October 18, 2021
Mr. Weston MacIntosh, JD
Senior Policy Analyst
MI Department of Licensing & Regulatory Affairs
Bureau of Professional Licensing
Boards & Committees Section
Lansing, MI 48909-8170
Re: Audiology-General Rules 2021-55LR; R.338.13 Telehealth
Dear Mr. MacIntosh:
On behalf of the American Academy of Otolaryngology-Head & Neck Surgery (AAO-HNS)1 and the
Michigan Otolaryngology Society, we are pleased to submit the following comments on the proposed
changes to the Audiology General Rules (2021-55LR). Specifically, our comments will address the
proposed provisions on Telehealth at Section R.338.13.
Telehealth is a service delivery model that has become an increasingly important alternative to in-
person care, particularly over the course of the ongoing COVID-19 pandemic. However, as a tool for
assessing, treating, and managing any type of patient health disorder, the rules, and responsibilities for
delivering services in this mode must be as robust as those required for delivering care in-person with
sufficient guardrails and enforcement mechanisms to protect the public.
R.338.13 of the newly proposed rule contains only three provisions. In two out of the three provisions,
only client/patient consent is referenced. This leaves many areas of this service delivery system open
for interpretation and application, it does not ensure patient protection. Following is a general list of
missing components for this telehealth regulation. It is not intended to be an exhaustive review of all
the provisions which should be addressed in the new rules. Rather it is demonstrative of the need for a
more rigorous set of regulations to protect patients in the state of Michigan.
1. Only those audiology services determined to be medically necessary, pursuant to a plan of care,
should be permitted.
2. Clarification is required regarding licensure, out-of-state provider requirements, knowledge, skills,
and training of providers.
3. Client selection-client eligibility varies. The regulations must address client characteristics such as
age, hearing ability, manual dexterity, access to technology, environment, etc.
4. Privacy/security measures – HIPPA, FERPA, HITECH, platform encryption- are required if client
information is compromised.
1 The AAO-HNS is the nation’s largest medical organization representing physician specialists who diagnose and
treat the ears, nose, throat and related structures of the head and neck.