What is an Autism Center of Excellence (COE)?

Medical Home: Centers of Excellence (COE)An autism Center of Excellence (COE) is an eligible individual evaluating and prescribing health care provider who:

  • has received the autism COE training authorized by the Washington State Health Care Authority (HCA), takes Washington State Medicaid insurance and has attested as a COE
  • or has been judged by the HCA to be qualified to diagnose autism and write a prescription for Applied Behavioral Analysis (ABA) services if appropriate

There are many different ways for children and youth to get a diagnosis of autism. In order for a child or youth to be eligible for ABA therapy through Apple Health/Medicaid, a recognized COE must conduct a comprehensive evaluation, and write an order for Applied Behavior Analysis therapy, within the last two years.

Who Can Be an Autism COE?

Health care provider categories:

  • Developmental pediatrician
  • Neurologist
  • Pediatric neurologist
  • Pediatric psychiatrist
  • Psychiatrist
  • Psychologist

OR

  • A qualified medical provider who has been designated by the HCA as a COE. These include physicians, ARNPs, and pediatric primary care naturopaths (NDs).  As of Jan 1, 2023 PA-Cs are also eligible if their supervising clinician is a COE.

COE requirements are detailed in Washington Administrative Code Chapter 182-531A WAC under WAC 182-531A-0200 Definitions, and WAC 182-531A-0800 Provider Requirements.

The HCA posts a list of COEs by county.  More information about who can be a COE: HCA ABA Program Billing Guide

What Does the Autism COE Designation Mean?  

An autism COE provider can evaluate and establish or confirm the diagnosis of an autism spectrum disorder and develop the multidisciplinary clinical treatment plan, including prescribing ABA therapy if appropriate, for Medicaid eligible children. COE required for Managed Care Organization (MCO) prescription approval.

COE status may help other insurance plans to authorize ABA services for their covered children but each insurance plan may have different diagnostic requirements. As of October 17, 2019, COEs can also make an autism diagnosis that will be accepted for Developmental Disabilities Administration (DDA) eligibility (with the exception of Naturopathic Doctors and PAs although that is currently being reviewed)

COE status and training is focused on making Autism Spectrum Disorder (ASD) diagnosis.

How to Become an Autism COE

To become an autism COE, eligible primary care providers need to:

  • Complete the autism COE Certification training
  • Return the attestation form to HCA and request to be listed as a COE
  • Be enrolled in Washington State Medicaid

Psychologists, developmental behavioral pediatricians, psychiatrists and neurologists should contact ABA@hca.wa.gov to be added to the official COE list to ensure there are no questions about having ABA prescriptions approved.

Upcoming Autism COE Trainings

HCA contracts with the University of Washington  to have experts provide COE training on evaluating and diagnosing children with autism and treatment options available, including accessing ABA therapy.

For more information, please see the COE Certification training page.

Please email Kate Orville (orville@uw.edu) you would like to be notified of future COE trainings.

Additional Training and Support for COEs

  • The Autism COE Quick Start Guide provides an overview of information and resources to guide you in developing your Autism COE practice for Medicaid patients and their families. This document includes tips for working with your administration, developing a comprehensive evaluation workflow, billing and coding guidelines, templates for documentation, feedback and referral processes, and community resources.  In addition to the overview, there are numerous appendices with specific, in-depth information including but not  limited to an autism clinic proposal template, EMR report templates, ABA referral documentation, screening and diagnostic tool recommendations, and more.
  • Providence Boyden Family Autism Center COE Monthly Online Training and Support Group – Flyer – Are you a freshly minted COE? Have you been a COE for a bit but still have questions about how to ensure accurate diagnoses for your  patients? Are you an experienced COE who would like to help support newer COEs in your community? Then this is the group for you!
    • Presented by the Center’s diagnostic team (PhDs, SLP etc.), this group offers training on implementation of the ADOS-2 assessment tool, overview of a recent case study and a Q & A period for all in attendance.  The intention of the group is to support COEs in achieving confidence and competency in carrying out diagnostic assessments.  The Center is in Everett, Snohomish County but the group is open to those diagnosing children and youth with autism across Washington State.
    • Second Wednesday of the month, 12-1 pm live online by Microsoft Teams.  Contact Jill McDaniel, PhD, BCBA-D, LBA, Clinical Manager of Providence Boyden Family Autism Center jill.mcdaniel@providence.org

 

Many clinicians who become Autism COEs want more training support for this role.  COEs can apply to be part of Project ECHO (Extension for Community Healthcare Outcomes) Autism Washington for additional training and consultation.  Many COEs also participate in interdisciplinary community diagnostic teams, often called School Medical Autism Review Teams (SMART).

Getting a Diagnosis of ASD in WA State

Children with Apple Health/Medicaid Insurance
Only COE providers may prescribe ABA therapy for children covered by WA State Medicaid plans. COE providers can be pediatricians, family medicine physicians, ARNPs and licensed naturopathic doctors. Providers of other specialties including neurology, psychiatry, developmental pediatrics and licensed clinical psychologists may also be granted COE status without obtaining specific COE training. The WA State Health Care Authority decides who has COE status and grants this privilege. It should be noted that any provider can make an ASD “medical” diagnosis for a Medicaid child but the prescription of ABA services will only be honored by Medicaid if it was made by a COE provider.

More information:

Schools
Schools make their own assessment to determine school provided intervention services. They are not required to use a diagnosis from a medical provider but generally do so.  There are no requirements as to what specific specialty, or specific autism training a provider needs to have obtained to make a diagnosis for the purposes of recommendations to schools.

Developmental Disabilities Administration (DDA)
Eligibility for services from the Developmental Disabilities Administration (DDA) are dependent on some specified diagnoses and a measure of functioning, generally adaptive skills.  As of October 7, 2024, DDA has expanded the scope of who can provide a diagnosis of autistic disorder (DSM-IV-TR) or autism spectrum disorder (DSM-5) for the purposes of establishing DDA eligibility by including ND and PA-Cs.

  • Board certified neurologist;
  • Board certified psychiatrist;
  • Licensed psychologist;
  • Advanced registered nurse practitioner (ARNP) associated with an autism center, developmental center, or center of excellence;
  • Licensed physician associated with an autism center, developmental center, or center of excellence; or
  • Board certified developmental and behavioral pediatrician.
  • ND or PA-C

Link to WAC 388-823-0500

DDA Eligible Conditions Specific to Age and Type of Evidence and Diagnostician (in multiple languages); English PDF 

School Medical Autism Review Team (SMART)

SMART is a model that builds on and expands community capacity in rural and under-served communities that do not have access to a local multidisciplinary diagnostic center.

In the SMART approach, experienced pediatric primary care providers, schools, early intervention agencies, and families come together and share their knowledge and evaluation results in order to facilitate a virtual, comprehensive assessment of a child. This process provides a close link between a child’s primary care provider (PCP) and school team, who sees the child on a daily basis. Using a shared document, the SMART tool, families are able to collect records of evaluations from their school, early intervention agency, local providers, and pediatrician to inform an interdisciplinary evaluation and diagnosis of autism.

SMART is a mechanism that in combination with Autism Center of Excellence (COE) training from the HCA, allows children to qualify for Applied Behavior Analysis (ABA) therapy covered by Medicaid.  Each county has their own unique pathway based on the providers and services available in their community.

Read more on SMART

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