September 18, 2020

Seema Verma, MPH Administrator Centers for Medicare & Medicaid Services U.S. Department of Health and Human Services 7500 Security Boulevard Baltimore, MD 21244-8016

RE: Enhanced Telehealth Coverage of Clinically Appropriate Hearing, Speech, Language, Swallowing, and Cognition Services

Dear Administrator Verma:

The undersigned audiologists and speech-language pathologists (SLPs) who treat Medicare beneficiaries, write to express our disappointment that the Centers for Medicare & Medicaid Services (CMS) has not recognized additional audiology and speech-language pathology services that may be safely provided via telehealth during the ongoing public health emergency (PHE). We join our national association, the American Speech-Language-Hearing Association (ASHA), urging you to immediately expand the additional audiology and speech-language pathology services included in the authorized telehealth services list for the duration of the PHE.1

Audiologists specialize in preventing, assessing, and treating hearing and balance disorders. SLPs identify, assess, and treat speech, language, swallowing, and cognitive impairments. Medicare beneficiaries must have continued access to our medically necessary diagnostic and therapeutic services to meet their functional goals. Providing these services via telehealth slows transmission of COVID-19 and ensures patients continue to receive the medically necessary treatment they need to meet their functional goals.

We appreciate that CMS has implemented flexibilities that meet the needs of some Medicare beneficiaries. However, the current list of approved telehealth procedure codes does not adequately ensure Medicare beneficiaries have access to the range of clinically appropriate audiology and speech-language pathology services they require. We urge CMS to expand the telehealth coverage list immediately.

Our national association notes that CMS has not expanded telehealth coverage to any additional procedure codes since April 2020. As the pandemic and PHE continue, CMS must continue to adapt policies to meet the ever-changing and growing needs of Medicare beneficiaries. We request that CMS add the following Current Procedural Terminology (CPT®) codes to the authorized telehealth services list for the duration of the PHE as soon as possible.

Recommended Audiology Telehealth Services • 92550 (tympanometry and reflex threshold measurements) • 92552 (pure tone audiometry, air only) • 92553 (pure tone audiometry, air and bone) • 92555 (speech audiometry threshold) • 92556 (speech audiometry threshold; with speech recognition) • 92557 (comprehensive audiometry) • 92563 (tone decay test)

Page 2

• 92565 (stenger test, pure tone) • 92567 (tympanometry) • 92568 (acoustic reflex testing; threshold) • 92570 (acoustic immittance testing, including tympanometry, acoustic reflex threshold and decay testing) • 92585 (auditory evoked potentials, comprehensive) • 92586 (auditory evoked potentials, limited) • 92587 (distortion product evoked otoacoustic emissions, limited, with interpretation and report) • 92625 (assessment of tinnitus) • 92626 (evaluation for pre-implant candidacy or post-implant status of auditory function; first hour) • 92627 (evaluation for pre-implant candidacy or post-implant status of auditory function; each additional 30 minutes)

The audiology CPT codes we recommend adding to the telehealth list represent core diagnostic tests for identifying the type, severity, and etiology of hearing loss or the need for further vestibular testing. Audiologists can conduct testing for any of the listed services using remote access software to connect with a computer-based audiometer or auditory brainstem response (ABR) testing system at the originating site. In addition, an audiologist can use a video otoscope connected to the same computer to examine the ear before testing to ensure cerumen will not impede testing. A trained facilitator at the originating site acts as an extension of the audiologist and performs very specific tasks at the audiologist’s direction, such as positioning the video- otoscope or placing headphones on the patient.

Although these services require the patient to leave the home to access audiologic testing equipment, telehealth provides a safe and effective means for the audiologist to conduct testing from a secondary location, such as a satellite office, without personal protective equipment (PPE) obscuring their face during the PHE. Visual cues, such as facial expressions and lip movement, are critical components of communication for patients with hearing loss. If the audiologist provides in-person testing with the necessary PPE, the quality and efficiency of testing may be significantly hampered by the need to write instructions or use a speech to text application to ensure the patient understands and complies with testing instructions.

Absent any means to receive core audiologic testing services via telehealth, Medicare beneficiaries with undiagnosed hearing or balance disorders face an even higher risk for isolation and depression. We urge CMS to allow Medicare beneficiaries access to practices that are already fully equipped and providing telehealth services to non-Medicare patient populations. Audiology telehealth services are well-established and diagnostic video-otoscopy, audiometry, otoacoustic emissions, and ABR conducted remotely yield equivalent results when compared to in-person testing.2 Medicare beneficiaries deserve the same level of access to the telehealth services available to patients enrolled in Medicaid and private health plans.

Recommended Speech-Language Pathology Telehealth Services • 92526 (treatment of swallowing dysfunction and/or oral function for feeding) • 92607 (evaluation for speech generating device; first hour) • 92608 (evaluation for speech generating device; each additional 30 minutes of evaluation time) • 92609 (therapeutic services using speech generating device, includes programming and modification) Page 3

• 92610 (evaluation of oral and pharyngeal swallowing function) • 92626 (evaluation for pre-implant candidacy or post-implant status of auditory function; first hour) • 92627 (evaluation for pre-implant candidacy or post-implant status of auditory function; each additional 30 min) • 96105 (assessment of aphasia, per hour) • 96125 (standardized cognitive performance testing, with time in interpretation and report, per hour) • 97129 (cognitive function intervention, initial 15 min) • 97130 (cognitive function intervention, each additional 15 min)

The speech-language pathology CPT codes we recommend adding to the telehealth list represent evaluation and treatment of a range of communication and swallowing disorders that SLPs already provide via telehealth to our non-Medicare patients.

These services do not require additional specialized equipment and we provide them safely with the patient at home, when clinically appropriate. In-person speech-language pathology services often require close contact with the patient and expanded telehealth coverage will enhance safety and reduce the risk of transmitting COVID-19 to patients, clinicians, and their families. For example, swallowing evaluation and treatment requires examination of the patient’s oral structure and function, and speech-generating device (SGD) services require the clinician to position the patient’s assistive equipment and reach over and around the patient to program and modify the device. Providing these services via telehealth with the assistance of a caregiver to position the patient and the video camera allows the clinician an equivalent level of access to examine the patient and perform clinical functions required during evaluation and treatment.

Medicare beneficiaries may not be identified for risk of aspiration because they are afraid to obtain in-person services during the pandemic. Without access to a clinical evaluation for swallowing, they may not receive further instrumental assessment when necessary and—most importantly—they may not receive the treatment they need to avoid aspiration and other complications. Clinically appropriate evaluation and treatment for swallowing disorders is critical; otherwise, patients cannot fully recognize or mitigate their risk of choking, aspiration, and death due to swallowing disorders.

Patients with neurodegenerative diseases, such as amyotrophic lateral sclerosis (ALS), may quickly lose their ability to communicate if they do not receive a speech-language pathology evaluation to determine their suitability for a speech-generating device (SGD). Local coverage determinations require an SGD evaluation by an SLP before delivery of the SGD.3 Without consistent access to therapy, patients with cognitive, communication, and swallowing disorders may see a decline in their functional ability to complete activities of daily living or communicate their physical or emotional needs leaving them susceptible to further medical complications and a reduced quality of life.

We want Medicare officials to know that, as clinicians and ASHA members, we take our obligation to provide high quality care for patients seriously. ASHA’s Code of Ethics requires that clinicians use their clinical judgment to determine the most appropriate services for their patients and deliver care via telehealth only if the services are equal in quality to those delivered in person.4 Delivering care that does not meet the standard of quality for in-person care represents an actionable violation of ASHA’s Code of Ethics. This standing policy helps ensure patient protection when receiving telehealth services from ASHA certified audiologists and SLPs. Page 4

A recent ASHA survey of audiologists and SLPs regarding telehealth services during the PHE showed that 38% of audiologists and 43% of SLPs who responded do not provide services to individual patients via telehealth because they determined such services were not clinically appropriate to meet their patient’s needs. This demonstrates that we maintain our commitment to upholding professional ethical standards and ensuring that only clinically appropriate patients receive audiology and speech-language pathology services at a quality equivalent to in-person care.

Thank you for taking the time to consider our perspective as clinicians who provide critical services to Medicare beneficiaries. We urge you to work with ASHA and other stakeholders— including consumer advocacy organizations representing the patients we serve—to expand Medicare’s coverage of telehealth services during the PHE to all clinically appropriate services. Adding the recommended codes will enhance our ability to meet the needs of our patients, return our clinical practices closer to normalcy, and further reduce the risk of transmitting COVID-19 as we move into the dangerous cold and flu season.

Thank you again for the work you have done to improve Medicare coverage during the PHE. We look forward to your continued efforts on behalf of Medicare enrolled providers and the beneficiaries we serve.

Sincerely,

Petition signatories

Rebecca Abner, KY Greggory Anderson, PA Harvey Abrams, PA Anna Anger, AZ Archana Acharya, NJ Amaris Anglero, MD Kristen Acuna, FL Teresa Anthony, FL June Adams, AL Marisol Aponte, TX Meagan Adams, MI Rocio G. Aramburu, AZ Corey Adams, OK Laura Armstrong, SD Sarah Adams, PA Karen Arndt, KY Dezra Adams, PA Meaghan Arnold, TX Michelle Adessa, OH Tasia Arnold, TX Lauren Adler, RI Tricia Ashby-Scabis, MD Raegan Agee, AR Teri Ashworth, NJ Christina Aguilar, NE Cory Atkinson, TX Diane Akins, MS Paul Austin, MA Suzanne Akui, HI Alli Bacher, HI Jan Alejado, NY Catherine Bacon, AZ David Alexander, MD Katherine Baczynski, NY Janine Alfirevic, IL Saskia Bagatais, NY Joanne Allagonez, HI Laurie Bailey, MA Joan Allen, IN Katlyn Baker, CT Molly Allen, MA Amy Baker, KS Hannah Allen, UT Angela Baker, KY Josefina Almanza-Ojeda, FL Danielle Baker, OR Cathy Alvarez, CA Brenda Baldeon, CA Holly Ambrozi, CO Elizabeth Baldt, NJ Anne Amsler, VA Andrea Ballard, NC Page 5

Meher Banajee, LA Laurie Botstein, GA Patricia Banas, WA Hannah Bowers, KY Dakshika Bandaranayake, KY Kathryn Boyd, FL Haley Bandy, IN Cynthia Boyd, SC Debra Banks, TX Maddie Boyles, KY Marcia Bannister, KS Kisa Bracey, TX Kristen Barber, AR Kaydra Brannan, TX Jolene Barbutes, OH Adrienne Bratcher, NM Taylor Barker, MS Minnie Bray, MO Stephanie barnard, CO Molly Brightbill, PA Donna Barnett, TN Michelle Britt-Thompson, MA Jenna Barrett, AZ Jaclyn Britton, HI Laura Barrett, VA Deanna Britton, WA Rachel Barrocas, OH Sonya Brooks, LA Patrick Bartholomew, NC Sherry Brooks, VA Terri Barton, KS Melissa Brothers, SC Darby Batchelor, KS Jean Brown, AZ Lisa Battani, KS Doreen Brown, MD Katherine Baumler, NC Emily Brown, OH Stephanie Bay, IL Ania Brown, OR Laura Bear, NY Tara Brown Ratzlaff, SD Cheryl Beaulieu, VT Kimberly Brownell, NY Diana Rose Becker, GA Ekaterina Bruno, CO Darci Becker, IA Cara Bryan, FL Sheri Becker, KS Karen Bryant, IA Stephanie Becker, KS Irene Bucher, IL Margot Beckerman, MI Kristen Buchignani, KY Anna Begley, WI Shawneen Buckley, CT Anna Bell, MS Melanie Buhr-Lawler, WI Haley Beran, NE Betty Bunce, KS karen berasi, CT Karen Bunce, NY Deborah Berndtson, VA Andrea Burcham, KS Kimberly Bernert, MO Alicia Burgos, MD Judith Bernier, WA Myna BURKS, MS Kari Besler, NC Tonee Burley, NJ Amy Beyer, FL Elizabeth Burns, NC Kara Bidstrup, CA Mary Burns, OR Anne Bielefeld-Schroeder, KY Karen Burrows, OH Jennifer Biener, NJ Wendy Burton, CA Julie Bingham, VA Mary-Jo Bush, MD Catherine Birchfield, KY Sarah Busser, FL Kennis Bishop, CA McKenzie Butcher, KS Patricia Blair, HI Christine Butler, CO Amy Bland, MD Stacy Bynum, VA Brenda Blum, CA Virginia Byrd, AL Katheryn Boada, CO Elizabeth Byrne, PA Beth Bolinger, IN Julia Cai, AZ Tracy Bond, AL Ambia Cail, OK Casey Bonsett, IN Taylor Callicutt, AL Hyrum Borrego, AZ Faviola Camarena, IL Victoria Bosley, WV Cheryl Campbell, CO Page 6

Cole Campbell, MO Ellen Cohn, NJ John Campbell, OK Kimberly Coker, TX Courtney Canaday, KS Nicole Colassi, MA Clifford Capria, AZ Bailey Cole, MN Susan , HI Donna Cole Wilson, WA Joshua Carpenter, KS Katherine Coleman, CA Olivia Carrillo, CA Noelle Coleman, OK Erin Carroll, AZ Heather Coles, NY Lynn Carswell, NC Abigael Collins, MA Alina Carter, MA Shannon Collins, NY Mary Casper, MD Mary Compton, NC Mary-Ellen Casper, TX Jordan Conn, KY Dinah Cassidy, CT Jessica Conrad, IN Ruth Castrigno, HI Christine Cook, DE Jenna Caton, NE Lois Cook, NY Kathleen Cazzato, AZ Melissa Cooke, SC Suzanne Cescon, NC Jeanne Copeland, KS Anna Challet, CA Karen Copeland, OK Kristina Chan, NY Sierra Corbin, OR Gina Chancellor, AL Kim Corbin-Lewis, UT Jane Chandler, MN Deb Corliss, MA Marissa Chappell, TN Becky Cornett, OH Tara Chay, AZ Jan Corwin, CA Tamy Chelst, MI Claire Costello, NY Sabina Cherenfant, FL Lauren Coster, OH Serena Chipara, IA Robert Cox, SC Laurie Chorev, MA Pilar Cox-Low, CA Nancy Christensen, OH James Coyle, PA Diana Christiana, TX Suzanne Coyle, VA Jeannine Christie, FL Tamara Cranfill, KY Kerry Church, SC Amanda Crawford, KY Kathleen Cienkowski, CT Laura Crawford, KY Elise Cimino, MA Warren Crescenzo, NJ Jon Clancy, CO Ryan Cronister, KS Victoria Clark, AZ Melanie Crouch, SC Raynell Clark, FL Sena Crutchley, NC Jamie M Clark, VA Elizabeth Cuadrado, CO Andrea Clauder, KS Brandt Culpepper, GA Kristin Cleary, ND Rachel Culross Nielsen, NE Lisa Cleary, SC Devin Cummings, TX Margaret Clerkin, CO Vanessa Curl, TX Tammy Cline, SD Lindsay Curtin, PA Pam Clink, OH Nikki D'Agostino, NJ Melanie Coate, KS Scott Dailey, IA Lara Cody, HI Avery Dakin, NY Stephanie Coe, CO Heena Damania, CT Ceri Coffield, KS Debora Daniels, KS Pamela Cogburn, TX Stephanie Daniels, TX Lorraine Cohen, CT Autumn Daquelente, PA Shelley Cohen, NY Wendy Darling, AZ Gila Cohen-Shaw, ME Marilyn Daugherty, AZ Page 7

Stephanie Davis, CA Tamela El Habachi, TX Deborah Davison, CA Mary Elder, KY Ernesto De Genova, NY Frances Eldis, MI Alexandria De Luna, TX Shelley Ellerston, IA Julie DeAngelis, CA Christopher Ellerston, IA Leigh Dearing, AZ Julia Ellerston, UT James DeBacker, OH Kim Elliott, OR Abigail Delehanty, PA Kellie C. Ellis, KY Yvette Deleo, TX Alyssa Elsasser, NE Stacie Delezene, NE Amanda Embree, KS Christie DeLuca, MA James Engracia, WA Amanda Demane, FL Michelle Eppley, IL Christine Demore, TN Amy Erickson, CO Melissa Denker, WY Linda Erickson, KS Paige Dennison, NE Shannon Erickson, TX Londa DeRouchey, SD Jocelyn Espinosa, AZ Mark Deruiter, PA Christine Eubanks, VA Angel Deruvo, NY Tommy Evans, KY Colleen Deshayes, NY Yarassette Fabela, TX Johnna Devin, IL Danai Fannin, NC Derick Deweber, OK William Farnham, FL Hilary Diefenbach, CO Megan Farrell, IA Sylvia Diehl, FL Maggie Farris, IN Kristin Dillon, KY Nicholas Fasanello, NC Susan DiMoia, PA Lauren Fay, NC Valerie Dionisio, CO Miriam Featherstone, GA Elizabeth DiRenzo, CA Alyssa Fenske, WI Steven Doettl, TN Carol Fenwick, CA Justine Dolan, CA Sarah Ferguson, UT Maggie Donaker, FL Stephanie Ferragine, WV Michele Donlon, MA Rachel Fetterhoff, MI Carrie Donohue, PA Katie Fey, WA Hannah Douglass, KY Christine Fiestas, TX Meghan Dowd, MD Naomi Finkelstein, CA Lauren Doyel, KY Katiana Fischer, NE Kevante Drew, GA Cathy Fisher, MT Tanya Duke, GA Marissa Fisher, TX Aubrey Dunlap, AZ Ginean Fitch, NV Kylie Dunne, CO Ann FitzGerald, WI Amanda Dunsmore, TN Emily Fitzpatrick, OH Alison Durkin, NY Karen Fleischer, MD Teresita Durkin, PA Carrie Fleming, VA Durrett, OK Taylor Foley, AZ Eric Dutson, UT Colleen Foley-Lunt, MA Jeffrey Edwards, LA Leigha Ford, NE Lisa Edwards, VA Sharon Frank, MA Katherine Egan, OR Denise Frankoff, NH Tori Ehlers, NE Carrie Fratecelli, KS Wendy Einhorn, CA Kristina Freeborn, OK Joselyn Eitemiller, WA Brianna Freed, CO Leisha Eiten, NE Cayleigh Freeling, TX Page 8

Nancy Freese, KS Sue Goldman, NJ Madison Friesel, NE Tessa Goldsmith, MA Hailey Frits, NC Amanda Gomez, GA Michelle Fritz, OH Roxanne Gonzales, CO Jill Froberg, AZ Jennifer Gonzalez, AZ Maria Frohlich, DE Ann Goodrich, AZ Melissa Fryer, OR Barbara Goodson, IL Kristina Fuentes, HI Sally Gorski, MN Candice Fuller, KS Claudia Grabowski, IL Jean Gagliotti, FL Meghan Grange, AZ Julie Gala, OH Rachel Granger, MA Gina Gallo, MA Jessica Grant, OR Miriam Galvan, NY Kristin Gravel, MN Lucia Gambino, NY Johanna Gray, MA Linda Ganz, NV Brittany Grayless, TN Evelyn Garcia, NC Connie Greeff, AZ Wanda Gard, KS Stephanie Green, CO Lori Garland, OH Ellen Greenblatt, MD Aubrey Garnett, FL Dawn Greer, AZ Andrea Garr, AZ Kasey Greff, AZ Casey Garvin, SC Dale Gregore, DE Dan Gaskell, MD Mark Gridley, KS Allison Gatewood, KS Margaret Griffin, OH Julie Gatts, KS Elizabeth Grillo, PA Christine Gerber, NY Justin Gripentrog, CO Terri Gerlach, NC Caroline Grogan, KY Samantha Ghali, KS Katherine Groon, CO Christina Gibson, NY Aileen Grullon Colon, FL SallyAnn Giess, CA AricA Guarino, IL Jessica Giglio, PA Sylvia Guerra, CA Amanda Gillespie, GA Tracie Guggenheim, OH William Gillispie, KS Janice Guice, GA Grace Gingrich, KY Josie Gustafson, FL Ruth Ginsburg, MA Valerie Guzzo, CA Maria Girardin, MA Mary Habegger, OH Gregg Givens, NC Chip Hahn, OH Brenda Gladfelter, KS Janet Hall, CA Lissette Glashan, TX Dena Hall, KS Mollie Glaspell, CA kari hall, KY Jessica Glasshoff, NE Patricia Hall, KY Ellen Gleimer-Hustead, CA Leslie Hall, KY Sarah Glenn, AZ Sarah Hall, MI Maryellen Glennon, AZ Kelly Hall, NC Sandra Glista, MI Olivia Hallock, NE Kimberlee Glowacki, CO Brooke Hallowell, MA Meghan Godoy, CA Jennifer Halter, OH Lisa Goerner, IN Kathleen Halverson, MD Allyson Goff, OH Bonnie Halvorson-Bourgeois, MA Irene Gofman, MA Ellen Hamby, TN Wendy Goldberg, FL Holly Hamilton, CA Donald Goldberg, OH Jeanie Hamilton, OH Page 9

Krista Hammer, NY Rebecca Hilger, FL Carmel Hammerbeck, KY Melanie Hilgers, KS Rachel Hand, IN Charlotte Hilker, IA Jaynee Handelsman, MI Jessie Hillock, IN Cian Hanrahan, MA Charlotte Himmelfarb, DC Diane Hansen, AZ Thomas Hinchey, CT Mary Hanson, WI Nickole Hines-Staples, TX Andrea Hanton, MI Sandy Hirsch, WA Mollie Harding, AZ Kimberly Hirte, UT Jayme Harkin, VA Dayna Hlinko, VA Ashley Harkrider, TN Toni Hobbs, AR Jamila Harley, MD Rebecca Hockhousen, RI Meredith Harold, KS Carol Hofbauer, OH David Harper, MN Jeffrey Hoffman, IA Maria Harrington, MD Lindsay Hohenberg, MA Lindsay Harris, UT Pam Holland, WV Robin Harrison, AZ Meghan Hollen Risse, FL Jennifer Harrison, GA Payton Hollister, MN Allanna Harrison, VA Kathleen Holterman, NJ Catherine Harston, KY Melanie Holzberg, NJ Ana Claudia Harten, MI Julie Honaker, OH Erin Harty, CA Marcia Hoodwin, FL Darla Hartzog, AL Dawn Hopkins, KY Rebecca Harvey, SD Alisha Horton, TX Pamela Hass, MO Helen Horwitz, OH Brooke Hatfield, MD Dan Houtz, UT Joanne Hathaway, AZ Holly Howard, GA Shirley Hauge, SD Melissa Hoy, PA Jennifer Hausladen, TN Tonya Hubbell, KS Laurie Alban Havens, MD Monica Hudnall, CA Marcia Hay-McCutcheon, AL melanie hudson, GA Susan Heath, IA Deanna Hughes, CA Lisa Heath, TX Allison Hughes, KS Angela Heaton, AZ Jacqueline Hughes, NJ Mackenzie Heck, OH Melissa Hulsing, KS Tricia Hedigner, TN Elizabeth Humphrey, TN Brian Hedman, OH Ella Hurrell, IN Lindsey Heidrick, MO Melissa Huse, MO Kimberly Heier, CA Laura Hussey, VA Augusta Helms Tillery, AZ Katherine Hutcheson, TX Sarah Henderson, WA Allison Hutchinson, IL Felicia Hennessey, IL Noreen Hyre, MD Amber Henry, AK Carolien Ibarra, AZ Bailie Hercold, AZ Sonia Ice, OK Gaby Heredia, TX Hina Imtiaz, FL Katherine Hermann, AZ Megan Ingalls, FL Andrea Hester, AL Kelly Ingram, AZ Carolyn Higdon, GA Renee Ingram, FL Rebekah Highfill, KS Michelle Inguanzo, TX Lisa Hilbert, OH Rebecca Inzana, MA Christy Hileman, IN Ashley Irick, TN Page 10

Rebecca Iwanczyk, TN Angie Keeton, UT Jeanne Iwashita, HI Daryl Kelehan, IA Loreliz Jacinto, CA Jennifer Kellams, CA Susan Jackson, MO Yolanda Keller-Bell, NC Eleanor Jackson, OH Kristina Kelley, TX Cheri Jackson, OK Ellen Kelsey, AK Linda Jacobs-Condit, NM Katherine Kenney, MI Melissa Jakubowitz, CA Leslie Kessler, MD Linda James, CT Lea Khoury, OH Sarah James, TX Taylor Kiesow, WI Kay James, TX Mikael Kimelman, PA Ashley Jang, AL Celia Kinder, IL Linda Jarmulowicz, TN Sally Kinealy, MO Kimberly Jay, WI Swathi Kiran, MA Marie Jette, CO Jennifer Kizner, CA Maggie Jetty, AZ Margaret Kjelgaard, KY Karen John, AZ Ilene Klegon, IL Kelly Johns, OH Amy Klepper, AZ Alecia Johnson, IN Barry Klor, IL Jamie JOhnson, KS Karen Kluin, MI Hannah Johnson, NE Molly Knigge, WI Melissa Johnson, NY Carol Knightly, PA Olga Johnson, TX Karen Kockler, IL Jeanene Johnson, TX Janet Koehnke, NJ Lori Johnson, WI Eveline Koenig, HI Elyse Johnson, WY Anna Kohlberg, MA Kathryn Johnston, KS Kathryn Kolbe, NC Scott Johnston, KY Lyda Kongswangwongsa, CA Jennifer Johnston, MA Laurie Korza, MA Susan Jones, ID Sayaka Koseki, MD Nicole Jones, TX Beth Kotsovolos, PA Sally Jones-McNamara, OH Phyllis Kovar, TX Lisa Jordan, CA Robert Kraemer, UT Maiya Jorge, NY Stacey Kraft, MA M.Simone Jorman, IL Mackenzie Kramer, AL Michaelle Justice, VA Michele Kramer, OH Erin Kahn, MD Robynne Kratchman, NJ Ellen Kandel, NJ Kara Kratzer, KY Ruchi Kapila, CA Lata Krishnan, IN Lindsay Kaplan, NY Catherine Krival, PA Amy Karas, MA Nancy Krovitz, MA Susan Kasunick, OH Heather Krug, WI Megan Kato, AK Lydia Kruse, IN Maria Katsaros, PA Crystal Kudirka, KY T. Katz, IL Kelly Kuehl, WA Meryl Kaufman, GA Nancy Kuhles, NV Farah Kaval, OH Jacque Kujath, AZ Diane Kavanaugh, NY Karen Kurcz, MI Kayla Kawamura, HI Barbara Kurman, NJ Shayla Keane, MA Diane Kurth, WY Erin Keefer, FL Lisa Kurtz-Myers, OH Page 11

Megan Kuussalo, KY Patricia LittleSoldier, NM HauKei Lam, TX Patricia Liu, CA Susan Lambrecht Smith, MA Jennifer Llado, MA Kady Lampley, IL Adam Lloyd, FL Janet Lamy, NY Susan Lloyd, NV Dee Lance, AR Andrea Lobb, UT Karen Lance, OH Janet Lober, KS Mario Landera, FL Domitille Lochet, FL Janet Lane, TX Shannon Locke, MO Kristen Lang, OH Shirley Locke, TX Jonelyn Langenstein, IL Gloria Loehle, MA Shelly Lanham, AZ Rosemary Loftin, AZ Jacqueline Lanier, MD Megan Logan, NJ Gwendolyn Lanoue, AZ Emma Logdahl, FL Haley Lanoue, WA Dana Longstreth, MT Deborah Lanza, CT Kimberly Lopatka, MD Elizabeth Lanza, IL Rose Mary Lopez, FL Alyssa Lanzi, DE brooke lordan, MA Jane Lapham, CA Renee Losey, NV Elissa Larkin Conlon, IL Joanna Lott, VA Amy Larocca, OH Nancy Lovering, AK Deirdre Larsen, LA Marian Lowther, FL Kristin Larson, KY Emily Lucero, MA Caroline Larson, WI Carol Lucero, WA Jessica Lathem, OK Sarah Luebke, IL Nancy Lawler, NY Jodi Lui, HI Ruth Lay, KS Erin Luke, OH Erica Lazarow, NY Rebecca Lulai, MN Malorie Leach, DC Donna Lundy, FL Claire Leake, OR Pamela Luyo, TX Hannah Leatherbury, NC Dawn Lwoery, OH Elizabeth Leatherman, KS Chrystal Lynn, TN Sydne Lee, CA Holly Lyons, KS Caitlyn Lee, VA Edwin Maas, PA Hannah Leeper, NE Ellen MacCracken, IL Traysa Leighton, CA Heather MacDougall, NC Amber Lemmon, FL Laurel Mackereth, VA Beatriz Leon, NJ Jennifer Mackey, MA Nichie Lessard, WA Leah Mackie, AZ Katie Lester, KY Yolanda Madar, AR Hoo Yee Leung, NY Jolene Madden, AZ Rachael Levy, MA Madison Maddox, NE Caroline Lewandowski, NY Ann Magdalen Sprinkle, NV Megan Licking, AZ Annette Mahan, AZ Renee Lightcap, WA Donna Maile, OH Audrey Liles, NC Carissa Maira, GA Sandy Lim Chun, CA Dorinda Malcolm, MD Jordan Lin, MA Madison Malone, KY Amy Linde, WI Andrea Malsom, MI Rachel Lingnau, NM Marissa Mancine, NJ Tracy Little, CO Leigh Mann, NJ Page 12

Angela Mansolillo, MA Laura McQuade, IL Megan Marble, NV Karen McQuaide, NJ Faye Maretic, CA Corey Meador, VA Lindsay Marino, MA Diane Meadows, NC Shavonne Mariscal, FL Charlotte Meek, TX Katherine Marks Hartigan, MA Joan Mele-McCarthy, MD Myranda Marotta, MA Lisa Melton-Sparks, MO Tracy Marr, OH Shelly Mendoza, OR Lori Marra, PA Shai Menina, GA Tiffany Marsh, FL Patricia Messer, TX Tara Marshall, KS Carol Meyer-Boldon, WI Sarah Marshall, WI Deirdre Michael, MN Leslie Martin, CA Kelsey Michaud, NH Christine Martin, IL Lydia Mike, NE Jennifer Martin, IL Mandy Mikula, TX Elizabeth Martin, MA Melissa Miller, FL Kiesha Martinez, CA Christie Miller, FL Laura Martinmaas, NV Kristina Millhouse, AZ Sandra Marusin, CO Milliner, IN Lynda Marvin, ME Hannah Milne, HI Matthew Masiello, NJ Nancy Minunni, NJ Mary Mason, PA Lynne Misuda, WA Micah Massingale, OR Jennifer Mitxhell, CA Alyssa Masuda, HI Makiko Miyatani, MI Ashley Mathews, NC Paige Mobley, OH Brittney Mathias, TX Valentina Mocchetti, NY Pamela Mathy, UT Rachael Mocerino, FL Patricia Mattox-Larson, NH Tiffany Mohr-Staley, FL Sue Maxfield, NY Jacqueline Mojica, NY Lynn Maxfield, UT Meghan Momphard, OR Amanda Maxwell, MO Barbara Moore, CA Beth Mayer, VA Mary Moore, IN Roberta Mayhue, FL Virginia Moore, KY Kathleen Mays, CO Mallory Moore, MO Gina Mazzucco, AZ Claire Moore, MO Danila McAsey, IL Kerry Moore, OK LisaRose McCabe, NJ Melanie Moore, Au.D., AZ Mary McCaffrey, MI Ashley Mora, TX Beth McCall, OH Calimar Morales-Sanchez, FL Amanda McCamey, TN Roberta Moralez, CA Kathy McCann, MA Amanda Morano-Villhauer, IA Christina McDougall, OK Erin Morgan, MO Joseph McEneaney, IL Mary Morgan, TX Shaunna McIntosh, CO Claudia Mornout, CA Krista McKenzie, NJ Aubrie D Morrell, HI Paige Mckinney, KY Kathryn Morrell, OR Tracey McLaughlin, NH Hope Morris, CA Wendi McMillan, NC Elizabeth Morrison, AZ Tena McNamara, IL Rick Morrison, NM Kathryn McNeal, OH Adrienne Mowry, UT Mindy McNeely, MO Kathleen Muhvic, OH Page 13 heather mullaney, HI Amy Olsen, NY Jonelle Mungcal, AZ Dalyn Opfer, KS Megan Murnan, NE Angie Orr, TN Charlotte Murrell, KY Christianne Osborn, OR Angela Mutziger, SD J.K. Oshiro, HI Brett Myers, UT Guadalupe Owen, WA Courtney Nakata, AZ Doreen Oyadomari, AL Lyndsey Nalu, FL Elizabeth Paganini, CA Hiba Naseem, CA Brittany Palmer, GA Linda Nash, NJ Panika Palmer, NY Jennifer Nasluchacz, OK Sarju Patel, IL Amir Nasser, MD Nundini Patel, WI Liza Naumann, RI Katie Patterson, KS Lisa Naylor, AZ Quinn Patton, NY Joanne Naylor, UT Patricia Pauley, OH Monique Neal, CA Bridgitt pauly, OH Kelly Neff, NM Meredith Pauly, PA Timothy Nejman, OH Michelle Payne, MO Teresa Nering, IN Julie Peacock, OR Adam Neuman, FL Kara Peavey-McDonough, KS Eric Neuman, VA Cathy Pelletier, MD Sara Neumann, OK Angela Pellittieri, OH Carmen Neuschotz, NY Kristen Pelzer, IL Staci Neustadt, AZ Maria Laura Pentucci, CA Tara Newsome, OH Sarah Perrie, GA Emily Nguyen, MA Amy Pestreich, NY Alice Nicholls, CA Linda Peterman, CA Sara Nichols, AZ Hannah Petersen, AR Sharon Nichols, HI Kathleen Peterson, AZ HoIIy NiIes, CO Brian Peterson, IA Dee Adams Nikjeh, FL ReShicka Peterson, OK Asha Ninan, NY Joy Peterson, PA Margaret Ninneman, CA Sally Peterson-Falzone, AZ David Nissen, KS Bridget Petitti, OH Meghan Noggle, VA Brian Petty, GA Cathy Noh, CA Erica Petty, OH Gwen Nolan, TX Melissa Philippsen, IN Nicole Nomura, HI Susan Philips, NY Laurie Norman, HI Brigid Piccolotti, OR Ashley Northam, OR Francine Pickus, NY cindy NORTON, IL Christina Pieper, AZ Yitty Novice, MD Jordyn Pierce, MA Isabel Nunez, NV Cassandra Pietrus, NJ Amy O'Bryan, KY Claire Pilewski, OH Erica O'Neil, NY Rebecca Piper, NJ Briana O'Neill, MA Kirby Pittman, KY Margaret O'Reagan-Salva, KS Rachel Pittmann, MA Alexis Oatman, KS Nora Pittmann, MA Beth OBrien, CO Donna Pitts, MD Jeridy Oetken, KS Taylor Pitz, CA Geraldine OLeary, HI Liz Platt, IL Page 14

Makenna Pluta, NE April Rice, KY Carol Polovoy, MD Anne Rice, TN Stephanie Popadic, HI Blair Richlin, NY Karmen Porter, KS Stephanie Ridge, NJ Julee Portner, HI Ellen Rielly, NY Beth Poss, MD Kathleen Riley, DE Kathleen Post, IL Caroline Riley, ID Jill Potratz, OR Barbara Riordan, KY Colleen Pouquette, AZ Christina Riseman, CO Ciera Powell, KY Erica Risi, PA Rachel Powell, MS Morgan Rittenberger, OH Julie Pratt, MI Mitzi Ritzman, NE Brenna Price, NM Donna Rivera, NM Brenda Price, OK Ana Rivera, TX Kimberly Pritikin, GA Gail Rivkin, NY Kathleen Prucha, NY Anna Robb, MO Joy Pruitt, HI Lindsey Roberg, NE Anne Prusak, CT Dixie Roberts, AZ Jamie Pulliza, IN Diane Roberts, CO Mary Pyfrom, FL Matthew Roberts, TX Heather Quillin, KS Sheri Robertson, AZ Bryn Quinlan, OR Theresa Robinson, GA Monica Quinn, PA Catherine Robinson, PA Megan Radder, MO Elizabeth Robinson, TN Nola Radford, TN Libby Rochlen, NY Katie Ragan, TN Leigh Anne Roden-Carrier, KY bethany Rajaratnam, PA Theresa Rodgers, LA alexandria rakowski, OH Meredith Rodriguez, FL Manish Rami, ND LaDonna Rodriquez, AZ Nancy Ramirez, TX Eugenia Rogers, NY Ishara Ramkissoon, VA Morgan Rogers, TN Mindi Ramsey, NC Alison Rogers, TN Laura Randen, MO Rebekah Rogers, TX Tara Randolph, MD Lizzette Roman, PR Christina Rappazzo, TX Wilmarie Roman, TX Kyle Ratliff, KY Massi Romanelli, UT Rachelle Rauma, CA Alyssa Rome, CA Carol Raymond, GA Christina Ronchi, MA Cheryl Razum, OH Laura Ronowski, WI Julia Read, MA Allison Root, MA Carina Ream, ME Kathleen Rose-Le, FL Lorna Reardon, OH Marci Rosenberg, MI Kristen Reber, KS Juli Rosenzweig, WA Jan Reed, IL Amy Rosneck, OH Jolene Reed, KS Mickey Rosner, GA Angela Rey, AZ Michelle Ross, CA Stella Reyes, CA Frances Ross, HI Cynthia Reyes-Pabon, PA Shawna Ross, NV Dani Reyes-Torres, HI Gina Rotondo, CA Kristen Reynolds, KY Rose Rotter, CO Maura Rhodes, AZ Julie Rowlett, MD Page 15

Renee Royles, CA Susan Schwartz, FL Audrey Rozell, PA Sandra Schwartz, PA Jennifer Rubenstein, VA Schweizer, NJ Jessica Rubinstein, CT Patricia Schwinn, OH Gerrie Rudoler, NJ Monica Scott, AR Valerie Ruff, OH Stephanie Scott, AZ Emily Runnoe, IL Diane Scott, NC Allison Rusiewicz, PA Maggie Scott, TX Joy Russell, CT Phillip Sechtem, UT Sarah Russell, MI Gabriele Seffert, ID Sarah Ruth, IA Alan Seitel, TX Kelly Rutherford, WV Enid Serrano Flaisher, MI Sandy Ryan, AZ Cali Shafer, PA Brenna Ryan, CA Barbara Shapiro, CO Jennifer Ryder, MD Laurie Sheehy, OH Stephen Sacks, CA Sunni Shepherd, KY Angela Sageser, KY Roy Shinn, PA Lauren Salyer, OH Starshine Shirley, CA Lauren Salzinger, NY Karen Shirley, NM Robin Samlan, AZ Carly Shoulders, KY Frank Sampey, AZ Judy Shragg, MN Monica Sampson, MD Pallavi Shukla, MA Autumn Sanderson, TN Polina Shuminsky, NY Sharon Sandridge, OH Louis Sieminski, PA Jenelle Sandy, IL Bette Siler, NY Jennifer Santer, MI Michele Simler, IL Anne Santoro, AZ Amanda Simmons, NC Santos, RI Amanda Simmons, TN Karen Sartin, TN Abbe simon, NC Erin Sarver, KY Jessica Simon, NH Katherine Saul, CA Cynthia Simonetti, NM Christina Saunier, KY Helena Sinai, MA Meghan Savage, TX Bonnie Singer, MA Krysta Sbriscia, MA Amie Sinor, MA Valerie Scarano, VA Nithya Siva, WA Renee Schaefer, WA Jonathan Sizemore, KY Leigh Schaid, OR Glenda Sizemore, KY Tina Scharn, TX Nicole Skeens, KY Candice Scharver, NC Paige Skinner, IA Tori Schaub, KY Delaney Skretta, NE Nancy Scherer, AZ Erin Skupien, IN Heather Schieda, OH Debbie Sloan, AZ Tracy Schloemer, MN Susan Smith, AZ Sarah Schneider, CA Amy Smith, ME Ashley Schneider, NY Nancy Smith, MO Sarah Schotte, KS Ashley Smith, MS Jennifer Schottler, VA Laura Smith, NY Jen Schulman, NY Danielle Smith, OH Lucy Schulson, MA Karah Smith, OR Lynette Schultz, FL Patricia Smoczyk, WI Jennifer Schultz, SD Jan Snavely, CA Page 16

Ginger Snawerdt, KS Lynn Summers, KY Melinda Snelgrove, SC Karen Sussman, NY Haley Snyder, PA Megan Swank, NV Lauren Solis, CA Meghan Swanson, AZ Anne Sommer, IN Courtney Swanson, OH Lisa Sommers, MA Crystal Swenson, MN Melanie Somogie, MO Myra Sydnor, MD Joseph Sonnenberg, NY Rebecca Syner, OH Julie Sosebee, TN Kathryne Syombathy, CT kimberly sottile, KY Annalise Tadych, WI Emily Souter, KS Susan Taecker, SD Amanda Spaeth, MD Sarah Talach, CA Tia Spagnuolo, PA Johnna Tanji, CA Sam Sparkman, KY Kristine Tanner, UT Teresa Spencer, KS Susan Tanney, IN Anne Spitler-Kashuba, CA Tammy Taylor, MA Kimberly Spivey, OK Josh Teitcher, IL Casey Spragg, AZ Cari Tellis, PA mary spremulli, FL Ann Temple, HI Katie Springer, NE Susie Ternes, KS Lindsey Sprinkle, AK Andrea Tharpe, OK Sarah Sraj, OH Jessica Thoene, NE Caterina Staltari, PA Alex Thomas, KY Christine stang, DE Molly Thompson, AK Bethany Stanleu, OR Lisa Thompson, AZ Lenae Stansky, KY Brittany Thompson, MA Heather Starmer, CA Heather Diane Thompson, TN Denise Stats-Caldwell, AZ Marisol Thornberry, FL Abigail Stecker, TN Tricia Tillinghast, NY Dawn Steele, IL Margaret Tiner, MI Timothy Steele, KS Ashlynn Tittle, AL Stephanie Steele, VA Megan Tobin, NY Roberta Steinhorn, MA Andrea Tobochnik, IN Jeff Stepen, IL Megan Tomlin, AZ Stephanie Stephens, VA Kristin Torres, FL Lesley Stephens, WA ELizabeth Torres, NM Lisa Stephens, WA Katherine Tranor, OH Maya Stevens, UT Lori Travis, KY Cheryl Stewart, IN Kelly Trejo, CA Colleen Stewart, KS Ruby Trejo, TX Erin Stewart, OH Carolynn Trepasso, CA Katia Stie, CA Jacqueline Trevino, TX Ruth Stonestreet, GA Jervaun Trier, CO Lauren Stout, WA Elizabeth Trueba, AZ Lara Strotheide, GA Daniella Trujillo, FL bonnie sugarman, NJ Linda Tucker-Simpson, NJ Maan Sukte, PA Monica Tullius, TX Carah Sullenbarger, IN Jill Tullman, CO Tara Sullivan, TX Gretchen Tulloch, NC Amy Sumbrum, NY Erica Twitchell, NJ Yumi Sumida, WA Elizabeth Uchtman, OH Page 17

Jennifer Ujcich, OH Karen Watson, KS Michelle Underhill, CO Curtis Watson, PA Christy Underwood, CA Kelly Watts, CA Mary Underwood, NE James Weakley, KY Kathleen Usher, FL Theresa Weaser, AZ Therese Uthke, AZ Candice Weatherford, TX Neha V, IL Amy Weatherly, FL Nahida V. Unwalla, NY Erin Weathers, PA Mayra Valdez, AZ Barbara Weber, PA Elizabeth Valdez, IL Carolyn Weber, PA Kelly VanDahm, AZ Allison wegman, TN Tatum Vankooten, NE Kelsi Wegner Sullivan, TX Wendy Vastine, CA Margaret Wehner, OH Mariah Vazquez, NE Kristen Weidner, KY Carmen Vega-Barachowitz, MA Madison Weinberger, NE Anne Ver Hoef, AK Juliet Weinhold, AZ Laura Verdun, VA Timothy Weise, MI Christine Verre, NV Francine Wenhardt, CA Malinda Via, OH Marissa West, KS Lisa Vickers, AZ Dana Wetmore, HI Candace Vickers, CA Christopher Whipple, NY Shelley Victor, FL Mary Whitaker, ID Brandon Viet, IA Gemma White, NY Elizabeth Vincent, KY Cortney White, WA Johanna Vine, OH Amanda Wiblemo, WY Jennifer Visker, OH Dayna Widoff, AZ Amy Vissing, IN Beatrix Wiedmer, WA Amy Vittori, MD Dana Wierzbicki, TX Donald Vogel, NY Stephanie Williams, AZ Blair Voigt, IA Kirstein Williams, GA Ramani Voleti, NY Kelly Williams, GA Rachel Vovos, OH Kristy Williams, UT Tara W., PA Nicolle Wilson, CA Kyle Wade, CA Caleb Wilson, CO Kirsten Wagner, OH Fae Wilson, MN Patrick Walden, NY Mary Anne Wilson, NY Wanda Waldman, KS Mary Wilson, PA Jenna Walker, KY Jennifer Wilson, TN Stephanie Walker, NY Keri Winchester, AZ Megan Walker, UT Allison Winters, KS Maria Wallace, CO Dorothea Wise, OH Sarah Wallace, PA Joanne Wisely, PA Colleen Walsh, PA Annemarie Wollet, OH Diane Walsh, TX Sheila Wood, KS Kayla Walters, KY Audrey Wood, MO Alisa Wang, AZ Haley Woods, AZ Hannah Ward, UT Michaela Woods, IA Marilyn Wark, TN Kaitlynn Wooten, OH Jenna Warner, AZ Linda Wright, MI Fatima Warren, KY Charisse Wright, TX Kari Watson, AZ Marcin Wroblewski, OR Page 18

Kelly Wulff, OR Elizabeth Zachman, KY Yun Chao Xu, CA Ashley Zapata, CT Julie Yatogo, HI Regina Zappi, MD Hazley Yeager, PA Courtney Zilka, MA Kelly Yeager, TN Catherine Zimmerman, TX Tomoko Yokooji, HI Syd Kapuamealani Zoll, HI Jenny York, OK Larry Zook, PA Amber Youngman, IL Lisa Zughni, WA

1 American Speech-Language-Hearing Associations. (n.d.). About the American Speech-Language-Hearing Association (ASHA). https://www.asha.org/about/. 2 Swanepoel, D. W., & Hall, J. W. (2010). A systematic review of telehealth applications in audiology. Telemedicine and e-Health, 16(2), 181-200. http://dx.doi.org/10.1089/tmj.2009.0111. 3 American Speech-Language-Hearing Association. (n.d.). Medicare Coverage Policy on Speech-Generating Devices. https://www.asha.org/practice/reimbursement/medicare/sgd_policy/. 4 American Speech-Language-Hearing Association. (2016). Code of Ethics. https://www.asha.org/Code-of-Ethics/.