Mo. Code Regs. Ann. tit. 19, § 100-1.040
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.
(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. SENIOR SERVICES
(B) Physician or nurse practitioner certification.
practitioner certification confirming the qualifying patient has at least one qualifying medical condition.
for all new and renewal patient applications.
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.
medical use in a public place, unless provided by law.
caregiver may serve as the primary caregiver for another qualifying patient.
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that the qualifying patient has voluntarily surrendered the identification card and that the identification card is no longer valid.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.
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.
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.
caregiver for a non-emancipated qualifying patient.
who holds a primary caregiver identification card shall purchase or possess medical marijuana product for a nonemancipated qualifying patient.
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.
(3) years.
(C) Primary caregiver responsibilities.
more than six (6) qualifying patients.
qualifying patient who is already served by two (2) primary CANNABIS REGULATION
caregivers.
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.
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.
dried, unprocessed marijuana product, or its equivalent, in a single transaction.
2. Consumers may only possess—
three (3) ounces of dried, unprocessed marijuana product, or its equivalent; or
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.
titioner 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.
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.
must state in their certification what amount the qualifying patient requires, which shall then be that patient’s limit.
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.
mary caregiver to possess on their behalf—
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
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.
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 CANNABIS REGULATION
and labeled with the qualifying patient’s name.
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.
purchase limitations in this section by combining purchases as a patient and as a consumer.
(5) Consumer personal cultivation, qualifying patient cultivation, and primary caregiver cultivation, generally.
(H) Consumer personal cultivation.
private residence.
personal cultivation identification cards, may grow marijuana at the same private residence.
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.
of three (3) ounces must be kept at a private residence in an enclosed, locked facility.
possession of a consumer shall be clearly labeled with the consumer’s name. SENIOR SERVICES
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.
qualifying patient cultivation identification cards, may share one (1) enclosed, locked facility.
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.
entitled to cultivate, or have cultivated on his or her behalf, more than six (6) flowering marijuana plants.
may be authorized for cultivation on behalf of the qualifying patient.
possession of a qualifying patient shall be clearly labeled with the qualifying patient’s name.
as long as the qualifying patient’s identification card is still valid, up to three (3) years from its date of issuance.
for all cultivation applications no matter how much time remains on the validity of the patient’s identification card.
renewable by submitting a renewal patient cultivation application, as long as the individual has an approved renewal patient application.
(J) Primary caregiver cultivation.
than one (1) qualifying patient and may utilize one (1) or more enclosed, locked facilities.
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.
ship may be authorized for cultivation on behalf of the qualifying patient.
sion of a primary caregiver shall be clearly labeled with the qualifying patient’s name.
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.
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.
as long as the primary caregiver’s identification card is still valid, up to three (3) years from its date of issuance.
all cultivation applications no matter how much time remains on the validity of the primary caregiver’s identification card.
by submitting a renewal caregiver cultivation application, SENIOR SERVICES
as long as the individual has an approved renewal caregiver application.
(6) Identification cards.
(A) Application requirements.
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.
obtain identification cards from the department, which will include unique, identifying numbers for each patient and each caregiver.
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.
obtain identification cards from the department, which will include unique, identifying numbers for each authorized cultivator.
for qualifying patient identification cards and renewal of such identification cards shall include at least the following information:
Social Security number;
ing address or, if the qualifying patient has no residence or mailing address, an address where the qualifying patient can receive mail;
D. A statement confirming that—
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
the qualifying patient needs a greater amount than six (6) ounces in a thirty- (30-) day period;
tification card issued by a state or federal government entity;
within the prior three (3) months;
patient under the age of eighteen (18), a certified emancipation order from the issuing court;
fying patient—
will serve as primary caregiver for the qualifying patient, dated within the previous ninety (90) days; and
plication is the qualifying patient’s parent or legal guardian and—
showing proof of relationship as qualifying patient’s parent; or
guardianship;
application is true and correct;
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
for primary caregiver identification cards and renewal of such identification cards shall include at least the following information:
Social Security number;
ing address;
ing patient for whom the applicant seeks to serve as primary caregiver;
tification card issued by a state or federal government entity;
within the prior three (3) months;
patient, patient authorization signed by the qualifying patient who the primary caregiver will serve and dated within the previous ninety (90) days;
fying 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—
showing the primary caregiver as the qualifying patient’s parent; or
ianship of the primary caregiver over the qualifying patient;
application is true and correct;
primary caregiver signed; and
sonal 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:
Security number;
dress;
place in Missouri;
card issued by a state or federal government entity;
within the prior three (3) months;
will cultivate marijuana; CANNABIS REGULATION
attestation that the cultivation will be located at a private residence in a single enclosed, locked facility that permits access to only the applicant;
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;
patient—
number; and
if applicable;
locked facility, the name and patient license number of up to one (1) other qualifying patient with whom the cultivation space will be shared;
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);
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;
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;
application is true and correct;
signed; and
(B) Application processes.
marijuana identification card applications.
a qualifying patient, each application to be a primary caregiver on behalf of a specific qualifying patient, and each application to cultivate marijuana.
on behalf of a qualifying patient may be made following approval of a qualifying patient or primary caregiver identification card.
as long as the qualifying patient or primary caregiver’s identification card is still valid.
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. SENIOR SERVICES
the time the patient or caregiver identification card is renewed.
posted on the department’s website.
ered 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.
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.
vation 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.
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.
vation identification cards may be denied.
mation in an application, the card for which the applicant is applying will be denied.
within fourteen (14) calendar days of being notified that an application is incomplete, the card for which the applicant is applying will be denied.
date the department sends a written explanation of how the application is incomplete to an email address provided by the applicant.
do so, an application for an identification card may be denied.
fee(s) associated with an application, the qualifying patient, primary caregiver, or cultivation identification card will be denied.
ing 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.
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.
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.
must renew their qualifying patient identification card before SENIOR SERVICES
the associated primary caregiver renewal application(s) will be processed.
tion will only serve to renew the primary caregiver identification card if the associated qualifying patient has an approved renewal patient application.
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.
able 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.
all required information.
tivation identification card if the individual has an approved renewal patient or caregiver application.
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.
identification cards may be sanctioned.
or Article XIV, any identification cards currently held by that individual may be revoked.
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.
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.
tion 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.
immediately make available access to his or her cultivation facility upon request from the department, the cultivation identification card shall be revoked.
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.
tion card holder advertises to sell or sells marijuana product, the individual’s identification card may be revoked.
ment may notify the card holder that it will not accept a new application for the same card type for a designated period of CANNABIS REGULATION
time.
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.
AUTHORITY: sections 1.3.(1)(b), 1.3.(2), 2.4(1)(b), and 2.4(4) of Article XIV, Mo. Const. Emergency rule filed Jan. 20, 2023, effective Feb. 3, 2023, expired Aug. 1, 2023. Original rule filed Jan. 20, 2023, effective July 30, 2023.