Current through Register Vol. 49, No. 18, September 16, 2024
(1) Certifying physician or nurse
practitioner qualifications. All physicians or nurse practitioners who intend
to certify patients for their patient medical marijuana licenses must be
licensed to practice in their respective fields and must be in good standing.
(A) A certifying physician must have a
current license to practice medicine or osteopathy. Practice of medicine or
osteopathy means practice by persons who hold a physician and surgeon license
pursuant to Chapter 334, RSMo, including those who are admitted to practice in
Missouri by reciprocity pursuant to section
334.043, RSMo.
(B) A nurse practitioner must have a current
Missouri or compact RN license and be recognized by the Missouri State Board of
Nursing as an advanced practice registered nurse.
(C) A physician is in good standing if -
1. The physician's license is registered with
the Missouri Board of Healing Arts as current, active, and not restricted in
any way, such as by designation as temporary or limited; and
2. The physician is not currently on the list
of individuals from whom the department will not accept
certifications.
(D) A
nurse practitioner is in good standing if -
1.
That individual's license is registered with the Missouri State Board of
Nursing as current and active;
2.
That individual's license is not restricted in any way, such as by designation
as cease and desist, denial of license, expired, restriction, revoked,
suspension, voluntary agreement to refrain from practice, or voluntary
surrender; and
3. That person is
not currently on the list of individuals from whom the department will not
accept certifications.
(2) Physician or nurse practitioner
certification. Physicians or nurse practitioners will submit certifications
electronically through a department-provided, web-based system. In the event of
system unavailability, the department will arrange to accept physician or nurse
practitioner certifications in an alternative, department-provided format and
will notify the public of those arrangements through its website.
(A) Physician or nurse practitioner
certifications must be issued no earlier than thirty (30) days before the date
the patient will apply for a patient identification card or renewal of a
patient identification card.
(B)
Physician or nurse practitioner certifications must include at least the
following information:
1. The physician's or
nurse practitioner's name, as it appears in the records of the Missouri
Division of Professional Registration;
2. The physician's or nurse practitioner's
licensee number;
3. Whether the
physician or nurse practitioner is licensed to practice medicine or osteopathy,
or is licensed as an advanced practiced registered nurse;
4. The physician's or nurse practitioner's
business address, telephone number, and email address;
5. The qualifying patient's name, date of
birth, and Social Security number;
6. The qualifying patient's qualifying
condition;
7. The physician's or
nurse practitioner's recommendation for the amount of medical marijuana product
the qualifying patient should be allowed to purchase in a thirty- (30-) day
period if the recommended amount is more than six (6) ounces of dried,
unprocessed marijuana or its equivalent.
A. If
the recommended amount is more than six (6) ounces in a thirty- (30-) day
period, the physician or nurse practitioner shall provide compelling reason(s)
why the qualifying patient needs a greater amount;
8. Statements confirming the following:
A. In the case of a non-emancipated
qualifying patient under the age of eighteen (18), before certifying the
qualifying patient for use of medical marijuana product, the physician or nurse
practitioner received the written consent of a parent or legal guardian who
asserts he or she will serve as a primary caregiver for the qualifying
patient;
B. The physician or nurse
practitioner met with and examined the qualifying patient, reviewed the
qualifying patient's medical records or medical history, reviewed the
qualifying patient's current medications and allergies to medications,
discussed the qualifying patient's current symptoms, and created a medical
record for the qualifying patient regarding the meeting;
C. In the opinion of the physician or nurse
practitioner, the qualifying patient suffers from the qualifying condition;
and
D. The physician or nurse
practitioner discussed with the qualifying patient risks associated with
medical marijuana, including known contraindications applicable to the patient,
risks of medical marijuana use to fetuses, and risks of medical marijuana use
to breastfeeding infants; and
9. The signature of the physician or nurse
practitioner and date signed.
(3) The department may request to interview
any physician or nurse practitioner who chooses to certify individuals as
qualifying patients. If such a request is made, the physician or nurse
practitioner shall arrange for the interview to occur as soon as possible but
no later than thirty (30) days after the department makes the request. If the
physician or nurse practitioner refuses an interview with the department, the
department may refuse to accept certifications from the physician or nurse
practitioner until the interview occurs.
(4) Physician or nurse practitioner
investigations. All complaints against physicians or nurse practitioners may be
submitted either via forms available on the department's website or by
otherwise notifying the department. Complaints shall include the name and
address of the physician or nurse practitioner against whom the complaint is
made and a clear description of what violation(s) the complainant believes the
physician or nurse practitioner has committed.
(A) After receiving a complaint against a
physician or nurse practitioner, the department will determine whether an
investigation is warranted. Investigations may also be initiated by the
department.
(B) If the department
conducts an investigation pursuant to a complaint, the physician or nurse
practitioner will receive a copy of the complaint. In the event the
investigation is initiated by the department, the physician or nurse
practitioner will receive a written description of the violation the department
believes the physician or nurse practitioner has committed.
(C) The department may conclude an
investigation by taking any of the following actions:
1. Dismissing the complaint;
2. Referring the complaint to the Missouri
State Board of Registration for the Healing Arts or Missouri State Board of
Nursing, as applicable;
3.
Referring the complaint to law enforcement; and
4. Refusing to accept any new certifications
from the physician or nurse practitioner for a reasonable period of time as
determined by the department and adding the physician's or nurse practitioner's
name to a publicly available list of physicians or nurse practitioners from
whom the department is not accepting certifications. Such action shall only be
taken upon concluding the physician or nurse practitioner has violated a
provision of this chapter, Article XIV of the Missouri Constitution, or any
other rule or law applicable to implementation of Article XIV. The length of
time the department shall refuse to accept the physician's or nurse
practitioner's certifications shall be based upon the following criteria:
A. Whether the physician or nurse
practitioner acted recklessly or knowingly in violating an applicable rule or
law;
B. The degree of imminent
danger to the health of a qualifying patient the physician's or nurse
practitioner's actions caused;
C.
The degree or recurrence of falsification of a physician or nurse practitioner
certification;
D. Whether the
department has previously received substantiated complaints against the
physician or nurse practitioner; and
E. Any aggravating circumstances.
(D) Upon completion of
an investigation, the department shall notify the physician or nurse
practitioner of any department action, the reasons for that action, and the
procedure for filing an application for a hearing.
(E) Any physician or nurse practitioner
aggrieved by the department's actions taken pursuant to this section may file
an application for a hearing with the department. The department shall grant
the application within fourteen (14) days after receipt by the department and
set the matter for hearing.
(F) The
provisions of Chapter 536, RSMo, for a contested case, except those provisions
or amendments that are in conflict with this section, shall apply to and govern
the proceedings contained in this section and the rights and duties of the
parties involved. The person requesting a hearing shall be entitled to present
evidence, pursuant to the provisions of Chapter 536, RSMo, relevant to the
allegations.
(G) Upon the record
made at the hearing, the director of the department or the director's designee
shall determine all questions presented and shall determine whether the initial
decision shall stand. The director of the department or the director's designee
shall clearly state the reasons for his or her decision.
(H) A person aggrieved by the decision
following the hearing shall be informed of his or her right to seek judicial
review as provided under Chapter 536, RSMo. If the person fails to appeal the
director of the department's findings within thirty (30) days of their
issuance, those findings shall constitute a final determination.
(I) A decision by the director of the
department shall be inadmissible in any civil or criminal action brought
against a physician or nurse practitioner.
