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In November 2018, Missouri became the 33rd state to approve the use of medical marijuana, and rules and regulations for medical marijuana are being drafted by the Missouri Department of Health & Senior Services (DHHS). On March 15, 2019, DHSS released more draft rules. Of the published draft rules, there is only one set that relates to physician certifications. However, hospitals and other health care providers will encounter numerous challenges once medical marijuana becomes available in Missouri in 2020.