Thursday, February 24, 2011

The Magic of Voice Labeling Systems

By Shannon Ramsay, CFILC’s Information & Assistance Advocate

 How would you like to be able to harness the power of your own voice to help you stay organized at home, at school, or around the office?  There are devices on the market today called voice labeling systems, which allow you to make customized labels by recording your voice on adhesive labels or plastic cards of varying sizes.

One of the voice-labeling systems on the market is called the RNIB PenFriend Voice Labeling System.  The PenFriend was originally introduced by the Royal National Institute for the Blind (RNIB) in London.  It is a small pen-shaped device between eight and nine inches long with a one gigabyte storage capacity for all the user’s voice notes.  The PenFriend comes with a built-in speaker and microphone as well as four simple buttons for turning the device on and off, controlling the volume, cycling through the device’s menus, and making recordings.  Along with the PenFriend, the user receives print and recorded instructions, batteries, a lanyard, and a USB connector.  The PenFriend also comes with sheets of 127 adhesive labels which are circular or square-shaped.  You will use these adhesive labels together with the pen-shaped device to create your labels.  When you have used up the initial package of labels, you can purchase additional packages of 380 labels.  These packages of replacement labels sell for $25-30 each.  The PenFriend Voice Labeling system sells for $130-150 depending on whether you purchase it on-line from the RNIB website or whether you buy it from Bay Area Digital, Independent Living Aids or the Speak To Me Catalog.

It is not necessary to have access to a computer to make labels with the PenFriend.  You only need to have a computer if you want to transfer music or other audio files onto the PenFriend through the USB connector cable.  The PenFriend can be used as a portable storage device in addition to a labeling system.

 In order to produce a label, you point the pen-shaped device at one of the adhesive labels and hold the record button down while you say what you want to record on the label.  The labels can be as short or as long and detailed as the user wishes to make them.  It is even possible to record over a label which you have already made.  In order to hear a note which you have recorded on a particular label you simply point the pen-shaped device at that label and the PenFriend will play back that recording for you.  The device has all the voice labels which you have created stored on its internal memory chip.

The PenFriend is a handy little device for marking mail, medicine bottles, CD’s and DVD’s, cleaning products, food packages, school projects, and all sorts of other things around the home or office.  This device can help you keep track of important papers or organize a filing system.  Since there is no limit to the length of the message which you can record on one of the PenFriend’s adhesive labels, you can include a recipe or operation instructions as part of the label.  This device is very compact and lightweight so you can take it with you wherever you go in a purse, a backpack, or a briefcase.  The PenFriend is a wonderful device for people who have difficulties remembering things or who do not have the dexterity to create hand-written labels or to operate a print labeler.  The PenFriend is also especially useful for individuals with print-related disabilities or visual impairments.

There is a similar voice-labeling system on the market called the Touch Memo Voice Labeling System.  It operates in essentially the same way as the PenFriend.   There are no real major differences between these voice labeling devices.  The Touch Memo Voice Labeling System comes with more adhesive labels than the PenFriend does as well as plastic tags and washable labels.  The Touch Memo Labeling System has three buttons and a volume wheel.  Unlike the PenFriend, the Touch Memo Labeling system can be recharged by using its power adapter or by connecting it to a computer with a USB connector.  It does not use regular AAA batteries like the PenFriend does.  Also, the Touch Memo Labeling System  has two gigabytes of storage instead of one gigabyte, which the PenFriend has.  In addition, the Touch Memo Voice Labeling System costs $100 more than the PenFriend does.

A third voice labeling system available for purchase is the VoxCom III Voice Labeling System.  This labeling device uses plastic cards on which you can record your voice notes.  The VoxCom III costs $119.95 with 50 plastic cards and $124.95 with 100 plastic cards.  You can record a 10-second note on one of the plastic cards and then play your voice label back by inserting the card into a slot on the VoiceCom III.  You can also record over labels which you have previously made on the plastic cards which come with this device.  This device operates with a 9-volt battery and comes with various mechanisms, such as magnets and rubber bands, for attaching the plastic cards to the things which you want to label. 
Have you ever used a voice-labeling system? If so, tell us about your experience in the comment area below.

Tuesday, February 15, 2011

The Medi-Cal TAR process and DME

Written by Kim Cantrell, CFILC's Director of Programs

A treatment authorization request, otherwise known as a TAR, is a form needed to pre-approve funding for treatment, including Medi-Cal approved assistive technology (AT). The TAR is submitted for Medi-Cal approval before the order is placed and provides medical justification for the AT requested. In almost all cases, to be approved by Medi-Cal TARs must include a medical assessment or physician’s prescription including the recipient’s condition and the benefits that he/she will realize through the use of an appropriate device.

Medi-Cal requires TARs for all AT devices costing more than one hundred dollars. Each year consumers are allowed a certain number of requests without TARs for items under $100 (i.e. crutches, canes). Durable medical equipment (DME), such as wheelchairs and walkers, needs to be approved by Medi-Cal and requires a TAR. The form must be completed properly for the order to be processed.

Completing a TAR requires teamwork between a physician and a Medi-Cal approved DME vendor. The physician describes the medical justification for the request on one portion of the TAR, and the vendor reports the price and describes the equipment requested on another portion. It is the vendor’s responsibility to submit the TAR to Medi-Cal.  

Before the TAR is written, the physician must justify the need for AT to both Medi-Cal and the vendor. The TAR process requires vendor-physician cooperation, so vendors may be reluctant to begin the process until they receive documented support from a physician. The medical justification begins with a physician’s prescription or an AT assessment by an occupational therapist or other qualified evaluator. If you or your physician is unsure what AT is needed, then it is a very good idea to be evaluated. Having a prescription and/or an assessment is a very important preliminary step in the TAR process.

Although the physician and vendor write the TAR, the consumer can assist in the process. Medi-Cal is more likely to deem a requested item medically necessary if they receive a physician’s detailed description of need. It is your responsibility to urge your physician to be as specific as possible when writing the prescription and the TAR. For example, rather than the physician simply writing “power wheelchair,” recommend the paperwork include necessary details such as “power wheelchair with reclining motion is medically necessary.”

Additionally, you can request a letter from the physician, on letterhead, describing your condition and the medical benefits you will realize through the AT requested. Talk to your physician regarding a time line for completing the letter. Due to time constraints, you and the physician may decide for you to write a draft of the letter. Of course, your letter is not intended to replace the physician’s final letter, but serves as a letter of self-advocacy explaining the need for AT in your own words. The final physician’s letter then becomes a team effort between you and the doctor.

Also, ask which person in the physician’s office actually writes the TAR. It may be the physician or it could be a nurse or office assistant. It helps to speak to the person responsible to make sure the TAR includes a detailed account of your needs.

Ultimately, you should strive to provide Medi-Cal with all relevant information regarding your claim. When the TAR request is submitted to Medi-Cal, it should include a prescription and/or assessment, a TAR, and, if possible, a physician’s letter explaining the medical necessity of the item.

If this process becomes overwhelming at any stage, contact an AT advocate. The advocate will help you understand your rights and will work on your behalf to make sure that your needs are being met throughout the TAR process. From the prescription to the delivery of the product, an advocate can facilitate communication with the vendor, the physician, and if necessary, Medi-Cal. If your TAR is denied, it is not too late to contact an advocate. Advocates are located throughout California, and they can help you understand the reason for the denial and how to appeal Medi-Cal’s initial decision.

Medi-Cal has 30 days to respond to your request—either to approve it, to deny it, or to defer it—once the TAR has been received or the request is automatically approved. If Medi-Cal defers the request by asking the vendor for additional information, Medi-Cal then has 30 more days to again approve, deny or defer your request. The potential for deferment of your TAR makes it is critical to provide Medi-Cal with as much information as possible, especially for expensive items.

For custom orders or expensive equipment, Medi-Cal may still contact the vendor with additional questions, even if you submitted a well-justified TAR and supplementary materials. The truth is that the volume of TARs Medi-Cal processes is staggering. According to a Medi-Cal employee, the deferment process allows Medi-Cal to catch up when TAR volume or complicated requests require more time than the initial 30-day period. Unfortunately, the practice of deferring requests is particularly harsh to the waiting consumer. If your TAR request is deferred, an AT advocate can work with you to contact Medi-Cal and ensure a decision is made as soon as possible.

It is important to note that the vast majority of requests are approved or denied within the 30-day period. Hopefully, by using some of the helpful hints described above, you will be able to benefit from the TAR process and receive Medi-Cal approval for the AT you require. 

Have you had to wait for a TAR to be approved? Do you have any other Medi-Cal TAR tips to add?  If so, please leave a comment below. 

Tuesday, February 8, 2011

How to Develop an AT Funding Strategy

By Kim Cantrell, CFILC’s Director of Programs

Finding funding for AT can be tricky. If you aren’t able to fund the device you want right away, don’t despair. It’s just time to get creative and develop an AT Funding Strategy. You are much more likely to get the device you need if you have a plan. In fact, while developing a funding strategy you may learn about a variety of AT options that you didn't know existed before you started. The process will help you think about a variety of issues including the purpose of the device, how often you will use it, the environment in which it will be used and your abilities.

Click here to check out the AT Network website for step-by-step instructions describing how you can create a funding strategy. The AT Network website offers information explaining how AT may be funded by California's Regional Centers, Medi-Cal and Medicare.  

Also, if you or someone you know needs assistive technology, we encourage you to contact the AT Network’s Information and Referral specialist at 1-800-390-2699 or to learn about additional funding resources.

Have you been successful in your search for assistive technology funding? What funding barriers have you encountered? Please let us know in the comment box below. 

Tuesday, February 1, 2011

That’s One Small Step for Reuse…

Written by Allan Friedman, CFILC’s Technologies Manager

Seeds have been planted and the sprouts of a new collaboration have begun to emerge.  Last fall we convened a summit of organizations that have an interest in AT reuse.  The group began to explore ways to work together for the common purpose of increasing access to used AT for all Californians. 

Out of that meeting came a small task force that has already met a few times via teleconference to begin to flesh out some of the ideas discussed at the summit for ways reuse programs can work together for their mutual benefit as well as the benefit of California’s disability community.  They identified a number of issues to explore including ways they can share information, trade donated equipment, collective purchasing agreements, transportation, public policy and funding. 

One of the task force’s first actions was to help AT Network staff determine the best way to utilize AT Act funds to support reuse in California.  Today’s release of a Request for Proposals (RFP) for grant funding and the concurrent initiation of the AT Repair and Reuse fund is just one small step in a process of building a true reuse network in California.

$150,000 has been allocated to fund a limited number of grants of up to $30,000 each.  Successful applicants will use this funding to make capital purchases or improvements that will enable them to sanitize and repair or refurbish wheelchairs, communication devices, CCTVs and other AT devices.  Applications for the competitive grants must be received by March 11, 2011. Visit for complete details.

In addition to the grants, a repair fund has been established to help small organizations pay for parts and repairs to devices that have been donated to their programs.  Organizations that accept donated DME and assistive devices can complete a simple online form for financial assistance to make the devices usable again.  While not a competitive process like the capacity building grants, the repair fund is small and available on a first-come, first-served basis.  There is a limit of one request per week for any organizations that apply. Details on the program can be found at

Both of these funds will mean a new life for many devices and enable low-income Californians to get assistive technology they might otherwise not be able to acquire.

“We heard a number of people at the summit say they have donations they could reassign to new users, but they are unable to pay for parts or repairs to make the devices usable,” said Kim Cantrell, AT Network Program Director.  “The repair fund will allow organizations to request a few hundred dollars for new wheelchair batteries or other parts and have a working device to provide to a low-income consumer.”

By helping organizations make some capital improvements to their reuse programs, we expect to enable them to turnaround even more devices, increasing the supply of quality used devices for Californians with disabilities.  These first steps, along with the efforts of the task force, are the beginnings of a statewide network that will make efficient use of donated devices and enable all Californians to have access to AT, new and used, that meet their functional needs and their pocketbooks as well.