Meet Jeremy, an active and fun-loving 12-year-old boy with a diagnosis of shaken baby syndrome. As a child it was thought that he would never speak, read, or write; let alone be an effective communicator. At first, Jeremy communicated through a means of pushing/pulling, grunting, screaming, verbalizing 4-6 words, and using barely recognizable signs. His constant inquisitiveness showed an enthusiasm for learning and communicating, which his SLP recognized immediately. She was certain that there was more that met the eye when it came to Jeremy. He was a smart boy; she just had to prove it to everyone else and to Jeremy himself.

At 6 ½ years old, Jeremy started using his first communication device, a Dynavox V. There is nothing like seeing a child’s face the very first time he activates a button saying, “My name is Jeremy.” Jeremy grew like a weed in the use of his device. Of course, he loved to “play” on it, so he had to be locked out of the settings, but he really used it to communicate. He proved that he was and is a very bright boy.

Eventually Jeremy grew tired of carrying his big device around and took to hiding it. He refused to use it and also began throwing it; needless to say it was out for repair frequently. Finally, after 5 ½ years he qualified for an upgrade. We knew Jeremy needed something that was more portable and looked cooler, which is when we found the Nova Chat.

In September 2013 his new Nova Chat 7 arrived. Despite all of our worries about how he would transition to the new device, Jeremy took to his Nova Chat like a duck to water. He needed extra guidance for only a few short weeks and then he had it down. He loved that it “looked like an iPad” and he felt cool carrying it around; he didn’t feel so different anymore. 

Jeremy uses the Chatpower 42 vocabulary file on his Nova chat 7 successfully in the classroom to answer teacher guided questions, do his math work, practice his writing, learn his Edmark reading words, read books, and to interject a novel remark here and there. It goes with him to every class, including field trips.

He loves to explore his Nova Chat and “work” on it every chance he gets. Jeremy is an excellent speller; nothing makes him happier than to go into the typing page and type out short messages, people’s names, or simply words that come to his mind - pretty amazing for a child who was not expected to read or write. Jeremy recognizes kindergarten and first grade site words and one of his favorite things to do is take a note book and pencil and write or copy words from books or his device. Not only did the device help to increase his literacy skills, but he has also increased his verbal vocabulary to over sixty words. He is still very hard to understand but will always go to his Nova Chat and try to find what he is trying to tell you.

He prefers to speak in two or three word phrases using his device, but can usually get his point across. His ability to communicate with others has increased even more with the use of his new Nova Chat 7.

Although he continues to hide his device on occasion, and must still be locked out of the programming mode, he enjoys using it in class and most of the time at home with his mom. It has really helped him to continue to grow as a person, and we cannot wait to see where he is in another 5 ½ years.

If your clients are covered by Medicare

If you provide services to clients covered by Medicare, we want to be sure you are aware of upcoming changes to how speech generating devices (SGD) will be administered by Medicare. 

Effective April 1 of this year, Medicare will reimburse a SGD under a ‘capped rental’ category.  This includes all six of the E-codes related to speech devices.  Capped rental is one of a number of reimbursement categories within Medicare and is typically used for products such as hospital beds. 

In the capped rental category, a SGD is rented from the supplier (PRC, Saltillo, etc.) for a period of up to 13 months.  After 13 consecutive months of the rental, ownership of the SGD will be transferred to the client.  Prior to this change, speech devices were considered ‘routinely purchased’, the device immediately became the property of the client and the supplier was paid after the device was delivered.  The capped rental category also allows for the re-use of speech devices that are rented, so it is very possible that future clients will not receive a new device under Medicare.

We are concerned that this change may cause problems for those clients who are admitted to a hospital, long term care facility, skilled nursing facility (SNF) or a hospice during the 13 month rental period, referred to as an “interruption in service”.  Clients and their families are required to notify PRC and Saltillo about changes in their medical or residential status affecting eligibility thus resulting in an interruption of service.  During an interruption in service, if a speech device is not arranged and paid for by the SNF, hospital or hospice, the client could be without any means of communication during these changes in settings because the equipment will need to be returned to the supplier. As you know, speech devices for these clients are often highly customized in terms of optimum access, vocabulary programs, client-specific content, etc. so even if ‘generic’ speech devices are available, they will not meet the needs of many clients.

If the interruption in service is long enough, the client may need a new evaluation in order to re-acquire a speech device. 

Our commitment

We all appreciate your clinical services to these clients and want you to know that both PRC and Saltillo are committed to providing the best possible solutions within the Medicare regulations, now and following April 1.  We believe the need to communicate is a constant, regardless of setting or location.  Your skilled evaluations and therapy services are essential to enabling these clients to communicate to the full extent of their abilities. 

We are working actively with other suppliers, patient advocacy groups, professional and trade associations and others to educate the decision-makers at the Center for Medicare and Medicaid Services about complications and the potential harm when this ruling goes into effect.  We believe Medicare is unaware of the diverse population of clients, the complexity of the needs within this population and the extent to which these devices are customized to meet those needs.  We will keep you informed on our progress in this education effort.  We will also be ready to comply with these new regulations on April 1.

You can review the final regulation at:

http://www.asha.org/News/2013/CMS-Determines-Rent-to-Own-as-Only-Option-for-SGDs/.