HF 221 (LSB 1600YH (3) 88)

HOUSE FILE 221

BY  STAED, KACENA, BENNETT, ABDUL-SAMAD, KURTH, LENSING, WESSEL-KROESCHELL, FORBES, JACOBY, BROWN-POWERS, GAINES, OLSON, COHOON, KURTZ, DONAHUE, KONFRST, MASCHER, WOLFE, and STECKMAN

A BILL FOR

An Act relating to the compassionate use of medical cannabis Act, reclassifying marijuana, including tetrahydrocannabinols, from a schedule I controlled substance to a schedule II controlled substance, providing for civil and criminal penalties and fees, and including effective date provisions.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  Section 124.204, subsection 4, paragraphs m and u, Code 2019, are amended by striking the paragraphs.
    Sec. 2.  Section 124.204, subsection 7, Code 2019, is amended by striking the subsection.
    Sec. 3.  Section 124.206, subsection 7, Code 2019, is amended to read as follows:
   7.  Hallucinogenic substances.  Unless specifically excepted or unless listed in another schedule, any material, compound, mixture, or preparation which contains any quantity of the following substances, or, for purposes of paragraphs “a” and “b”, which contains any of its salts, isomers, or salts of isomers whenever the existence of such salts, isomers, or salts of isomers is possible within the specific chemical designation (for purposes of this paragraph only, the term “isomer” includes the optical, positional, and geometric isomers):
   a.  Marijuana when used for medicinal purposes pursuant to rules of the board.
   b.  Tetrahydrocannabinols, meaning tetrahydrocannabinols naturally contained in a plant of the genus cannabis (cannabis plant) as well as synthetic equivalents of the substances contained in the cannabis plant, or in the resinous extractives of such plant, and synthetic substances, derivatives, and their isomers with similar chemical structure and pharmacological activity to those substances contained in the plant, such as the following:
   (1)  1 cis or trans tetrahydrocannabinol, and their optical isomers.
   (2)  6 cis or trans tetrahydrocannabinol, and their optical isomers.
   (3)  3,4 cis or trans tetrahydrocannabinol, and their optical isomers. (Since nomenclature of these substances is not internationally standardized, compounds of these structures, regardless of numerical designation of atomic positions covered.)
   b.  c.  Nabilone [another name for 

nabilone: (+-) - trans-3-(1,1-dimethylheptyl)-6,6a,7,8,10,10a-hexahydro-1-hydroxy-6,6-

dimethyl-9H-dibenzo[b,d]pyran-9-one].
   c.  d.  Dronabinol [(-)-delta-9-trans-tetrahydrocannabinol] in an oral solution in a drug product approved for marketing by the United States food and drug administration.
    Sec. 4.  Section 124.401, subsection 5, unnumbered paragraph 3, Code 2019, is amended to read as follows:
   A person may knowingly or intentionally recommend, possess, use, dispense, deliver, transport, or administer cannabidiol medical cannabis if the recommendation, possession, use, dispensing, delivery, transporting, or administering is in accordance with the provisions of chapter 124E 124F. For purposes of this paragraph, “cannabidiol” “medical cannabis” means the same as defined in section 124E.2 124F.2.
    Sec. 5.  NEW SECTION.  124F.1  Short title.
   This chapter shall be known and may be cited as the “Compassionate Use of Medical Cannabis Act”.
    Sec. 6.  NEW SECTION.  124F.2  Definitions.
   As used in this chapter:
   1.  “Debilitating medical condition” means any of the following:
   a.  Cancer, if the underlying condition or treatment produces one or more of the following:
   (1)  Intractable pain.
   (2)  Nausea or severe vomiting.
   (3)  Cachexia or severe wasting.
   b.  Multiple sclerosis.
   c.  Epilepsy or seizure disorders.
   d.  AIDS or HIV as defined in section 141A.1.
   e.  Glaucoma.
   f.  Hepatitis C.
   g.  Crohn’s disease or ulcerative colitis.
   h.  Amyotrophic lateral sclerosis.
   i.  Ehlers-Danlos syndrome.
   j.  Post-traumatic stress disorder.
   k.  Tourette’s syndrome.
   l.  Any terminal illness, with a probable life expectancy of under one year, if the illness or its treatment produces one or more of the following:
   (1)  Intractable pain.
   (2)  Nausea or severe vomiting.
   (3)  Cachexia or severe wasting.
   m.  Intractable pain.
   n.  Parkinson’s disease.
   o.  Muscular dystrophy.
   p.  Huntington’s disease.
   q.  Alzheimer’s disease.
   r.  Complex regional pain syndrome, type I and II.
   s.  Rheumatoid arthritis.
   t.  Polyarteritis nodosa.
   u.  Any other chronic or debilitating disease or medical condition or its medical treatment approved by the department pursuant to rule.
   2.  “Department” means the department of public health.
   3.  “Disqualifying felony offense” means a violation under federal or state law of a felony offense, which has as an element the possession, use, or distribution of a controlled substance, as defined in 21 U.S.C. §802(6).
   4.  “Enclosed, locked facility” means a closet, room, greenhouse, or other enclosed area equipped with locks or other security devices that permit access only by authorized personnel.
   5.  “Health care practitioner” means an individual licensed under chapter 148 to practice medicine and surgery or osteopathic medicine and surgery or an individual licensed to practice medicine in any other state who provides specialty care for an Iowa resident for one or more of the debilitating medical conditions provided in this chapter.
   6.  “Intractable pain” means a pain in which the cause of the pain cannot be removed or otherwise treated with the consent of the patient and which, in the generally accepted course of medical practice, no relief or cure of the cause of the pain is possible, or none has been found after reasonable efforts. Reasonable efforts for relieving or curing the cause of the pain may be determined on the basis of but are not limited to any of the following:
   a.  When treating a nonterminally ill patient for intractable pain, evaluation by the attending physician and one or more physicians specializing in pain medicine or the treatment of the area, system, or organ of the body perceived as the source of the pain.
   b.  When treating a terminally ill patient, evaluation by the attending physician who does so in accordance with the level of care, skill, and treatment that would be recognized by a reasonably prudent physician under similar conditions and circumstances.
   7.  “Medical cannabis” means any species of the genus cannabis plant, or any mixture or preparation of them, including whole plant extracts and resins.
   8.  “Medical cannabis dispensary” means an entity licensed under section 124F.8 that acquires medical cannabis from a medical cannabis manufacturer in this state for the purpose of dispensing medical cannabis in this state pursuant to this chapter.
   9.  “Medical cannabis manufacturer” means an entity licensed under section 124F.6 to manufacture and to possess, cultivate, transport, or supply medical cannabis pursuant to the provisions of this chapter.
   10.  “Primary caregiver” means a person, at least eighteen years of age, who has been designated by a patient’s health care practitioner or a person having custody of a patient, as a necessary caretaker taking responsibility for managing the well-being of the patient with respect to the use of medical cannabis pursuant to the provisions of this chapter.
   11.  “Written certification” means a document signed by a health care practitioner, with whom the patient has established a patient-provider relationship, which states that the patient has a debilitating medical condition and identifies that condition and provides any other relevant information.
    Sec. 7.  NEW SECTION.  124F.3  Health care practitioner certification —— duties.
   1.  Prior to a patient’s submission of an application for a medical cannabis registration card pursuant to section 124F.4, a health care practitioner shall do all of the following:
   a.  Determine, in the health care practitioner’s medical judgment, whether the patient whom the health care practitioner has examined and treated suffers from a debilitating medical condition that qualifies for the use of medical cannabis under this chapter, and if so determined, provide the patient with a written certification of that diagnosis.
   b.  Provide explanatory information as provided by the department to the patient about the therapeutic use of medical cannabis.
   c.  Determine, on an annual basis, if the patient continues to suffer from a debilitating medical condition and, if so, issue the patient a new certification of that diagnosis. This paragraph shall not apply if the patient is suffering from an incurable debilitating medical condition.
   d.  Otherwise comply with all requirements established by the department pursuant to rule.
   2.  A health care practitioner may provide, but has no duty to provide, a written certification pursuant to this section.
    Sec. 8.  NEW SECTION.  124F.4  Medical cannabis registration card.
   1.  Issuance to patient.  The department may approve the issuance of a medical cannabis registration card by the department of transportation to a patient who:
   a.  Is at least eighteen years of age.
   b.  Is a permanent resident of this state.
   c.  Submits a written certification to the department signed by the patient’s health care practitioner that the patient is suffering from a debilitating medical condition.
   d.  Submits an application to the department, on a form created by the department, in consultation with the department of transportation, that contains all of the following:
   (1)  The patient’s full name, Iowa residence address, date of birth, and telephone number.
   (2)  A copy of the patient’s valid photograph identification.
   (3)  Full name, address, and telephone number of the patient’s health care practitioner.
   (4)  Full name, residence address, date of birth, and telephone number of each primary caregiver of the patient, if any.
   (5)  Any other information required by rule.
   e.  Submits a medical cannabis registration card fee of one hundred dollars to the department. If the patient attests to receiving social security disability benefits, supplemental security insurance payments, or being enrolled in the medical assistance program, the fee shall be twenty-five dollars.
   2.  Patient card contents.  A medical cannabis registration card issued to a patient by the department of transportation pursuant to subsection 1 shall contain, at a minimum, all of the following:
   a.  The patient’s full name, Iowa residence address, and date of birth.
   b.  The patient’s photograph.
   c.  The date of issuance and expiration of the registration card.
   d.  Any other information required by rule.
   3.  Issuance to primary caregiver.  For a patient in a primary caregiver’s care, the department may approve the issuance of a medical cannabis registration card by the department of transportation to the primary caregiver who:
   a.  Submits a written certification to the department signed by the patient’s health care practitioner that the patient in the primary caregiver’s care is suffering from a debilitating medical condition.
   b.  Submits an application to the department, on a form created by the department, in consultation with the department of transportation, that contains all of the following:
   (1)  The primary caregiver’s full name, residence address, date of birth, and telephone number.
   (2)  The patient’s full name.
   (3)  A copy of the primary caregiver’s valid photograph identification.
   (4)  Full name, address, and telephone number of the patient’s health care practitioner.
   (5)  Any other information required by rule.
   c.  Submits a medical cannabis registration card fee of twenty-five dollars to the department.
   4.  Primary caregiver card contents.  A medical cannabis registration card issued by the department of transportation to a primary caregiver pursuant to subsection 3 shall contain, at a minimum, all of the following:
   a.  The primary caregiver’s full name, residence address, and date of birth.
   b.  The primary caregiver’s photograph.
   c.  The date of issuance and expiration of the registration card.
   d.  The registration card number of each patient in the primary caregiver’s care. If the patient in the primary caregiver’s care is under the age of eighteen, the full name of the patient’s parent or legal guardian.
   e.  Any other information required by rule.
   5.  Expiration date of card.  A medical cannabis registration card issued pursuant to this section shall expire one year after the date of issuance and may be renewed.
   6.  Card issuance —— department of transportation.
   a.  The department may enter into a chapter 28E agreement with the department of transportation to facilitate the issuance of medical cannabis registration cards pursuant to subsections 1 and 3.
   b.  The department of transportation may issue renewal medical cannabis registration cards through an online or in-person process.
    Sec. 9.  NEW SECTION.  124F.5  Medical advisory board —— duties.
   1.  No later than August 15, 2019, the director of public health shall establish a medical advisory board consisting of nine practitioners representing the fields of neurology, pain management, gastroenterology, oncology, psychiatry, pediatrics, infectious disease, family medicine, and pharmacy, and three patients or primary caregivers with valid medical cannabis registration cards. The practitioners shall be nationally board-certified in their area of specialty and knowledgeable about the use of medical cannabis.
   2.  A quorum of the advisory board shall consist of seven members.
   3.  The duties of the advisory board shall include but not be limited to the following:
   a.  Reviewing and recommending to the department for approval additional chronic or debilitating diseases or medical conditions or their treatments as debilitating medical conditions that qualify for the use of medical cannabis under this chapter.
   b.  Accepting and reviewing petitions to add chronic or debilitating diseases or medical conditions or their medical treatments to the list of debilitating medical conditions that qualify for the use of medical cannabis under this chapter.
   c.  Working with the department regarding the requirements for the licensure of medical cannabis manufacturers and medical cannabis dispensaries, including licensure procedures.
   d.  Advising the department regarding the location of medical cannabis dispensaries throughout the state, the form and quantity of allowable medical cannabis to be dispensed to a patient or primary caregiver, and the general oversight of medical cannabis manufacturers and medical cannabis dispensaries in this state.
   e.  Convening at least twice per year to conduct public hearings and to review and recommend for approval petitions, which shall be maintained as confidential personal health information, to add chronic or debilitating diseases or medical conditions or their medical treatments to the list of debilitating medical conditions that qualify for the use of medical cannabis under this chapter.
   f.  Recommending improvements relating to the effectiveness of the provisions of this chapter.
   g.  In making recommendations pursuant to this section, consideration of the economic and financial impacts on patients and the medical cannabis industry, and making recommendations that minimize the extent of such impacts to the greatest extent practicable.
    Sec. 10.  NEW SECTION.  124F.6  Medical cannabis manufacturer licensure.
   1.  a.  The department shall license up to four medical cannabis manufacturers to manufacture  medical cannabis within this state consistent with the provisions of this chapter by December 1, 2019. The department shall license new medical cannabis manufacturers or relicense the existing medical cannabis manufacturers by December 1 of each year.
   b.  Information submitted during the application process shall be confidential until the medical cannabis manufacturer is licensed by the department unless otherwise protected from disclosure under state or federal law.
   2.  As a condition for licensure, a medical cannabis manufacturer must agree to begin supplying medical cannabis to medical cannabis dispensaries in this state by July 2, 2020.
   3.  The department shall consider the following factors in determining whether to license a medical cannabis manufacturer:
   a.  The technical expertise of the medical cannabis manufacturer regarding medical cannabis.
   b.  The qualifications of the medical cannabis manufacturer’s ownership and management team.
   c.  The long-term financial stability of the medical cannabis manufacturer.
   d.  The ability to provide appropriate security measures on the premises of the medical cannabis manufacturer.
   e.  Whether the medical cannabis manufacturer has demonstrated an ability to meet certain medical cannabis production needs for medical use regarding the range of recommended dosages for each debilitating medical condition, the range of chemical compositions of any plant of the genus cannabis that will likely be medically beneficial for each of the debilitating medical conditions, and the form of the medical cannabis in the manner determined by the department pursuant to rule.
   f.  The medical cannabis manufacturer’s projection of and ongoing assessment of fees on patients with debilitating medical conditions.
   g.  The medical cannabis manufacturer’s experience in medical cannabis production, plant extraction, and pharmaceutical formulations.
   4.  The department shall require each medical cannabis manufacturer to contract with a laboratory approved by the department to test the medical cannabis produced by the manufacturer. The department shall require that the laboratory report testing results to the manufacturer in a manner determined by the department pursuant to rule.
   5.  Each entity submitting an application for licensure as a medical cannabis manufacturer shall pay a nonrefundable application fee of fifteen thousand dollars to the department.
    Sec. 11.  NEW SECTION.  124F.7  Medical cannabis manufacturers.
   1.  A medical cannabis manufacturer shall contract with a laboratory approved by the department for purposes of testing the medical cannabis manufactured by the medical cannabis manufacturer as to content, contamination, and consistency. The cost of all laboratory testing shall be paid by the medical cannabis manufacturer.
   2.  The operating documents of a medical cannabis manufacturer shall include all of the following:
   a.  Procedures for the oversight of the medical cannabis manufacturer and procedures to ensure accurate recordkeeping.
   b.  Procedures for the implementation of appropriate security measures to deter and prevent the theft of medical cannabis and unauthorized entrance into areas containing medical cannabis.
   3.  A medical cannabis manufacturer shall implement security requirements, including requirements for protection of each location by a fully operational security alarm system, facility access controls, perimeter intrusion detection systems, and a personnel identification system.
   4.  A medical cannabis manufacturer shall not share office space with, refer patients to, or have any financial relationship with a health care practitioner.
   5.  A medical cannabis manufacturer shall not permit any person to consume medical cannabis on the property of the medical cannabis manufacturer.
   6.  A medical cannabis manufacturer is subject to reasonable inspection by the department.
   7.  A medical cannabis manufacturer shall not employ a person who is under eighteen years of age or who has been convicted of a disqualifying felony offense. An employee of a medical cannabis manufacturer shall be subject to a background investigation conducted by the division of criminal investigation of the department of public safety and a national criminal history background check.
   8.  A medical cannabis manufacturer shall not operate in any location, whether for manufacturing, cultivating, harvesting, packaging, or processing, within one thousand feet of a public or private school existing before the date of the medical cannabis manufacturer’s licensure by the department.
   9.  A medical cannabis manufacturer shall comply with reasonable restrictions set by the department relating to signage, marketing, display, and advertising of medical cannabis.
   10.  a.  A medical cannabis manufacturer shall provide a reliable and ongoing supply of medical cannabis to medical cannabis dispensaries pursuant to this chapter.
   b.  All manufacturing, cultivating, harvesting, packaging, and processing of medical cannabis shall take place in an enclosed, locked facility at a physical address provided to the department during the licensure process.
   c.  A medical cannabis manufacturer shall not manufacture edible medical cannabis products utilizing food coloring.
   d.  A medical cannabis manufacturer shall manufacture a reliable and ongoing supply of medical cannabis to treat every debilitating medical condition listed in this chapter.
   11.  The department shall establish and collect an annual fee from a medical cannabis manufacturer not to exceed the cost of regulating and inspecting the manufacturer in the calendar year.
    Sec. 12.  NEW SECTION.  124F.8  Medical cannabis dispensary licensure.
   1.  a.  The department shall license by April 2, 2020, twelve medical cannabis dispensaries to dispense medical cannabis within this state consistent with the provisions of this chapter. The department shall license new medical cannabis dispensaries or relicense the existing medical cannabis dispensaries by December 1 of each year.
   b.  Information submitted during the application process shall be confidential until the medical cannabis dispensary is licensed by the department unless otherwise protected from disclosure under state or federal law.
   2.  As a condition for licensure, a medical cannabis dispensary must agree to begin supplying medical cannabis to patients by July 16, 2020.
   3.  The department shall consider the following factors in determining whether to license a medical cannabis dispensary:
   a.  The technical expertise of the medical cannabis dispensary regarding medical cannabis.
   b.  The qualifications of the medical cannabis dispensary’s owners and management team.
   c.  The long-term financial stability of the medical cannabis dispensary.
   d.  The ability to provide appropriate security measures on the premises of the medical cannabis dispensary.
   e.  The medical cannabis dispensary’s projection and ongoing assessment of fees for the purchase of medical cannabis on patients with debilitating medical conditions.
   4.  Each entity submitting an application for licensure as a medical cannabis dispensary shall pay a nonrefundable application fee of fifteen thousand dollars to the department.
    Sec. 13.  NEW SECTION.  124F.9  Medical cannabis dispensaries.
   1.  a.  Medical cannabis dispensaries shall be located based on geographical need throughout the state to improve patient access.
   b.  A medical cannabis dispensary may dispense medical cannabis pursuant to the provisions of this chapter but shall not dispense any medical cannabis in a form or quantity other than the form or quantity allowed by the department pursuant to rule.
   2.  The operating documents of a medical cannabis dispensary shall include all of the following:
   a.  Procedures for the oversight of the medical cannabis dispensary and procedures to ensure accurate recordkeeping.
   b.  Procedures for the implementation of appropriate security measures to deter and prevent the theft of medical cannabis and unauthorized entrance into areas containing medical cannabis.
   3.  A medical cannabis dispensary shall implement security requirements, including requirements for protection by a fully operational security alarm system, facility access controls, perimeter intrusion detection systems, and a personnel identification system.
   4.  A medical cannabis dispensary shall not share office space with, refer patients to, or have any financial relationship with a health care practitioner.
   5.  A medical cannabis dispensary shall not permit any person to consume medical cannabis on the property of the medical cannabis dispensary.
   6.  A medical cannabis dispensary is subject to reasonable inspection by the department.
   7.  A medical cannabis dispensary shall not employ a person who is under eighteen years of age or who has been convicted of a disqualifying felony offense. An employee of a medical cannabis dispensary shall be subject to a background investigation conducted by the division of criminal investigation of the department of public safety and a national criminal history background check.
   8.  A medical cannabis dispensary shall not operate in any location within one thousand feet of a public or private school existing before the date of the medical cannabis dispensary’s licensure by the department.
   9.  A medical cannabis dispensary shall comply with reasonable restrictions set by the department relating to signage, marketing, display, and advertising of medical cannabis.
   10.  Prior to dispensing of any medical cannabis, a medical cannabis dispensary shall do all of the following:
   a.  Verify that the medical cannabis dispensary has received a valid medical cannabis registration card from a patient or a patient’s primary caregiver, if applicable.
   b.  Assign a tracking number to any medical cannabis dispensed from the medical cannabis dispensary.
   c.  (1)  Properly package medical cannabis in compliance with federal law regarding child resistant packaging and exemptions for packaging for elderly patients, and label medical cannabis with a list of all active ingredients and individually identifying information, including all of the following:
   (a)  The name and date of birth of the patient and the patient’s primary caregiver, if appropriate.
   (b)  The medical cannabis registration card numbers of the patient and the patient’s primary caregiver, if applicable.
   (c)  The chemical composition of the medical cannabis.
   (2)  Proper packaging of medical cannabis shall include but not be limited to all of the following:
   (a)  Warning labels regarding the use of medical cannabis by a woman during pregnancy and while breastfeeding.
   (b)  Clearly labeled packaging indicating that an edible medical cannabis product contains medical cannabis and which packaging shall not imitate candy products or in any way make the product marketable to children.
    Sec. 14.  NEW SECTION.  124F.10  Fees.
   Medical cannabis registration card fees and medical cannabis manufacturer and medical cannabis dispensary application and annual fees collected by the department pursuant to this chapter shall be retained by the department, shall be considered repayment receipts as defined in section 8.2, and shall be used for the purpose of regulating medical cannabis manufacturers and medical cannabis dispensaries and for other expenses necessary for the administration of this chapter.
    Sec. 15.  NEW SECTION.  124F.11  Department duties —— rules.
   1.  a.  The department shall maintain a confidential file of the names of each patient to or for whom the department issues a medical cannabis registration card, the name of each primary caregiver to whom the department issues a medical cannabis registration card under section 124F.4, and the names of each health care practitioner who provides a written certification for medical cannabis pursuant to this chapter.
   b.  Individual names contained in the file shall be confidential and shall not be subject to disclosure, except as provided in subparagraph (1).
   (1)  Information in the confidential file maintained pursuant to paragraph “a” may be released on an individual basis to the following persons under the following circumstances:
   (a)  To authorized employees or agents of the department and the department of transportation as necessary to perform the duties of the department and the department of transportation pursuant to this chapter.
   (b)  To authorized employees of state or local law enforcement agencies, but only for the purpose of verifying that a person is lawfully in possession of a medical cannabis registration card issued pursuant to this chapter.
   (c)  To authorized employees of a medical cannabis dispensary, but only for the purpose of verifying that a person is lawfully in possession of a medical cannabis registration card issued pursuant to this chapter.
   (d)  To any other authorized persons recognized by the department by rule, but only for the purpose of verifying that a person is lawfully in possession of a medical cannabis registration card issued pursuant to this chapter.
   (2)  Release of information pursuant to subparagraph (1) shall be consistent with the federal Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191.
   2.  The department shall adopt rules pursuant to chapter 17A to administer this chapter which shall include but not be limited to rules to do all of the following:
   a.  Govern the manner in which the department shall consider applications for new and renewal medical cannabis registration cards.
   b.  Identify criteria and set forth procedures for including additional chronic or debilitating diseases or medical conditions or their medical treatments on the list of debilitating medical conditions that qualify for the use of medical cannabis. Procedures shall include a petition process and shall allow for public comment and public hearings before the medical advisory board.
   c.  Set forth additional chronic or debilitating diseases or medical conditions or associated medical treatments for inclusion on the list of debilitating medical conditions that qualify for the use of medical cannabis as recommended by the medical advisory board.
   d.  Establish, in consultation with medical cannabis manufacturers and medical cannabis dispensaries, the form and quantity of medical cannabis allowed to be dispensed to a patient or primary caregiver pursuant to this chapter. The form and quantity of medical cannabis shall be appropriate to serve the medical needs of patients with debilitating medical conditions.
   e.  Establish, in conjunction with the medical advisory board, requirements for the licensure of medical cannabis manufacturers and medical cannabis dispensaries and set forth procedures for medical cannabis manufacturers and medical cannabis dispensaries to obtain licenses.
   f.  Develop a dispensing system for medical cannabis within this state that provides for all of the following:
   (1)  Medical cannabis dispensaries within this state housed on secured grounds and operated by licensed medical cannabis dispensaries.
   (2)  The dispensing of medical cannabis to patients and their primary caregivers to occur at locations designated by the department.
   g.  Establish and collect annual fees from medical cannabis manufacturers and medical cannabis dispensaries to cover the costs associated with regulating and inspecting medical cannabis manufacturers and medical cannabis dispensaries.
   h.  Specify and implement procedures that address public safety including security procedures and product quality including measures to ensure contaminant-free cultivation of medical cannabis, safety, and labeling.
   i.  Establish and implement a medical cannabis inventory and delivery tracking system to track medical cannabis from production by a medical cannabis manufacturer through dispensing at a medical cannabis dispensary.
    Sec. 16.  NEW SECTION.  124F.12  Reciprocity.
   A valid medical cannabis registration card, or its equivalent, issued under the laws of another state that allows an out-of-state patient to possess or use medical cannabis in the jurisdiction of issuance shall have the same force and effect as a valid medical cannabis registration card issued pursuant to this chapter, except that an out-of-state patient in this state shall not obtain medical cannabis from a medical cannabis dispensary in this state and an out-of-state patient shall not smoke medical cannabis.
    Sec. 17.  NEW SECTION.  124F.13  Use of medical cannabis —— affirmative defenses.
   1.  A health care practitioner, including any authorized agent or employee thereof, shall not be subject to prosecution for the unlawful certification, possession, or administration of marijuana under the laws of this state for activities arising directly out of or directly related to the certification or use of medical cannabis in the treatment of a patient diagnosed with a debilitating medical condition as authorized by this chapter.
   2.  A medical cannabis manufacturer, including any authorized agent or employee thereof, shall not be subject to prosecution for manufacturing, possessing, cultivating, harvesting, packaging, processing, transporting, or supplying medical cannabis pursuant to this chapter.
   3.  A medical cannabis dispensary, including any authorized agent or employee thereof, shall not be subject to prosecution for transporting, supplying, or dispensing medical cannabis pursuant to this chapter.
   a.  In a prosecution for the unlawful possession of marijuana under the laws of this state, including but not limited to chapters 124 and 453B, it is an affirmative and complete defense to the prosecution that the patient has been diagnosed with a debilitating medical condition, used or possessed medical cannabis pursuant to a certification by a health care practitioner as authorized under this chapter, and, for a patient eighteen years of age or older, is in possession of a valid medical cannabis registration card.
   b.  In a prosecution for the unlawful possession of marijuana under the laws of this state, including but not limited to chapters 124 and 453B, it is an affirmative and complete defense to the prosecution that the person possessed medical cannabis because the person is a primary caregiver of a patient who has been diagnosed with a debilitating medical condition and is in possession of a valid medical cannabis registration card, and where the primary caregiver’s possession of the medical cannabis is on behalf of the patient and for the patient’s use only as authorized under this chapter.
   c.  If a patient or primary caregiver is charged with the commission of a crime and is not in possession of the person’s medical cannabis registration card, any charge or charges filed against the person shall be dismissed by the court if the person produces to the court prior to or at the person’s trial a medical cannabis registration card issued to that person and valid at the time the person was charged.
   4.  An agency of this state or a political subdivision thereof, including any law enforcement agency, shall not remove or initiate proceedings to remove a patient under the age of eighteen from the home of a parent based solely upon the parent’s or patient’s possession or use of medical cannabis as authorized under this chapter.
    Sec. 18.  NEW SECTION.  124F.14  Penalties.
   1.  A person who knowingly or intentionally possesses or uses medical cannabis in violation of the requirements of this chapter is subject to the penalties provided under chapters 124 and 453B.
   2.  A medical cannabis manufacturer or a medical cannabis dispensary shall be assessed a civil penalty of up to one thousand dollars per violation for any violation of this chapter in addition to any other applicable penalties.
    Sec. 19.  NEW SECTION.  124F.15  Use of medical cannabis —— smoking prohibited.
   A patient shall not consume medical cannabis possessed or used as authorized under this chapter by smoking medical cannabis.
    Sec. 20.  NEW SECTION.  124F.16  Employment.
   1.  An employer in this state may retain, create, reinstate, or enforce a written zero tolerance policy prohibiting the possession or use of medical cannabis or any derivative thereof including cannabidiol by an employee in the employer’s workplace, including but not limited to a policy prohibiting an employee from having any detectable amount of medical cannabis or any derivative thereof including cannabidiol in the employee’s body while at work.
   2.  An employer’s prohibition of the possession or use of medical cannabis or any derivative thereof including cannabidiol under this section shall not be considered to be an unfair or discriminatory employment practice under section 216.6.
    Sec. 21.  Section 730.5, subsection 11, paragraph f, Code 2019, is amended to read as follows:
   f.  Testing or taking action against an employee or prospective employee with a confirmed positive test result due to the employee’s or prospective employee’s use of medical cannabidiol cannabis as authorized under chapter 124E 124F.
    Sec. 22.  REPEAL.  Chapter 124E, Code 2019, is repealed.
    Sec. 23.  EMERGENCY RULES.  The department may adopt emergency rules under section 17A.4, subsection 3, and section 17A.5, subsection 2, paragraph “b”, to implement the provisions of this division of this Act and the rules shall be effective immediately upon filing unless a later date is specified in the rules. Any rules adopted in accordance with this section shall also be published as a notice of intended action as provided in section 17A.4.
    Sec. 24.  TRANSITION PROVISIONS.
   1.  A medical cannabidiol registration card issued under chapter 124E prior to the effective date of this Act remains effective and continues in effect as issued for the twelve-month period following its issuance. This Act does not preclude a medical cannabidiol registration card holder from seeking to renew the registration card prior to the expiration of the twelve-month period.
   2.  Members of the medical cannabidiol board created in section 124E.5 shall continue to serve until the appointment of the medical advisory board created in section 124F.5.
   3.  Any rule, form, order, license, or directive promulgated by the medical cannabidiol board created in section 124E.5, or by the department, in force and effect immediately prior to the appointment of the medical advisory board, shall continue in full force and effect until the earlier of the following:
   a.  It is amended, rescinded, or supplemented by the affirmative actions of the medical advisory board or the department, as applicable.
   b.  It expires by its own terms.
   4.  A medical cannabidiol manufacturer licensed pursuant to section 124E.6 and operating immediately prior to the effective date of this Act shall operate as a medical cannabis manufacturer pursuant to section 124F.6 until the earlier of the following:
   a.  The license is revoked by the affirmative action of the department.
   b.  The license expires by its own terms.
   c.  The medical cannabidiol manufacturer becomes licensed as a medical cannabis manufacturer.
   5.  A medical cannabidiol dispensary licensed pursuant to section 124E.8 and operating immediately prior to the effective date of this Act shall operate as a medical cannabis dispensary pursuant to section 124F.8 until the earlier of the following:
   a.  The license is revoked by the affirmative action of the department.
   b.  The license expires by its own terms.
   c.  The medical cannabidiol dispensary becomes licensed as a medical cannabis dispensary.
    Sec. 25.  EFFECTIVE UPON ENACTMENT.  This Act, being deemed of immediate importance, takes effect upon enactment.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill creates the compassionate use of medical cannabis Act, reclassifies marijuana, including tetrahydrocannabinols, from a schedule I controlled substance to a schedule II controlled substance, and provides for civil and criminal penalties and fees. 
   OVERVIEW. The bill allows a patient with a debilitating medical condition who receives a written certification from the patient’s health care practitioner that the patient has a debilitating medical condition and who submits the written certification along with an application to the department of public health (department) for a medical cannabis registration card to allow for the lawful use of medical cannabis to treat the patient’s debilitating medical condition. A patient who is issued a medical cannabis registration card will be able to receive medical cannabis directly from a medical cannabis dispensary operated and licensed in this state.
   RECLASSIFICATION. The bill reclassifies marijuana, including tetrahydrocannabinols as a schedule II controlled substance instead of a schedule I controlled substance and strikes references to the authority of the board of pharmacy to adopt rules for the use of marijuana or tetrahydrocannabinols for medicinal purposes. 
   A schedule I controlled substance is a highly addictive substance that has no accepted medical use in the United States and a schedule II controlled substance is a highly addictive substance that has an accepted medical use in the United States. The reclassification of marijuana from a schedule I controlled substance to a schedule II controlled substance would allow a physician to issue a prescription for marijuana under state law. However, federal regulations may prohibit such prescriptions.
   The penalties remain unchanged for violations involving marijuana under the bill. The penalties under Code section 124.401 range from a class “B” felony punishable by up to 50 years of confinement to a serious misdemeanor punishable by up to six months of confinement depending on the amount of marijuana involved in the offense.
   The bill amends Code section 124.401, relating to prohibited acts involving controlled substances, to provide that it is lawful for a person to knowingly or intentionally recommend, possess, use, dispense, deliver, transport, or administer medical cannabis if the recommendation, possession, use, dispensing, delivery, transporting, or administering is in accordance with the provisions of the bill.
   DEFINITIONS. The bill provides the following definitions:
   “Debilitating medical condition” means cancer, multiple sclerosis, epilepsy or seizure disorders, AIDS or HIV, Hepatitis C, Crohn’s disease or ulcerative colitis, amyotrophic lateral sclerosis, intractable pain, glaucoma, any terminal illness with a probable life expectancy of under one year, Ehlers-Danlos syndrome, post-traumatic stress disorder, Tourette’s syndrome, and any other chronic or debilitating disease or medical condition or its medical treatment approved by the department by rule.
   “Health care practitioner” means an individual licensed under Code chapter 148 to practice medicine and surgery or osteopathic medicine and surgery or an individual licensed to prescribe medicine in any other state who provides specialty care to an Iowa resident for one or more debilitating medical conditions specified in the bill.
   “Medical cannabis” means any species of the genus cannabis plant, or any mixture or preparation of them, including whole plant extracts and resins.
   “Medical cannabis manufacturer” means an entity licensed by the department to manufacture and to possess, cultivate, transport, or supply, medical cannabis pursuant to the bill.
   “Medical cannabis dispensary” means an entity licensed under the bill that acquires medical cannabis from a medical cannabis manufacturer in this state for the purpose of dispensing medical cannabis in this state pursuant to the bill.
   “Primary caregiver” means a person, at least 18 years of age, who has been designated by a patient’s health care practitioner or a person having custody of a patient, as a necessary caretaker taking responsibility for managing the well-being of the patient with respect to the use of medical cannabis pursuant to the bill.
   “Written certification” means a document signed by a health care practitioner, with whom the patient has established a patient-provider relationship, which states that the patient has a debilitating medical condition and which identifies that condition, and provides any other relevant information.
   HEALTH CARE PRACTITIONER CERTIFICATION. The bill provides that prior to a patient’s submission of an application for a medical cannabis registration card, if a health care practitioner determines that the patient whom the health care practitioner has examined and treated suffers from a debilitating medical condition, the health care practitioner may provide the patient with a written certification of that diagnosis. The health care practitioner must also provide explanatory information to the patient about the therapeutic use of medical cannabis, and if the patient continues to suffer from a debilitating medical condition, the health care practitioner may issue the patient a new certification of that diagnosis on an annual basis. The bill specifies that a health care practitioner has no duty to provide a written certification.
   MEDICAL CANNABIS REGISTRATION CARD —— PATIENT AND PRIMARY CAREGIVER. The department may approve the issuance of a medical cannabis registration card to a patient who is at least 18 years of age and is a permanent resident of this state, who submits a written certification by the patient’s health care practitioner to the department, and who submits an application to the department with certain information along with a medical registration card fee. The department may also approve the issuance of a medical cannabis registration card to a primary caregiver who is at least 18 years of age, who submits a written certification by the patient’s health care practitioner to the department on behalf of the patient, and who submits an application to the department with certain information along with a medical cannabis registration card fee. A medical cannabis registration card expires one year after the date of issuance and may be renewed.
   MEDICAL ADVISORY BOARD. The director of public health is directed to establish a medical advisory board, no later than August 15, 2019, to consist of nine practitioners representing the fields of neurology, pain management, gastroenterology, oncology, psychiatry, pediatrics, infectious disease, family medicine, and pharmacy, and three patients or primary caregivers with valid medical cannabis registration cards. The duties of the board include but are not limited to reviewing and recommending to the department for approval additional chronic or debilitating diseases or medical conditions or their treatments as debilitating medical conditions that qualify for the use of medical cannabis under the bill.
   MEDICAL CANNABIS MANUFACTURERS AND MEDICAL CANNABIS DISPENSARIES —— LICENSURE. The bill requires the department to license up to four medical cannabis manufacturers for the manufacture of medical cannabis within this state by December 1, 2019, and to license twelve medical cannabis dispensaries by April 2, 2020. Information submitted during the application process is confidential until the medical cannabis manufacturer or the medical cannabis dispensary is licensed by the department unless otherwise protected from disclosure under state or federal law. As a condition for licensure, a medical cannabis manufacturer must agree to begin supplying medical cannabis to medical cannabis dispensaries in this state by July 2, 2020, and a medical cannabis dispensary must agree to begin supplying medical cannabis to patients by July 16, 2020. The department is directed to consider several factors in determining whether to license a medical cannabis manufacturer and a medical cannabis dispensary including technical expertise, employee qualifications, financial stability, security measures, and production needs and capacity. Each medical cannabis manufacturer is required to contract with a laboratory approved by the department to test the medical cannabis produced by the manufacturer and to report testing results to the medical cannabis manufacturer. Each entity submitting an application for licensure as a medical cannabis manufacturer shall pay a nonrefundable application fee of $15,000 to the department and each entity submitting an application for licensure as a medical cannabis dispensary shall pay a nonrefundable application fee of $15,000 to the department.
   MEDICAL CANNABIS MANUFACTURERS AND MEDICAL CANNABIS DISPENSARIES —— ADDITIONAL PROVISIONS. The operating documents of a medical cannabis manufacturer and a medical cannabis dispensary shall include procedures for oversight and recordkeeping activities of the medical cannabis manufacturer and the medical cannabis dispensary and certain security measures undertaken by the medical cannabis manufacturer and the medical cannabis dispensary. A medical cannabis manufacturer and a medical cannabis dispensary are prohibited from sharing office space with, referring patients to, or having a financial relationship with a health care practitioner, permitting any person to consume medical cannabis on the property of the medical cannabis manufacturer or the medical cannabis dispensary, employing a person who is under 18 years of age or who has been convicted of a disqualifying felony offense, and from operating in any location within 1,000 feet of a public or private school existing before the date of the licensure of the medical cannabis manufacturer or the medical cannabis dispensary. In addition, a medical cannabis manufacturer and a medical cannabis dispensary are subject to reasonable inspection and certain reasonable restrictions.
   A medical cannabis manufacturer is required to provide a reliable and ongoing supply of medical cannabis to medical cannabis dispensaries and shall not manufacture edible medical cannabis products utilizing food coloring. All manufacturing, cultivating, harvesting, packaging, and processing of medical cannabis is required to take place in an enclosed, locked facility.
   Prior to dispensing any medical cannabis, a medical cannabis dispensary is required to verify that the medical cannabis dispensary has received a valid medical cannabis registration card from a patient or a patient’s primary caregiver, if applicable, assign a tracking number to any medical cannabis dispensed from the medical cannabis dispensary, and properly package and label medical cannabis in compliance with the provisions of the bill and certain federal laws. 
   DEPARTMENT DUTIES —— CONFIDENTIALITY. The department is required to maintain a confidential file of the names of each patient and primary caregiver issued a medical cannabis registration card, and the names of each health care practitioner who provides a written certification for medical cannabis under the bill. Individual names contained in the file shall be confidential and shall not be subject to disclosure, except that information in the confidential file may be released on an individual basis to authorized employees or agents of the department, the department of transportation, and a medical cannabis dispensary as necessary to perform their duties, to authorized employees of state or local law enforcement agencies for the purpose of verifying that a person is lawfully in possession of a medical cannabis registration card, and to any other authorized employees for the purpose of verifying that a person is lawfully in possession of a medical cannabis registration card. Release of information must also be consistent with federal Health Insurance Portability and Accountability Act regulations.
   ADDITIONAL DEPARTMENT DUTIES —— RULES. The bill requires the department to adopt rules relating to the manner in which the department shall consider applications for new and renewal medical cannabis registration cards, identify criteria and set forth procedures for including additional chronic or debilitating diseases or medical conditions or their medical treatments on the list of debilitating medical conditions, establish the form and quantity of medical cannabis allowed to be dispensed to a patient or primary caregiver in the form and quantity appropriate to serve the medical needs of the patient with the debilitating medical condition, establish requirements for the licensure of medical cannabis manufacturers and medical cannabis dispensaries, develop a dispensing system for medical cannabis within this state that follows certain requirements, establish and implement a medical cannabis inventory and delivery tracking system, and specify and implement procedures that address public safety including security procedures and product quality, safety, and labeling.
   RECIPROCITY. The bill provides that a valid medical cannabis registration card, or its equivalent, issued under the laws of another state that allows an out-of-state patient to possess or use medical cannabis in the jurisdiction of issuance shall have the same force and effect as a valid medical cannabis card issued under the bill, except that an out-of-state patient in this state shall not obtain medical cannabis from a medical cannabis dispensary and an out-of-state patient shall not smoke medical cannabis in this state.
   USE OF MEDICAL CANNABIS —— SMOKING PROHIBITED. The bill provides that a patient shall not consume the medical cannabis by smoking the medical cannabis.
   USE OF MEDICAL CANNABIS —— AFFIRMATIVE DEFENSES. The bill provides prosecution immunity for a health care practitioner, a medical cannabis manufacturer, and a medical cannabis dispensary, including any authorized agents or employees of the health care practitioner, medical cannabis manufacturer, and medical cannabis dispensary, for activities undertaken by the health care practitioner, medical cannabis manufacturer, and medical cannabis dispensary pursuant to the provisions of the bill.
   The bill provides that in a prosecution for the unlawful possession of marijuana under the laws of this state, including but not limited to Code chapters 124 (controlled substances) and 453B (excise tax on unlawful dealing in certain substances), it is an affirmative and complete defense to the prosecution that the patient has been diagnosed with a debilitating medical condition, used or possessed medical cannabis pursuant to a certification by a health care practitioner, and, for a patient age 18 or older, is in possession of a valid medical cannabis registration card. The bill provides a similar affirmative defense for a primary caretaker of a patient who has been diagnosed with a debilitating medical condition who is in possession of a valid medical cannabis registration card.
   The bill provides that an agency of this state or a political subdivision thereof, including any law enforcement agency, shall not remove or initiate proceedings to remove a patient under the age of 18 from the home of a parent based solely upon the parent’s or patient’s possession or use of medical cannabis as authorized under the bill.
   PENALTIES. The bill provides that a person who knowingly or intentionally possesses or uses medical cannabis in violation of the requirements of the bill is subject to the penalties provided under Code chapters 124 and 453B. In addition, a medical cannabis manufacturer or a medical cannabis dispensary shall be assessed a civil penalty of up to $1,000 per violation for any violation of the bill in addition to any other applicable penalties.
   REPEAL. The bill repeals Code chapter 124E, the medical cannabidiol Act.
   EMERGENCY RULES. The bill provides that the department may adopt emergency rules and the rules shall be effective immediately upon filing unless a later date is specified in the rules. 
   EFFECTIVE DATE. The bill takes effect upon enactment.
   TRANSITION PROVISIONS. The bill provides that a medical cannabis registration card issued under Code chapter 124E (medical cannabidiol Act) prior to the effective date of the bill, shall remain effective and continues in effect as issued for the 12-month period following its issuance. The bill also provides that members of the medical cannabidiol board shall continue to serve until the appointment of the medical advisory board and that rules, forms, orders, licenses, and directives promulgated by the medical cannabidiol board that are in force and effect immediately prior to the appointment of the medical advisory board shall remain in full force and effect until amended, rescinded, or supplemented by affirmative actions of the medical advisory board or they expire by their own terms.