appreciate the support on it. 00:24:07.619 --> 00:24:09.519 Yeah. Well, that's all the time we've got. Um, 00:24:09.759 --> 00:24:13.380 I want you to come back to chat about, uh, what's 00:24:13.380 --> 00:24:15.299 been going on with the law and justice. Yeah. 00:24:15.299 --> 00:24:17.400 There's plenty going on there. Yep. Uh, after 00:24:17.400 --> 00:24:20.079 cutoff and, uh, juvenile rehabilitation, maybe 00:24:20.079 --> 00:24:21.859 a little bit. Yeah. I think we need to talk about 00:24:21.859 --> 00:24:24.599 those things too. So, um, let's schedule another 00:24:24.599 --> 00:24:26.720 podcast. I'm sure that our listenership will 00:24:26.720 --> 00:24:29.119 be eagerly waiting for sure. They just, yeah, 00:24:29.240 --> 00:24:31.099 they're going off. When's Brad going to be back? 00:24:32.759 --> 00:24:34.630 No, thanks. ball though yeah look forward to 00:24:34.630 --> 00:24:38.369 it we'll talk to you all right bye thanks for 00:24:38.369 --> 00:24:40.690 tuning in to county connection stay in the loop 00:24:40.690 --> 00:24:43.170 by subscribing to us through your preferred podcasting 00:24:43.170 --> 00:24:45.970 app and following us on linkedin facebook and 00:24:45.970 --> 00:24:48.410 instagram and don't forget to join the hub your 00:24:48.410 --> 00:24:50.329 go -to source for the latest news and updates 00:24:50.329 --> 00:24:52.369 from the washington state association of counties 00:24:52.369 --> 00:24:55.390 until next time stay connected and stay informed