Missouri Practice Structure Guide: A Permissive State, a Contract Rule on Collaboration and a New Telehealth Questionnaire Provision

Entity and Ownership

The Professional Corporation Law of Missouri lists physicians, surgeons and doctors of osteopathy as a professional service. Incorporators must each be licensed, and a certificate from the licensing authority, the Board of Registration for the Healing Arts for physicians, must be filed with the Secretary of State before articles issue. A professional corporation renders one type of professional service plus ancillary services unless the licensing authorities permit combinations, so physician and nurse practitioner co-ownership of one corporation is not clearly authorized and we found no Board rule permitting it. Shares go only to qualified licensed persons, certain partnerships or LLCs of licensees and professional corporations, violating issuances are void, the name must include Professional Corporation or P.C., and an annual report lists officers, directors and shareholders. We found no professional LLC provision in the LLC chapter.

The Corporate Practice Position

The Board's discipline statute has no ground barring corporate employment of physicians, though it covers assisting or enabling unlicensed practice. In State ex inf. Sager v. Lewin (Mo. App. 1907), the respondents conceded a corporation cannot be organized to practice medicine, but the court held a company chartered to furnish treatment could contract with patients and physicians as hospitals do, so its physician owner's employment was not a charter violation. It is a 1907 intermediate appellate decision and not recent authority. Law-firm commentary describes Missouri as having no corporate practice doctrine, while advising a check of each licensing authority's rules, and vendor claims that only physicians may own a med spa cite no authority. We found no Board position on MSOs, private equity or lay-owned med spas and no Missouri transaction notice law.

The Management Agreement and Fees

The discipline statute has no general fee-splitting ground, though it makes fraudulent fees and overcharging unprofessional conduct, attributes advertising by an entity in which the licensee has a financial interest to the licensee, and covers a physical-therapy referral-fee ground. We found no Missouri authority on percentage-based management fees.

The collaboration statute is the key contract rule. No contract or term of employment may require a physician to act as a collaborating physician against their will, and no contract may limit the collaborating physician's ultimate authority over protocols or standing orders or over delegation of their authority, with a mirror rule for advanced practice nurses. One collaborating physician may not enter arrangements with more than six full-time-equivalent nurses, physician assistants and assistant physicians in non-hospital settings, and the written arrangement must include chart review of 10% of charts every 14 days and 20% where controlled substances are prescribed. Employer-employee non-competes are allowed if reasonable, with a presumption of reasonableness at one year or less, and we found no physician-specific statute.

Med Spa and Telehealth Rules

We found no Missouri med spa registration, license or medical director statute, and vendor claims of a required medical director cite nothing. House Bill 2372, signed July 13, 2026 and effective August 28, 2026, rewrote the telehealth statutes. A physician-patient relationship may be established by an in-person exam, a consult with a physician who has an established relationship, or a telemedicine encounter if the standard of care does not require in-person care, and the physician must evaluate the patient before treating. A patient-completed questionnaire must be reviewed by the treating professional and supply information as though the evaluation were in person. A provider using a questionnaire to establish the relationship must be employed or contracted with a business entity that is licensed to provide health care in Missouri. We found no definition or guidance for that phrase, and Missouri does not license professional corporations as health care entities, so questionnaire-based models need counsel's interpretation before they rely on it.

How We Structure It

As a rule we set up a professional corporation owned by the licensed physician, with no exceptions for what looks like a more flexible state. Patients pay the physician-owned practice. The practice pays the management company a fixed monthly fee under a written management services agreement. The management company pays MedGrid a fixed monthly retainer for consulting. The MSO never practices medicine, and the physician makes every clinical decision. In Missouri we keep the same physician-owned structure, with collaboration authority in the physician's hands and a flat-fee agreement.

Disclaimer

This article is general educational information, not legal advice. Entity and corporate practice rules change, and parts of this summary rest on secondary sources, so have health care counsel in the state confirm the structure before you form or sign anything.