# COMAR Title 14 — Independent Agencies

## Subtitle 17 — Maryland Cannabis Administration

### Chapter 04 — Medical Cannabis Program

**Authority:** Alcoholic Beverages and Cannabis Article, §§36-201, 36-301, 36-302, 36-410, and 36-601, Annotated Code of Maryland

**Administrative History:** Effective date:

**Administrative History:** Regulations .01—.10 adopted as an emergency provision effective July 1, 2023 (50:14 Md. R. 559); emergency status expired June 30, 2024

**Administrative History:** Regulations .01—.09 adopted as an emergency provision effective June 7, 2024 (51:14 Md. R. 676)

**Administrative History:** Regulations .01—.09 adopted effective July 22, 2024 (51:14 Md. R. 678)

**Administrative History:** Regulation .07 repealed effective April 14, 2025 (52:7 Md. R. 324)

**Administrative History:** Regulation .08 amended and recodified to be Regulation .07 effective April 14, 2025 (52:7 Md. R. 324)

**Administrative History:** Regulation .09 amended and recodified to be Regulation .08 effective April 14, 2025 (52:7 Md. R. 324)

**Administrative History:** Regulation .09 adopted effective April 14, 2025 (52:7 Md. R. 324)

#### Regulation .01 Certifying Providers.

*COMAR 14.17.04.01*

A. Provider Registration.

  (1) A provider seeking registration as a certifying provider shall submit an application in the manner specified by the Administration.

  (2) The Administration may approve certifying provider applications to treat:

    (a) A chronic or debilitating disease or medical condition that results in a patient being admitted into hospice or receiving palliative care; or

    (b) A chronic or debilitating disease or medical condition or the treatment of a chronic or debilitating disease or medical condition that produces:

      (i) Cachexia, anorexia, or wasting syndrome;

      (ii) Severe or chronic pain;

      (iii) Severe nausea;

      (iv) Seizures;

      (v) Severe or persistent muscle spasms;

      (vi) Glaucoma;

      (vii) Post-traumatic stress disorder; or

      (viii) Any other condition that is severe and for which other medical treatments have been ineffective if the symptoms reasonably can be expected to be relieved by the medical use of cannabis.

  (3) A certifying provider may apply to amend the approval at any time.

  (4) The application shall be deemed approved unless the Administration notifies the applicant that the application has been denied.

B. A certifying provider may discuss the use of medical cannabis with a patient, including but not limited to:

  (1) Contraindications;

  (2) Dosage;

  (3) Problem use; and

  (4) Harm reduction and safety precautions.

C. Certifying Provider Registration Renewal.

  (1) An approval is valid for 2 years.

  (2) A certifying provider shall apply to renew a registration to certify at the time of renewal of the provider’s license.

  (3) The Administration shall provide a certifying provider with notice of renewal 90 business days before expiration of the registration.

  (4) The Administration shall grant the application for renewal of registration if:

    (a) The certifying provider attests that:

      (i) The certifying provider’s license to practice in Maryland is active, unrestricted, and in good standing; and

      (ii) The certifying provider’s registration by the State to prescribe controlled dangerous substances is valid; and

    (b) The certifying provider has otherwise complied with this chapter.

  (5) If a certifying provider fails to obtain a renewal of a registration to issue written certifications, the certifying provider may not issue written certifications.

D. A certifying provider may not receive compensation, including promotion, recommendation, advertising, subsidized rent, or anything of value, from a licensee.

E. Action Against a Provider.

  (1) After a written notice and a hearing in accordance with COMAR 14.17.22 if such hearing is properly requested, the Administration may deny a certifying provider’s application for registration, or revoke registration to certify if the provider:

    (a) Fraudulently applies for approval;

    (b) Fraudulently issues a written certification; or

    (c) Fails to comply with this chapter.

  (2) The Administration shall report any finding to the provider’s State licensing board and may refer any allegation of fraud or conduct that threatens public health by a certifying provider.

#### Regulation .02 Patient and Caregiver Registry.

*COMAR 14.17.04.02*

A. The Administration shall maintain a registry of qualifying patients and caregivers.

B. Patient Registration.

  (1) An individual seeking to become a qualifying patient shall complete the online registration process established by the Administration.

  (2) The Administration shall issue a unique patient identifier to each person who registers as a qualifying patient.

C. Caregiver Registration.

  (1) A qualifying patient, or a parent or legal guardian of a qualifying patient younger than 18 years old, may designate:

    (a) For a qualifying patient 18 years old or older, up to two caregivers; and

    (b) For a qualifying patient younger than 18 years old, up to four caregivers, including the patient’s parent or legal guardian.

  (2) An individual seeking to become a caregiver shall complete the online registration process established by the Administration.

  (3) The Administration shall issue a unique caregiver identifier to each person who registers with the Administration.

D. To designate the relationship between a qualifying patient and a registered caregiver, a qualifying patient or a parent or legal guardian of a qualifying patient younger than 18 years old shall designate the caregiver using the caregiver’s unique identifier through the Administration’s website.

E. A qualifying patient, or a parent or guardian of a qualifying patient younger than 18 years old, may terminate a caregiver by completing the online process established by the Administration.

F. The Administration shall provide access to the Administration’s registry to a Maryland law enforcement agency on a real-time basis only for just cause to verify that a patient or caregiver is registered with the Administration.

G. Patient or Caregiver Identification Cards.

  (1) A qualifying patient or registered caregiver may purchase an identification card by paying the fee in COMAR 14.17.21.

  (2) The identification card fee is waived for a qualifying patient enrolled in the:

    (a) Maryland Medical Assistance Program; or

    (b) Veterans Administration Maryland Health Care System.

  (3) If an identification card is lost, destroyed, or stolen, the cardholder shall, within 72 hours of becoming aware of the loss, destruction, or theft, report the loss, destruction, or theft to the Administration.

  (4) Misuse of Identification Card.

    (a) If an individual other than the qualifying patient or caregiver to whom an identification card has been issued attempts to use an identification card, a registered dispensary agent to whom it is offered shall confiscate it and initiate the return of the card to the Administration within 5 business days.

    (b) The Administration may notify the certifying provider and revoke the identification card of a qualifying patient or caregiver who allows another person to use an identification card which has been issued to the qualifying patient or caregiver.

H. If there is any change in the qualifying patient or the caregiver name or address, the qualifying patient or caregiver shall:

  (1) Notify the Administration within 30 days; and

  (2) If seeking a replacement identification card, pay the identification card replacement fee to obtain a new identification card.

#### Regulation .03 Written Certification.

*COMAR 14.17.04.03*

A. Issuing a Written Certification.

  (1) A certifying provider may determine that a patient qualifies for a written certification only if the:

    (a) Qualifying patient:

      (i) Has registered with the Administration;

      (ii) Meets the certifying provider’s inclusion criteria; and

      (iii) Does not meet the certifying provider's exclusion criteria; and

    (b) Certifying provider:

      (i) Has a bona fide provider-patient relationship with the qualifying patient; and

      (ii) Has determined that the potential benefits of the medical use of cannabis likely outweigh the health risks for the patient.

  (2) If a certifying provider determines that a patient qualifies for a written certification, the certifying provider shall:

    (a) Issue a written certification in the form required by the Administration;

    (b) Transmit the written certification to the Administration using the designated online process; and

    (c) If requested, provide a copy of the written certification to the qualifying patient.

  (3) A written certification shall include the:

    (a) Provider’s name, Maryland Board of Physicians, Board of Dental Examiners, Board of Podiatric Medical Examiners, or Board of Nursing license number, and office telephone number;

    (b) Qualifying patient’s name, date of birth, address, and county of residence;

    (c) Medical condition requiring medical cannabis; and

    (d) The date of qualification as a qualifying patient.

  (4) A written certification may contain, if applicable, a written statement certifying that, in the provider’s professional opinion, a 30-day supply of medical cannabis would be inadequate to meet the medical needs of the qualifying patient.

  (5) A certifying provider shall terminate a written certification if:

    (a) The qualifying patient meets the provider’s exclusion criteria;

    (b) Treatment with medical cannabis is no longer necessary for the qualifying patient;

    (c) Adverse effects of medical cannabis outweigh the benefits to the qualifying patient’s health; or

    (d) There is evidence that the qualifying patient engaged in diversion of medical cannabis.

  (6) A certifying provider may terminate a written certification if the qualifying patient demonstrates misuse of any substance.

  (7) A certifying provider shall notify the Administration within 1 business day of the termination of a written certification.

  (8) A qualifying patient shall have only one certifying provider at any time.

B. Written Certification Renewal.

  (1) A qualifying patient may seek renewal of a written certification not less than 30 calendar days after it was issued by notifying the patient’s certifying provider.

  (2) A certifying provider may renew the written certification for a qualifying patient if the certifying provider determines the patient still meets the criteria set forth in §A(1) of this regulation.

  (3) Upon renewing a written certification for a qualifying patient, a certifying provider shall notify the Administration.

  (4) Prior to renewing a written certification, a certifying provider shall conduct a full assessment of the qualifying patient within 365 days before the reissuance.

  (5) The full assessment in §B(4) of this regulation may be conducted via telehealth as defined by the certifying provider’s licensing board.

#### Regulation .04 Product Reservation for Qualifying Patients.

*COMAR 14.17.04.04*

A dispensary may only sell or dispense high potency products to a qualified patient or registered caregiver, as specified in COMAR 14.17.13.03.

#### Regulation .05 Accommodations for Qualifying Patients.

*COMAR 14.17.04.05*

A. A standard dispensary licensed under COMAR 14.17.06.08 shall:

  (1) Provide exclusive access to the licensed premises to qualifying patients and registered caregivers for at least 1 hour per day that the dispensary is operational or a dedicated service line to serve only qualifying patients and caregivers for the duration of the licensed premises’ operating hours;

  (2) Conspicuously display information about the reserved hours or dedicated service line for qualifying patients and registered caregivers, whichever is applicable on:

    (a) The front of the licensed premises; and

    (b) If applicable, the licensed dispensary’s social media accounts and public-facing website;

  (3) If providing reserved hours, maintain a consistent schedule; and

  (4) If providing a dedicated service line, shall make a good faith effort to prioritize qualifying patients and registered caregivers.

B. A standard dispensary may offer additional time and accommodation for qualifying patients and registered caregivers beyond the requirements in §A of this regulation, including reserving for qualifying and registered caregivers:

  (1) Priority access to the dispensary service area; and

  (2) Parking spaces near the entrance of the dispensary, if applicable.

#### Regulation .06 Compassionate Use Fund.

*COMAR 14.17.04.06*

A. The purpose of the Compassionate Use Fund is to reduce the cost of obtaining a medical assessment to determine the appropriateness of treatment with cannabis or reduce the cost of medical cannabis for individuals enrolled in the Maryland Medical Assistance Program or in the Veterans Affairs Maryland Health Care System.

B. Eligibility for Compassionate Use Fund.

  (1) A patient enrolled in the Maryland Medical Assistance Program or in the Veterans Affairs Maryland Health Care System may attest to a certifying provider eligibility for the Compassionate Use Fund due to their coverage status.

  (2) A certifying provider shall verify the individual’s eligibility for the Compassionate Use Fund due to their coverage status and provide documentation of eligibility status to the Administration.

  (3) A certifying provider shall reverify patient enrollment in the Maryland Medical Assistance Program or in the Veterans Affairs Maryland Health Care System annually.

C. Reimbursement of Written Certification.

  (1) A certifying provider may submit to the Administration for reimbursement of the written certification for individuals enrolled in the Maryland Medical Assistance Program or in the Veterans Affairs Maryland Health Care System.

  (2) In order to submit for reimbursement under this section, a certifying provider shall:

    (a) Verify a patient’s active enrollment in the Maryland Medical Assistance Program or the Veterans Affairs Maryland Health Care System at the time the written certification is given;

    (b) Conspicuously display a standard assessment and evaluation fee to be paid by the patient to obtain a written certification;

    (c) Offer a discount of $50 off the provider’s fee to provide written certifications to patients eligible under §B of this regulation; and

    (d) Charge an assessment and evaluation fee not to exceed the amount conspicuously displayed in §C(2)(b) of this regulation to obtain a written certification to all patients, regardless of eligibility under §B of this regulation.

  (3) Nothing in this section prohibits a certifying provider from offering a discount above $50 off the provider’s fee to provide written certifications to patients eligible under §B of this regulation.

D. Reimbursement.

  (1) On a monthly basis, a certifying provider may request reimbursement from the Administration for the discounted prices offered to eligible patients under this regulation.

  (2) A certifying provider may submit a request for reimbursement by the 15th of the following month, in the manner specified by the Administration.

  (3) To request reimbursement, a certifying provider shall provide the Administration with detailed records of the discounts provided, including:

    (a) A list of qualifying patients who obtained discounts in the past month, and whether the patient was enrolled in the Maryland Medical Assistance Program or the Veterans Affairs Maryland Health Care System;

    (b) An itemized account of the discounts provided to eligible patients in the past month, indicating:

      (i) The full price of the written certification; and

      (ii) Reduced cost paid by the eligible patient; and

    (c) Any additional information requested by the Administration.

  (4) To the extent funds are available within the Compassionate Use Fund, the Administration shall reimburse a certifying provider for eligible expenses.

  (5) If the Compassionate Use Fund lacks sufficient funds to reimburse a certifying provider:

    (a) The Administration shall cease providing reimbursements; and

    (b) A certifying provider is no longer required to provide discounts pursuant to this regulation.

#### Regulation .07 Clinical Directors.

*COMAR 14.17.04.07*

A. A licensed dispensary shall appoint at least one individual to function as clinical director who:

  (1) Is eligible to serve as a certifying provider, as defined in COMAR 14.17.01;

  (2) Is a licensed pharmacist in good standing with the State Board of Pharmacy; or

  (3) Has substantial education, training, and experience in the medical use of cannabis, as determined by the Administration and is a:

    (a) Registered nurse in good standing with the State Board of Nursing; or

    (b) Licensed naturopathic doctor in good standing with the State Board of Physicians.

B. During the hours of operation, a licensed dispensary shall have a clinical director:

  (1) On-site; or

  (2) Available via electronic communication.

C. A clinical director shall:

  (1) Register as a clinical director with the Administration;

  (2) Complete at least one training course each year that is approved by the Administration, which includes:

    (a) The latest scientific research on medical cannabis;

    (b) The risks and benefits of medical cannabis; and

    (c) Other information considered necessary by the Administration;

  (3) Educate qualifying patients and caregivers on:

    (a) Treatment of the qualifying patient’s medical condition with medical cannabis;

    (b) Potential drug-to-drug interactions, including interactions with alcohol, prescription drugs, non-prescription drugs, and supplements;

    (c) Possible side effects or contraindications of medical cannabis use;

    (d) The potential for differing strengths and effects of medical cannabis strains; and

    (e) Different methods, forms, and routes of medical cannabis administration; and

  (4) Provide training to dispensary agents on:

    (a) Guidelines for providing information to qualifying patients related to risks, benefits, and side effects associated with medical cannabis;

    (b) Recognizing signs and symptoms of substance abuse; and

    (c) Guidelines for refusing to provide medical cannabis to an individual who appears to be under the influence of drugs or alcohol.

D. A clinical director for a licensed dispensary may not provide a written certification for medical cannabis to any qualifying patient.

E. A standard dispensary is not subject to §§A—C of this regulation until the licensee has been licensed and operational for a period of at least 24 months.

F. A micro dispensary is not subject to §§A—C of this regulation.

G. The Administration may request information from licensed dispensaries on clinical director utilization in a manner specified by the Administration.

#### Regulation .08 Tax Exemption of Medical Cannabis.

*COMAR 14.17.04.08*

Medical cannabis sold to qualifying patients or registered caregivers under this chapter shall be exempt from any sales and use tax assessment.

#### Regulation .09 Medical Product Availability.

*COMAR 14.17.04.09*

A. A qualifying patient, registered caregiver, certifying provider, licensee, or clinical director may submit to the Administration, in a manner prescribed by the Administration, information about medical cannabis products that are scarce, limited in production, or no longer available.

B. The Administration may implement programs or incentives to address product scarcity.