CASCADES

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:

• 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.

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