Missouri’s governor signed into law SB 579 (the “Act”), on June 8, 2016, establishing new telemedicine practice standards, including explicitly allowing a valid physician-patient relationship to be established via telemedicine. Here is a summary of the Act’s key provisions:
Telemedicine. “Telehealth” and “telemedicine” is defined as the delivery of health care services by means of information and communication technologies which facilitate the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care while such patient is at the originating site and the health care provider is at the distant site. Telemedicine also includes asynchronous store-and-forward technology.
Onsite Clinicians. There is no requirement for any patient-site telepresenter, unless necessary to meet the standard of care for the treatment of the patient’s medical condition.
Licensure. Providers must be licensed to practice in Missouri, unless they meet a licensure exception (e.g., consultation).
Consultations. The Act adds the following consultation exceptions:
An informal consultation performed by a health care provider licensed in another state, outside of the context of a contractual relationship, and on an irregular or infrequent basis without the expectation or exchange of direct or indirect compensation;
Furnishing of health care services by a health care provider licensed and located in another state in case of an emergency or disaster; provided that, no charge is made for the medical assistance; or
Episodic consultation by a health care provider licensed and located in another state who provides such consultation services on request to a physician in Missouri.
Physician-Patient Relationship and Standard of Care. A valid physician-patient relationship must be established with the person receiving the telemedicine services, and this can be done via telemedicine if the standard of care does not require an in-person encounter. The telemedicine technology must be sufficient to allow an informed diagnosis as though the medical interview and physical examination was performed in person. Prior to providing treatment or issuing prescriptions, the physician must interview the patient, collect and review relevant medical history, and perform an examination sufficient for the diagnosis and treatment of the patient. A questionnaire, whether via the internet or telephone, is not an acceptable medical interview and examination for the provision of treatment by telehealth. A physician-patient relationship established via telemedicine must include the following elements:
Obtaining a reliable medical history and performing a physical examination of the patient adequate to establish the diagnosis for which the drug is being prescribed and to identify underlying conditions or contradictions to the treatment recommended or provided;
Having sufficient dialogue with the patient regarding treatment options and the risks and benefits of treatment or treatments;
If appropriate, following up with the patient to assess the therapeutic outcome;
Maintaining a contemporaneous medical record that is readily available to the patient and, subject to the patient’s consent, to the patient’s other health care professionals, and
Maintaining the electronic prescription information as part of the patient’s medical record.
Remote Prescribing.Physicians may prescribe drugs via telemedicine, including controlled substances, only in connection with a valid physician-patient relationship and the requirements set forth above.
Telephone Evaluations and Internet Questionnaires. No health care provider may prescribe any drug, controlled substance, or other treatment to a patient based solely on a telephone evaluation unless a previously-established and ongoing physician-patient relationship exists between such physician and the patient. No health care provider may prescribe any drug, controlled substance, or other treatment based solely on an internet request or an internet questionnaire.
Disclosures and Informed Consent. The Act does not explicitly require disclosures or informed consent to the patient prior to providing telemedicine services.
Originally, this post was an alert sent to the American Health Lawyers Association’s (AHLA) Health and Information Technology Practice Group Members. It appears here with permission. For more information, visit AHLA’s website.
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