Missouri 2025 Regular Session

Missouri Senate Bill SB108 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1
2	2	EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted
3	3	and is intended to be omitted in the law.
4	4	FIRST REGULAR SESSION
5	5	SENATE BILL NO. 108
6	6	103RD GENERAL ASSEMBLY
7	7	INTRODUCED BY SENATOR BROWN (16).
8	8	1277S.01I KRISTINA MARTIN, Secretary
9	9	AN ACT
10	10	To repeal sections 191.1146 and 334.108, RSMo, and to enact in lieu thereof two new sections
11	11	relating to telemedicine.
12	12
13	13	Be it enacted by the General Assembly of the State of Missouri, as follows:
14	14	Section A. Sections 191.1146 and 334.108, RSMo, are 1
15	15	repealed and two new sections enacted in lieu thereof, to be 2
16	16	known as sections 191.1146 and 334.108, to read as follows:3
17	17	191.1146. 1. Physicians licensed under chapter 334 1
18	18	who use telemedicine shall ensure that a properly 2
19	19	established physician -patient relationship exists with the 3
20	20	person who receives the telemedicine services. The 4
21	21	physician-patient relationship may be established by: 5
22	22	(1) An in-person encounter through a medical 6
23	23	[interview] evaluation and physical examination; 7
24	24	(2) Consultation with another physician, or that 8
25	25	physician's delegate, who has an established relationship 9
26	26	with the patient and an agreement with the physician to 10
27	27	participate in the patient's care; or 11
28	28	(3) A telemedicine encounter, if the standard of care 12
29	29	does not require an in -person encounter, and in accordance 13
30	30	with evidence-based standards of practice and telemedicin e 14
31	31	practice guidelines that address the clinical and 15
32	32	technological aspects of telemedicine. 16
33	33	2. In order to establish a physician -patient 17
34	34	relationship through telemedicine: 18 SB 108 2
35	35	(1) The technology utilized shall be sufficient to 19
36	36	establish an informed diagnosis as though the medical 20
37	37	[interview] evaluation and, if required to meet the standard 21
38	38	of care, the physical examination has been performed in 22
39	39	person; and 23
40	40	(2) Prior to providing treatment, including issuing 24
41	41	prescriptions or physician ce rtifications under Article XIV 25
42	42	of the Missouri Constitution, a physician who uses 26
43	43	telemedicine shall [interview] evaluate the patient, collect 27
44	44	or review the patient's relevant medical history, and 28
45	45	perform an examination sufficient for the diagnosis and 29
46	46	treatment of the patient. [A] Any questionnaire completed 30
47	47	by the patient, whether via the internet or telephone, shall 31
48	48	include such information sufficient to provide the 32
49	49	information as though the medical evaluation has been 33
50	50	performed in person, othe rwise such questionnaire does not 34
51	51	constitute an acceptable medical [interview] evaluation and 35
52	52	examination for the provision of treatment by telehealth. 36
53	53	334.108. 1. Prior to prescribing any drug, controlled 1
54	54	substance, or other treatm ent through telemedicine, as 2
55	55	defined in section 191.1145, or the internet, a physician 3
56	56	shall establish a valid physician -patient relationship as 4
57	57	described in section 191.1146. This relationship shall 5
58	58	include: 6
59	59	(1) Obtaining a reliable medical his tory and, if 7
60	60	required to meet the standard of care, performing a physical 8
61	61	examination of the patient, adequate to establish the 9
62	62	diagnosis for which the drug is being prescribed and to 10
63	63	identify underlying conditions or contraindications to the 11
64	64	treatment recommended or provided; 12 SB 108 3
65	65	(2) Having sufficient [dialogue] exchange with the 13
66	66	patient regarding treatment options and the risks and 14
67	67	benefits of treatment or treatments; 15
68	68	(3) If appropriate, following up with the patient to 16
69	69	assess the therapeutic outcome; 17
70	70	(4) Maintaining a contemporaneous medical record that 18
71	71	is readily available to the patient and, subject to the 19
72	72	patient's consent, to the patient's other health care 20
73	73	professionals; and 21
74	74	(5) Maintaining the electronic prescription 22
75	75	information as part of the patient's medical record. 23
76	76	2. The requirements of subsection 1 of this section 24
77	77	may be satisfied by the prescribing physician's designee 25
78	78	when treatment is provided in: 26
79	79	(1) A hospital as defined in section 197.020; 27
80	80	(2) A hospice program as defined in section 197.250; 28
81	81	(3) Home health services provided by a home health 29
82	82	agency as defined in section 197.400; 30
83	83	(4) Accordance with a collaborative practice agreement 31
84	84	as [defined] described in section 334.104; 32
85	85	(5) Conjunction with a physician assistant licensed 33
86	86	pursuant to section 334.738; 34
87	87	(6) Conjunction with an assistant physician licensed 35
88	88	under section 334.036; 36
89	89	(7) Consultation with another physician who has an 37
90	90	ongoing physician-patient relationship with the patient, and 38
91	91	who has agreed to supervise the patient's treatment, 39
92	92	including use of any prescribed medications; or 40
93	93	(8) On-call or cross-coverage situations. 41
94	94	3. No health care provider, as defined in section 42
95	95	376.1350, shall prescribe any drug, controlled substance, or 43
96	96	other treatment to a patient based solely on an evaluation 44 SB 108 4
97	97	over the telephone; except that, a physician or such 45
98	98	physician's on-call designee, or an advanced practice 46
99	99	registered nurse, a physician assistan t, or an assistant 47
100	100	physician in a collaborative practice arrangement with such 48
101	101	physician, may prescribe any drug, controlled substance, or 49
102	102	other treatment that is within his or her scope of practice 50
103	103	to a patient based solely on a telephone evaluation i f a 51
104	104	previously established and ongoing physician -patient 52
105	105	relationship exists between such physician and the patient 53
106	106	being treated. 54
107	107	4. No health care provider shall prescribe any drug, 55
108	108	controlled substance, or other treatment to a patient [based 56
109	109	solely on an internet request or an internet questionnaire ] 57
110	110	in the absence of a proper provider -patient relationship, as 58
111	111	described in section 191.1146 . 59
112	112	