Senate Study Bill 1243 - Introduced SENATE FILE _____ BY (PROPOSED COMMITTEE ON WAYS AND MEANS BILL BY CHAIRPERSON BOLKCOM) A BILL FOR An Act creating the medical cannabis Act and providing for 1 civil and criminal penalties and fees. 2 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 3 TLSB 2576XC (4) 86 rh/rj

S.F. _____ Section 1. Section 124.401, subsection 5, unnumbered 1 paragraph 3, Code 2015, is amended to read as follows: 2 A person may knowingly or intentionally recommend, possess, 3 use, dispense, deliver, transport, or administer cannabidiol 4 medical cannabis if the recommendation, possession, use, 5 dispensing, delivery, transporting, or administering is in 6 accordance with the provisions of chapter 124D 124E . For 7 purposes of this paragraph, “cannabidiol” “medical cannabis” 8 means the same as defined in section 124D.2 124E.2 . 9 Sec. 2. NEW SECTION . 124E.1 Short title. 10 This chapter shall be known and may be cited as the “Medical 11 Cannabis Act” . 12 Sec. 3. NEW SECTION . 124E.2 Definitions. 13 As used in this chapter: 14 1. “Debilitating medical condition” means any of the 15 following: 16 a. Cancer. 17 b. Multiple sclerosis. 18 c. Epilepsy. 19 d. AIDS or HIV as defined in section 141A.1. 20 e. Glaucoma. 21 f. Hepatitis C. 22 g. Crohn’s disease or ulcerative colitis. 23 h. Amyotrophic lateral sclerosis. 24 i. Ehlers-danlos syndrome. 25 j. Post-traumatic stress syndrome. 26 k. Any other chronic or debilitating disease or medical 27 condition or its medical treatment approved by the department 28 pursuant to rule. 29 2. “Department” means the department of public health. 30 3. “Disqualifying felony offense” means a violation under 31 federal or state law of a felony offense, which has as an 32 element the possession, use, or distribution of a controlled 33 substance, as defined in 21 U.S.C. §802(6). 34 4. “Enclosed, locked facility” means a closet, room, 35 -1- LSB 2576XC (4) 86 rh/rj 1/ 23

S.F. _____ greenhouse, or other enclosed area equipped with locks or other 1 security devices that permit access only by a cardholder. 2 5. “Health care practitioner” means an individual licensed 3 under chapter 148 to practice medicine and surgery or 4 osteopathic medicine and surgery, a physician assistant 5 licensed under chapter 148C, or an advanced registered nurse 6 practitioner licensed pursuant to chapter 152 or 152E. 7 6. “Medical cannabis” means any species of the genus 8 cannabis plant, or any mixture or preparation of them, 9 including whole plant extracts and resins. 10 7. “Medical cannabis dispensary” means an entity licensed 11 under section 124E.6 that dispenses and acquires, possesses, 12 cultivates, or manufactures medical cannabis pursuant to this 13 chapter. 14 8. “Medical cannabis manufacturer” means an entity licensed 15 by the department to manufacture and to possess, cultivate, 16 transport, supply, or dispense medical cannabis pursuant to the 17 provisions of this chapter. 18 9. “Primary caregiver” means a person, at least eighteen 19 years of age, who has been designated by a patient’s health 20 care practitioner or a person having custody of a patient, as 21 a necessary caretaker taking responsibility for managing the 22 well-being of the patient with respect to the use of medical 23 cannabis pursuant to the provisions of this chapter. 24 10. “Written certification” means a document signed by a 25 health care practitioner, with whom the patient has established 26 a patient-provider relationship, which states that the patient 27 has a debilitating medical condition and identifies that 28 condition and provides any other relevant information. 29 Sec. 4. NEW SECTION . 124E.3 Health care practitioner 30 certification —— duties. 31 1. Prior to a patient’s submission of an application for a 32 medical cannabis card pursuant to section 124E.4, a health care 33 practitioner shall do all of the following: 34 a. Determine, in the health care practitioner’s medical 35 -2- LSB 2576XC (4) 86 rh/rj 2/ 23

S.F. _____ judgment, whether the patient whom the health care practitioner 1 has examined and treated suffers from a debilitating medical 2 condition that qualifies for the use of medical cannabis under 3 this chapter, and if so determined, provide the patient with a 4 written certification of that diagnosis. 5 b. Provide explanatory information as provided by the 6 department to the patient about the therapeutic use of medical 7 cannabis. 8 2. Determine, on an annual basis, if the patient continues 9 to suffer from a debilitating medical condition and, if so, 10 issue the patient a new certification of that diagnosis. 11 3. Otherwise comply with all requirements established by 12 the department pursuant to rule. 13 4. A health care practitioner may provide, but has no duty 14 to provide, a written certification pursuant to this section. 15 Sec. 5. NEW SECTION . 124E.4 Medical cannabis registration 16 card. 17 1. Issuance to patient. The department may approve the 18 issuance of a medical cannabis registration card by the 19 department of transportation to a patient who: 20 a. Is at least eighteen years of age. 21 b. Is a permanent resident of this state. 22 c. Submits a written certification to the department signed 23 by the patient’s health care practitioner that the patient is 24 suffering from a debilitating medical condition. 25 d. Submits an application to the department, on a form 26 created by the department, in consultation with the department 27 of transportation, that contains all of the following: 28 (1) The patient’s full name, Iowa residence address, date 29 of birth, and telephone number. 30 (2) A copy of the patient’s valid photo identification. 31 (3) Full name, address, and telephone number of the 32 patient’s health care practitioner. 33 (4) Full name, residence address, date of birth, and 34 telephone number of each primary caregiver of the patient, if 35 -3- LSB 2576XC (4) 86 rh/rj 3/ 23

S.F. _____ any. 1 (5) Any other information required by rule. 2 2. Patient card contents. A medical cannabis registration 3 card issued to a patient by the department of transportation 4 pursuant to subsection 1 shall contain, at a minimum, all of 5 the following: 6 a. The patient’s full name, Iowa residence address, and date 7 of birth. 8 b. The patient’s photo. 9 c. The date of issuance and expiration date of the 10 registration card. 11 d. Any other information required by rule. 12 3. Issuance to primary caregiver. For a patient in a 13 primary caregiver’s care, the department may approve the 14 issuance of a medical cannabis registration card by the 15 department of transportation to the primary caregiver who: 16 a. Is at least eighteen years of age. 17 b. Submits a written certification to the department signed 18 by the patient’s health care practitioner that the patient in 19 the primary caregiver’s care is suffering from a debilitating 20 medical condition. 21 c. Submits an application to the department, on a form 22 created by the department, in consultation with the department 23 of transportation, that contains all of the following: 24 (1) The primary caregiver’s full name, residence address, 25 date of birth, and telephone number. 26 (2) The patient’s full name. 27 (3) A copy of the primary caregiver’s valid photo 28 identification. 29 (4) Full name, address, and telephone number of the 30 patient’s health care practitioner. 31 (5) Any other information required by rule. 32 4. Primary caregiver card contents. A medical cannabis 33 registration card issued by the department of transportation to 34 a primary caregiver pursuant to subsection 3 shall contain, at 35 -4- LSB 2576XC (4) 86 rh/rj 4/ 23

S.F. _____ a minimum, all of the following: 1 a. The primary caregiver’s full name, residence address, and 2 date of birth. 3 b. The primary caregiver’s photo. 4 c. The date of issuance and expiration date of the 5 registration card. 6 d. The full name of each patient in the primary caregiver’s 7 care. 8 e. Any other information required by rule. 9 5. Expiration date of card. A medical cannabis registration 10 card issued pursuant to this section shall expire one year 11 after the date of issuance and may be renewed. 12 6. Card issuance —— department of transportation. The 13 department may enter into a chapter 28E agreement with the 14 department of transportation to facilitate the issuance of 15 medical cannabis registration cards pursuant to subsections 1 16 and 3. 17 Sec. 6. NEW SECTION . 124E.5 Medical advisory board —— 18 duties. 19 1. No later than August 15, 2015, the director of public 20 health shall establish a medical advisory board consisting 21 of nine practitioners representing the fields of neurology, 22 pain management, gastroenterology, oncology, psychiatry, 23 infectious disease, family medicine, gynecology, and pharmacy. 24 The practitioners shall be nationally board-certified in their 25 area of specialty and knowledgeable about the use of medical 26 cannabis. 27 2. A quorum of the advisory board shall consist of five 28 members. 29 3. The duties of the advisory board shall include but not be 30 limited to the following: 31 a. Reviewing and recommending to the department for 32 approval additional chronic or debilitating diseases or 33 medical conditions or their treatments as debilitating medical 34 conditions that qualify for the use of medical cannabis under 35 -5- LSB 2576XC (4) 86 rh/rj 5/ 23

S.F. _____ this chapter. 1 b. Accepting and reviewing petitions to add chronic or 2 debilitating diseases or medical conditions or their medical 3 treatments to the list of debilitating medical conditions that 4 qualify for the use of medical cannabis under this chapter. 5 c. Advising the department regarding the location of 6 medical cannabis dispensaries throughout the state, the form 7 and quantity of allowable medical cannabis to be dispensed 8 to a patient or primary caregiver, and the general oversight 9 of medical cannabis manufacturers and medical cannabis 10 dispensaries in this state. 11 d. Convening at least twice per year to conduct public 12 hearings and to evaluate petitions, which shall be maintained 13 as confidential personal health information, to add chronic or 14 debilitating diseases or medical conditions or their medical 15 treatments to the list of debilitating medical conditions that 16 qualify for the use of medical cannabis under this chapter. 17 Sec. 7. NEW SECTION . 124E.6 Medical cannabis manufacturer 18 licensure. 19 1. a. The department shall license four medical cannabis 20 manufacturers to manufacture medical cannabis within this state 21 consistent with the provisions of this chapter by December 22 1, 2015. The department shall license new medical cannabis 23 manufacturers or relicense the existing medical cannabis 24 manufacturers by December 1 of each year. 25 b. Information submitted during the application process 26 shall be confidential until the medical cannabis manufacturer 27 is licensed by the department unless otherwise protected from 28 disclosure under state or federal law. 29 2. As a condition for licensure, a medical cannabis 30 manufacturer must agree to begin supplying medical cannabis to 31 patients by July 1, 2016. 32 3. The department shall consider the following factors in 33 determining whether to license a medical cannabis manufacturer: 34 a. The technical expertise of the medical cannabis 35 -6- LSB 2576XC (4) 86 rh/rj 6/ 23

S.F. _____ manufacturer in medical cannabis. 1 b. The qualifications of the medical cannabis manufacturer’s 2 employees. 3 c. The long-term financial stability of the medical cannabis 4 manufacturer. 5 d. The ability to provide appropriate security measures on 6 the premises of the medical cannabis manufacturer. 7 e. Whether the medical cannabis manufacturer has 8 demonstrated an ability to meet certain medical cannabis 9 production needs for medical use in the manner determined by 10 the department pursuant to rule. 11 f. The medical cannabis manufacturer’s projection and 12 ongoing assessment of fees on patients with debilitating 13 medical conditions. 14 4. The department shall require each medical cannabis 15 manufacturer to contract with the state hygienic laboratory 16 at the university of Iowa in Iowa City to test the medical 17 cannabis produced by the manufacturer. The department shall 18 require that the laboratory report testing results to the 19 manufacturer in a manner determined by the department pursuant 20 to rule. 21 5. Each entity submitting an application for licensure as a 22 medical cannabis manufacturer shall pay an application fee of 23 seven thousand five hundred dollars to the department. 24 Sec. 8. NEW SECTION . 124E.7 Medical cannabis manufacturers 25 —— medical cannabis dispensaries. 26 1. a. A medical cannabis manufacturer shall operate three 27 medical cannabis dispensaries, which may include the medical 28 cannabis manufacturer’s single location for manufacturing and 29 cultivating, harvesting, packaging, or processing. 30 b. A medical cannabis manufacturer shall begin dispensing 31 medical cannabis from at least one medical cannabis dispensary 32 by July 1, 2016. 33 c. The medical cannabis dispensaries shall be located based 34 on geographical need throughout the state to improve patient 35 -7- LSB 2576XC (4) 86 rh/rj 7/ 23

S.F. _____ access. 1 d. A medical cannabis manufacturer shall disclose the 2 proposed locations for the medical cannabis dispensaries to the 3 department during the licensure process. 4 e. A medical cannabis manufacturer shall operate only one 5 location where all manufacturing and cultivating, harvesting, 6 packaging, or processing shall be conducted. The other medical 7 cannabis dispensaries may dispense medical cannabis pursuant 8 to the provisions of this chapter but shall not dispense any 9 medical cannabis in a form or quantity other than the form or 10 quantity allowed by the department pursuant to rule. 11 2. A medical cannabis manufacturer shall contract with the 12 state hygienic laboratory at the university of Iowa in Iowa 13 City for purposes of testing the medical cannabis manufactured 14 by the medical cannabis manufacturer as to content, 15 contamination, and consistency. The cost of all laboratory 16 testing shall be paid by the medical cannabis manufacturer. 17 3. The operating documents of a medical cannabis 18 manufacturer shall include all of the following: 19 a. Procedures for the oversight of the medical cannabis 20 manufacturer and procedures to ensure accurate record keeping. 21 b. Procedures for the implementation of appropriate security 22 measures to deter and prevent the theft of medical cannabis and 23 unauthorized entrance into areas containing medical cannabis. 24 4. A medical cannabis manufacturer shall implement security 25 requirements, including requirements for protection of each 26 location by a fully operational security alarm system, facility 27 access controls, perimeter intrusion detection systems, and a 28 personnel identification system. 29 5. A medical cannabis manufacturer shall not share 30 office space with, refer patients to, or have any financial 31 relationship with a health care practitioner. 32 6. A medical cannabis manufacturer shall not permit any 33 person to consume medical cannabis on the property of the 34 medical cannabis manufacturer. 35 -8- LSB 2576XC (4) 86 rh/rj 8/ 23

S.F. _____ 7. A medical cannabis manufacturer is subject to reasonable 1 inspection by the department. 2 8. A medical cannabis manufacturer shall not employ 3 a person under twenty-one years of age or who has been 4 convicted of a disqualifying felony offense. An employee 5 of a medical cannabis manufacturer shall be subject to a 6 background investigation conducted by the division of criminal 7 investigation of the department of public safety and a national 8 criminal history background check. 9 9. A medical cannabis manufacturer shall not operate in 10 any location, whether for dispensing or for manufacturing, 11 cultivating, harvesting, packaging, or processing, within one 12 thousand feet of a public or private school existing before the 13 date of the medical cannabis manufacturer’s licensure by the 14 department. 15 10. A medical cannabis manufacturer shall comply with 16 reasonable restrictions set by the department relating to 17 signage, marketing, display, and advertising of medical 18 cannabis. 19 Sec. 9. NEW SECTION . 124E.8 Medical cannabis manufacturer 20 —— production and dispensation. 21 1. Production. 22 a. A medical cannabis manufacturer shall provide a reliable 23 and ongoing supply of medical cannabis for all patients served 24 pursuant to this chapter. 25 b. All manufacturing, cultivating, harvesting, 26 manufacturing, packaging, and processing of medical cannabis 27 shall take place in an enclosed, locked facility at a physical 28 address provided to the department during the licensure 29 process. 30 2. Dispensation. Prior to dispensing of any medical 31 cannabis, the medical cannabis manufacturer shall do all of the 32 following: 33 a. Verify that the medical cannabis manufacturer has 34 received a valid medical cannabis registration card from a 35 -9- LSB 2576XC (4) 86 rh/rj 9/ 23

S.F. _____ patient or a patient’s primary caregiver, if applicable. 1 b. Assign a tracking number to any medical cannabis 2 dispensed from the manufacturer. 3 c. Properly package medical cannabis in compliance with 4 federal law regarding child resistant packaging and exemptions 5 for packaging for elderly patients, and label medical cannabis 6 with a list of all active ingredients and individually 7 identifying information, including all of the following: 8 (1) The name and date of birth of the patient and the 9 patient’s primary caregiver, if appropriate. 10 (2) The medical cannabis registration card numbers of the 11 patient and the patient’s primary caregiver, if applicable. 12 (3) The chemical composition of the medical cannabis. 13 Sec. 10. NEW SECTION . 124E.9 Department duties —— rules. 14 1. a. The department shall maintain a confidential file 15 of the names of each patient to or for whom the department 16 issues a medical cannabis registration card and the name of 17 each primary caregiver to whom the department issues a medical 18 cannabis registration card under section 124E.4. 19 b. Individual names contained in the file shall be 20 confidential and shall not be subject to disclosure, except as 21 provided in subparagraph (1). 22 (1) Information in the confidential file maintained 23 pursuant to paragraph “a” may be released on an individual basis 24 to the following persons under the following circumstances: 25 (a) To authorized employees or agents of the department and 26 the department of transportation as necessary to perform the 27 duties of the department and the department of transportation 28 pursuant to this chapter. 29 (b) To authorized employees of state or local law 30 enforcement agencies, but only for the purpose of verifying 31 that a person is lawfully in possession of a medical cannabis 32 registration card issued pursuant to this chapter. 33 (c) To authorized employees of a medical cannabis 34 manufacturer, but only for the purpose of verifying that 35 -10- LSB 2576XC (4) 86 rh/rj 10/ 23

S.F. _____ a person is lawfully in possession of a medical cannabis 1 registration card issued pursuant to this chapter. 2 (2) Release of information pursuant to subparagraph 3 (1) shall be consistent with the federal Health Insurance 4 Portability and Accountability Act of 1996, Pub. L. No. 5 104-191. 6 2. The department shall adopt rules pursuant to chapter 7 17A to administer this chapter which shall include but not be 8 limited to rules to do all of the following: 9 a. Govern the manner in which the department shall consider 10 applications for new and renewal medical cannabis registration 11 cards. 12 b. Identify criteria and set forth procedures for 13 including additional chronic or debilitating diseases or 14 medical conditions or their medical treatments on the list of 15 debilitating medical conditions that qualify for the use of 16 medical cannabis. Procedures shall include a petition process 17 and shall allow for public comment and public hearings before 18 the medical advisory board. 19 c. Set forth additional chronic or debilitating diseases or 20 medical conditions or their medical treatments for inclusion 21 on the list of debilitating medical conditions that qualify 22 for the use of medical cannabis as recommended by the medical 23 advisory board. 24 d. Establish the form and quantity of medical cannabis 25 allowed to be dispensed to a patient or primary caregiver 26 pursuant to this chapter. The form and quantity of medical 27 cannabis shall be appropriate to serve the medical needs of 28 patients with debilitating conditions. 29 e. Establish requirements for the licensure of medical 30 cannabis manufacturers and set forth procedures for medical 31 cannabis manufacturers to obtain licenses. 32 f. Develop a dispensing system for medical cannabis within 33 this state that provides for all of the following: 34 (1) Medical cannabis manufacturing facilities within this 35 -11- LSB 2576XC (4) 86 rh/rj 11/ 23

S.F. _____ state housed on secured grounds and operated by licensed 1 medical cannabis manufacturers. 2 (2) The dispensing of medical cannabis to patients and 3 their primary caregivers to occur at locations designated by 4 the department. 5 g. Establish medical cannabis registration card application 6 and renewal fees. 7 h. Specify and implement procedures that address public 8 safety including security procedures and product quality 9 including measures to ensure contaminant-free cultivation of 10 medical cannabis, safety, and labeling. 11 Sec. 11. NEW SECTION . 124E.10 Reciprocity. 12 A valid medical cannabis registration card, or its 13 equivalent, issued under the laws of another state that allows 14 an out-of-state patient to possess or use medical cannabis in 15 the jurisdiction of issuance shall have the same force and 16 effect as a valid medical cannabis registration card issued 17 pursuant to this chapter, except that an out-of-state patient 18 in this state shall not obtain medical cannabis from a medical 19 cannabis dispensary in this state. 20 Sec. 12. NEW SECTION . 124E.11 Use of medical cannabis —— 21 smoking prohibited. 22 A patient shall not consume medical cannabis possessed or 23 used as authorized by this chapter by smoking medical cannabis. 24 Sec. 13. NEW SECTION . 124E.12 Use of medical cannabis —— 25 affirmative defenses. 26 1. A health care practitioner, including any authorized 27 agent or employee thereof, shall not be subject to 28 prosecution for the unlawful certification, possession, or 29 administration of marijuana under the laws of this state for 30 activities arising directly out of or directly related to the 31 certification or use of medical cannabis in the treatment of 32 a patient diagnosed with a debilitating medical condition as 33 authorized by this chapter. 34 2. A medical cannabis manufacturer, including any 35 -12- LSB 2576XC (4) 86 rh/rj 12/ 23

S.F. _____ authorized agent or employee thereof, shall not be subject 1 to prosecution for manufacturing, possessing, cultivating, 2 harvesting, packaging, or processing, or transporting, 3 supplying, or dispensing medical cannabis pursuant to this 4 chapter. 5 3. A medical cannabis dispensary, including any authorized 6 agent or employee thereof, shall not be subject to prosecution 7 for transporting, supplying, or dispensing medical cannabis 8 pursuant to this chapter. 9 a. In a prosecution for the unlawful possession of marijuana 10 under the laws of this state, including but not limited to 11 chapters 124 and 453B, it is an affirmative and complete 12 defense to the prosecution that the patient has been diagnosed 13 with a debilitating medical condition, used or possessed 14 medical cannabis pursuant to a certification by a health care 15 practitioner as authorized under this chapter, and, for a 16 patient eighteen years of age or older, is in possession of a 17 valid medical cannabis registration card. 18 b. In a prosecution for the unlawful possession of marijuana 19 under the laws of this state, including but not limited to 20 chapters 124 and 453B, it is an affirmative and complete 21 defense to the prosecution that the person possessed medical 22 cannabis because the person is a primary caregiver of a patient 23 who has been diagnosed with a debilitating medical condition 24 and is in possession of a valid medical cannabis registration 25 card, and where the primary caregiver’s possession of the 26 medical cannabis is on behalf of the patient and for the 27 patient’s use only as authorized under this chapter. 28 c. If a patient or primary caregiver is charged with the 29 commission of a crime and is not in possession of the person’s 30 medical cannabis registration card, any charge or charges filed 31 against the person shall be dismissed by the court if the 32 person produces to the court prior to or at the person’s trial 33 a medical cannabis registration card issued to that person and 34 valid at the time the person was charged. 35 -13- LSB 2576XC (4) 86 rh/rj 13/ 23

S.F. _____ 4. An agency of this state or a political subdivision 1 thereof, including any law enforcement agency, shall not remove 2 or initiate proceedings to remove a patient under the age 3 of eighteen from the home of a parent based solely upon the 4 parent’s or patient’s possession or use of medical cannabis as 5 authorized under this chapter. 6 Sec. 14. NEW SECTION . 124E.13 Penalties. 7 1. A person who knowingly or intentionally possesses or 8 uses medical cannabis in violation of the requirements of this 9 chapter is subject to the penalties provided under chapters 124 10 and 453B. 11 2. A medical cannabis manufacturer shall be assessed a civil 12 penalty of up to one thousand dollars per violation for any 13 violation of this chapter in addition to any other applicable 14 penalties. 15 Sec. 15. EMERGENCY RULES. The department may adopt 16 emergency rules under section 17A.4, subsection 3, and section 17 17A.5, subsection 2, paragraph “b”, to implement the provisions 18 of this Act and the rules shall be effective immediately upon 19 filing unless a later date is specified in the rules. Any 20 rules adopted in accordance with this section shall also be 21 published as a notice of intended action as provided in section 22 17A.4. 23 Sec. 16. TRANSITION PROVISIONS. A medical cannabis 24 registration card issued under chapter 124D prior to July 1, 25 2015, remains effective and continues in effect as issued for 26 the twelve-month period following its issuance. This Act does 27 not preclude the permit holder from seeking to renew the permit 28 under this Act prior to the expiration of the twelve-month 29 period. 30 Sec. 17. REPORTS. The university of Iowa Carver college of 31 medicine and college of pharmacy shall, on or before July 1 of 32 each year, beginning July 1, 2016, submit a report detailing 33 the scientific literature, studies, and clinical trials 34 regarding the use of medical cannabis on patients diagnosed 35 -14- LSB 2576XC (4) 86 rh/rj 14/ 23

S.F. _____ with debilitating medical conditions as defined in this Act to 1 the department of public health and the general assembly. 2 Sec. 18. REPEAL. Chapter 124D, Code 2015, is repealed. 3 EXPLANATION 4 The inclusion of this explanation does not constitute agreement with 5 the explanation’s substance by the members of the general assembly. 6 This bill creates the medical cannabis Act and provides for 7 civil and criminal penalties and fees. 8 OVERVIEW. The bill allows a patient with a debilitating 9 medical condition who receives written certification from 10 the patient’s health care practitioner that the patient has 11 a debilitating medical condition and who submits the written 12 certification along with an application to the department of 13 public health (department) for a medical cannabis registration 14 card to allow for the lawful use of medical cannabis to treat 15 the patient’s debilitating medical condition. A patient who 16 is issued a medical cannabis registration card will be able 17 to receive medical cannabis directly from a medical cannabis 18 dispensary in this state operated by a medical cannabis 19 manufacturer licensed by the state. 20 DEFINITIONS. The bill provides the following definitions: 21 “Debilitating medical condition” means cancer, multiple 22 sclerosis, epilepsy, AIDS or HIV, glaucoma, hepatitis C, 23 Crohn’s disease or ulcerative colitis, amyotrophic lateral 24 sclerosis, Ehlers-danlos syndrome, post-traumatic stress 25 syndrome, and any other chronic or debilitating disease or 26 medical condition or its medical treatment approved by the 27 department by rule. 28 “Health care practitioner” means an individual licensed 29 under Code chapter 148 to practice medicine and surgery 30 or osteopathic medicine and surgery, a physician assistant 31 licensed under Code chapter 148C, or an advanced registered 32 nurse practitioner licensed pursuant to Code chapter 152 or 33 152E. 34 “Medical cannabis” means any species of the genus cannabis 35 -15- LSB 2576XC (4) 86 rh/rj 15/ 23

S.F. _____ plant, or any mixture or preparation of them, including whole 1 plant extracts and resins. 2 “Medical cannabis dispensary” means an entity licensed under 3 the bill that dispenses and acquires, possesses, cultivates, or 4 manufactures medical cannabis pursuant to the bill. 5 “Medical cannabis manufacturer” means an entity licensed 6 by the department to manufacture and to possess, cultivate, 7 transport, supply, or dispense medical cannabis pursuant to the 8 provisions of this chapter. 9 “Primary caregiver” means a person, at least 18 years of age, 10 who has been designated by a patient’s health care practitioner 11 or a person having custody of a patient, as a necessary 12 caretaker taking responsibility for managing the well-being 13 of the patient with respect to the use of medical cannabis 14 pursuant to the bill. 15 “Written certification” means a document signed by a health 16 care practitioner, with whom the patient has established a 17 patient-provider relationship, which states that the patient 18 has a debilitating medical condition and provides any other 19 relevant information. 20 HEALTH CARE PRACTITIONER CERTIFICATION. The bill provides 21 that prior to a patient’s submission of an application 22 for a medical cannabis registration card, if a health care 23 practitioner determines that the patient whom the health 24 care practitioner has examined and treated suffers from a 25 debilitating medical condition, the health care practitioner 26 may provide the patient with a written certification of that 27 diagnosis. If the health care practitioner provides the 28 written certification, the practitioner must also provide 29 explanatory information to the patient about the therapeutic 30 use of medical cannabis, and if the patient continues to suffer 31 from a debilitating medical condition, issue the patient a new 32 certification of that diagnosis on an annual basis. 33 MEDICAL CANNABIS REGISTRATION CARD —— PATIENT AND PRIMARY 34 CAREGIVER. The department may approve the issuance of a 35 -16- LSB 2576XC (4) 86 rh/rj 16/ 23

S.F. _____ medical cannabis registration card by the department of 1 transportation to a patient who is at least 18 years of age and 2 is a permanent resident of this state, who submits a written 3 certification by the patient’s health care practitioner to the 4 department, and who submits an application to the department 5 of public health with certain information. The department 6 of public health may also approve the issuance of a medical 7 cannabis registration card by the department of transportation 8 to a primary caregiver who is at least 18 years of age, 9 submits a written certification by the patient’s health care 10 practitioner to the department on behalf of the patient, 11 and submits an application to the department with certain 12 information. A medical cannabis registration card expires one 13 year after the date of issuance and may be renewed. 14 MEDICAL ADVISORY BOARD. The director of public health is 15 directed to establish a medical advisory board, no later than 16 August 15, 2015, to consist of nine practitioners representing 17 the fields of neurology, pain management, gastroenterology, 18 oncology, psychiatry, infectious disease, family medicine, 19 gynecology, and pharmacy. The practitioners shall be 20 nationally board-certified in their area of specialty and 21 knowledgeable about the use of medical cannabis. The duties of 22 the board include reviewing and recommending to the department 23 for approval additional chronic or debilitating diseases or 24 medical conditions or their treatments as debilitating medical 25 conditions that qualify for the use of medical cannabis under 26 the bill, accepting and reviewing petitions to add chronic or 27 debilitating diseases or medical conditions or their treatments 28 to the list of debilitating medical conditions that qualify 29 for the use of medical cannabis under the bill, and advising 30 the department regarding the location of medical cannabis 31 dispensaries, the form and quantity of allowable medical 32 cannabis to be dispensed to a patient or primary caregiver, and 33 the general oversight of medical cannabis manufacturers and 34 medical cannabis dispensaries. 35 -17- LSB 2576XC (4) 86 rh/rj 17/ 23

S.F. _____ MEDICAL CANNABIS MANUFACTURER LICENSURE. The bill 1 requires the department to license four medical cannabis 2 manufacturers for the manufacture of medical cannabis within 3 this state by December 1, 2015, and to license new medical 4 cannabis manufacturers or relicense existing medical cannabis 5 manufacturers by December 1 of each year. Information 6 submitted during the application process is confidential 7 until the medical cannabis manufacturer is licensed by the 8 department unless otherwise protected from disclosure under 9 state or federal law. As a condition for licensure, a medical 10 cannabis manufacturer must agree to begin supplying medical 11 cannabis to patients by July 1, 2016. The department is 12 directed to consider several factors in determining whether to 13 license a medical cannabis manufacturer including technical 14 expertise, employee qualifications, financial stability, 15 security measures, and production needs and capacity. Each 16 medical cannabis manufacturer is required to contract with the 17 state hygienic laboratory at the university of Iowa to test the 18 medical cannabis produced by the manufacturer and to report 19 testing results to the medical cannabis manufacturer. Each 20 entity submitting an application for licensure shall pay an 21 application fee of $7,500. 22 MEDICAL CANNABIS MANUFACTURERS —— MEDICAL CANNABIS 23 DISPENSARIES. The bill requires a medical cannabis 24 manufacturer to operate three medical cannabis dispensaries in 25 this state. A medical cannabis manufacturer is required to 26 begin dispensing medical cannabis from at least one medical 27 cannabis dispensary by July 1, 2016. The medical cannabis 28 dispensaries shall be located based on geographical need 29 throughout the state to improve patient access. A medical 30 cannabis manufacturer shall operate only one location where 31 all manufacturing and cultivating, harvesting, packaging, and 32 processing shall be conducted. The other medical cannabis 33 dispensaries may dispense medical cannabis pursuant to the 34 provisions of the bill but shall not dispense any medical 35 -18- LSB 2576XC (4) 86 rh/rj 18/ 23

S.F. _____ cannabis in a form or quantity other than the form or quantity 1 allowed by the department pursuant to rule. 2 The operating documents of a medical cannabis manufacturer 3 shall include procedures for oversight and recordkeeping 4 activities of the medical cannabis manufacturer and security 5 measures undertaken by the medical cannabis manufacturer. 6 A medical cannabis manufacturer is prohibited from sharing 7 office space with, referring patients to, or having a financial 8 relationship with a health care practitioner, permitting any 9 person to consume medical cannabis on the property of the 10 medical cannabis manufacturer, employing a person who is under 11 21 years of age or who has been convicted of a disqualifying 12 felony offense, and from operating in any location, whether 13 for dispensing or for manufacturing, cultivating, harvesting, 14 packaging, and processing, within 1,000 feet of a public or 15 private school existing before the date of the medical cannabis 16 manufacturer’s licensure. A medical cannabis manufacturer 17 shall be subject to reasonable inspection and shall be subject 18 to reasonable restrictions relating to signage, marketing, 19 display, and advertising of the medical cannabis. 20 MEDICAL CANNABIS MANUFACTURER —— PRODUCTION AND 21 DISPENSATION. A medical cannabis manufacturer is required to 22 provide a reliable and ongoing supply of medical cannabis for 23 all patients served pursuant to the provisions of the bill, 24 and all manufacturing, cultivating, harvesting, packaging, and 25 processing of medical cannabis is required to take place in an 26 enclosed, locked facility at a physical address provided to the 27 department during the licensure process. 28 Prior to the dispensing of any medical cannabis, the medical 29 cannabis manufacturer is required to verify that the medical 30 cannabis manufacturer has received a valid medical cannabis 31 registration card from a patient or a patient’s primary 32 caregiver, if applicable, assign a tracking number to any 33 medical cannabis dispensed from the manufacturer, and properly 34 package and label medical cannabis in compliance with the 35 -19- LSB 2576XC (4) 86 rh/rj 19/ 23

S.F. _____ provisions of the bill and certain federal laws. 1 CONFIDENTIALITY. The department is required to maintain 2 a confidential file of the names of each patient and primary 3 caregiver issued a medical cannabis registration card. 4 Individual names contained in the file shall be confidential 5 and shall not be subject to disclosure, except that information 6 in the confidential file may be released on an individual 7 basis to authorized employees or agents of the department, 8 the department of transportation, and a medical cannabis 9 manufacturer as necessary to perform their duties and to 10 authorized employees of state or local law enforcement agencies 11 for the purpose of verifying that a person is lawfully in 12 possession of a medical cannabis registration card. Release 13 of information must also be consistent with federal Health 14 Insurance Portability and Accountability Act regulations. 15 ADDITIONAL DEPARTMENT DUTIES —— RULES. The bill requires 16 the department to adopt rules relating to the manner in which 17 the department shall consider applications for new and renewal 18 medical cannabis registration cards, identify criteria and 19 set forth procedures for including additional chronic or 20 debilitating diseases or medical conditions or their medical 21 treatments on the list of debilitating medical conditions, 22 establish the form and quantity of medical cannabis allowed to 23 be dispensed to a patient or primary caregiver in the form and 24 quantity appropriate to serve the medical needs of the patient 25 with the debilitating medical condition, establish requirements 26 for the licensure of medical cannabis manufacturers, develop 27 a dispensing system for medical cannabis within this state 28 that follows certain requirements, establish medical cannabis 29 registration card application and renewal fees, and specify 30 and implement procedures that address public safety including 31 security procedures and product quality, safety, and labeling. 32 RECIPROCITY. The bill provides that a valid medical 33 cannabis registration card, or its equivalent, issued under 34 the laws of another state that allows an out-of-state patient 35 -20- LSB 2576XC (4) 86 rh/rj 20/ 23