Modifies provisions relating to telemedicine

SECOND REGULAR SESSION
HOUSE BILL NO. 2702
103RD GENERAL ASSEMBL Y
INTRODUCED BY REPRESENT A TIVE KNIGHT .
5882H.01I JOSEPH ENGLER, Chief Clerk
AN ACT
T o repeal sections 191.1 146 and 334.108, RSMo, and to enact in lieu thereof two new
sections relating to telemedicine.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Sections 191.1 146 and 334.108, RSMo, are repealed and two new sections
2 enacted in lieu thereof, to be known as sections 191.1 146 and 334.108, to read as follows:
191.1 146. 1. Physicians licensed under chapter 334 who use telemedicine shall
2 ensure that a properly established physician-patient relationship exists with the person who
3 receives the telemedicine services. The physician-patient relationship may be established by:
4 (1) An in-person encounter through a medical [ interview ] evaluation and physical
5 examination;
6 (2) Consultation with another physician, or that physician's delegate, who has an
7 established relationship with the patient and an agreement with the physician to participate in
8 the patient's care; or
9 (3) A telemedicine encounter , if the standard of care does not require an in-person
10 encounter , and in accordance with evidence-based standards of practice and telemedicine
11 practice guidelines that address the clinical and technological aspects of telemedicine.
12 2. In order to establish a physician-patient relationship through telemedicine:
13 (1) The technology utilized shall be suf ficient to establish an informed diagnosis as
14 though the medical [ interview ] evaluation and , if req uired to meet the standard of car e,
15 the physical examination has been performed in person; [ and ]
16 (2) Prior to providing treatment, including issuing prescriptions or physician
17 certifications under Article XIV of the Missouri Constitution, a physician who uses
EXPLANA TION — Matter enclosed in bold-faced brackets [thus] in the above bill is not enacted and is
intended to be omitted from the law . Matter in bold-face type in the above bill is proposed language.
18 telemedicine shall [ interview ] evaluate the patient, collect or review the patient's relevant
19 medical history , and perform an examination suff icient for the diagnosis and treatment of the
20 patient. [ A ] Any questionnaire completed by the patient, whether via the internet or
21 telephone, shall be revie wed by the trea ting health care pro fessional, as defined in section
22 376.1350, and shall include such information sufficient to pr ovide the information as
23 though the medical evaluation has been performed in person, otherwise such
24 questionnair e does not constitute an acceptable medical [ interview ] evaluation and
25 examination for the provision of treatment by telehealth ; and
26 (3) Any pr ovider that uses a questionnaire to establish a physician-patient
27 r elationship thr ough telemedicine shall be employed or contracted with a business entity
28 that is licensed to pr ovide health care in this state.
29 3. A health care pr ovider that uses a medical evaluation questionnair e completed
30 by the patient by way of the internet or telephone shall prov ide a written r eport within
31 fourteen days of evaluation to the patient's primary health car e pr ovider , if provi ded by
32 the patient, that contains:
33 (1) The identity of the patient;
34 (2) The date of the evaluation;
35 (3) The diagnosis and trea tment pr ovided, if any; and
36 (4) Any further instructions pr ovided to the patient .
334.108. 1. Prior to prescribing any drug, controlled substance, or other treatment
2 through telemedicine, as defined in section 191.1 145, or the internet, a physician shall
3 establish a valid physician-patient relationship as described in section 191.1 146. This
4 relationship shall include:
5 (1) Obtaining a reliable medical history and , if requ ired to meet the standard of
6 car e, performing a physical examination of the patient, adequate to establish the diagnosis for
7 which the drug is being prescribed and to identify underlying conditions or contraindications
8 to the treatment recommended or provided;
9 (2) Having suff icient [ dialogue ] exchange with the patient regarding treatment
10 options and the risks and benefits of treatment or treatments;
11 (3) If appropriate, following up with the patient to assess the therapeutic outcome;
12 (4) Maintaining a contemporaneous medical record that is readily available to the
13 patient and, subject to the patient's consent, to the patient's other health care professionals;
14 and
15 (5) Maintaining the electronic prescription information as part of the patient's medical
16 record.
17 2. The requirements of subsection 1 of this section may be satisfied by the prescribing
18 physician's designee when treatment is provided in:
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19 (1) A hospital as defined in section 197.020;
20 (2) A hospice program as defined in section 197.250;
21 (3) Home health services provided by a home health agency as defined in section
22 197.400;
23 (4) Accordance with a collaborative practice agreement as [ defined ] described in
24 section 334.104;
25 (5) Conjunction with a physician assistant licensed pursuant to section 334.738;
26 (6) Conjunction with an assistant physician licensed under section 334.036;
27 (7) Consultation with another physician who has an ongoing physician-patient
28 relationship with the patient, and who has agreed to supervise the patient's treatment,
29 including use of any prescribed medications; or
30 (8) On-call or cross-coverage situations.
31 3. No health care provider , as defined in section 376.1350, shall prescribe any drug,
32 controlled substance, or other treatment to a patient based solely on an evaluation [ over the
33 telephone ] thr ough telemedicine ; except that, a physician or such physician's on-call
34 designee, or an advanced practice registered nurse, a physician assistant, or an assistant
35 physician in a collaborative practice arrangement with such physician, may prescribe any
36 drug, controlled substance, or other treatment that is within his or her scope of practice to a
37 patient based solely on a [ telephone ] telemedicine evaluation if a previously established and
38 ongoing physician-patient relationship exists between such physician and the patient being
39 treated.
40 4. No health care provider shall prescribe any drug, controlled substance, or other
41 treatment to a patient [ based solely on an internet request or an internet questionnaire ] in the
42 absence of a pr oper prov ider -patient relat ionship, as described in section 191.1 146.
43 5. Medical records of any drug, controll ed substance, or other tr eatment
44 pr escribed thr ough telemedicine, as defined in section 191.1 145, shall be collected,
45 stor ed, and maintained in accordance with the Health Insurance Portability and
46 Accountability Act of 1996, which allows for the sharing of pr otected health information
47 for continuity of care between health care pr oviders for tr eatment, payment, and health
48 car e operations .
✔
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