What is a Center of Excellence (COE)?
An autism Center of Excellence (COE) is any medical practice, psychology practice, multidisciplinary assessment team or individual health care provider that:
- has received the COE training authorized by the Washington State Health Care Authority (HCA)
- 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 a COE?
A hospital, medical center, or certain health care provider categories:
- Developmental pediatrician
- Pediatric neurologist
- Pediatric psychiatrist
- A qualified medical provider who has been designated by the HCA as a COE (physicians, ARNPs and pediatric primary care naturopaths are eligible)
What Does the COE Designation Mean?
A 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)
COE status and training is focused on making Autism Spectrum Disorder (ASD) diagnosis.
How to Become a COE
To become a COE, eligible primary care providers need to:
- Complete the COE Certification training
- Return the attestation form to HCA and request to be listed as a COE
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 Seattle Children’s Autism Center 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 (firstname.lastname@example.org) you would like to be notified of future COE trainings.
Additional Training and Support for COEs
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.
- Washington State HCA Washington Apple Health (Medicaid): Applied Behavioral Analysis (ABA) Program Billing Guide
- HCA webpage: Autism and ABA Therapy – How to access ABA therapy access through your Managed Care Organization
- Washington Administrative Code Chapter 182-531A WAC Applied Behavioral Analysis
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.
- Washington State Office of Superintendent of Public Instruction (OSPI): Eligibility for Special Education
- WAC 392-172A-01035 Child with a disability or student eligible for special education.
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 17, 2019, 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 physician and ARNP COEs.
DDA will accept a diagnosis from any of the following professionals:
- 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.
Note: DDA does not accept a diagnosis of autism from naturopathic physicians for the purpose of DDA eligibility.
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