Missouri Code of State Regulations
Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES
Division 100 - Division of Cannabis Regulation
Chapter 1 - Marijuana
Section 19 CSR 100-1.040 - Consumers, Qualifying Patients, and Primary Caregivers
Universal Citation: 19 MO Code of State Regs 100-1.040
Current through Register Vol. 49, No. 18, September 16, 2024
PURPOSE: Under Article XIV, Section 1 of the Missouri Constitution, patients with qualifying medical conditions have the right to discuss freely with their physicians the possible benefits of medical marijuana use and the right to use medical marijuana for treatment under the ethical supervision of a physician or nurse practitioner. Additionally, under Article XIV, Section 2 of the Missouri Constitution, adults at least twenty-one (21) years of age have the right to access marijuana. Pursuant to the same article, the Department of Health and Senior Services is tasked with ensuring patient access to medical marijuana and adult access to marijuana, subject to reasonable restrictions. This rule explains how the department will implement provisions of Article XIV related to consumers, qualifying patients, and primary caregivers.
(1) Consumers. Individuals twenty-one (21) years of age and older may purchase and possess marijuana product in accordance with the rules set forth herein. Consumers may obtain authority to cultivate as set forth below.
(2) Qualifying patients. Individuals eighteen (18) years of age or older and emancipated individuals under the age of eighteen (18) may obtain a medical marijuana patient identification card to purchase and possess medical marijuana product in accordance with the rules set forth herein. Non-emancipated individuals under the age of eighteen (18) may obtain a medical marijuana patient identification card with the written consent of a custodial parent or legal guardian. Qualifying patients, with the exception of non-emancipated minors, may also obtain authority to cultivate as set forth below.
(A) Medical marijuana patient
identification cards are valid for three (3) years.
(B) Physician or nurse practitioner
certification.
1. All qualifying patients must
have a physician or nurse practitioner certification confirming the qualifying
patient has at least one qualifying medical condition.
2. A physician or nurse practitioner
certification is required for all new and renewal patient
applications.
3. The physician or
nurse practitioner certification must be submitted within a new or renewal
patient application, and the signature date on the certification must be less
than thirty (30) days old on the application's submission date.
(C) Qualifying patient
responsibilities.
1. No qualifying patient
shall smoke marijuana product for medical use in a public place, unless
provided by law.
2. No qualifying
patient who is under the care of a primary caregiver may serve as the primary
caregiver for another qualifying patient.
3. If a qualifying patient is no longer
entitled to medical marijuana product or no longer wishes to hold a medical
marijuana identification card, they must notify the department within ten (10)
days of that change. The department will confirm in writing that the qualifying
patient has voluntarily surrendered the identification card and that the
identification card is no longer valid.
(D) Non-emancipated qualifying patients.
Individuals under the age of eighteen (18) may obtain a medical marijuana
patient identification card with the written consent of a custodial parent or
legal guardian.
1. A physician or nurse
practitioner shall not issue a certification for the medical use of marijuana
product for a non-emancipated qualifying patient without the written consent of
a parent or legal guardian of the qualifying patient.
2. The department shall not issue a
qualifying patient identification card on behalf of a non-emancipated
qualifying patient without the written consent of a parent or legal guardian of
the qualifying patient. Such card shall be issued to the parent or guardian and
not directly to the patient.
3.
Only a parent or legal guardian may serve as a primary caregiver for a
non-emancipated qualifying patient.
4. Only the qualifying patient's parent or
legal guardian who holds a primary caregiver identification card shall purchase
or possess medical marijuana product for a nonemancipated qualifying
patient.
5. A parent or legal
guardian who holds a primary caregiver identification card shall supervise the
administration of medical marijuana product to a non-emancipated qualifying
patient.
(3) Primary caregivers. Individuals twenty-one (21) years of age or older may obtain a primary caregiver identification card which allows them to purchase and possess medical marijuana product on behalf of up to six (6) qualifying patients. Primary caregivers may also obtain authority to cultivate as set forth below.
(A) Primary caregiver
identification cards are valid for three (3) years.
(B) Individuals seeking primary caregiver
status for nonemancipated qualifying patients must be the parent or legal
guardian of the qualifying patient.
(C) Primary caregiver responsibilities.
1. No individual shall serve as the primary
caregiver for more than six (6) qualifying patients.
2. No individual shall serve as a primary
caregiver for a qualifying patient who is already served by two (2) primary
caregivers.
3. If a primary
caregiver is no longer entitled to serve as a primary caregiver or no longer
wishes to hold a primary caregiver identification card, they must notify the
department within ten (10) days of that change. The department will confirm in
writing that the primary caregiver has voluntarily surrendered the
identification card and that the identification card is no longer
valid.
4. Primary caregivers shall
provide ethical, safe, and secure access to medical marijuana product for the
associated patient by way of purchase, possession, administration, and
cultivation, if applicable.
(4) Purchase and possession limitations.
(A) Consumers.
1. Consumers may only purchase up to three
(3) ounces of dried, unprocessed marijuana product, or its equivalent, in a
single transaction.
2. Consumers
may only possess-
A. In the case of consumers
who do not cultivate, up to three (3) ounces of dried, unprocessed marijuana
product, or its equivalent; or
B.
In the case of consumers who are cultivating marijuana, any supply of marijuana
cultivated by the consumer in excess of the consumer's three (3) ounce limit
must remain in an enclosed, locked facility at a private residence.
(B) Qualifying patients
and primary caregivers.
1. Absent a
certification from a physician or nurse practitioner authorizing more,
qualifying patients may only purchase, or have purchased on their behalf by
their primary caregivers, up to six (6) ounces of dried, unprocessed marijuana,
or its equivalent, per qualifying patient, in a thirty-(30-) day
period.
2. The six (6) ounce
purchase limit established in this section shall not apply to a qualifying
patient with a certification from a physician or nurse practitioner that there
are compelling reasons why the qualifying patient needs a greater amount than
the limit established in this section.
A. In
such a case, the physician or nurse practitioner must state in their
certification what amount the qualifying patient requires, which shall then be
that patient's limit.
B. If the
patient's amount is increased after they receive a qualifying patient
identification card, the patient must submit a request to the department to
increase their purchase limit within thirty (30) days of the physician's or
nurse practitioner's signature date. The department shall, within thirty (30)
days, either approve or deny the request. The increase will not be effective
until the department approves the request.
3. Qualifying patients may only possess, or
instruct a primary caregiver to possess on their behalf-
A. In the case of qualifying patients who do
not cultivate or have medical marijuana cultivated on their behalf, up to a
sixty- (60-) day supply of dried, unprocessed marijuana per qualifying patient,
or its equivalent; or
B. In the case
of qualifying patients who are cultivating marijuana for medical use or whose
primary caregivers are cultivating marijuana on their behalf, up to a ninety-
(90-) day supply of dried, unprocessed marijuana or its equivalent, so long as
the supply of medical marijuana product in excess of a sixty- (60-) day supply
remains in an enclosed, locked facility.
4. Primary caregivers may possess a separate
legal limit for each qualifying patient under their care and a separate legal
limit for themselves if they are a qualifying patient, each of which shall be
stored separately for each qualifying patient and labeled with the qualifying
patient's name.
5. Possession of
between the legal limit and up to twice the legal limit shall subject the
possessor to department sanctions, including an administrative penalty of up to
two hundred dollars ($200) and loss of the possessor's identification card(s)
for up to a year.
(5) Consumer personal cultivation, qualifying patient cultivation, and primary caregiver cultivation, generally.
(A) Except for good cause, any consumer,
licensed qualifying patient with the exception of non-emancipated qualifying
patients, or licensed primary caregiver on behalf of a qualifying patient may
obtain authorization to cultivate up to six (6) flowering marijuana plants, six
(6) non-flowering marijuana plants fourteen (14) inches tall or more, and six
(6) non-flowering plants under fourteen (14) inches tall at any given time in a
single enclosed, locked facility, subject to the limitations below.
(B) Non-emancipated qualifying patients are
not eligible for patient cultivation authorization, but a parent or legal
guardian who is the primary caregiver may obtain authorization to cultivate on
behalf of the non-emancipated qualifying patient.
(C) A qualifying patient may not be
authorized for both qualifying patient cultivation and consumer personal
cultivation at the same time.
(D)
All consumer personal cultivation, qualifying patient, and primary caregiver
cultivation shall take place in an enclosed, locked facility, as defined in
this chapter.
(E) Nothing in this
section shall convey or establish a right to cultivate marijuana in a facility
where state law or a private contract would otherwise prohibit doing
so.
(F) Consumer personal
cultivation, qualifying patient, and primary caregiver cultivation shall not
take place at a place of business.
(G) The department shall provide each
consumer, qualifying patient, or primary caregiver who receives a cultivation
authorization with a cultivation authorization identification card, which shall
be clearly displayed within the enclosed cultivation area and in close
proximity to the marijuana plants. The authorization shall list the name of the
consumer, qualifying patient, or primary caregiver who has been authorized to
cultivate, and the address at which that individual is authorized to cultivate
marijuana.
(H) Consumer personal
cultivation.
1. All consumer personal
cultivation must take place at a private residence.
2. Up to two (2) consumers, who both hold
valid consumer personal cultivation identification cards, may grow marijuana at
the same private residence.
3. No
more than twelve (12) flowering marijuana plants, twelve (12) non-flowering
plants fourteen (14) inches tall or more, and twelve (12) non-flowering plants
under fourteen (14) inches tall may be cultivated by consumers at a single
private residence, regardless of the number of consumers who live at that
private residence.
4. Plants and
marijuana produced by the plants in excess of three (3) ounces must be kept at
a private residence in an enclosed, locked facility.
5. All cultivated flowering marijuana plants
in the possession of a consumer shall be clearly labeled with the consumer's
name.
6. A consumer personal
cultivation identification card shall be valid for twelve (12) months from its
date of issuance and shall be renewable with the submittal of a renewal
application.
(I)
Qualifying patient cultivation.
1. Up to two
(2) qualifying patients, who both hold valid qualifying patient cultivation
identification cards, may share one (1) enclosed, locked facility.
2. No more than twelve (12) flowering
marijuana plants, twelve (12) non-flowering plants fourteen (14) inches tall or
more, and twelve (12) non-flowering plants under fourteen (14) inches tall may
be cultivated in a single enclosed, locked facility.
3. Under no circumstance will a qualifying
patient be entitled to cultivate, or have cultivated on his or her behalf, more
than six (6) flowering marijuana plants.
4. Only one (1) individual in a
patient-caregiver relationship may be authorized for cultivation on behalf of
the qualifying patient.
5. All
cultivated flowering marijuana plants in the possession of a qualifying patient
shall be clearly labeled with the qualifying patient's name.
6. A patient cultivation identification card
shall be valid as long as the qualifying patient's identification card is still
valid, up to three (3) years from its date of issuance.
A. The cultivation application fee will be
the same for all cultivation applications no matter how much time remains on
the validity of the patient's identification card.
B. The cultivation identification card shall
be renewable by submitting a renewal patient cultivation application, as long
as the individual has an approved renewal patient application.
(J) Primary caregiver
cultivation.
1. A primary caregiver may
cultivate on behalf of more than one (1) qualifying patient and may utilize one
(1) or more enclosed, locked facilities.
2. No primary caregiver cultivating marijuana
for more than one (1) qualifying patient may exceed a total of twenty-four (24)
flowering plants, twenty-four (24) non-flowering plants fourteen (14) inches
tall or more, and twenty-four (24) non-flowering plants under fourteen (14)
inches tall.
3. Only one (1)
individual in a patient-caregiver relationship may be authorized for
cultivation on behalf of the qualifying patient.
4. All cultivated flowering marijuana plants
in the possession of a primary caregiver shall be clearly labeled with the
qualifying patient's name.
5. A
primary caregiver cultivator who is also authorized as a qualifying patient
cultivator may grow the plants that belong to them as a qualifying patient
cultivator, and the plants grown on behalf of their qualifying patient(s) using
the same enclosed, locked facility.
6. A primary caregiver cultivator who is also
authorized as a consumer personal cultivator may not grow the plants that
belong to them as an authorized consumer personal cultivator and the plants
grown on behalf of their qualifying patient(s) using the same enclosed, locked
facility.
7. A caregiver
cultivation identification card shall be valid as long as the primary
caregiver's identification card is still valid, up to three (3) years from its
date of issuance.
A. The cultivation
application fee will be the same for all cultivation applications no matter how
much time remains on the validity of the primary caregiver's identification
card.
B. The cultivation
identification card shall be renewable by submitting a renewal caregiver
cultivation application, as long as the individual has an approved renewal
caregiver application.
(6) Identification cards.
(A) Application requirements.
1. The department will receive applications
for qualifying patient, primary caregiver, and cultivation authorization
identification cards electronically through a department- provided, web-based
application system. In the event of application system unavailability, the
department will arrange to accept applications in an alternative,
department-provided format and will notify the public of those arrangements
through its website.
A. Qualifying patients
and primary caregivers shall obtain identification cards from the department,
which will include unique, identifying numbers for each patient and each
caregiver.
B. A qualifying patient
or their primary caregiver(s) who wish to cultivate shall also obtain an
identification card to cultivate for the exclusive use of that qualifying
patient, which will include unique, identifying numbers for each authorized
cultivator.
C. Consumers who wish
to cultivate marijuana shall obtain identification cards from the department,
which will include unique, identifying numbers for each authorized
cultivator.
2. Qualifying
patient identification cards. All applications for qualifying patient
identification cards and renewal of such identification cards shall include at
least the following information:
A. The
qualifying patient's name, date of birth, and Social Security number;
B. The qualifying patient's residence address
and mailing address or, if the qualifying patient has no residence or mailing
address, an address where the qualifying patient can receive mail;
C. The qualifying patient's email
address;
D. A statement confirming
that-
(I) One (1) physician or nurse
practitioner certification, which is less than thirty (30) days old, has been
submitted on behalf of the qualifying patient and is available for review
within the submitted application; and
(II) If applicable, there are compelling
reason(s) why the qualifying patient needs a greater amount than six (6) ounces
in a thirty- (30-) day period;
E. A legible copy of the qualifying patient's
photo identification card issued by a state or federal government
entity;
F. A clear, color photo of
the applicant's face taken within the prior three (3) months;
G. If the qualifying patient is an
emancipated qualifying patient under the age of eighteen (18), a certified
emancipation order from the issuing court;
H. If the qualifying patient is a
non-emancipated qualifying patient-
(I)
Written consent of a parent or legal guardian who will serve as primary
caregiver for the qualifying patient, dated within the previous ninety (90)
days; and
(II) An attestation that
the individual signing the application is the qualifying patient's parent or
legal guardian and-
(a) A copy of a birth
certificate or adoption record showing proof of relationship as qualifying
patient's parent; or
(b) A copy of
documentation establishing legal guardianship;
I. An attestation that the information
provided in the application is true and correct;
J. The signature of the qualifying patient
and date the qualifying patient signed, or, in the case of a non-emancipated
qualifying patient, the signature of the parent or legal guardian who completed
the qualifying patient application and will serve as primary caregiver for the
qualifying patient; and
K. All
applicable fees.
3.
Primary caregiver identification cards. All applications for primary caregiver
identification cards and renewal of such identification cards shall include at
least the following information:
A. The
primary caregiver's name, date of birth, and Social Security number;
B. The primary caregiver's residence address
and mailing address;
C. The primary
caregiver's email address;
D. The
name and patient license number of the qualifying patient for whom the
applicant seeks to serve as primary caregiver;
E. A legible copy of the primary caregiver's
photo identification card issued by a state or federal government
entity;
F. A clear, color photo of
the applicant's face taken within the prior three (3) months;
G. Except in the case of a non-emancipated
qualifying patient, patient authorization signed by the qualifying patient who
the primary caregiver will serve and dated within the previous ninety (90)
days;
H. If the qualifying patient
is a non-emancipated qualifying patient, written consent of the parent or legal
guardian who will serve as the qualifying patient's primary caregiver, dated
within the previous ninety (90) days, and-
(I) A copy of a birth certificate or adoption
record showing the primary caregiver as the qualifying patient's parent;
or
(II) A copy of documentation
establishing legal guardianship of the primary caregiver over the qualifying
patient;
I. An
attestation that the information provided in the application is true and
correct;
J. The signature of the
primary caregiver and date the primary caregiver signed; and
K. All applicable fees.
4. Cultivation cards. All applications for
consumer personal cultivation identification cards, qualifying patient
cultivation identification cards, and primary caregiver cultivation
identification cards and renewal of such cards shall include at least the
following information:
A. The applicant's
name, date of birth, and Social Security number;
B. The applicant's residence address and
mailing address;
C. A statement
that the applicant's cultivation will take place in Missouri.
D. The applicant's email address;
E. A legible copy of the applicant's photo
identification card issued by a state or federal government entity;
F. A clear, color photo of the applicant's
face taken within the prior three (3) months;
G. The address of the location in which the
applicant will cultivate marijuana;
H. For consumer personal cultivation
authorization, attestation that the cultivation will be located at a private
residence in a single enclosed, locked facility that permits access to only the
applicant;
I. For qualifying
patient or primary caregiver cultivation authorization, attestation that the
cultivation will be located in a single enclosed, locked facility that permits
access to only the qualifying patient and his or her licensed caregiver(s), as
applicable;
J. If the cultivation
will be by or on behalf of a qualifying patient-
(I) The qualifying patient's name and patient
license number; and
(II) The
primary caregiver's name and license number, if applicable;
K. If a qualifying patient seeks
to share an enclosed, locked facility, the name and patient license number of
up to one (1) other qualifying patient with whom the cultivation space will be
shared;
L. If a primary caregiver,
requesting authorization to cultivate on behalf of a qualifying patient, seeks
to grow plants for multiple patients in a single enclosed, locked facility, the
names and patient license numbers of up to five (5) other qualifying patients,
plus their own name and qualifying patient license number if the space is going
to be used for their own qualifying patient cultivation and cultivation on
behalf of their qualifying patient(s);
M. If a consumer seeks to grow marijuana at
the same private residence as one (1) other licensed consumer personal
cultivator, the name and license number of one (1) other licensed consumer
personal cultivator who will be cultivating at that private
residence;
N. A statement affirming
the applicant's agreement to immediately make available access to the
cultivation space upon request from the department. Such access will be only
for purposes of confirming compliance with this rule and will be limited to the
enclosed, locked facility and any areas necessary to reach and enter the
facility on a path of the applicant's choosing;
O. An attestation that the information
provided in the application is true and correct;
P. The signature of the applicant and date
the applicant signed; and
Q. All
applicable fees.
(B) Application processes.
1. The department shall charge a
non-refundable fee for marijuana identification card applications.
A. There will be a separate fee for each
application to be a qualifying patient, each application to be a primary
caregiver on behalf of a specific qualifying patient, and each application to
cultivate marijuana.
B. Requests
for authority to cultivate medical marijuana on behalf of a qualifying patient
may be made following approval of a qualifying patient or primary caregiver
identification card.
(I) A cultivation
authorization will only remain valid as long as the qualifying patient or
primary caregiver's identification card is still valid.
(II) The fee for an application to cultivate
on behalf of a qualifying patient will be the same for all applications no
matter how much time remains on the validity of the patient or caregiver's
identification card at the time of the request for cultivation authorization is
submitted.
(III) The cultivation
authorization must be renewed at the time the patient or caregiver
identification card is renewed.
C. Current fees, including any adjustments,
will be posted on the department's website.
2. An application for an identification card
will be considered received when the department receives a complete
application. A complete application is an application that includes all
information required by this rule. The department will notify an applicant once
if an application is incomplete and will specify in that notification what
information is missing.
3. Upon
receiving a complete application for a qualifying patient identification card,
primary caregiver identification card, or qualifying patient cultivation
identification card, the department shall, within thirty (30) days, either
approve the application or provide a written explanation for its denial.
A. In the case of qualifying patient and
patient cultivation identification cards, if the department fails to deny or
fails to approve a complete application within thirty (30) days, a card will be
issued that will be valid for three (3) years and will serve all the same
functions as would a card issued after application
approval.
4. If the name
or address of a consumer personal cultivator, qualifying patient, or primary
caregiver changes after an identification card is issued, the consumer,
qualifying patient, or primary caregiver shall notify the department within
fourteen (14) calendar days of the change.
5. Denial. Qualifying patient, primary
caregiver, and cultivation identification cards may be denied.
A. If an applicant provides false or
misleading information in an application, the card for which the applicant is
applying will be denied.
B. If an
applicant fails to provide a complete application within fourteen (14) calendar
days of being notified that an application is incomplete, the card for which
the applicant is applying will be denied.
(I)
An applicant will be considered notified on the date the department sends a
written explanation of how the application is incomplete to an email address
provided by the applicant.
C. If the department determines there is good
cause to do so, an application for an identification card may be
denied.
D. If the applicant fails
to pay the requisite application fee(s) associated with an application, the
qualifying patient, primary caregiver, or cultivation identification card will
be denied.
E. Any denial shall be
issued by the department in writing to the consumer, qualifying patient, or
primary caregiver, and shall include the specific reasons for the denial and
the process for requesting review of the department's decision.
6. Renewal.
A. Qualifying patient identification cards
are valid for three (3) years from their date of issuance and shall be
renewable by submitting, prior to expiration by at least thirty (30) days but
no sooner than sixty (60) days, a new or renewal application, which shall
include all required information, including a new physician
certification.
B. Primary caregiver
identification cards are valid for three (3) years from their date of issuance
and shall be renewable by submitting, prior to expiration by at least thirty
(30) days but no sooner than sixty (60) days, a new or renewal application,
which shall include all required information.
(I) A qualifying patient with a primary
caregiver(s) must renew their qualifying patient identification card before the
associated primary caregiver renewal application(s) will be
processed.
(II) The approved
primary caregiver renewal application will only serve to renew the primary
caregiver identification card if the associated qualifying patient has an
approved renewal patient application.
C. Qualifying patient cultivation and primary
caregiver cultivation identification cards are valid as long as the qualifying
patient's or primary caregiver's identification card is still valid, up to
three (3) years from its date of issuance.
(I)
The cultivation identification card shall be renewable by submitting, prior to
expiration by at least thirty (30) days but no sooner than sixty (60) days, a
new or renewal patient or caregiver cultivation application.
(II) The renewal cultivation application
shall include all required information.
(III) The application will only serve to
renew the cultivation identification card if the individual has an approved
renewal patient or caregiver application.
D. Consumer cultivation identification cards
are valid for one (1) year from their date of issuance and shall be renewable
by submitting, prior to expiration by at least thirty (30) days but no sooner
than sixty (60) days, a new or renewal application, which shall include all
required information.
(C) Administrative penalties.
1. Qualifying patient, primary caregiver, and
cultivation identification cards may be sanctioned.
A. If a card holder violates any provision of
this chapter, any identification cards currently held by that individual may be
revoked.
B. If, after an
identification card has been issued, the department determines that an
applicant has failed to provide a complete application including requisite
application fees, or has provided false or misleading information in the
application, the department may revoke the identification card.
C. If a card holder is found to be in
possession of an amount of marijuana product between the legal limit applicable
to that individual and up to twice the legal limit applicable to that
individual, they shall be subject to department sanctions, including an
administrative penalty of up to two hundred dollars ($200) and loss of their
identification card for up to a year.
D. If a qualifying patient, primary
caregiver, or cultivation card holder commits a criminal offense related to
distribution of marijuana product, whether or not a criminal charge has been
filed, any marijuana identification cards currently held by that individual
shall be revoked.
E. If a
cultivation identification card holder fails to immediately make available
access to his or her cultivation facility upon request from the department, the
cultivation identification card shall be revoked.
F. If a consumer cultivator, qualifying
patient, or primary caregiver uses combustible gases or other dangerous
materials to extract resins from marijuana, the individual's identification
card may be subject to department sanctions, including an administrative
penalty of one thousand dollars ($1000) and loss of their identification card
for up to one (1) year.
G. If a
qualifying patient, primary caregiver, or cultivation card holder advertises to
sell or sells marijuana product, the individual's identification card may be
revoked.
2. In any case
of identification card revocation, the department may notify the card holder
that it will not accept a new application for the same card type for a
designated period of time.
3. Any
revocation shall be issued by the department in writing to the consumer or
qualifying patient or, in the case of a primary caregiver, to the qualifying
patient and the primary caregiver, and shall include the specific reasons for
the revocation and the process for requesting review of the department's
decision.
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