What is a Center of Excellence?
A Center of Excellence (COE) is any medical practice, psychology practice, or multidisciplinary assessment team that has received the COE training authorized by the Health Care Authority or has been judged by the HCA to be qualified to write a prescription for Applied Behavioral Analysis (ABA) services. 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 Center of Excellence (COE) must conduct a comprehensive evaluation, and write an order for Applied Behavior Analysis therapy, within the last two years.
WHAT a COE Training Qualifies a Provider to Do
Pediatricians or other primary care providers including family medicine physicians and ARNPs who complete a 1 day COE training AND REQUEST to be listed by the WA State Health Care Authority (HCA) as a COE will be able prescribe ABA therapy for Medicaid eligible children. COE status may help other insurance plans to authorize ABA services for their covered children but each insurance plan may have different diagnostic requirements. COE status and training is focused entirely on making Autism Spectrum Disorder (ASD) diagnosis.
Getting a Diagnosis of ASD in WA State
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
Eligibility for services from the Developmental Disability Administration (DDA) are dependent on some specified diagnoses and a measure of functioning, generally adaptive skills. DDA will accept an autism diagnosis only from certain specialties including:
- ARNPs associated with an autism or developmental center
- Board Certified Neurologist
- Board Certified Psychiatrist
- Developmental Pediatrician
- Licensed Clinical Psychologist
DDA Eligible Conditions Specific to Age and Type of Evidence and Diagnostician (in multiple languages); English PDF
Only COE (Center of Excellence) providers may prescribe ABA therapy for children covered by WA State Medicaid plans. COE providers can be general pediatricians, family medicine physicians, ARNPs. 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 has 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.
School Medical Autism Review Team (SMART)
SMART is a model that builds on and expands community capacity in rural and underserved 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.
To view an example of the pathway a child goes through to get and autism diagnosis, Skagit County Multidisciplinary Autism Review Team put together this spreadsheet. Credit goes to Kay Walter. for creating this document. Each county has their own unique pathway based on the providers and services available in their community.
Read more on SMART