Kentucky Medical Cannabis Program: Practitioner Certification and Telehealth Guidelines

What this means for your practice

For healthcare businesses, particularly telehealth providers operating or considering operations in Kentucky, this guidance is critical. The explicit requirement for an *initial in-person examination* to establish a bona fide practitioner-patient relationship for medical cannabis certifications means that a purely virtual model for initial patient engagement in this context is not compliant. Telehealth companies must either implement a hybrid care model, facilitate in-person evaluations through partnerships, or ensure their practitioners are aware of this specific state mandate. However, the allowance for *subsequent* written certifications and ongoing relationship maintenance via telehealth consultations provides flexibility for long-term patient care. Practitioners must meticulously document their compliance with the in-person initial visit, patient review, counseling, and consent requirements, and register appropriately with the state licensing board and the Kentucky Medical Cannabis Program. Failure to adhere to these provisions, including the specific statutory requirements for a bona fide relationship and certification, could lead to regulatory scrutiny and enforcement actions.

The Kentucky Medical Cannabis Program has issued guidance detailing the requirements for physicians and advanced practice registered nurses (APRNs) seeking to provide written certifications for patients. This framework establishes the necessary steps for practitioners to become authorized, register with the state program, and conduct patient evaluations, emphasizing both in-person and telehealth components.

Practitioner Authorization and Registration

To become an authorized medical cannabis practitioner in Kentucky, physicians and APRNs must first be authorized by their respective state licensing boards to provide such certifications. Following this, they are required to register with the Kentucky Medical Cannabis Program through the state's Practitioner Authorization Registration Portal. This registration is a prerequisite to issuing any written certifications for medical cannabis use.

Core Requirements for Written Certifications

Kentucky Revised Statute (KRS) 218B.050 outlines the specific process practitioners must follow when providing a patient with a written certification for medical cannabis. These steps include:

• Establishing a Bona Fide Practitioner-Patient Relationship: This relationship must be established with the patient, serving as the foundation for treatment.
• Diagnosis of a Qualifying Condition: The practitioner must diagnose the patient with a medical condition, or confirm a diagnosis from another healthcare provider, that they believe is likely to benefit safely and effectively from medical cannabis.
• Review of Electronic Monitoring System (EMS) Report: Practitioners are mandated to review a report from the electronic monitoring system, established by KRS 218A.202, covering at least 12 months immediately preceding the report date for the patient.
• Patient Consultation on Risks and Side Effects: A thorough consultation must occur with the patient, or their custodial parent/legal guardian if the patient is a minor, regarding the potential risks and side effects of medical cannabis. This includes discussing possible interactions with any other medications the patient is currently taking.
• Obtaining Consent for Minors: If the patient is a minor child, the practitioner must obtain consent from the patient's custodial parent or legal guardian responsible for treatment decisions.

In-Person vs. Telehealth Requirements

A critical distinction in the Kentucky program involves the modality of patient interaction:

• Initial Certification: The *initial* written certification must be provided during an in-person examination of the patient by the medical cannabis practitioner. The certification must then be recorded in the state's medical cannabis practitioner registry within 24 hours of this in-person examination.
• Subsequent Certifications and Renewals: For subsequent written certifications, including those for renewing a registry identification card (medical cannabis card), practitioners may provide these electronically or during the course of a telehealth consultation.

Defining a Bona Fide Practitioner-Patient Relationship

KRS 218B.010 defines a bona fide practitioner-patient relationship as a treating or consulting relationship where the medical cannabis practitioner has:

• Completed an initial in-person examination and assessment of the patient's medical history and current medical condition.
• Consulted with the patient regarding the possible medical, therapeutic, and palliative properties of medical cannabis.
• Advised the patient of the possible risks and side effects associated with medical cannabis, including potential interactions with other medications.
• Established an expectation for providing follow-up care and treatment in accordance with administrative regulations.

Importantly, while the bona fide practitioner-patient relationship *must* be established during an initial in-person visit, it *can be maintained via telehealth* for ongoing care.

Written Certification Validity

For the purpose of applying for a registry identification card, a written certification is valid for a period of not more than 60 days. A medical cannabis practitioner has the discretion to renew a written certification for an additional three periods, each not exceeding 60 days. After these additional extensions have been utilized, the medical cannabis practitioner may issue another written certification to the patient only after another examination, which may be conducted either in-person or via telehealth.

Key Facts

| Detail | Value | |---|---| | Eligible Practitioners | Physicians and Advanced Practice Registered Nurses (APRNs) authorized by their state licensing board. | | Initial Patient Visit Requirement | An initial in-person examination is mandatory to establish a bona fide practitioner-patient relationship and provide the first written certification. | | Subsequent Patient Visits | Renewals and maintenance of the bona fide relationship may be conducted via telehealth. | | Written Certification Validity | Initial certification valid for up to 60 days, renewable for three additional 60-day periods. A new examination (in-person or telehealth) is required thereafter. | | Key Statutes Referenced | KRS 218B.050, KRS 218B.010, KRS 218A.202 | | Registration Requirement | Practitioners must register with the Kentucky Medical Cannabis Program via the Practitioner Authorization Registration Portal. |

Frequently Asked Questions

Who is eligible to provide written certifications for medical cannabis in Kentucky?

Physicians and advanced practice registered nurses (APRNs) who are authorized through their respective licensing boards and have registered with the Kentucky Medical Cannabis Program.

Is an in-person visit always required for a patient to receive a medical cannabis certification?

Yes, an initial in-person examination of the patient by the medical cannabis practitioner is required to establish a bona fide practitioner-patient relationship and provide the first written certification. However, subsequent certifications and renewals may be provided electronically or during a telehealth consultation.

How is a bona fide practitioner-patient relationship defined for medical cannabis in Kentucky?

It means a treating or consulting relationship where the practitioner has completed an initial in-person examination, consulted with the patient on medical cannabis properties and risks, advised on side effects and drug interactions, and established an expectation for follow-up care. While established in-person, it can be maintained via telehealth.

How long is a written certification for medical cannabis valid in Kentucky?

A written certification is valid for a period of not more than 60 days. It may be renewed for an additional three periods of no more than 60 days each. After these extensions, another in-person or telehealth examination is required to issue a new certification.

What information must a practitioner review before issuing a medical cannabis certification?

The practitioner must review a report from the state's electronic monitoring system (KRS 218A.202) related to the patient for at least 12 months immediately preceding the date of the report.

Source: kymedcan.ky.gov — FDA Warned Against Unapproved Compounded Ketamine for Psychiatric Disorders