H.F. 2589 Section 1. Section 124E.2, subsection 2, paragraph i, Code 1 2020, is amended to read as follows: 2 i. Untreatable Chronic pain. 3 Sec. 2. Section 124E.2, subsections 5 and 6, Code 2020, are 4 amended to read as follows: 5 5. “Health care practitioner” means an individual licensed 6 under chapter 148 to practice medicine and surgery or 7 osteopathic medicine and surgery , a physician assistant 8 licensed under chapter 148C, a podiatrist licensed pursuant to 9 chapter 149, an advanced registered nurse practitioner licensed 10 under chapter 152, or an advanced practice registered nurse 11 under chapter 152E, who is a patient’s primary care provider. 12 “Health care practitioner” shall not include a physician 13 assistant licensed under chapter 148C or an advanced registered 14 nurse practitioner licensed pursuant to chapter 152 or 152E . 15 6. “Medical cannabidiol” means any pharmaceutical 16 grade cannabinoid found in the plant Cannabis sativa L. or 17 Cannabis indica or any other preparation thereof that has 18 a tetrahydrocannabinol level of no more than three percent 19 and that is delivered in a form recommended by the medical 20 cannabidiol board, approved by the board of medicine, and 21 adopted by the department pursuant to rule. 22 Sec. 3. Section 124E.2, Code 2020, is amended by adding the 23 following new subsection: 24 NEW SUBSECTION . 7A. “Total tetrahydrocannabinol” means 25 eighty-seven and seven-tenths percent of the amount of 26 tetrahydrocannabinol plus the amount of tetrahydrocannabinolic 27 acid. 28 Sec. 4. Section 124E.4, subsection 1, unnumbered paragraph 29 1, Code 2020, is amended to read as follows: 30 Subject to subsection 7 , the department may approve the 31 issuance of issue a medical cannabidiol registration card by 32 the department of transportation to a patient who: 33 Sec. 5. Section 124E.4, subsection 1, paragraph d, 34 unnumbered paragraph 1, Code 2020, is amended to read as 35 -1- LSB 5589HV (3) 88 ss/rh 1/ 8

H.F. 2589 follows: 1 Submits an application to the department, on a form created 2 by the department, in consultation with the department of 3 transportation, that contains all of the following: 4 Sec. 6. Section 124E.4, subsection 1, paragraph f, Code 5 2020, is amended by striking the paragraph. 6 Sec. 7. Section 124E.4, subsection 2, unnumbered paragraph 7 1, Code 2020, is amended to read as follows: 8 A medical cannabidiol registration card issued to a patient 9 by the department of transportation pursuant to subsection 1 10 shall contain, at a minimum, all of the following: 11 Sec. 8. Section 124E.4, subsection 2, paragraph b, Code 12 2020, is amended by striking the paragraph. 13 Sec. 9. Section 124E.4, subsection 3, unnumbered paragraph 14 1, Code 2020, is amended to read as follows: 15 For a patient in a primary caregiver’s care, subject to 16 subsection 7 , the department may approve the issuance of issue 17 a medical cannabidiol registration card by the department of 18 transportation to the primary caregiver who: 19 Sec. 10. Section 124E.4, subsection 3, paragraph b, 20 unnumbered paragraph 1, Code 2020, is amended to read as 21 follows: 22 Submits an application to the department, on a form created 23 by the department, in consultation with the department of 24 transportation, that contains all of the following: 25 Sec. 11. Section 124E.4, subsection 3, paragraph c, Code 26 2020, is amended by striking the paragraph. 27 Sec. 12. Section 124E.4, subsection 4, unnumbered paragraph 28 1, Code 2020, is amended to read as follows: 29 A medical cannabidiol registration card issued by the 30 department of transportation to a primary caregiver pursuant to 31 subsection 3 shall contain, at a minimum, all of the following: 32 Sec. 13. Section 124E.4, subsection 4, paragraph b, Code 33 2020, is amended by striking the paragraph. 34 Sec. 14. Section 124E.4, subsection 6, Code 2020, is amended 35 -2- LSB 5589HV (3) 88 ss/rh 2/ 8

H.F. 2589 by striking the subsection. 1 Sec. 15. Section 124E.5, subsection 2, Code 2020, is amended 2 to read as follows: 3 2. The medical cannabidiol board shall convene at least 4 twice but no more than four times per year. 5 Sec. 16. Section 124E.5, subsection 6, Code 2020, is amended 6 to read as follows: 7 6. The medical cannabidiol board may recommend a statutory 8 revision to the definition of medical cannabidiol contained in 9 this chapter that increases the tetrahydrocannabinol level to 10 more than three percent, however, any such recommendation shall 11 be submitted to the general assembly during the regular session 12 of the general assembly following such submission. The general 13 assembly shall have the sole authority to revise the definition 14 of medical cannabidiol for purposes of this chapter . 15 Sec. 17. Section 124E.9, Code 2020, is amended by adding the 16 following new subsections: 17 NEW SUBSECTION . 13. A medical cannabidiol dispensary 18 shall employ a pharmacist or pharmacy technician licensed or 19 registered pursuant to chapter 155A for the purpose of making 20 dosing recommendations. 21 NEW SUBSECTION . 14. A medical cannabidiol dispensary shall 22 not dispense more than a combined total of four and one-half 23 grams of total tetrahydrocannabinol to a patient and the 24 patient’s primary caregiver in a ninety-day period, except as 25 provided in subsection 15. The department may decrease this 26 limit by rule as provided in section 124E.11, subsection 2, 27 paragraph “c” . 28 NEW SUBSECTION . 15. A medical cannabidiol dispensary 29 may dispense more than a combined total of four and one-half 30 of total tetrahydrocannabinol to a patient and the patient’s 31 primary caregiver in a ninety-day period if any of the 32 following apply: 33 a. The health care practitioner who certified the patient to 34 receive a medical cannabidiol registration card certifies that 35 -3- LSB 5589HV (3) 88 ss/rh 3/ 8

H.F. 2589 patient’s debilitating medical condition is a terminal illness 1 with a life expectancy of less than one year. A certification 2 issued pursuant to this paragraph shall include a total 3 tetrahydrocannabinol cap deemed appropriate by the patient’s 4 health care practitioner. 5 b. The health care practitioner who certified the patient to 6 receive a medical cannabidiol registration card certifies that 7 the patient has participated in the medical cannabidiol program 8 and that the health care practitioner has determined that four 9 and one-half of total tetrahydrocannabinol in a ninety-day 10 period is insufficient to treat the patient’s debilitating 11 medical condition. A certification issued pursuant to this 12 paragraph shall include a total tetrahydrocannabinol cap deemed 13 appropriate by the patient’s health care practitioner. 14 Sec. 18. Section 124E.11, subsection 1, paragraph b, 15 subparagraph (1), subparagraph division (a), Code 2020, is 16 amended to read as follows: 17 (a) To authorized employees or agents of the department and 18 the department of transportation as necessary to perform the 19 duties of the department and the department of transportation 20 pursuant to this chapter . 21 Sec. 19. Section 124E.11, subsection 1, paragraph b, 22 subparagraph (1), subparagraph division (c), Code 2020, is 23 amended to read as follows: 24 (c) To authorized employees of a medical cannabidiol 25 dispensary, but only for the purpose purposes of verifying that 26 a person is lawfully in possession of a medical cannabidiol 27 registration card issued pursuant to this chapter and that a 28 person has not purchased total tetrahydrocannabinol in excess 29 of the amount authorized by this chapter . 30 Sec. 20. Section 124E.11, subsection 1, paragraph b, 31 subparagraph (1), Code 2020, is amended by adding the following 32 new subparagraph division: 33 NEW SUBPARAGRAPH DIVISION . (e) To a health care 34 practitioner for the purpose of determining whether a patient 35 -4- LSB 5589HV (3) 88 ss/rh 4/ 8

H.F. 2589 seeking a written certification pursuant to section 124E.3 has 1 already received a written certification from another health 2 care practitioner. 3 Sec. 21. Section 124E.12, subsection 7, Code 2020, is 4 amended to read as follows: 5 7. Notwithstanding any law to the contrary, the department, 6 the department of transportation, the governor, or any employee 7 of any state agency shall not be held civilly or criminally 8 liable for any injury, loss of property, personal injury, or 9 death caused by any act or omission while acting within the 10 scope of office or employment as authorized under this chapter . 11 Sec. 22. NEW SECTION . 124E.20 Observational effectiveness 12 study. 13 The department may conduct an observational effectiveness 14 study in cooperation with patients and health care 15 practitioners and pursuant to rules of the department in order 16 to study the effectiveness of medical cannabidiol in the 17 treatment of debilitating medical conditions. 18 Sec. 23. PROTECTION OF FEDERAL FUNDING. The department 19 of public health shall request guarantees from the agencies 20 of the federal government providing funding to educational 21 and long-term care facilities that facilities with policies 22 allowing patients to possess medical cannabidiol on the grounds 23 of the facilities consistent with chapter 124E or allowing 24 facility staff to administer medical cannabidiol to a patient 25 shall not lose eligibility for any federal funding due to such 26 policies. 27 Sec. 24. TRANSITION PROVISIONS. A medical cannabidiol 28 registration card issued prior to July 1, 2020, remains 29 effective and continues in effect as issued for the 30 twelve-month period following its issuance. 31 EXPLANATION 32 The inclusion of this explanation does not constitute agreement with 33 the explanation’s substance by the members of the general assembly. 34 This bill relates to the medical cannabidiol program. 35 -5- LSB 5589HV (3) 88 ss/rh 5/ 8

H.F. 2589 The bill replaces “untreatable pain” with “chronic pain” on 1 the list of debilitating medical conditions for which a patient 2 may receive a written certification to receive a medical 3 cannabidiol registration card. 4 The bill adds physician assistants, advanced registered 5 nurse practitioners, advanced practice registered nurses, and 6 podiatrists to the list of health care practitioners allowed to 7 certify a patient to receive a medical cannabidiol registration 8 card. 9 The bill removes the 3 percent tetrahydrocannabinol (THC) 10 limit on medical cannabidiol. The bill prohibits a medical 11 cannabidiol patient or a patient’s primary caregiver from 12 receiving more than 4.5 grams of total THC in a 90-day period. 13 However, a medical cannabidiol dispensary may dispense more 14 than 4.5 grams of total THC in a 90-day period to a patient 15 or a patient’s primary caregiver, up to a cap determined by 16 the patient’s health care practitioner, if the health care 17 practitioner who certified the patient to receive a medical 18 cannabidiol registration card certifies that the patient has 19 a debilitating medical condition with a life expectancy of 20 less that one year or that the patient has participated in the 21 medical cannabidiol program and the health care practitioner 22 has determined that 4.5 grams of total THC in a 90-day period 23 is insufficient to treat the patient’s debilitating medical 24 condition. The bill allows medical cannabidiol dispensaries 25 to access the files of the department of public health to 26 determine whether a patient has received more than 4.5 grams 27 of total THC in a 90-day period. The bill defines “total 28 THC” as the amount of THC plus 87.7 percent of the amount of 29 tetrahydrocannabinolic acid. 30 The bill removes the department of transportation from the 31 process of issuing medical cannabidiol registration cards and 32 makes conforming Code changes. The bill directs the department 33 of public health to issue medical cannabidiol registration 34 cards. The bill also removes the requirement that a medical 35 -6- LSB 5589HV (3) 88 ss/rh 6/ 8

H.F. 2589 cannabidiol registration card include a photograph of the 1 patient or primary caregiver. 2 The bill removes the prohibitions on patients and primary 3 caregivers with certain disqualifying felony offenses from 4 receiving a medical cannabidiol registration card. 5 The bill removes the limit on the number of meetings per year 6 of the medical cannabidiol board. Current law sets the maximum 7 number of meetings to four per year. 8 The bill removes a provision allowing the medical 9 cannabidiol board to recommend statutory revisions to 10 the definition of medical cannabidiol that increase the 11 tetrahydrocannabinol level to more than 3 percent. 12 The bill requires medical cannabidiol dispensaries to employ 13 a pharmacist or pharmacy technician for the purpose of making 14 medical cannabidiol dosing recommendations. 15 The bill allows health care practitioners to access the 16 patient registry maintained by the department of public health 17 to determine whether a patient seeking a written certification 18 for a medical cannabidiol registration card has already 19 received a written certification from another health care 20 practitioner. 21 The bill requires the department of public health to 22 conduct an observational effectiveness study, in cooperation 23 with patients and health care practitioners, on the efficacy 24 of medical cannabis products. The bill also requires the 25 department to seek guarantees from federal agencies that 26 provide funding to educational and long-term care facilities 27 that facilities with policies allowing patients to possess 28 medical cannabis on the property of the facility or allowing 29 facility staff to administer medical cannabis to a patient 30 will not lose eligibility for any federal funding due to such 31 policies. 32 The bill provides that a medical cannabidiol registration 33 card issued prior to July 1, 2020, by the department of 34 transportation shall remain valid until the card’s expiration 35 -7- LSB 5589HV (3) 88 ss/rh 7/ 8