Ballot to Implementation: A Program’s Journey

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  • November 10, 2022, the Department posted draft rules for implementing the new provisions of Article XIV of the Missouri Constitution. Following the same processes as were used in previous rulemaking efforts, the Department encouraged feedback from the public regarding the program rules for a two week period in an effort to gather all relevant feedback before filing final rules for formal rulemaking.
  • November 8, 2022, Missouri voters passed Constitutional Amendment 3, which allows individuals age 21 and older to legally possess and consume marijuana in Missouri. The Department of Health and Senior Services was given authority to regulate the production and distribution of marijuana for this purpose.
  • On September 15, 2022, the Department released a press announcement regarding the additional transfer of $13 million in funds from Missouri’s medical marijuana program to the Missouri Veterans Commission (MVC). This marks the fourth transfer to date for a total of $26,978,820.

    Article XIV includes a provision requiring that fees and taxes generated by the medical marijuana program, less operational expenses, be transferred to the MVC for health and care services for military veterans.

    "The state’s medical marijuana program has been a great success," said Lyndall Fraker, Director of the Section of Medical Marijuana Regulation with DHSS. “We have a safe and well-regulated program that is benefiting the nearly 200,000 qualified patients, which in turn, is benefiting veteran services right here in Missouri.”
  • August 4, 2022, the Department released the Missouri Medical Marijuana Regulatory Program’s third Annual Report to the Governor. The Department is required to annually submit a report to the Governor regarding the efficient discharge of its responsibilities under Article XIV Section 1 of the Missouri Constitution. Reported activities are based on the program year of December 6, 2020, through December 5, 2021. During the third program year, the Department issued 119,894 patient licenses in addition to renewing 38,347 patient licenses and issuing 4,979 agent (facility employee) identification cards. The Department also began facility annual inspections and completed 267 commencement inspections. The Department implemented many process improvements during the program year, including a new call management system and an electronic physician certification form.
  • May 18, 2022, the Department released a press announcement regarding the additional transfer of $5 million in funds from the Veterans’ Health and Care Fund to the Missouri Veterans Commission (MVC). This marks the third transfer to date for a total of $13,978,820 transferred. Article XIV includes a provision requiring that fees and taxes generated by the medical marijuana program, less operational expenses, be transferred to the MVC for health and care services for military veterans. “Today, patients are being served by more than 180 dispensary facilities in Missouri – a 20% increase from last fall,” said Lyndall Fraker, Director of the Section for Medical Marijuana Regulation with DHSS. “We are happy to see the veterans served by MVC continue to benefit from these contributions.”
  • April 22, 2022, the Department posted draft dispensary rule revisions to the website to solicit public suggestions. While it is not required to post or solicit public suggestions during the drafting phase of rulemaking, the Department is committed to transparency and to engaging the public in the development of the program’s regulatory framework.
  • March 17, 2022, the Department posted new fee tables that take effect July 1, 2022. Per Article XIV, Section 1, certain application fees and licenses are adjusted annually by the percentage of increase or decrease of the Consumer Price Index published by the U.S. Department of Labor.

2021

  • December 20, 2021, fourteen months after the first sale to a qualified patient occurred in a Missouri medical marijuana dispensary, the total sales as part of the state-regulated medical marijuana program reached the $200 million mark. More than 300 facilities are now operating in Missouri as cultivators, manufacturers, dispensaries, testing laboratories, transporters and seed to sale providers. “Nearly every facility who was part of the initial round of licensing is now up and running and providing beneficial products and service to the patients of Missouri,” said Lyndall Fraker, Director of the Section for Medical Marijuana Regulation. “We are proud of the tenacity shown by both our regulatory team and all of the facility operators who were able to clear so many hurdles that COVID-19 presented during a critical time.”
  • September 16, 2021, the Department made the second transfer of funds from Missouri’s medical marijuana program to the Missouri Veterans Commission (MVC). The total amount transferred was $6,843,310. Article XIV states that medical marijuana sold in licensed dispensaries will be taxed at a rate of four percent. “Patients are being served by more than 140 dispensary facilities in Missouri now, and we are very pleased to see their sales revenue where it is,” said Lyndall Fraker, Director of the Section of Medical Marijuana Regulation with DHSS. “Ultimately, this is how we are able to provide much-needed funding for the veteran’s commission.”
  • August 18, 2021, the Department released the Missouri Medical Marijuana Regulatory Program’s second Annual Report to the Governor. The Department is required to annually submit a report to the Governor regarding the efficient discharge of its responsibilities under Article XIV Section 1 of the Missouri Constitution. Reported activities are based on the program year of December 6, 2019, through December 5, 2020. The Department is charged with providing safe and secure access to medical marijuana for qualifying Missouri patients. During the second program year, the Department issued 56,448 patient licenses and renewed 12,062 patient licenses. The Department also began facility commencement inspections, giving approval to operate to 10 cultivation, two laboratory testing, two transportation, one manufacturing, and 17 dispensary facilities. In the current and upcoming program year, the Department will continue to monitor facilities’ progress and ability to meet the needs of patients.
  • January 28, 2021, the Department began allowing physicians to create accounts within the Missouri Medical Marijuana Portal as part of the first phase in implementing electronic submission of Physician Certification Forms. This added feature offers a secure account for physicians, whose identities will be verified by the Department at the time of account creation, and ensure they meet eligibility requirements for certifying physicians. It also creates efficiencies by reducing patient application requirements, opportunity for application errors, and Department processing time. Physician account registration supports direct communication between certifying physicians and the Department, strengthening our partnership in working to create a safe and secure program for Missouri medical marijuana patients.

2020

  • December 21, 2020, the Missouri Circuit Court of Cole County ruled in favor of the Department in the case of Sarcoxie Nursery Cultivation Center, LLC, et al., v Randall Williams, et al., Case No. 19AC-CC00556. The following are brief excerpts from the court ruling:
    • The Department’s regulations regarding limitations on the number of licenses issued in the state and economic impact scoring are valid and constitutional and do not conflict with state law. The plain language of Article XIV contemplated facility license limitations, and the Department was authorized to implement such limits.
    • Economic impact scoring adjustments are not special laws and the state has a legitimate governmental interest in improving the economic conditions of communities within the state. It does not impair patient access to allow economic impact scoring adjustments in the scoring and ranking process for facility applications.
    • License limits bear a rational relationship to legitimate government interests, including:
      • The effectiveness of governmental oversight and regulation decreases as the number of facility licenses increases as licensees would be progressively less qualified;
      • The government must incur additional regulation costs to ensure destruction of excess marijuana when facilities are incentivized by oversupply to sell excess marijuana into the black market;
      • Unlimited licenses result in putting patients at risk as government has finite resource to regulate.
  • October 16, 2020, the first medical marijuana sales occurred. Missouri has had one of the fastest implementations of a medical marijuana program in the United States. The Department implemented the Medical Marijuana Regulatory Program in a little over 23 months when calculating from the date voters approved the Constitutional amendment to the date of first sale. Missouri’s testing provision required that a laboratory testing facility be approved to operate prior to the first sale. The first laboratory received approval to operate in late September.
  • September 11, 2020, the Department announced that it has begun the process of transferring $2,135,510 from the Missouri’s medical marijuana regulatory program to the Missouri Veterans Commission (MVC). Article XIV of the Missouri Constitution includes a provision requiring that fees and taxes related to the medical marijuana regulatory program, less operational expenses, be transferred to the MVC for health and care services for military veterans. Thus far, the Department has only collected fees related to facility and patient licensing. With more facilities and the first testing laboratory now operational, medical marijuana will soon be available for purchase from licensed dispensaries, and medical marijuana purchases will be taxed at a rate of four percent.
  • July 14, 2020, the Department posted 15 User Guide Video Tutorials assist patients and caregivers with creating and managing their application in the Missouri Medical Marijuana Program’s Patient Registry. Each short video focuses on a specific topic in the application process, such as how to enter physician and condition information or how to find and correct a rejected application.

  • July 13, 2020, Governor Parson signed House Bill 1896 into law. This bill included an emergency clause making it effective upon approval. HB 1896 includes the following provisions:

    • Makes the standard for issuing a physician certification for medical marijuana via telemedicine the same as the standard for issuing a prescription via telemedicine.
    • Grants the Department of Health and Senior Services (DHSS) the authority to mandate as part of the medical marijuana facility application, that all employees, officers, managers, staff, and owners of marijuana facilities are required to submit fingerprints for criminal background checks to the Missouri State Highway Patrol. The fingerprints will also be forwarded to the Federal Bureau of Investigation for a federal criminal background check.
    • Prohibits the sale of edible marijuana-infused products, packaging or logos that appeal to individuals under the age of eighteen. Prohibits medical marijuana-infused product shapes such as human, animal, or fruit, including realistic, artistic, caricature, or cartoon renderings.
    • Requires any package for an edible marijuana-infused product containing at least 10 mg of THC to be stamped with a universal symbol to include a diamond containing the letters “THC”, the letter M to show it’s for medical purposes, and the number of milligrams of THC.
    • Gives DHSS the authority to establish rules and regulations prohibiting edible marijuana-infused products designed to appeal to persons under the age of eighteen, and to create a process by which any medical marijuana facility or certified entity may seek approval of any edible marijuana-infused product design, package, or label prior to the product’s manufacture or sale to determine compliance.
    • Any medical marijuana facility or certified entity regulated by DHSS found in violation of this bill will be subject to sanctions, including an administrative penalty.
  • June 8, 2020, the Department re-activated its toll-free Patient Services’ customer call line. The call line was temporarily suspended during the State’s response to the covid-19 pandemic. During that time, Patient Services continued to process applications, call applicants regarding application corrections, and answer customer emails.
  • June 5, 2020, the Department released the Missouri Medical Marijuana Regulatory Program’s first Annual Report to the Governor. The Department is required to annually submit a report to the Governor regarding the efficient discharge of its responsibilities under Article XIV Section 1 of the Missouri Constitution. Reported  activities are based on the program year of December 6, 2018, through December 5, 2019. Article XIV contained several Constitutional deadlines for its first program year including: begin accepting pre-file facility license applications by January 5, 2019, make all application forms and instructions publicly available by June 4, 2019, being accepting patient, caregiver, and patient cultivation applications by July 4, 2019, and being accepting facility applications by August 3, 2019.  The Department successfully met each of these deadlines.
  • June 5, 2020, the Department posted to its website two new graphics tracking facility compliance measures. The first showed the number of licensees that have completed a process through which the Department verifies the licensee meets minimum standards for licensure. The second showed the number of facility commencement inspections requested, in-progress, and completed. Both graphics were designed to be updated as facilities progress through these processes.
  • May 12, 2020, the Department published adjusted fee schedules for facilities and patients. Article XIV Section 1, states, “…application and license fees shall be increased or decreased each year by the percentage of increase or decrease from the end of the previous calendar year of the Consumer Price Index, or successor index as published by the U.S. Department of Labor or its successor agency”. The Department will annually implement fee adjustments to align with the Medical Marijuana Regulatory Program’s budget cycle and State’s fiscal year of July 1 – June 30, and will annually publish new fees each Spring. The Consumer Price Index rose 2.3 percent from 2018 to 2019. This increase was applied to licensure fees for July 2, 2020 – June 30, 2021.
  • April 9, 2020, the Department held a call with representatives from Missouri law enforcement associations, Department of Public Safety and Department of Corrections. The purpose of the call was to provide updates on program implementation and guidance on Medical Marijuana Regulatory Program rules.
  • April 1, 2020, the Department launched its Missouri Medical Marijuana Regulatory Program Patient Services Weekly Newsletter. Sign up here to become a member and stay up to date with weekly updates from the patient services team. Subscription members have the capability to log into their subscription account and view archived copies of past editions of the newsletter. The Department also launched two new webpages. On the About Us page, visitors can learn about the history of the Missouri Medical Marijuana Regulatory Program, the Department’s organizational structure, and priorities for the program. The Feedback page provides visitors the opportunity to take short surveys about the program’s customer service and website.
  • March 4-5, 2020, the Department held a mandatory Medical Marijuana Facilities Welcome Meeting in Jefferson City for all facility licensees. Each facility was represented by two staff members of their choosing per license. Attendees were provided an opportunity to meet the Section for Medical Marijuana Regulation’s Facility Licensing and Compliance team; learn about program policies and procedures; and network with other licensees. Other state agencies including the Departments of Agriculture, Labor and Industrial Relations, Natural Resources, Public Safety, and Revenue also attended the meeting to provide the state’s new industry with information on their respective regulations and requirements, as well as information to help their new business in Missouri. A great resource for these and other new Missouri businesses is the state’s Open for Business portal that is intended to help businesses navigate government.
  • March 3, 2020, the Department posted draft rule revisions to the website for public comments.  While it is not required to post or solicit public comments during the drafting phase of rulemaking, the Department is committed to transparency and in engaging the public in the development of the program’s regulatory framework.
  • Issuance of licenses:
    • Laboratory Testing facilities – December 19, 2019
    • Transportation facilities – December 23, 2019
    • Cultivation facilities – December 26, 2019
    • Infused-Products Manufacturing facilities – January 10, 2020
    • Dispensary facilities – January 24, 2020
    • Seed to Sale – January 31, 2020

2019

  • November 26, 2019, the Department filed Emergency Rule 19 CSR 30-95.028, Additional Licensing Procedures, which were set to become effective December 5, 2019.  This change permits the Department to award licensure to the next entity on the Rank and Score list in the event that an awarded entity fails to accept licensure or otherwise cannot begin operations.
  • August 3 – 19, 2019, the Department held an open application period to accept facility applications for licensing and certification of cultivation, infused-products manufacturing, dispensary, testing, seed-to-sale, and transportation facilities. The Constitution mandated the Department begin accepting and processing facility applications no later than August 3, 2019. The Department held an open application period to accept facility applications for licensing and certification of cultivation, infused-products manufacturing, dispensary, testing, seed-to-sale, and transportation facilities. 
  • August 9, 2019, the Office of Administration awarded the third-party blind scoring contract to vendor Wise Health Solutions, Inc.  Based on research of other state medical marijuana facility licensing processes and public input, the Department adopted a blind scoring process to be conducted by an independent third-party in order to create a fair and impartial license award process.
  • As of July 26, 2019, video tutorials and informational tools were posted to the website to assist facility applicants in navigating the application process.
  • June 28, 2019, the Department opened the registry portal to the public and began accepting patient, caregiver, and patient cultivation applications.  The constitution mandated the Department begin accepting and processing these applications no later than July 4, 2019, even though there were no licensed dispensaries.
  • June 4, 2019, the Department posted all sample application forms and instructions for patients and facilities to the website for public review as required by the constitution. 
  • By May 31, 2019, a call center began answering public inquiries from 8:30- 3:30 daily as well as responding to emails received through MedicalMarijuanaInfo@health.mo.gov
  • By May 20, 2019, the Department received numerous public comments on proposed rules. Beginning February 21, 2019, the Department placed drafts of proposed rules on its website and maintained a Suggestion Form for public input on the drafts. There were over 600 public comments received on the filed emergency rules. 
  • As of April 25, 2019, 10 Advisory Committee meetings held, one for each of the facility application scoring criteria established by constitution. The purpose of the advisory committees was to submit expert advice on the application questions to implement the numerical scoring system established by Article XIV. These committees reviewed and suggested revisions to initial drafts of facility application scoring criteria questions based on their expertise and public comments. In addition, the advisory committees recommended weights for each scoring criteria question and topic. Each committee consisted of representatives from topic-relevant state agencies as well as members of the public with experience in the topic of their committee. Information regarding committee representatives, meeting dates, meeting minutes and audio of meetings can be found here.
  • April 5, 2019, the Office of Administration awarded a contract for medical marijuana facility and patient application system. Click here to learn more about the state’s procurement rules. This system was necessary to timely process applications for patient cards and facility licenses per the constitution. 
  • As of March 7, 2019, five public forums were held to educate the public about the new program and to receive public suggestions. The forums engaged over 775 individuals representing constituents, law enforcement, local government, and other state agencies. Public input from these forums were used to help develop program rules.
    • February 13, 2019: Jefferson City
    • February 27, 2019: Poplar Bluff
    • February 28, 2019: St. Louis
    • March 6, 2019: Kanas City
    • March 7, 2019: Springfield
  • As of February 4, 2019, the Department staffed the new program’s leadership, drafted emergency rules, established the program’s webpage, and requested appropriation authority. 
  • As of January 10, 2019, the Department issued a news release advising the public of the rule making process.  Article XIV mandated that all application forms and instructions for patients, caregivers, and facilities be made available by June 4, 2019. In order for the Department to create, receive, evaluate, and approve or deny each of these application types and for an applicant to determine whether applying was in their best interest, it was necessary that both the Department and the applicant know what would be required of them going forward. Patients and caregivers needed to know what would be required of them if they were approved as a patient or caregiver, and the Department needed to know how to evaluate whether an individual qualified and how to regulate that individual’s authorizations as soon as the individual was approved. Relatedly, businesses needed to know what would be required of them if they were approved as a medical marijuana facility, and the Department needed to know how to evaluate whether the businesses were best qualified to operate as a particular type of facility in Missouri. All of this necessitated that a regulatory framework be in place on the day applications were made available on June 4, 2019. To meet this constitutional deadline, it was necessary to initially draft emergency rules. Because of the importance of public input, a process was created to post draft rules on the Department website for public comment before filing the rules. Revised draft rules were posted with the comments incorporated. This process of posting drafts and revised drafts continued until filing the rules. 
  • As of January 5, 2019, the Department began accepting pre-filed facility applications as required by dates established in constitution for program implementation. 

2018

  • As of December 6, 2018, Article XIV became effective on December 6, 2018, and grants authority to the Missouri Department of Health and Senior Services to license and regulate medical marijuana in Missouri. Specifically, the Department shall have the authority to:
    • Grant or refuse to grant state licenses;
    • Suspend, restrict and revoke any issued license and/or certification;
    • Impose fines or administrative penalties as authorized under this law or rules promulgated pursuant to this law;
    • Develop forms, certificates, licenses, identification cards, and applications;
    • Track Seed to Sale of medical marijuana;
    • Issue standards for sanitation, storage, transportation, and labeling of marijuana and marijuana-infused products;
    • Charge fees;
    • Implement and enforce safe use of marijuana including inspections, investigations, searches, and seizures.
  • November 6, 2018, 65% of Missouri voters approved constitutional Amendment 2 as Article XIV Section 1. Right to access medical marijuana.