The purpose of these guidelines is to provide guidance to assist Pennsylvania’s early childhood programs, as they continue to show progress and increase the number of children supported ininclusive settings. Children with disabilities require access to be actively included with the same social and learning opportunities as typical peers. Research shows that embracing children at a young age improves outcomes for both children with special learning needs and typically developing peers. The document reviews recommended practice, research, federal law, state law, and guidance from the Department of Education and Human Services, as well as guidance from the Office of Child Development and Early Learning. The effective components of inclusion are detailed, as well as toolsto assess and achieve these components. In summary, the guidelines highlight the 3 critical components of inclusion (Access, Participation and Support), and identify tools to aid in achieving effective inclusion. Inclusion goes beyond placement in a regular early childhood classroom orproviding services in a natural environment. Inclusion is about having children actively participate using their abilities in day-to- day activities and routines as members of the community.


 little puzzleGuidelines to Support Implementation of OCDEL Announcement on Inclusion. A Resource for Administrators and Coaches






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For Immediate Release

‘ABA in PA’ Group Meets to Address Services for Children with Autism

HERSHEY, June 6, 2017 – A local group of parents and industry professionals is meeting in Hershey to strategize about ways to ensure that children with autism receive better access to quality Applied Behavior Analysis (ABA) therapy.

The third annual meeting of the ABA in PA Initiative will take place on Thursday, June 8, 2017 from 9 a.m. to 4:30 p.m. at the Penn State Milton S. Hershey Medical Center’s University Conference Center, 500 University Drive in Hershey.

“It’s more important than ever that we focus our efforts on promoting advocacy for individuals with special needs, given the uncertainty of the level of investments for autism services on the state level, along with the uncertain fate of health coverage on the national level,” said Dr. Cheryl Tierney, MD, MPH, a board-Certified behavior and developmental pediatrician at Penn State Health Milton S. Hershey Medical Center and president of the ABA in PA Initiative. “This annual meeting serves as a critical opportunity for professionals, parents and advocates to come together to explore the best ways to ensure that individuals with autism are receiving the services they need an deserve, including ABA therapy.”

Members of the media are welcome to cover the meeting, and parents and professionals are available for interview. 


The ABA in PA Initiative is an advocacy organization dedicated to change the future for all children in Pennsylvania with Autism Spectrum Disorder by ensuring access to ABA therapy via Medical Assistance.

The ABA in PA Initiative aims to bring the autism community together as one united voice to urge Pennsylvania and private sector to listen to our concerns and take immediate action to address the service gap for ABA.

One in 68 children is diagnosed with Autism Spectrum Disorder, according to the Centers for Disease Control and Prevention.

Applied Behavior Analysis is a systematic and intensive teaching approach that involves breaking skills down into small, easy-to-learn steps. It is widely recognized as the single most effective treatment for children with autism and the only treatment shown to lead to significant, lasting improvements in the lives of individuals with autism.

Studies have shown that children with autism who participated in intensive ABA programs showed significant improvements in IQ, language skills, and academic performance. Some children in these studies were able to move successfully to mainstream public school classes, where they can learn alongside typically developing peers.

The American Academy of Pediatrics and the US Surgeon General endorse ABA therapy.

However, according to ABA in PA members, Pennsylvania’s Medical Assistance (MA) program does not cover ABA therapy in a manner that is consistent with the medically accepted standard of care, or in an amount, duration and scope sufficient to reasonably achieve its purpose of improving the lives of children with autism.

While Pennsylvania provides services to many children with autism, these services are not designed to treat developmental or neurological disorders, such as autism. The services provided today are designed to treat the behavioral “symptoms” of autism.  

ABA in PA participants say ABA therapy must be recognized in Pennsylvania as distinct service offering to children with autism. However, unlike other states, Pennsylvania has refused to recognize ABA therapy as distinct service under the state’s MA program. 

For media inquiries, contact at This email address is being protected from spambots. You need JavaScript enabled to view it., Or by phone at 413-262-2453





The purpose of this bulletin is to reissue the guidelines to be used when requests for prior authorization of Applied Behavioral Analysis (ABA) using Behavioral Specialist Consultant-Autism Spectrum Disorder (BSC-ASD) services or BSC-ASD and Therapeutic Staff Support (TSS) services for children and adolescents under age 21 with autism spectrum disorders (ASD) are reviewed and inform Behavioral Health Managed Care Organization(s) (BH-MCOs) and providers of the documentation that will be needed to support the medical necessity of ABA.


OMHSAS-17-01 Attachment.pdf


The purpose of this bulletin is to inform Behavioral Health Managed Care Organizations (BH-MCOs) and providers of the procedures for requesting Applied Behavioral Analysis (ABA) using Behavioral Specialist Consultant-Autism Spectrum Disorder (BSC-ASD) and Therapeutic Staff Support (TSS) services, the minimum qualifications needed to provide ABA using BSC-ASD and TSS services, and the procedure code and modifier combinations that can be used to bill for services when BSC-ASD and TSS services are used by appropriately qualified individuals to provide ABA.


OMHSAS-17-02 Attachment I.PDF

OMHSAS-17-02 Attachment II.PDF




This essay is a factual rebuttal of the blog entry “The Shocking Controversy of ABA Therapy” writing by A. Stout and published on The Autism Site.


While A. Stout, is certainly entitled to her opinion, one which I respect as someone diagnosed with autism spectrum disorder, it is irresponsible to publish negative comments about ABA therapy, based on very inaccurate information.  There is a seemingly misunderstanding of ABA therapy that has helped many on the autism spectrum in their daily lives.

Applied behavior analysis (ABA) is an evidence based practice (EBP), which means it is a model of professional decision making in which professionals integrate the best available evidence, keeping in mind client values, context and clinical expertise to provide the best services (first link).

ABA is the scientific study of behavior, based on the science of learning and behavior.  The therapeutic practices focus on increasing functional behaviors and decrease maladaptive (negative) behaviors.  This is done through reinforcement principles and focuses on the positives.

ABA focuses on the social impact of the client.  Social impact refers to one’s ability to essentially functioning within society, including communication, social skills, activities of daily living (hygiene routines, cooking, cleaning, etc.) reading and academics.  These are all very important skills clients must learn to their maximum potential for daily functioning.

Behavior analysis was first studied by B.F. Skinner in 1938. Within in the field of ABA there are many subcategories of therapies, which all use ABA principals to focus on the social structure of the client.  Some of these therapies are: discrete trial training (DTT), verbal behavior (VB or AVB), pivotal response training (PRT), Early Intensive Behavior Intervention (EIBI) and Treatment and Education of Autistic and Related Communication- handicapped Children (TEACCH). Many of Skinner’ techniques are still relevant today, including verbal behavior.

The main question A. Stout asks throughout her opinion piece, is “Would I feel good, okay or comfortable doing this with a neurotypical (NT) child?”.  This insinuates again that ABA is just for clients on the autism spectrum or with other disabilities.  However, everyone’s daily life, including NT’s incorporate ABA principles. To prove this point, throughout this factually based rebuttal, NT examples will be highlighted to demonstrate everyday ABA practicality for all people, not just people diagnosed on the autism spectrum.

Ms. Stout states a falsehood when she states in ABA, “you reward a wanted behavior and punish an unwanted behavior”. Punishment in the everyday sense does not happen in ABA therapy.  To understand this, it is best to learn the definitions of reinforcement and punishment in the field of ABA.

In ABA reinforcement refers to increasing a desired behavior.  It has possible to have positive reinforcement, where something is added to increase a desired behavior or negative reinforcement where something is removed to increase a desired behavior.

NT example: (positive reinforcement) You go to work for two weeks, you get a pay check.  The pay check is there to ensure you keep coming to work, as most of us would not continually show up to work without getting paid.

NT example: (negative reinforcement) A child is given a spelling worksheet.  The child believes there are too many problems, for every 3 problems completed a problem is crossed out. Therefore, the child is going to complete more problems to get some removed. (This is also a common accommodation in the school domain.)

Punishment in ABA world is vastly different from what most people refer to as punishment.  Punishment in ABA is where you are decreasing behaviors. Indeed, that is all punishment means in ABA. It is the opposite of reinforcement and has nothing to do with “punishment” in everyday language. As with reinforcement, there is positive punishment, where something is added to decrease negative behavior and negative punishment, where something is removed to decrease a negative behavior.

NT example: (positive punishment) You are running late for work and speeding.  You get pulled over and get a speeding ticket.  After this incident, you now do the speed limit.

NT example: (negative punishment) A child comes home late for curfew from playing with friends. As a result parents take the child’s bike for a week.  The child is not late for curfew again.

With that brief background knowledge (and I do mean brief!) I will address the numbered points in the remaining of the blog, which has many inaccuracies.

  1. ABA therapy does work on compliance as it is a needed skill for daily functioning, in everyone’s life.  The way we gain compliance in ABA will look different in each program depending on the board-certified behavior analyst (BCBA) who develops the treatment plan. However, we NEVER “force” clients to comply with a smile.


There are times when we use systematic techniques to decrease sensitivity to foods, clothing, other textures (soap, toothpaste, etc.), but it is done slowly over time.  At no time is a child ever forced to immediately be exposed to aversive conditions or forced to do anything.  Specific procedures are put into place to reinforce certain behaviors to make the aversive stimuli less aversive and more reinforcing.  In ABA the child is NEVER, EVER hurt or harmed through EBP therapeutic techniques.


NT example:  Children need to comply with parents, teachers, etc.  Some of these are of course non-*preferred demands.  A child cleans their room, they get a dollar.  This is compliance gained through the ABA principle of positive reinforcement for desired behaviors.


  1. Everyone exhibits self-stimulatory behaviors, including children on the autism.  While there are times when self-stimulatory behaviors will be replaced with more socially accepted behaviors or limited depending on the environment.  However, the overall belief of those practicing ABA is that stimming provides some needed sensory input and is a form of self-calming when overstimulated in the environment.


Will we “allow” a child to stim for hours because it has a need that is being met? No, as this is not functional for anyone.  If this occurs replacement behaviors are introduced based on ABA techniques and have the same function of the non-functional behavior.  However, some hand flapping, verbal and visual stims on occasion for sensory input/ calming is acceptable.


While we always encourage children to explore topics of interest, as therapist we encourage them to do it in a socially acceptable manner and learn social cues to not socially isolate themselves in the natural environment.

NT example:  Biting of nails when not actively engaged is a self-stimulatory behavior.  Many people do this and do not realize it is a stim.

  1. Reinforcers are used daily in everyone’s lives.  Our functioning is based on reinforcement principles derived from ABA.  While reinforcers are sometimes withheld when a high reinforcer is needed for something such as toilet training, they can also be held so reinforcer satiation does not happen (when the item is given so much it is no longer preferred) and so other reinforcers from the natural environment can be introduced.  

NT example:  When a child comes home from school, they must do their homework and complete chores before going outside to play or use electronics, whichever is more reinforcing.

It is evident that ABA is useful in everyday practice for all.  ABA is even more useful as a therapy for children and adults with autism and other disabilities to increase functional communication, desired behaviors, social skills and activities of daily living, while decreasing negative behaviors through systematic programming based on data collection.  Many children and adults alike on the autism spectrum have had immense improvement in the quality of daily life due to successful ABA therapy.



Dr. Kristin M. Kosmerl, BCBA-D, LBS is a Board Certified Behavior Analyst- Doctorate and PA Licensed Behavior Specialist.  She is the president and owner of Autism & Behavioral Consulting, LLC in Palm Beach, Florida and Reading, Pennsylvania.  She has worked with children on the autism spectrum for over 16 years.  Dr. Kosmerl is a founding board member and current member of the ABA in PA Initiative.

About the ABA in PA Initiative.  The ABA in PA Initiative is a 501 (c)(3) nonprofit advocacy organization made up of parents, industry professionals, and lawmakers dedicated to change the future for all children in Pennsylvania with Autism Spectrum Disorder (ASD) by ensuring access to Applied Behavior Analysis (ABA) therapy.



ABA in PA Logo 2 Med


Do you ever wonder if your child’s care would be better if your ABA therapist (BSC/BCBA) worked with your child’s other therapists (ex. SLP, OT) at the same time?  I know many of you do!  Having your ABA therapist working with your child's provider team (speech, OT, special instruction etc.) is part of good care coordination and will help your child make the best progress possible. It also keeps everyone on the same page and allows your ABA Team to lead the program. Co-Treatment is considered a “best practice”.


So what can you do if you are told "This can't happen” or “We are not allowed to do that”?


If you are told that your BSC (Board Certified Behavior Analyst, BCBA) cannot co-treat with say, your speech pathologist, you should be complaining about that.


First you should distinguish between your provider agency saying you can't do this and a true insurance denial. If you have a formal denial from your MCO (managed care insurance company) then you can file a grievance by following the instructions on the denial notice.  If it is just your provider agency saying you can't do it, you can call your MCO (the number on your insurance card) and request help filing a complaint against the agency itself.


Obtaining a brief doctor's letter explaining why it is medically necessary and best practice to submit to the insurance plan, in the case of a denial, can help.  (Do you need a sample letter to give to your child’s doctor?  That’s easy!  Go to our website,, click on our Resources tab, and under our Document Downloads you will find a sample letter.)


But the best approach is a proactive one that addresses this at the ISP meeting and clearly has this written into the plan. If the provider agency "thinks they can't", they should get a formal response from the MCO. If the MCO says "NO" by denying the request, you should also write to This email address is being protected from spambots. You need JavaScript enabled to view it., and copy Rachel Mann, This email address is being protected from spambots. You need JavaScript enabled to view it. so they will take it up with the DHS (Department of Human Services).  This is an issue that we hope to address in the new regulations coming out by the state and hope to streamline this issue for EVERYONE.  


We hope this information is helpful to everyone who follows us.  We want the care your child receives to be as good as it can be.  If you aren’t following us, make sure you like and follow us so you don’t miss out on all our news and updates.  




little puzzleTemplate for Providers: Letter of Medical Necessity for Providing ABA w/Another Provider Type


From my family to yours, Have a Great Labor Day weekend!


Cheryl Tierney, MD


Section Chief, Developmental Pediatrics, Penn State Children's Hospital