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Missouri

Counselors

Source

“191.1145.  Definitions — telehealth services authorized, when. — 1.  As used in sections 191.1145 and 191.1146, the following terms shall mean:

  (1)  "Asynchronous store-and-forward transfer", the collection of a patient's relevant health information and the subsequent transmission of that information from an originating site to a health care provider at a distant site without the patient being present;

  (2)  "Clinical staff", any health care provider licensed in this state;

  (3)  "Distant site", a site at which a health care provider is located while providing health care services by means of telemedicine;

  (4)  "Health care provider", as that term is defined in section 376.1350;

  (5)  "Originating site", a site at which a patient is located at the time health care services are provided to him or her by means of telemedicine.  For the purposes of asynchronous store-and-forward transfer, originating site shall also mean the location at which the health care provider transfers information to the distant site;

  (6)  "Telehealth" or "telemedicine", 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.  Telehealth or telemedicine shall also include the use of asynchronous store-and-forward technology.

  2.  Any licensed health care provider shall be authorized to provide telehealth services if such services are within the scope of practice for which the health care provider is licensed and are provided with the same standard of care as services provided in person.  This section shall not be construed to prohibit a health carrier, as defined in section 376.1350, from reimbursing nonclinical staff for services otherwise allowed by law.

  3.  In order to treat patients in this state through the use of telemedicine or telehealth, health care providers shall be fully licensed to practice in this state and shall be subject to regulation by their respective professional boards.

  4.  Nothing in subsection 3 of this section shall apply to:

  (1)  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;

  (2)  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

  (3)  Episodic consultation by a health care provider licensed and located in another state who provides such consultation services on request to a physician in this state.

  5.  Nothing in this section shall be construed to alter the scope of practice of any health care provider or to authorize the delivery of health care services in a setting or in a manner not otherwise authorized by the laws of this state.

  6.  No originating site for services or activities provided under this section shall be required to maintain immediate availability of on-site clinical staff during the telehealth services, except as necessary to meet the standard of care for the treatment of the patient's medical condition if such condition is being treated by an eligible health care provider who is not at the originating site, has not previously seen the patient in person in a clinical setting, and is not providing coverage for a health care provider who has an established relationship with the patient.

  7.  Nothing in this section shall be construed to alter any collaborative practice requirement as provided in chapters 334 and 335.”

Social Workers

Source

“191.1145.  Definitions — telehealth services authorized, when. — 1.  As used in sections 191.1145 and 191.1146, the following terms shall mean:

  (1)  "Asynchronous store-and-forward transfer", the collection of a patient's relevant health information and the subsequent transmission of that information from an originating site to a health care provider at a distant site without the patient being present;

  (2)  "Clinical staff", any health care provider licensed in this state;

  (3)  "Distant site", a site at which a health care provider is located while providing health care services by means of telemedicine;

  (4)  "Health care provider", as that term is defined in section 376.1350;

  (5)  "Originating site", a site at which a patient is located at the time health care services are provided to him or her by means of telemedicine.  For the purposes of asynchronous store-and-forward transfer, originating site shall also mean the location at which the health care provider transfers information to the distant site;

  (6)  "Telehealth" or "telemedicine", 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.  Telehealth or telemedicine shall also include the use of asynchronous store-and-forward technology.

  2.  Any licensed health care provider shall be authorized to provide telehealth services if such services are within the scope of practice for which the health care provider is licensed and are provided with the same standard of care as services provided in person.  This section shall not be construed to prohibit a health carrier, as defined in section 376.1350, from reimbursing nonclinical staff for services otherwise allowed by law.

  3.  In order to treat patients in this state through the use of telemedicine or telehealth, health care providers shall be fully licensed to practice in this state and shall be subject to regulation by their respective professional boards.

  4.  Nothing in subsection 3 of this section shall apply to:

  (1)  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;

  (2)  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

  (3)  Episodic consultation by a health care provider licensed and located in another state who provides such consultation services on request to a physician in this state.

  5.  Nothing in this section shall be construed to alter the scope of practice of any health care provider or to authorize the delivery of health care services in a setting or in a manner not otherwise authorized by the laws of this state.

  6.  No originating site for services or activities provided under this section shall be required to maintain immediate availability of on-site clinical staff during the telehealth services, except as necessary to meet the standard of care for the treatment of the patient's medical condition if such condition is being treated by an eligible health care provider who is not at the originating site, has not previously seen the patient in person in a clinical setting, and is not providing coverage for a health care provider who has an established relationship with the patient.

  7.  Nothing in this section shall be construed to alter any collaborative practice requirement as provided in chapters 334 and 335.”

Marriage and Family Therapists

Source

“191.1145.  Definitions — telehealth services authorized, when. — 1.  As used in sections 191.1145 and 191.1146, the following terms shall mean:

  (1)  "Asynchronous store-and-forward transfer", the collection of a patient's relevant health information and the subsequent transmission of that information from an originating site to a health care provider at a distant site without the patient being present;

  (2)  "Clinical staff", any health care provider licensed in this state;

  (3)  "Distant site", a site at which a health care provider is located while providing health care services by means of telemedicine;

  (4)  "Health care provider", as that term is defined in section 376.1350;

  (5)  "Originating site", a site at which a patient is located at the time health care services are provided to him or her by means of telemedicine.  For the purposes of asynchronous store-and-forward transfer, originating site shall also mean the location at which the health care provider transfers information to the distant site;

  (6)  "Telehealth" or "telemedicine", 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.  Telehealth or telemedicine shall also include the use of asynchronous store-and-forward technology.

  2.  Any licensed health care provider shall be authorized to provide telehealth services if such services are within the scope of practice for which the health care provider is licensed and are provided with the same standard of care as services provided in person.  This section shall not be construed to prohibit a health carrier, as defined in section 376.1350, from reimbursing nonclinical staff for services otherwise allowed by law.

  3.  In order to treat patients in this state through the use of telemedicine or telehealth, health care providers shall be fully licensed to practice in this state and shall be subject to regulation by their respective professional boards.

  4.  Nothing in subsection 3 of this section shall apply to:

  (1)  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;

  (2)  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

  (3)  Episodic consultation by a health care provider licensed and located in another state who provides such consultation services on request to a physician in this state.

  5.  Nothing in this section shall be construed to alter the scope of practice of any health care provider or to authorize the delivery of health care services in a setting or in a manner not otherwise authorized by the laws of this state.

  6.  No originating site for services or activities provided under this section shall be required to maintain immediate availability of on-site clinical staff during the telehealth services, except as necessary to meet the standard of care for the treatment of the patient's medical condition if such condition is being treated by an eligible health care provider who is not at the originating site, has not previously seen the patient in person in a clinical setting, and is not providing coverage for a health care provider who has an established relationship with the patient.

  7.  Nothing in this section shall be construed to alter any collaborative practice requirement as provided in chapters 334 and 335.”

Psychologists

Source

Missouri is a PSYPACT PARTICIPATING STATE- MO HB 1719/MO SB 660 (Enacted 6/1/2018)

"To practice telepsychology under the authority of PSYPACT, you will need to apply for and obtain an E.Passport from the Association of State and Provincial Psychology Boards (ASPPB) and apply for and obtain an Authority to Practice Interjurisdictional Telepsychology (APIT) from the PSYPACT Commission."

Refer to the source provided for all requirements and limitations

Psychiatrists

Source

Title XII PUBLIC HEALTH AND WELFARE Chapter 191

191.1145.  Definitions — telehealth services authorized, when. — 1.  As used in sections 191.1145 and 191.1146, the following terms shall mean:

  “(1)  "Asynchronous store-and-forward transfer", the collection of a patient's relevant health information and the subsequent transmission of that information from an originating site to a health care provider at a distant site without the patient being present;

  (2)  "Clinical staff", any health care provider licensed in this state;

  (3)  "Distant site", a site at which a health care provider is located while providing health care services by means of telemedicine;

  (4)  "Health care provider", as that term is defined in section 376.1350;

  (5)  "Originating site", a site at which a patient is located at the time health care services are provided to him or her by means of telemedicine.  For the purposes of asynchronous store-and-forward transfer, the originating site shall also mean the location at which the health care provider transfers information to the distant site;

  (6)  "Telehealth" or "telemedicine", 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.  Telehealth or telemedicine shall also include the use of asynchronous store-and-forward technology.

  2.  Any licensed health care provider shall be authorized to provide telehealth services if such services are within the scope of practice for which the health care provider is licensed and are provided with the same standard of care as services provided in person.  This section shall not be construed to prohibit a health carrier, as defined in section 376.1350, from reimbursing nonclinical staff for services otherwise allowed by law.

  3.  In order to treat patients in this state through the use of telemedicine or telehealth, health care providers shall be fully licensed to practice in this state and shall be subject to regulation by their respective professional boards.

  4.  Nothing in subsection 3 of this section shall apply to:

  (1)  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;

  (2)  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

  (3)  Episodic consultation by a health care provider licensed and located in another state who provides such consultation services on request to a physician in this state.

  5.  Nothing in this section shall be construed to alter the scope of practice of any health care provider or to authorize the delivery of health care services in a setting or in a manner not otherwise authorized by the laws of this state.

  6.  No originating site for services or activities provided under this section shall be required to maintain immediate availability of on-site clinical staff during the telehealth services, except as necessary to meet the standard of care for the treatment of the patient's medical condition if such condition is being treated by an eligible health care provider who is not at the originating site, has not previously seen the patient in person in a clinical setting, and is not providing coverage for a health care provider who has an established relationship with the patient.

  7.  Nothing in this section shall be construed to alter any collaborative practice requirement as provided in chapters 334 and 335.”

Refer to the source provided for all requirements and limitations.

Missouri Professional Regulation/Health & Safety Online Prescribing

Source

“Prescribing or dispensing drugs without sufficient examination is prohibited including failing to establish a valid physician-patient relationship pursuant to section 334.108.”

Source

“A telemedicine encounter can establish a physician-patient relationship if the standard of care does not require an in-person encounter and in accordance with evidence-based standards of practice and telemedicine practice guidelines that address the clinical and technological aspects of telemedicine.”

“In order to establish a physician-patient relationship through telemedicine:

  • The technology utilized shall be sufficient to establish an informed diagnosis as though the medical interview and physical examination has been performed in-person; and
  • Prior to providing treatment, including issuing prescriptions, a physician who uses telemedicine shall interview the patient, collect or review relevant medical history, and perform an examination sufficient for the diagnosis and treatment of the patient.  A questionnaire completed by the patient, whether via the internet or telephone, does not constitute an acceptable medical interview and examination for the provision of treatment by telehealth.”

Source

“334.108.  Telemedicine or internet prescriptions and treatment, establishment of physician-patient relationship required. — 1.  Prior to prescribing any drug, controlled substance, or other treatment through telemedicine, as defined in section 191.1145, or the internet, a physician shall establish a valid physician-patient relationship as described in section 191.1146.  This relationship shall include:

  (1)  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 contraindications to the treatment recommended or provided;

  (2)  Having sufficient dialogue with the patient regarding treatment options and the risks and benefits of treatment or treatments;

  (3)  If appropriate, following up with the patient to assess the therapeutic outcome;

  (4)  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

  (5)  Maintaining the electronic prescription information as part of the patient's medical record.

  2.  The requirements of subsection 1 of this section may be satisfied by the prescribing physician's designee when treatment is provided in:

  (1)  A hospital as defined in section 197.020;

  (2)  A hospice program as defined in section 197.250;

  (3)  Home health services provided by a home health agency as defined in section 197.400;

  (4)  Accordance with a collaborative practice agreement as defined in section 334.104;

  (5)  Conjunction with a physician assistant licensed pursuant to section 334.738;

  (6)  Conjunction with an assistant physician licensed under section 334.036;

  (7)  Consultation with another physician who has an ongoing physician-patient relationship with the patient, and who has agreed to supervise the patient's treatment, including use of any prescribed medications; or

  (8)  On-call or cross-coverage situations.

  3.  No health care provider, as defined in section 376.1350, shall prescribe any drug, controlled substance, or other treatment to a patient based solely on an evaluation over the telephone; except that, a physician or such physician's on-call designee, or an advanced practice registered nurse, a physician assistant, or an assistant physician in a collaborative practice arrangement with such physician, may prescribe any drug, controlled substance, or other treatment that is within his or her scope of practice to a patient based solely on a telephone evaluation if a previously established and ongoing physician-patient relationship exists between such physician and the patient being treated.

  4.  No health care provider shall prescribe any drug, controlled substance, or other treatment to a patient based solely on an internet request or an internet questionnaire.”

Refer to the source provided for all requirements and limitations.

Nurses

“As a party state to the Nurse Licensure Compact (NLC), Missouri issues multistate licenses to nurses and applicants who reside in the state and recognizes multistate licenses issued by other party states, for practice in Missouri. A nurse holding a multistate license is entitled to practice in any NLC party state, but must comply at all times with the laws of the state where he or she is currently practicing.”

“It should be noted that not every state in the US is an NLC party state; a map of participating states, as well as further resources related to the NLC, are available on the Nurse Licensure Compact website.”

Refer to the source provided for all requirements and limitations.

Missouri Professional Regulation/Health & Safety Online Prescribing

Source

“Prescribing or dispensing drugs without sufficient examination is prohibited including failing to establish a valid physician-patient relationship pursuant to section 334.108.”

Source

“A telemedicine encounter can establish a physician-patient relationship if the standard of care does not require an in-person encounter and in accordance with evidence-based standards of practice and telemedicine practice guidelines that address the clinical and technological aspects of telemedicine.”

“In order to establish a physician-patient relationship through telemedicine:

  • The technology utilized shall be sufficient to establish an informed diagnosis as though the medical interview and physical examination has been performed in-person; and
  • Prior to providing treatment, including issuing prescriptions, a physician who uses telemedicine shall interview the patient, collect or review relevant medical history, and perform an examination sufficient for the diagnosis and treatment of the patient.  A questionnaire completed by the patient, whether via the internet or telephone, does not constitute an acceptable medical interview and examination for the provision of treatment by telehealth.”

Source

“334.108.  Telemedicine or internet prescriptions and treatment, establishment of physician-patient relationship required. — 1.  Prior to prescribing any drug, controlled substance, or other treatment through telemedicine, as defined in section 191.1145, or the internet, a physician shall establish a valid physician-patient relationship as described in section 191.1146.  This relationship shall include:

  (1)  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 contraindications to the treatment recommended or provided;

  (2)  Having sufficient dialogue with the patient regarding treatment options and the risks and benefits of treatment or treatments;

  (3)  If appropriate, following up with the patient to assess the therapeutic outcome;

  (4)  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

  (5)  Maintaining the electronic prescription information as part of the patient's medical record.

  2.  The requirements of subsection 1 of this section may be satisfied by the prescribing physician's designee when treatment is provided in:

  (1)  A hospital as defined in section 197.020;

  (2)  A hospice program as defined in section 197.250;

  (3)  Home health services provided by a home health agency as defined in section 197.400;

  (4)  Accordance with a collaborative practice agreement as defined in section 334.104;

  (5)  Conjunction with a physician assistant licensed pursuant to section 334.738;

  (6)  Conjunction with an assistant physician licensed under section 334.036;

  (7)  Consultation with another physician who has an ongoing physician-patient relationship with the patient, and who has agreed to supervise the patient's treatment, including use of any prescribed medications; or

  (8)  On-call or cross-coverage situations.

  3.  No health care provider, as defined in section 376.1350, shall prescribe any drug, controlled substance, or other treatment to a patient based solely on an evaluation over the telephone; except that, a physician or such physician's on-call designee, or an advanced practice registered nurse, a physician assistant, or an assistant physician in a collaborative practice arrangement with such physician, may prescribe any drug, controlled substance, or other treatment that is within his or her scope of practice to a patient based solely on a telephone evaluation if a previously established and ongoing physician-patient relationship exists between such physician and the patient being treated.

  4.  No health care provider shall prescribe any drug, controlled substance, or other treatment to a patient based solely on an internet request or an internet questionnaire.”

Refer to the source provided for all requirements and limitations.

Medicaid Telehealth Parity Law

Source: MO Revised Statute Sec. 191.1145(6)

(6) "Telehealth" or "telemedicine", 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. Telehealth or telemedicine shall also include the use of asynchronous store-and-forward technology.

Refer to the source provided for all requirements and limitations.

Originating Site Reimbursement: See above  

Private Pay Telehealth Parity Law

Source: MO Revised Statutes § 376.1900

"2. Each health carrier or health benefit plan that offers or issues health benefit plans which are delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2014, shall not deny coverage for a health care service on the basis that the health care service is provided through telehealth if the same service would be covered if provided through face-to-face diagnosis, consultation, or treatment.

3. A health carrier may not exclude an otherwise covered health care service from coverage solely because the service is provided through telehealth rather than face-to-face consultation or contact between a health care provider and a patient."

Refer to the source provided for all requirements and limitations.

Payment Parity

We are not aware of any explicit payment parity.

Permission for the Temporary Practice of Clinicians Licensed Outside the State

We are not aware of any permission that allows for services delivered by Counselors, Social Workers, or Marriage and Family Therapists.

For Psychologists: Missouri is a participating member of PSYPACThttps://www.asppb.net/mpage/legislative

Note: As this is a free resource and Rules and Regulations regarding Telehealth are always changing, we appreciate any updates or corrections. They can be emailed to us at This email address is being protected from spambots. You need JavaScript enabled to view it. with a link to the source or a citation of the rule or regulation.

THTC Program Button

Telemental health is not a separate service from mental health services. All state licensing boards require that licensed clinicians follow all the regulations for practicing under their license no matter what medium of communication is used. All licensing boards also require that clinicians only practice within the boundaries of their competence. This usually requires education, continuing education, and/or supervision in telemental health. Complete our telehealth training program to cover all the essential competencies of providing telemental health services and earn the THTC (Telemental Health Training Certificate).

1 comment

  • Comment Link Thomethia Thrist Monday, 23 March 2020 21:16 posted by Thomethia Thrist

    I would like to more information on the telemental health training.

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