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.  
Missing Criteria  
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.  
5. Due consideration must be given to technology, connectivity, settings-equipment, quality,  
maintenance, technical support, internet speed, synchronous vs. asynchronous, originating sites.  
6. Regulations should include requirements for facilitators, including the supervision of  
assistants/students.  
7. Physician oversight, identical to that which is currently in place for in-person services, should be  
maintained.  
8. Safety/emergency measures should be in place for remote clients.  
Conclusion  
The AAO-HNS and the Michigan Otolaryngology Society urge the Department of Licensing and  
Regulatory Affairs to carefully review the proposed rules regarding telehealth by audiologists. We urge  
the Department to consider adding additional requirements to clarify the proper application of this  
alternative service delivery model to better protect patients and the public.  
Thank you for the opportunity to provide comment regarding the proposed telehealth rules. If you have  
any questions or require further information, please do not hesitate to contact Janice Brannon, Senior  
Advisor, State Advocacy at jbrannon@entnet.org.  
Respectfully submitted,  
James C. Denneny, III, MD  
Executive Vice President/CEO  
American Academy of Otolaryngology- Head and Neck Surgery  
Tamer A. Ghanem, M.D. Ph.D.  
President  
Michigan Otolaryngologic Society  
;