Telehealth has rapidly evolved from an alternative option into a foundational pillar of modern healthcare delivery. As technology advances and patient adoption grows, state regulators continue to refine legal standards to ensure patient safety, data privacy, and clinical efficacy.
Missouri House Bill No. 2372 (HB 2372) amends a range of healthcare statutes, including the requirements for forming the physician-patient relationship as well as prescribing provisions. These amendments took effect on August 28, 2026. Below is a breakdown of the telehealth-related amendments enacted under HB 2372.
Establishing the Provider-Patient Relationship via Telehealth
Under the prior framework, a valid physician-patient relationship could be established through an in-person “interview” and examination, consultation with another physician who has an existing relationship with the patient, or a compliant telemedicine encounter. HB 2372 refines and formalizes these requirements:
- Evaluation and Questionnaire Standards: Before providing treatment, issuing prescriptions, or granting physician certifications under Article XIV of the Missouri Constitution, a healthcare provider with prescriptive authority using telehealth must evaluate the patient, collect or review the patient’s relevant medical history, and perform an examination sufficient for diagnosis and treatment.
- Limits on Asynchronous/Standalone Questionnaires: A questionnaire a patient completes online or by telephone must be reviewed by the treating healthcare professional and must include information sufficient to substitute for an in-person medical evaluation and examination. If it does not, the questionnaire alone does not satisfy the evaluation-and-examination requirement for providing treatment by telehealth.
- Corporate Entity Licensing Requirement: Any provider who uses a questionnaire to establish a provider-patient relationship through telehealth must be employed by, or contracted with, a “business entity that is licensed to provide health-care” in Missouri. HB 2372 does not elaborate on what licensure is required.
Mandatory Reporting to Primary Care Providers (§ 191.1146.3)
To support care coordination, HB 2372 retains and clarifies a reporting mandate that applies whenever a medical evaluation questionnaire is used:
- 14-Day Written Report Requirement: A healthcare provider who relies on a medical evaluation questionnaire completed online or by telephone must furnish a written report to the patient’s primary health care provider within 14 days of the evaluation, but only if the patient has supplied that primary provider’s information.
- Required Report Contents: The report must identify (1) the patient, (2) the date of the evaluation, (3) the diagnosis and treatment provided, if any, and (4) any further instructions given to the patient.
Prescribing and Treatment Standards via Telehealth
HB 2372 also amends the prescribing rules:
- Prerequisites to Prescribing: Before prescribing any drug, controlled substance, or other treatment through telemedicine (as defined at § 191.1145) or the internet, a physician must establish a valid relationship under § 191.1146. This carryover requirement includes: obtaining a reliable medical history and, where the standard of care requires it, a physical examination; having a sufficient exchange with the patient about treatment options and the risks and benefits of treatment; following up with the patient when appropriate; maintaining a contemporaneous medical record reasonably available to the patient and, with the patient’s consent, to other treating providers; and maintaining the electronic prescription information as part of that record.
- “Telephone” Standard Broadened to “Telemedicine”: Prior law barred prescribing based solely on an evaluation over the telephone, subject to an exception for a physician (or the physician’s on-call designee, or an advanced practice registered nurse, physician assistant, or assistant physician with a collaborative practice arrangement with that physician) who has a previously established, ongoing physician-patient relationship with the patient. HB 2372 replaces “telephone” with “telemedicine” in both the general prohibition and the exception. Both the prohibition and the exception now expressly reach the full range of telemedicine modalities, not telephone contact alone.
- No Prescribing Without an Established Relationship: The statute removes the prior reference to “internet requests or internet questionnaires” as the basis for the prohibition and replaces it with a broader rule: no health care provider may prescribe any drug, controlled substance, or other treatment to a patient in the absence of a proper provider-patient relationship, as described in § 191.1146.
Telemedicine Recordkeeping and HIPAA Compliance (§ 334.108.5)
HB 2372 also addresses medical record management and privacy standards for telemedicine-based prescribing:
- HIPAA Alignment: Medical records of any drug, controlled substance, or other treatment prescribed through telemedicine (as defined at § 191.1145) must be collected, stored, and maintained in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
- Continuity of Care: The statute notes that HIPAA’s allowance for sharing protected health information between providers for treatment, payment, and health care operations should be used to support continuity of care.
Key Takeaways for Missouri Providers and Telehealth Entities
- Review asynchronous intake models: Platforms relying on standalone online questionnaires should confirm the tool collects data equivalent to an in-person evaluation, and that an appropriately licensed healthcare professional reviews every submission.
- Confirm entity licensing: Telehealth companies that use questionnaires to establish a provider-patient relationship in Missouri should be properly licensed (or contracted with an entity licensed) to provide healthcare in the state.
- Build in 14-day PCP notification workflows: Automate or otherwise structure the process for sending post-evaluation reports to a patient’s primary care provider within the 14-day window.
- Confirm scope of § 191.1146: Remember it applies to physicians licensed under Chapter 334; providers relying on the broader “health care provider” prescribing rules in § 334.108(3)–(4) should independently confirm which practitioners and modalities those provisions reach.
- Audit prescribing workflows: Confirm no prescription or certification issues without a fully compliant physician-patient relationship, and that telemedicine-based prescribing is being evaluated against the same established-relationship requirement.
Disclaimer: This post is for informational and educational purposes only and does not constitute legal advice. Healthcare providers and entities should consult qualified legal counsel to ensure full compliance with Missouri statutes and regulations.