Bill > S10

Introduced Session

This bill makes various revisions to the State medical marijuana program, including revising the requirements to authorize a patient for medical marijuana, expanding the types of health care practitioners who can authorize medical marijuana for qualifying patients; increasing the quantity of medical marijuana that can be dispensed to certain patients; establishing institutional caregivers who can assist patients and residents in health care facilities with the medical use of marijuana; revising the permit requirements for alternative treatment centers (ATCs); and establishing additional protections for registry cardholders. Authorizing Patients for Medical Marijuana Current law sets for an enumerated list of debilitating medical conditions that can qualify a patient for the medical use of marijuana. The bill changes the term "debilitating medical condition" to "qualifying medical condition," and updates and revises the list of conditions in certain ways, including adding additional conditions and providing that medical marijuana may be used as a treatment of first resort for any condition included in the list, which are: seizure disorder, including epilepsy; intractable skeletal muscular spasticity; post-traumatic stress disorder; glaucoma; positive status for human immunodeficiency virus; acquired immune deficiency syndrome; cancer; amyotrophic lateral sclerosis; multiple sclerosis; muscular dystrophy; inflammatory bowel disease, including Crohn's disease; terminal illness, if the patient has a prognosis of less than 12 months of life; anxiety; migraine; Tourette's syndrome; chronic pain; or any other medical condition or its treatment that is approved by the Department of Health (DOH). The bill expands the list of professionals who can authorize patients for the medical use of marijuana. Current law only allows physicians to authorize patients; the bill would provide that any health care practitioner who is authorized under State and federal law to prescribe controlled dangerous substances may authorize patients for medical marijuana, including physicians, physician assistants, and advanced practice nurses. The bill provides that health care practitioners will not be required to register with the DOH, or be publicly listed in any DOH registry, as a condition of authorizing patients for medical marijuana. The bill provides that, in order to authorize a qualifying patient who is a minor for medical marijuana, the health care practitioner will be required to either: (1) be trained in the care of pediatric patients; or (2) obtain written confirmation from a health care practitioner trained in the care of pediatric patients establishing that, following examination of the patient or a review of the patient's record, the minor patient is likely to receive therapeutic or palliative benefits from the medical use of marijuana to treat or alleviate symptoms associated with the patient's debilitating medical condition. The bill provides that qualifying patients and designated caregivers who are registered with a medical marijuana program in another state will be deemed to be qualifying patients and designated caregivers for the purposes of New Jersey law, provided the individual possesses a valid registry card and a photo identification card issued by the other state; the patient or caregiver will be authorized to possess and administer medical marijuana while in New Jersey and will be subject to the other protections of New Jersey law, but will not be authorized to obtain medical marijuana from an ATC in the State. The DOH is to seek to establish medical marijuana reciprocity agreements with other states. Dispensing Requirements for Medical Marijuana The bill increases the maximum amount of medical marijuana that may be dispensed to a patient for a 30-day period from two ounces to two and one-half ounces commencing January 1, 2019 and continuing until July 1, 2019, whereupon the maximum amount will increase to three ounces, or the equivalent amount of medical marijuana in any other form according to guidelines for recommended equivalent dosage amounts, to be established by the Commissioner of Health by regulation. These quantity limits will not apply to a qualifying patient who is receiving hospice care or who is terminally ill with a prognosis of less than 12 months to live. Additionally, qualifying patients who are not on hospice care or who are not terminally ill may petition the DOH for a waiver from the quantity limits, which may be granted if it is deemed necessary to meet the patient's treatment needs and is consistent with the purposes of the medical marijuana program. Current law authorizes a patient to be issued multiple written instructions for medical marijuana authorizing up to a 90-day supply; the bill revises this to authorize up to 180-day supply. The bill removes a provision that limited distribution of edible forms of medical marijuana to qualifying patients who are minors, and specifies that medical marijuana may be distributed in transdermal, sublingual, and tincture forms, as well as in the forms authorized under current law. The bill provides that medical marijuana may be dispensed to a patient by any ATC in the State that is authorized to dispense medical marijuana; under current law, patients are to be registered with, and may only be dispensed medical marijuana from, a single ATC where the patient is registered. The bill requires that, prior to dispensing medical marijuana, an ATC will be required to access a system currently maintained by the Division of Consumer Affairs in the Department of Law and Public Safety that tracks medical marijuana dispensations in the State, in order to ascertain whether any medical marijuana was dispensed for the patient within the preceding 30 days. Upon dispensing medical marijuana, the ATC will be required to transmit to the authorizing health care practitioner information concerning the amount, form, and strain of medical marijuana that was dispensed. Health care practitioners will be required to update the system on a daily basis with authorizations and written instructions issued by the practitioner for medical marijuana. The commissioner will be required to develop curricula for health care practitioners to assist them in counseling patients regarding the quantity, dosing, and administration of medical marijuana appropriate for the patient, and for alternative treatment center employees to assist them in counseling patients regarding the form and strain of medical marijuana appropriate for the patient. Designated and Institutional Caregivers The bill changes the term "primary caregiver" to "designated caregiver and allows patients to concurrently have up to two designated caregivers, or more with DOH approval. Additionally, each caregiver will be permitted to concurrently care for up to two qualifying patients. The bill further provides that a designated caregiver who is an immediate family member of the patient will not be required to complete a criminal history record background check. "Immediate family" is defined to mean a spouse, child, sibling, or parent; the parents or siblings of a spouse; and the spouses of the individual's siblings and children. The bill also establishes the position of "institutional caregiver," which is an employee of a health care facility who is authorized to obtain and administer medical marijuana to qualifying patients who are patients or residents at the health care facility. An institutional caregiver will be required to be a New Jersey resident, at least 18 years of age, and authorized, within the employee's scope of practice, to possess and administer controlled dangerous substances to patients and residents. An institutional caregiver will be required to undergo a criminal history background check unless the individual has already done so as a condition of employment in the individual's current position. An institutional caregiver registration will be valid for one year. Medical marijuana may be dispensed to an institutional caregiver, provided the caregiver furnishes an authorization from the patient indicating the caregiver is authorized to obtain medical marijuana on the patient's behalf. The bill requires an institutional caregiver application to include a certification from the applicant's employer attesting that: the health care facility has authorized the applicant to serve as an institutional caregiver assisting patients or residents with medical marijuana; the facility has established appropriate security measures to guard against theft, diversion, adulteration, and unauthorized access of medical marijuana; the facility has established protocols to guard against adverse drug interactions between medical marijuana and other medications; the facility will not charge a patient for medical marijuana in excess of the actual cost of acquiring the medical marijuana plus the reasonable costs incurred in acquiring the medical marijuana; and the facility will promptly notify the DOH in the event that an institutional caregiver ceases to be employed by the facility or is convicted of a crime or offense. The bill expressly provides that nothing in its provisions is to be construed to require any facility to authorize employees to serve as institutional caregivers. Alternative Treatment Centers The bill requires the DOH to issue discrete endorsements for ATCs in relation to cultivating, manufacturing, and dispensing medical marijuana; each ATC may hold one or more such endorsements. The bill identifies the activities and functions authorized by each endorsement type. The DOH will be required to periodically evaluate whether the current number of ATC permits and endorsements is sufficient to meet the needs of qualifying patients, and will issue such requests for applications as may be needed to address outstanding patient needs. The bill sets forth the various criteria to be considered when reviewing applications, including the applicant's operational experience, workforce development plan, community impact analysis, security capabilities, storage systems, emergency management plan, and proposed location, along with any other criteria the commissioner deems appropriate. To the extent possible, the DOH is to seek to ensure that at least 15 percent of new ATC permits are issued to minority-owned, woman-owned, and veteran-owned businesses, with additional preference being given to applicants with ownership interests that meet more than one category. The bill provides that a new initial ATC permit will be valid for three years and that all ATC permits are renewable on a biennial basis. The bill sets forth certain requirements for the sale or transfer of an ATC permit, which include completing a criminal history record background check of the entity purchasing or receiving the permit, as well as certain requirements specific to nonprofit ATCs, which will be required to comply with the requirements of the "New Jersey Nonprofit Corporation Act," N.J.S.15A:1-1 et seq. If the debts and liabilities of a nonprofit ATC exceed the value of all assets of the ATC other than the permit, the ATC may pay $300,000 to DOH and sell its permit for a sum that satisfies all outstanding obligations. The bill provides that ATCs will be permitted to establish a medical advisory board to advise the ATC on all aspects of its business. A medical advisory board is to comprise five members: three healthcare professionals, including at least one physician; one qualifying patient who resides in the same area as the ATC; and one business owner from the same area as the ATC. No owner, director, officer, or employee of an ATC may serve on a medical advisory board. Medical advisory boards are to meet at least two times per year. The bill authorizes the DOH to issue additional permit types in connection with medical marijuana as may be necessary and appropriate to maximize the effectiveness and efficiency of the State medical marijuana program, including, but not limited to, permits for providing laboratory services and conducting research in connection with the medical use of marijuana. The bill prohibits DOH employees from holding any financial interest in an ATC or receiving anything of value from an ATC in connection with reviewing, processing, or making recommendations with respect to an ATC permit application. The bill provides that a health care practitioner or an immediate family member of a health care practitioner who authorizes patients for medical marijuana may not hold any profit or ownership interest in an ATC. A health care practitioner or the immediate family member of a practitioner who seeks to be an owner, director, officer, or employee of an ATC or otherwise hold an interest in an ATC is to certify that the practitioner has not authorized any patients for medical marijuana in the preceding 90 days. A violation of this prohibition will constitute a crime of the fourth degree, which is punishable by imprisonment for up to 18 months, up to a $10,000 fine, or both. The bill specifies that nothing in the prohibition will prohibit any health care practitioner from serving on the governing board or medical advisory board of an ATC, provided the practitioner receives no special compensation or remuneration from the ATC, including payments based on patient volumes or the number of authorizations issued by the practitioner. The DOH will be authorized to impose penalties or take administrative action against an ATC, and its employees, officers, investors, directors, or governing board, for any failure to comply with the laws and regulations governing the State medical marijuana program, including, but not limited to, imposing fines, referring the matter to another State agency, and suspending or terminating any endorsements and permits held by the alternative treatment center. Legal Protections for Patients and Caregivers The bill provides that qualifying patients and designated caregivers may not be discriminated against when enrolling in schools and institutions of higher education, or when renting or leasing real property, solely on the basis of the medical use of marijuana or their status as a registry cardholder. However, the bill provides that nothing is to require a school, institution of higher education, or landlord to take any action that would jeopardize a monetary grant or privilege of licensure based on federal law. Schools, institutions, and landlords may not be penalized or denied benefits under State law solely on the basis of enrolling or renting or leasing real property to a registered patient. Further, the bill provides that medical marijuana is to be treated the same as any other medication for the purposes of furnishing medical care, including determining the individual's eligibility for an organ transplant. The bill establishes protections from adverse employment actions for qualifying patients. Specifically, employers will be prohibited from taking any adverse employment action against an employee based on the employee's status as a registry identification cardholder or based on a positive test for marijuana, unless the employer establishes, by a preponderance of the evidence, that the lawful use of medical marijuana impaired the employee's ability to perform the employee's job responsibilities. An employer may consider an employee's ability to perform the employee's job responsibilities to be impaired when the employee manifests specific articulable symptoms while working that decrease or lessen the employee's performance of the duties or tasks of the employee's job position. If an employer has a drug testing policy and an employee or job applicant tests positive for marijuana, the employee or job applicant is to be offered an opportunity to present a legitimate medical explanation for the positive test result, such as a practitioner's recommendation for medical marijuana, a registry identification card, or both, or request a retest of the original sample at the employee's or job applicant's own expense. Nothing in the bill will restrict an employer's ability to prohibit or take adverse employment action for the possession or use of intoxicating substances during work hours, require an employer to commit any act that would cause the employer to be in violation of federal law, or require the employer to take any action that would result in the loss of a federal contract or federal funding. Employers will not be penalized or denied any benefit under State law for employing a person who is a registry cardholder. The bill updates the current annual reporting requirements concerning the medical marijuana program to reflect the changes made to the program under the bill, and additionally requires that DOH include in the report any incidents of diversion of medical marijuana that occur.

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Committee Categories

Declan O'Scanlon (R)*,  Nick Scutari (D)*,  Joe Vitale (D)*,  Christopher Bateman (R),  Richard Codey (D),  Nia Gill (D),  Vin Gopal (D),  Linda Greenstein (D),  Troy Singleton (D),  Shirley Turner (D), 

Substituted by A10 (ACS/1R) (on 05/30/2019)