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EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted
and is intended to be omitted in the law.
SECOND REGULAR SESSION
SENATE BILL NO. 1453
103RD GENERAL ASSEMBLY
INTRODUCED BY SENATOR BROWN (16).
6201S.01I KRISTINA MARTIN, Secretary
AN ACT
To repeal sections 191.1146 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 191.1146 and 334.108, RSMo, are 1
repealed and two new sections enacted in lieu thereof, to be 2
known as sections 191.1146 and 334.108, to read as follows:3
191.1146. 1. Physicians licensed under chapter 334 1
who use telemedicine shall ensure that a properly 2
established physician-patient relationship exists with the 3
person who receives the telemedicine services. The 4
physician-patient relationship may be established by: 5
(1) An in-person encounter through a medical 6
[interview] evaluation and physical examination; 7
(2) Consultation with another physician, or that 8
physician's delegate, who has an established relationship 9
with the patient and an agreement with the physician to 10
participate in the patient's care; or 11
(3) A telemedicine encounter, if the standard of care 12
does not require an in-person encounter, and in accordance 13
with evidence-based standards of practice and telemedicine 14
practice guidelines that address the clinical and 15
technological aspects of telemedicine. 16
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2. In order to establish a physician-patient 17
relationship through telemedicine: 18
(1) The technology utilized shall be sufficient to 19
establish an informed diagnosis as though the medical 20
[interview] evaluation and, if required to meet the standard 21
of care, the physical examination has been performed in 22
person; [and] 23
(2) Prior to providing treatment, including issuing 24
prescriptions or physician certifications under Article XIV 25
of the Missouri Constitution, a physician who uses 26
telemedicine shall [interview] evaluate the patient, collect 27
or review the patient's relevant medical history, and 28
perform an examination sufficient for the diagnosis and 29
treatment of the patient. [A] Any questionnaire completed 30
by the patient, whether via the internet or telephone, shall 31
be reviewed by the treating health care professional, as 32
defined in section 376.1350, and shall include such 33
information sufficient to provide the information as though 34
the medical evaluation has been performed in person, 35
otherwise such questionnaire does not constitute an 36
acceptable medical [interview] evaluation and examination 37
for the provision of treatment by telehealth; and 38
(3) Any provider that uses a questionnaire to 39
establish a physician-patient relationship through 40
telemedicine shall be employed or contracted with a business 41
entity that is licensed to provide health care in this state. 42
3. A health care provider, utilizing a medical 43
evaluation questionnaire completed by the patient by way of 44
the internet or telephone, shall provide a written report to 45
the patient's primary health care provider within fourteen 46
days of evaluation, if provided by the patient, that 47
contains: 48
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(1) The identity of the patient; 49
(2) The date of the evaluation; 50
(3) The diagnosis and treatment provided, if any; and 51
(4) Any further instructions provided to the patient. 52
334.108. 1. Prior to prescribing any drug, controlled 1
substance, or other treatment through telemedicine, as 2
defined in section 191.1145, or the internet, a physician 3
shall establish a valid physician-patient relationship as 4
described in section 191.1146. This relationship shall 5
include: 6
(1) Obtaining a reliable medical history and, if 7
required to meet the standard of care, performing a physical 8
examination of the patient, adequate to establish the 9
diagnosis for which the drug is being prescribed and to 10
identify underlying conditions or contraindications to the 11
treatment recommended or provided; 12
(2) Having a sufficient [dialogue] exchange with the 13
patient regarding treatment options and the risks and 14
benefits of treatment or treatments; 15
(3) If appropriate, following up with the patient to 16
assess the therapeutic outcome; 17
(4) Maintaining a contemporaneous medical record that 18
is readily available to the patient and, subject to the 19
patient's consent, to the patient's other health care 20
professionals; and 21
(5) Maintaining the electronic prescription 22
information as part of the patient's medical record. 23
2. The requirements of subsection 1 of this section 24
may be satisfied by the prescribing physician's designee 25
when treatment is provided in: 26
(1) A hospital as defined in section 197.020; 27
(2) A hospice program as defined in section 197.250; 28
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(3) Home health services provided by a home health 29
agency as defined in section 197.400; 30
(4) Accordance with a collaborative practice agreement 31
as [defined] described in section 334.104; 32
(5) Conjunction with a physician assistant licensed 33
pursuant to section 334.738; 34
(6) Conjunction with an assistant physician licensed 35
under section 334.036; 36
(7) Consultation with another physician who has an 37
ongoing physician-patient relationship with the patient, and 38
who has agreed to supervise the patient's treatment, 39
including use of any prescribed medications; or 40
(8) On-call or cross-coverage situations. 41
3. No health care provider, as defined in section 42
376.1350, shall prescribe any drug, controlled substance, or 43
other treatment to a patient based solely on an evaluation 44
[over the telephone] through telemedicine; except that, a 45
physician or such physician's on-call designee, or an 46
advanced practice registered nurse, a physician assistant, 47
or an assistant physician in a collaborative practice 48
arrangement with such physician, may prescribe any drug, 49
controlled substance, or other treatment that is within his 50
or her scope of practice to a patient based solely on a 51
[telephone] telemedicine evaluation if a previously 52
established and ongoing physician-patient relationship 53
exists between such physician and the patient being treated. 54
4. No health care provider shall prescribe any drug, 55
controlled substance, or other treatment to a patient [based 56
solely on an internet request or an internet questionnaire] 57
in the absence of a proper provider-patient relationship, as 58
described in section 191.1146. 59
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5. Medical records of any drug, controlled substance, 60
or other treatment prescribed through telemedicine, as 61
defined in section 191.1145, shall be collected, stored, and 62
maintained in accordance with the Health Insurance 63
Portability and Accountability Act of 1996, which allows for 64
the sharing of protected health information for continuity 65
of care between health care providers for treatment, 66
payment, and health care operations. 67
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