Ala. Admin. Code r. 538-X-2-.06

Current through Register Vol. 43, No. 1, October 31, 2024

Section 538-X-2-.06 - Caregiver Registration

(1) Unless otherwise provided in paragraph 2. of this rule, only Alabama residents who are natural persons 21 years of age or older may register with the Commission to serve as a caregiver for a qualifying patient.

(2) Notwithstanding the age limitation in paragraph 1. of this rule, a minor patient's parent or legal guardian 19 years of age or older and who otherwise meets the requirements of the Act and this Chapter, may serve as the minor patient's caregiver.

(3) No person shall serve as a caregiver for any patient before registering with the Commission as provided in the Act and this Chapter.

(4) A patient shall designate no more than two caregivers. The Commission shall register no more than two caregivers for each patient.

(5) A competent adult patient may change caregivers with 14 days' written notice to the certifying physician, who (acting individually or through a designated representative) shall notify the Commission of the change on the patient registry.

(6) An individual shall serve as a caregiver for no more than three patients. Except as provided in paragraph 8. of this rule, the Commission shall associate no more than three patients for each caregiver.

(7) A caregiver must possess a medical cannabis card, and pay an application fee, for each patient for whom the caregiver provides care.

(8) Notwithstanding the limitations in paragraphs 4. and 6. of this Rule, upon a written request, the Commission may, in its discretion, permit an individual to serve as a caregiver for more than three patients and/or for a patient to designate more than two caregivers:

(a) In order to avoid unnecessary hardship to the patient or patients;

(b) Where the patients' care is being provided in a hospital, long-term care facility, or through a hospice program licensed under Alabama law; or

(c) Where the caregiver is simultaneously caring for multiple patients who reside in the same household as the caregiver.

(9) Except upon a demonstration of extraordinary circumstances and with the express permission of the Commission, an individual caregiver may not serve in such capacity as to more than ten patients simultaneously.

(10) If a patient requests permission to change a caregiver before renewal, the licensed certifying physician or the physician's representative shall note the request on the patient registry, setting forth information relating to the proposed caregiver, so as to conform with the caregiver registration requirements under the Act and this Chapter. The Commission shall approve a new caregiver only if such individual meets the requirements of the Act and this Chapter.

(11) A patient's licensed certifying physician shall not serve as the patient's caregiver.

(12) The Commission shall deny a submission for a caregiver registration if the individual identified on the submission is included in one or more of the following databases:

(a) The list of excluded individuals and entities maintained by the office of inspector general in the United States Department of Health and Human Services pursuant to 42 U.S.C. part 1320a-7 (as amended) and 42 U.S.C. part 1320c-5 (as amended) (i.e., indicating that the individual has been sanctioned for or convicted of fraud, theft or other dishonest and illegal conduct with respect to Medicare or other Government agencies related to healthcare).

(b) The Alabama Department of Human Resources' online registry of individuals who have been determined to be indicated of abuse.

(c) The state or federal sex offender registry.

(d) The Alabama Department of Correction's or U.S. Bureau of Prisons' registry of inmates and parolees.

(e) Any governmental database indicating that the health care provider seeking caregiver status has neglected or abused a patient, a long-term care facility resident, or residential care facility resident or misappropriated property of any such resident.

(13) Medical Cannabis may not be possessed by or administered to anyone other than a registered qualified patient, unless the person is a caregiver who is placed on the registry established by the Commission in accordance with the Act and this Chapter. A registered caregiver may possess and administer medical cannabis only to those patients with whom the caregiver's registration is associated.

(14) An individual who meets the caregiver eligibility requirements under the Act and this Chapter may be registered as a caregiver if the following are electronically submitted to the Commission through the patient registry:

(a) Identification of a patient who is registered or attempting to register as a patient pursuant to the Act and this Chapter, and for whom the individual intends to serve as a caregiver;

(b) Completed caregiver registration information entered into the patient registry in accordance with paragraph 14 of this rule; and

(c) Required application fee as set by the Commission.

(15) Only the caregiver, or a licensed certifying physician with whom the patient or prospective patient has a bona fide physician-patient relationship, or the physician's representative, may submit the caregiver's registration. For a caregiver's registration submission to be considered complete, the applicable caregiver registration fee, all of the information supplied as to patients as set forth in 538-x-.05 -2. of this Chapter, as well as the following items must be submitted to the Commission in a manner suitable to the Commission:

(a) The full name, residential address, telephone number, date of birth, and email address of the caregiver and the associated patient.

(b) Associated patient's registration number issued by the Commission, if available.

(c) Caregivers government-issued identification number (such as a driver's license number, Alabama Identification Card number or Social Security Number). Caregivers must present a registered certifying physician with an unexpired driver's license, unexpired Alabama Identification Card, unexpired passport, Social Security Card, Birth Certificate, or other documentation proving identity as may be approved by the Commission.

(d) A digital color photograph of the caregiver taken no more than 30 days prior to submission of the caregiver registration.

(e) Indication whether the caregiver certification is new or a renewal.

(f) The following written attestations of the prospective caregiver:

1. That the registered certifying physician has explained the possible risks and benefits associated with the use of medical cannabis;

2. That the registered certifying physician has obtained the caregiver's consent to treat the patient with medical cannabis; and

3. That the caregiver has agreed to comply with the provisions of the Act and this Chapter.

(g) The following written attestations of the registered certifying physician as to the caregiver, in addition to those relating to the patient under paragraph 2.j. of Rule 538-X-2-.05:

1. That the caregiver is suitable to the patient's treatment or therapy through the use of medical cannabis; and

2. That the caregiver, on behalf of the patient, has provided voluntary informed written consent as to the following matters required by § 20-2A-33(5), Code of Ala. 1975, (as amended):

(i) The federal and state classification of cannabis as a Schedule I controlled substance.

(ii) The approval and oversight status of cannabis by the Food and Drug Administration.

(iii) The current state of research on the efficacy of cannabis to treat the qualifying medical condition or conditions.

(iv) The potential for addiction.

(v) The potential effect that cannabis may have on a patient's coordination, motor skills, and cognition, including a warning against operating heavy machinery, operating a motor vehicle, or engaging in activities that require an individual to be alert or respond quickly.

(vi) The potential side effect of cannabis use.

(vii) The risks, benefits, and drug interactions of cannabis.

(viii) A statement that the use of medical cannabis could result in termination from employment without recourse.

(ix) A statement that the costs associated with the patient's use of medical cannabis may not be covered by insurance or government assistance programs.

(x) That the patient's de-identified health information contained in the patient's medical record within the patient registry may be used for research purposes or used to monitor compliance with this chapter, as further provided in § 20-2A-35(c), Code of Ala. 1975, (as amended).

(h) Such other information as the Commission may reasonably require.

(16) All prospective caregivers shall attest to the following:

(a) That the prospective caregiver meets the qualifications for a caregiver set forth in Rule 538-X-2-.04;

(b) That the registered certifying physician has explained to the caregiver the possible risks and benefits associated with the use of medical cannabis;

(c) That the prospective caregiver agrees to serve as the caregiver for the patient identified on their registry submission;

(d) That the prospective caregiver agrees to control the dosage and frequency of the use of medical cannabis in accordance with any instruction for use provided by the certifying physician; and

(e) That the prospective caregiver agrees to comply with the Act and this Chapter.

(f) If the patient is under the age of 19, that the prospective caregiver understands the information provided by the certifying physician and knowingly consents to the use of medical cannabis by the patient.

(17) A caregiver registration shall be valid from the date of issuance and expire one year later.

(18) The Commission shall send a notification to each caregiver 45 calendar days before the expiration date on the caregiver's medical cannabis card.

(19) To maintain a valid caregiver registration, a caregiver must annually renew the caregiver registration submission, in accordance with this Rule. Renewal applications, fees, and required documentation must be submitted no less than 14 calendar days before the expiration of the caregiver's medical cannabis card.

Ala. Admin. Code r. 538-X-2-.06

Adopted by Alabama Administrative Monthly Volume XL, Issue No. 11, August 31, 2022, eff. 10/15/2022.

Author: William H. Webster

Statutory Authority:Code of Ala. 1975, §§ 20-2A-22, as amended.