Telemedicine in Missouri: Law, Policies, Rules, and Regulations

The State of Missouri first enacted its telemedicine parity law in 2013. Since then, Missouri has worked towards improving the accessibility of remote healthcare in the state, which resulted in the 2016 statute that expanded telehealth access to schools and patient homes.

Although there is no explicit payment parity in Missouri law, health carriers are prohibited from excluding telemedicine or telehealth services from coverage solely because the services were not delivered in-person. 

Here’s a detailed overview of Missouri’s law, policies, rules, and regulations that pertain to delivering telemedicine and telehealth services to patients in the state. 

Telemedicine and Telehealth Definition in Missouri

Unlike most states, Missouri doesn’t make a clear distinction between the terms “telemedicine” and “telehealth.” 

Under Missouri telemedicine law — Senate Bill 579 — both are defined as the delivery of healthcare services through the use of information and communication technology, from a healthcare provider at an originating site to a patient at a distant site.

For such services to be considered telemedicine or telehealth, they must facilitate:

• Assessment, diagnosis, and treatment
• Consultation
• Education
• Care management and self-care management

It’s curious that Missouri law doesn’t separate the two terms, given that certain rules, regulations, and limitations apply exclusively to telemedicine, while others only pertain to telehealth. The practical difference between the two is that telemedicine involves examination, diagnosis, and treatment, while telehealth mainly refers to consultations.

SB 579 also explicitly states that asynchronous store-and-forward technology isn’t included in the definition of telemedicine and telehealth.

Other Key Definitions

Missouri telemedicine law provides other key definitions that specify additional legal guidelines for practicing telemedicine and telehealth in the state.

These definitions include:

1. Originating sites
2. Distant sites
3. Healthcare providers
4. Clinical staff
5. Asynchronous store-and-forward technology

Originating sites — The statute states that an originating site is any site at which the patient is located when receiving telemedicine services. Regarding store-and-forward technology, an originating site is the location of the healthcare provider who transfers medical information to a distant site.

The definition does explicitly state that the provider is delivering “telemedicine services”, but considering that Missouri law uses telemedicine and telehealth interchangeably, it’s safe to assume that the same definition applies to telehealth as well. 

The wording also implies that any location at which the patient receives remote medical care is considered an eligible originating site, including the patient’s home. 

Distant sites — A distant site is any site at which the healthcare provider is located while providing telemedicine services. 

Healthcare providers — Under Missouri law, healthcare providers are:

• Physicians
• Physicians-in-training
• Hospitals
• Long-term care facilities
• Health maintenance organizations
• Registered or licensed practical nurses
• Psychologists
• Dentists
• Optometrists
• Podiatrists
• Pharmacists
• Chiropractors
• Physical therapists
• Any other Missouri licensed or certified person or entity that provides healthcare services

The definition of healthcare providers is quite inclusive and practically enables all licensed or certified medical professionals in the State of Missouri to practice telemedicine and telehealth. 

Clinical staff — Any healthcare provider licensed to practice medicine in the state of Missouri. 

Asynchronous store-and-forward technology — SB 579 defines store-and-forward technology as the collection and transmission of patient’s medical information from a provider at an originating site to a different provider at a distant site, without the patient being present.

The reason why Missouri law defines store-and-forward as a separate term from telemedicine and telehealth is a specific reimbursement rule for leveraging this technology to facilitate providing remote healthcare services to the MO Healthnet program participants. 

MO Healthnet will only reimburse asynchronous store-and-forward technology for orthopedics, dermatology, ophthalmology, and optometry, provided that the technology is used to facilitate the delivery of: 

1. Diabetic retinopathy
2. Burn and wound care
3. Dental services that require a diagnosis
4. Maternal-fetal medicine ultrasounds

Eligible Providers

Senate Bill 579 states that any healthcare provider licensed or certified to practice medicine in the state of Missouri, acting within their scope of practice, can deliver healthcare services via telemedicine and telehealth. 

There are a few instances where telemedicine and telehealth services can be provided to patients in the State of Missouri by medical professionals licensed in another state. 

These exceptions include:

1. Informal consultations provided by a medical professional licensed in another state, where such services are provided outside of the context of a contractual relationship.
2. Informal consultations delivered infrequently or irregularly, where there is no expectation or exchange of compensation, whether directly or indirectly. 
3. Telemedicine or telehealth services provided by a medical professional licensed and located in another state, in case of an emergency or disaster, provided that no charge is made for the services.
4. Episodic consultations performed by a healthcare professional outside of the State of Missouri, provided that such services were requested by a physician in this state.

Missouri Telemedicine and Telehealth Practice Standards

Senate Bill 579 states that any medical professional practicing telemedicine or telehealth in the State of Missouri will be held to the same standards of practice that apply to in-person medical care. 

Establishing a Physician-Patient Relationship

Missouri law dictates that physicians who practice telemedicine must establish a valid physician-patient relationship prior to providing telemedicine services. 

This relationship may be established by:

1. An in-person encounter, through a medical interview and physical examination of the patient.
2. Consultation with a physician who has an established relationship with the patient, and agrees to allow the telemedicine practitioner to participate in the patient’s care. 
3. A telemedicine encounter, provided that the standard of care does not require an in-person encounter and that the technology use is sufficient to provide an examination, diagnosis, and treatment, and is compliant with telemedicine practice guidelines.

Senate Bill 579 further explains how a valid physician-patient relationship can be established through telemedicine: 

1. The technology used must enable the physician to establish an informed diagnosis, as though the medical examination was performed in-person. 
2. Prior to providing treatment, the physician must collect and review the patient’s relevant medical history and examine the patient in a manner that’s sufficient for diagnosis. 

The obvious question is, how can you ensure that the telemedicine solution you’re using is sufficient to perform examination, diagnosis, and treatment in accordance with the standards of care? 

The answer is simple — by choosing a solution that’s specifically designed for healthcare professionals. Curogram is a fully HIPAA compliant telemedicine solution that enables you to set up a virtual clinic and admit patients online in a secure environment through a live, two-way video platform. 

When a patient schedules an online appointment, Curogram will automatically send them an electronic patient intake form a few days prior to the telemedicine or telehealth encounter. This way, you’ll have all the necessary medical information before the appointment and will be able to determine whether the intended services align with the standards of care, given the patient’s medical condition.

If you deem that the patient’s condition requires a physical examination, you must advise them to seek in-person medical care. This is how Curogram can help ensure that you’re fully compliant with Missouri telemedicine and telehealth rules and regulations. 

Informed Patient Consent

Missouri law provides no reference regarding patient consent, apart from providing telehealth services to MO Healthnet program (Missouri Medicaid) participants, where informed patient consent is required. In addition to obtaining explicit patient consent, telehealth practitioners must also ensure the confidentiality of medical information.

Patient consent is also required for initiating asynchronous store-and-forward services. 

We would advise you to obtain patient consent and introduce them to potential confidentiality risk associated with providing medical care remotely, whenever you are providing any telemedicine or telehealth services. 

Online Prescriptions

No healthcare professional may prescribe any drug, controlled substance, or other treatment to a patient without a sufficient medical examination. Among other things, this includes performing a physical examination of the patient. 

In other words, providers cannot issue prescriptions based solely on a telemedicine encounter. 

In order to prescribe any medication to telemedicine patients, the doctor-patient relationship must include:

1. Obtaining the patient’s relevant medical history and performing a physical examination in order to form an adequate diagnosis for which the drug is being prescribed. The physician must also identify underlying conditions or contraindications to the recommended treatment
2. Having an extensive dialogue with the patient regarding possible treatment options and risks and benefits associated with the treatment
3. Following up with the patient, when necessary, to assess the therapeutic outcome
4. Maintaining a comprehensive medical record that can be issued to the patient or the patient’s primary healthcare provider, subject to the patient’s consent
5. Maintaining electronic prescription information as part of the patient’s medical record

Senate Bill 579 also states that no healthcare provider can prescribe any drugs, controlled substances, and other treatments as a result of phone consultation or based solely on an internet questionnaire. 

Insurance Coverage

Missouri law states that private payers should reimburse telemedicine and telehealth providers at the same rates as if the services were delivered in-person. Health carriers providing health benefit plans cannot deny coverage for telemedicine or telehealth based solely on the fact that services were delivered remotely. 

Private payer laws do not require health carriers to reimburse the providers for site origination fees or costs of provisioning telehealth services. The health carrier may limit the coverage of healthcare services provided through telehealth, if the same limitations would apply if the services were delivered in an in-person setting.

Location Restrictions

Missouri telemedicine and telehealth policy provides a list of locations considered eligible settings for telemedicine. 

Eligible settings for telemedicine include: 

• Physician’s or healthcare provider’s office 
• Hospitals
• Critical access hospitals 
• Rural health clinics 
• Federally qualified health centers 
• Long-term care facilities 
• Dialysis center s
• Missouri state habilitation centers or regional offices 
• Community mental health centers 
• Missouri state mental health facilities 
• Missouri state facilities 
• Missouri residential treatment facilities licensed by and under contract with the children’s division 
• A comprehensive substance treatment and rehabilitation (CSTAR) program 
• Schools
• The MO HealthNet recipient’s home 
• Clinical designated areas in a pharmacy 
• Child assessment centers

Cross-State Licensing

Out-of-state medical professionals can offer remote healthcare services under special conditions we listed in the “Eligible providers” section. Apart from these exceptions, providers cannot offer telemedicine or telehealth services to patients in Missouri unless they’re licensed or certified to practice medicine in the state.

Missouri did not join the Interstate Medical Licensure Compact, so patients can only seek remote healthcare services from medical professionals in the state.

MO Healthnet — Missouri’s Medicaid Program

MO Healthnet provides additional rules and regulations that apply to telehealth providers delivering remote medical care to the program’s participants. 

Note that MO Healthnet’s CSTAR Manual provides detailed guidelines for telehealth services, but doesn’t touch on telemedicine. Although the manual doesn’t explicitly say so, the wording does imply that examination, diagnosis, and treatment of MO Healthnet participants must be conducted in-person.

Missouri Medicaid will reimburse the providers for services delivered through live, two-way video communication, as well as remote patient monitoring (RPM).

MO Healthnet Policy

Healthcare services provided to Missouri’s Medicaid participants must meet the same standards as if they were delivered in-person. 

When delivering telehealth services in a school, the provider must first obtain an authorization from the child’s parent or guardian. The authorization does not need to be obtained for subsequent telehealth encounters and is valid for the duration of the current school year.

Eligible Providers

Missouri’s Medicaid doesn’t limit the practice of telehealth. Any Missouri licensed or certified medical professional can provide telehealth services to the program’s participants, provided they act within their scope of practice and that the services delivered are consistent with the standard of care applicable to in-person medical care.

To be reimbursed for telehealth services delivered to Medicaid patients, providers must be fully licensed in the State of Missouri and enrolled as MHD providers, prior to rendering the services. 

Eligible Sites

MO Healthnet does not impose any location restrictions regarding eligibility for telehealth encounters. Any site is considered eligible, so long as the provider can ensure that the telehealth services delivered to patients meet the standards of care otherwise applicable to an in-person setting.

Retention of Records

MO Healthnet providers must maintain medical records for five years (seven years for the Nursing Home, CSTAR, and Community Psychiatric Rehabilitation Programs) from the date of service. 

Providers must also make the records readily available for inspection and audit by the Missouri Department of Social Services, Missouri Medicaid Audit and Compliance Unit, or its representative upon request.

If you opt to deliver telehealth services through a video platform that isn’t specifically designed for healthcare professionals, you will have to manually enter the relevant medical information into your electronic health record.

Curogram integrates with over 700 EHRs, eliminating the redundant administrative tasks and allowing your medical staff to dedicate more time to treating patients. 

Remote Patient Monitoring

The Missouri Department of Social Services describes conditions under which MO Healthnet will reimburse providers for home telemonitoring services.

Eligible conditions for telemonitoring services include:

• Heart disease
• Congestive heart failure
• Diabetes
• Cancer
• Chronic obstructive pulmonary disease
• Pregnancy
• Hypertension
• Asthma
• Mental illness or serious emotional disturbance
• Myocardial infarction
• Stroke

Start Practicing Telemedicine in Missouri with Curogram

Curogram is a fully HIPAA compliant telemedicine solution that’s designed specifically for healthcare providers. What this means is that Curogram comes with all the built-in safeguards and capabilities that enable you to deliver remote healthcare services to patients in accordance with Missouri and federal laws. 

We’ve taken care of all the technical details, so you don’t have to spend valuable time and resources consulting a lawyer and hiring an IT professional to help you meet all the requirements. 

With Curogram, you can set up your virtual clinic and start admitting patients online in less than 48 hours! 

Compliance with the law and HIPAA rules isn’t the only thing you need to consider when choosing a telemedicine solution. Ease-of-use should also be one of the critical factors. 

Curogram is a perfect solution because it’s:

1. Easy for patients to use
2. Easy for medical staff to use
3. Easy for doctors to use

Easy for Patients to Use

Patients don’t want to (and shouldn’t) go through the trouble of downloading an app and creating an account to attend a telemedicine or telehealth meeting. They already have several pages of apps on their phone, and installing another app for one or two virtual doctor’s appointments a year is quite frustrating.

There’s also the fact that older generations aren’t as tech-savvy and might have trouble with installing the app, and that’s if their phones can support it. Troubleshooting the app installation prior to the appointment wastes both your doctors’ and patients’ time. 

With Curogram, patients simply receive a link in an SMS that they can click to join your virtual clinic. They’ll be redirected to the waiting room where your staff can prep them for the appointment before the doctor takes over. 

Easy for Medical Staff to Use

Curogram mimics the in-person workflows your medical personnel is used to. Patients submit their intake forms and join the waiting rooms where your staff can acquire additional medical information, if necessary, and prepare them for the virtual visit. 

The medical staff can also easily share PHI among themselves and with partners through Curogram, as well as send visit summaries and other medical information to patients in a 100% secure manner — all from a single, web-based dashboard.

Easy for Doctors to Use

Doctors using Curogram can see patients in the waiting room, along with the status MAs and nurses can assign them. Any available doctor can initiate a call with the patient when they are ready.

It’s vital to minimize the time doctors have to spend on onboarding patients. Curogram makes it easy for doctors to get in and out of video visits, and our waiting room management tools allow the staff to handle patient check-in and check-out with ease. 

This enables doctors to focus on the encounter, without having to worry about onboarding and IT issues, allowing them to admit more patients daily, ultimately increasing the revenue of your practice.

If you want to learn more about Curogram and test our telemedicine solution — register for your free demo today.

Telemedicine by State

Don’t see your state? We just haven’t written about it yet! Stay tuned on our blog or check out our article on telemedicine reimbursement by state.