What is a Center of Excellence (COE)?

Medical Home: Centers of Excellence (COE)A Center of Excellence (COE) is any medical practice, psychology practice, or multidisciplinary assessment team 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 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 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
  • Neurologist
  • Pediatric neurologist
  • Pediatric psychiatrist
  • Psychiatrist
  • Psychologist

OR

  • A qualified medical provider who has been designated by the HCA as a COE (physicians, ARNPs and pediatric primary care naturopaths are eligible)

The HCA posts a list of COEs by county.  More information about who can be a COE: HCA ABA Program Billing Guide (see pages 16-17)

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.

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 1.5 day COE training
  • Return the attestation form to HCA and request to be listed as a COE
  • Receive confirmation from HCA that they have been accepted 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.

Upcoming COE Certification trainings:

  • December 6-7, 2019 (Friday/Saturday) in Spokane -more information coming shortly.  The local host organizer for the training is Northwest Autism Center.
  • March 6-7, 2020 (Friday/Saturday) in Mount Vernon.

For more information, please contact orville@uw.edu.

Please email ABA@hca.wa.gov if you would like to be notified of future COE trainings.

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, and 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 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 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.

Link to WAC 388-823-0500

(Materials need to be updated to include amended WAC):
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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