Missouri Management Services Agreement Guide: The Collaboration Contract Rule and the Questionnaire Provision
Missouri law says no contract may limit a collaborating physician's ultimate authority over protocols, standing orders or delegation, which directly constrains management agreement terms.
Key Highlights
- No contract or term of employment may require a physician to act as collaborating physician against their will or limit the physician's ultimate authority over protocols, standing orders or delegation.
- The discipline statute has no general fee-splitting ground, and we found no authority on percentage fees.
- Advertising by an entity in which the licensee has a financial interest is attributed to the licensee.
- The 2026 telehealth law requires a provider using a questionnaire to be employed or contracted with a business entity licensed to provide health care, and the phrase is undefined.
How to Price the Management Fee
The discipline statute has no general fee-splitting ground, though it makes fraudulent fees and overcharging unprofessional conduct, and we found no authority on percentage fees. We use a fixed fee for defined services.
What the Practice Must Keep
The practice keeps the collaborating physician's ultimate authority over protocols, standing orders and delegation, and the collaboration terms the statute requires: chart review of 10% of charts every 14 days and 20% where controlled substances are prescribed, and a limit of six full-time-equivalent nurses, physician assistants and assistant physicians per physician in non-hospital settings.
Terms to Avoid
Avoid any term that limits the collaborating physician's authority or requires a physician to collaborate against their will. Avoid advertising the MSO controls, since advertising by an entity in which the licensee has a financial interest is attributed to the licensee. Do not assume a professional corporation satisfies the 2026 telehealth wording, since Missouri does not license professional corporations as health care entities.
Term, Records and Departing Clinicians
Employer-employee non-competes are allowed if reasonable, with a presumption at one year or less, and we found no physician-specific statute. We do not use them for employed clinicians.
Filings, Notices and Watch Items
We found no Missouri transaction notice law. House Bill 2372 took effect August 28, 2026, and questionnaire-based models need counsel's interpretation of the licensed business entity wording.
Drafting Checklist
- Fee: fixed for defined services.
- Collaboration: no term limiting the physician's authority over protocols or delegation.
- Chart review: 10% every 14 days, 20% for controlled substances.
- Advertising: approved by the licensee.
- Telehealth: counsel reviews questionnaire models.
How We Draft It
Patients pay the physician-owned practice, the practice pays the management company a fixed monthly fee under the agreement, and the management company pays MedGrid a fixed monthly retainer for consulting. The management company never practices medicine, and the agreement never moves a clinical decision to it. Our template follows the same flat-fee design in every state, with the state-specific limits below layered on top.
Disclaimer
This article is general educational information, not legal advice. Management agreement rules change and differ by state, and this summary draws on our published state guide, parts of which rest on secondary sources, so have health care counsel in the state review any agreement before you sign.
MedGrid MSO provides management services to independently owned practices; it does not practise medicine and does not direct clinical decisions. Requirements vary by state and by service, and change over time — nothing on this page is legal or medical advice. Talk to us or your own counsel before making a structural decision for your clinic.