24104 Federal Register / Vol. 77, No. 77 / Friday, April 20, 2012 / Rules and Regulations 

DEPARTMENT OF TRANSPORTATION 

Federal Motor Carrier Safety 

Administration 

49 CFR Parts 350, 383, 390, and 391 

[Docket No. FMCSA–2008–0363] 

RIN 2126–AA97 

National Registry of Certified Medical 

Examiners 

AGENCY: Federal Motor Carrier Safety 

Administration (FMCSA), DOT. 

ACTION: Final rule. 

SUMMARY: FMCSA establishes a National 

Registry of Certified Medical Examiners 

(National Registry) with requirements 

that all medical examiners who conduct 

physical examinations for interstate 

commercial motor vehicle (CMV) 

drivers meet the following criteria: 

Complete certain training concerning 

FMCSA’s physical qualification 

standards, pass a test to verify an 

understanding of those standards, and 

maintain and demonstrate competence 

through periodic training and testing. 

Following establishment of the National 

Registry and a transition period, FMCSA 

will require that motor carriers and 

drivers use only those medical 

examiners on the Agency’s National 

Registry and will only accept as valid 

medical examiner’s certificates issued 

by medical examiners listed on the 

National Registry. FMCSA is developing 

the National Registry program to 

improve highway safety and driver 

health by requiring that medical 

examiners be trained and certified so 

they can determine effectively whether 

a CMV driver’s medical fitness for duty 

meets FMCSA’s standards. 

DATES: Effective on May 21, 2012. 

Compliance required beginning on May 

21, 2014. 

FOR FURTHER INFORMATION CONTACT: 

Elaine Papp, Office of Carrier, Driver 

and Vehicle Safety Standards (MC– 

PSP), Federal Motor Carrier Safety 

Administration, 1200 New Jersey 

Avenue SE., Washington, DC 20590– 

0001. Telephone (202) 366–4001. Email: 

FMCSAMedical@dot.gov. 

ADDRESSES: Availability of Rulemaking 

Documents: For access to docket 

FMCSA–2008–0363 to read background 

documents and comments received, go 

to http://www.regulations.gov at any 

time, or to U.S. Department of 

Transportation, Room W12–140, 1200 

New Jersey Avenue SE., Washington, 

DC 20590, between 9 a.m. and 5 p.m. 

e.t., Monday through Friday, except 

Federal holidays. 

Privacy Act: Anyone is able to search 

the electronic form of all comments 

received into any of our dockets by the 

name of the individual submitting the 

comment (or signing the comment, if 

submitted on behalf of an association, 

business, labor union, etc.). You may 

review DOT’s complete Privacy Act 

Statement, published in the Federal 

Register on April 11, 2000 (65 FR 

19476), or you may visit http:// 

DocketInfo.dot.gov. 

SUPPLEMENTARY INFORMATION: This 

document is organized as follows: 

I. Table of Acronyms and Abbreviations 

II. Legal Basis for the Rulemaking 

III. Background 

IV. Discussion of Comments Received on the 

Proposed Rule 

V. Section-by-Section Explanation of 

Changes from the NPRM 

VI. Regulatory Analyses and Notices 

TABLE OF ACRONYMS AND ABBREVIATIONS

Acronym or 

abbreviation Term 

AANP ........................................................................... American Academy of Nurse Practitioners 

AAOHN ........................................................................ American Association of Occupational Health Nurses

AAPA ........................................................................... American Academy of Physician Assistants 

ABA .............................................................................. American Bus Association 

ACOEM ........................................................................ American College of Occupational and Environmental Medicine 

ADA .............................................................................. American Diabetes Association 

Advocates .................................................................... Advocates for Highway and Auto Safety 

AME ............................................................................. Aviation Medical Examiner 

APN .............................................................................. Advanced Practice Nurse 

ATA .............................................................................. American Trucking Associations, Inc. 

BISC ............................................................................. Bus Industry Safety Council 

CAA .............................................................................. Clean Air Act 

CDL .............................................................................. Commercial Driver’s License 

CDLIS .......................................................................... Commercial Driver’s License Information System 

CME ............................................................................. Continuing Medical Education 

CMV ............................................................................. Commercial Motor Vehicle 

DC ................................................................................ Doctor of Chiropractic 

DEP .............................................................................. Diabetes Expert Panel 

DO ................................................................................ Doctor of Osteopathy 

DOT ............................................................................. U.S. Department of Transportation 

EA ................................................................................ Environmental Assessment 

FHWA .......................................................................... Federal Highway Administration 

FMCSA ........................................................................ Federal Motor Carrier Safety Administration 

FMCSRs ...................................................................... Federal Motor Carrier Safety Regulations 

HIPAA .......................................................................... Health Insurance Portability and Accountability Act 

ISAREC ........................................................................ Indiana Statewide Association of Rural Electric Cooperatives 

LTCCS ......................................................................... Large Truck Crash Causation Study 

LFC .............................................................................. Licencia Federal de Conductor 

MCMIS ......................................................................... Motor Carrier Management Information System 

MCSAP ........................................................................ Motor Carrier Safety Assistance Program 

MD ............................................................................... Doctor of Medicine 

ME ................................................................................ Medical Examiner 

MEP ............................................................................. Medical Expert Panel 

Med. Cert./CDL ............................................................ Medical Certification Requirements as Part of the CDL

MOU ............................................................................. Memorandum of Understanding 

MRB ............................................................................. (FMCSA’s) Medical Review Board 

MRO ............................................................................. Medical Review Officer 


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Federal Register / Vol. 77, No. 77 / Friday, April 20, 2012 / Rules and Regulations 24105 

TABLE OF ACRONYMS AND ABBREVIATIONS—Continued 

Acronym or 

abbreviation Term 

NADME ........................................................................ National Academy of DOT Medical Examiners 

NAFTA ......................................................................... North American Free Trade Agreement 

NCCA ........................................................................... National Commission of Certifying Agencies 

NPRM .......................................................................... Notice of Proposed Rulemaking 

National Registry ......................................................... National Registry of Certified Medical Examiners 

NSTA ........................................................................... National School Transportation Association 

NTSB ........................................................................... National Transportation Safety Board 

OOIDA ......................................................................... Owner-Operator Independent Drivers Association 

PA ................................................................................ Physician Assistant 

PHI ............................................................................... Protected Health Information 

PIA ............................................................................... Privacy Impact Assessment 

PII ................................................................................. Personally Identifiable Information 

PRA .............................................................................. Paperwork Reduction Act 

RDS ............................................................................. Role Delineation Study 

RIA ............................................................................... Regulatory Impact Analysis 

SAFETEA–LU .............................................................. Safe, Accountable, Flexible, Efficient Transportation Equity Act: A Legacy for Users 

SBA .............................................................................. Small Business Administration 

SDLAs .......................................................................... State Driver Licensing Agencies 

Wynne .......................................................................... Wynne Transport Services, Inc. 

I. Summary of the Final Rule 

This rule establishes a training, 

testing, and registration program to 

certify medical professionals as 

qualified to conduct medical 

certification examinations of 

commercial drivers. Current regulations 

require all interstate commercial drivers 

(with certain limited exceptions) to be 

medically examined by a licensed 

health care provider to determine 

whether these drivers meet the FMCSA 

physical qualification requirements. All 

drivers must carry a medical examiner’s 

certificate as proof that they have passed 

this physical qualification examination. 

The MEs who conduct said physical 

examinations must retain copies of the 

Medical Examination Reports of all 

drivers they examine and certify. The 

Medical Examination Report lists the 

specific results of the various medical 

tests used to determine whether a driver 

meets the physical qualification 

standards set forth in subpart E of part 

391 of the FMCSRs. 

Before the adoption of this rule, there 

was no required training program for the 

medical professionals who conduct 

driver physical examinations, although 

the FMCSRs required MEs to be 

knowledgeable about the regulations (49 

CFR 391.43(c)(1)). The former rules 

required that any medical professional 

licensed by his or her State to conduct 

physical examinations could conduct 

driver medical certification exams. No 

specific knowledge of the Agency’s 

physical qualification standards was 

required or verified by testing. As a 

result, some of the medical 

professionals who conduct these 

examinations may be unfamiliar with 

FMCSA physical qualification standards 

and how to apply them. These 

professionals may also be unaware of 

the mental and physical rigors that 

accompany the occupation of CMV 

driver, and how various medical 

conditions (and the therapies used to 

treat them) can affect the ability of 

drivers to safely operate CMVs. 

This rule establishes the National 

Registry to ensure that all MEs who 

conduct driver medical certifications 

have been trained in FMCSA physical 

qualifications standards and guidelines. 

In order to be listed on the National 

Registry, MEs are required to attend an 

accredited training program and pass a 

certification test to assess their 

knowledge of the Agency’s physical 

qualifications standards and guidelines 

and how to apply them to drivers. Upon 

passing this certification test, and 

meeting the other administrative 

requirements associated with the 

Program, MEs will be listed on the 

National Registry. Once this rule is fully 

implemented, only medical certificates 

issued to drivers by MEs on the National 

Registry will be considered valid by the 

Agency as proof of medical certification. 

II. Legal Basis for the Rulemaking 

The primary legal basis for the 

National Registry of Certified Medical 

Examiners program comes from 49 

U.S.C. 31149, enacted by section 4116(a) 

of Safe, Accountable, Flexible, Efficient 

Transportation Equity Act: A Legacy for 

Users, Public Law 109–59, 119 Stat. 

1726 (Aug. 10, 2005) (SAFETEA–LU). 

Subsection (d) of section 31149 provides 

that: 

The Secretary, acting through the 

Federal Motor Carrier Safety 

Administration— 

• Shall establish and maintain a 

current national registry of medical 

examiners who are qualified to perform 

examinations and issue medical 

certificates; 

• Shall remove from the registry the 

name of any medical examiner that fails 

to meet or maintain the qualifications 

established by the Secretary for being 

listed in the registry or otherwise does 

not meet the requirements of this 

section or regulation issued under this 

section; 

• Shall accept as valid only medical 

certificates issued by persons on the 

national registry of medical examiners; 

and 

• May make participation of medical 

examiners in the national registry 

voluntary if such a change will enhance 

the safety of operators of commercial 

motor vehicles. 

In addition to implementing the 

provisions in subsection (d), which 

specifically directs the establishment of 

a national registry of qualified medical 

examiners, FMCSA implements through 

this rulemaking certain other provisions 

from section 31149 related to a national 

registry. First, subsection (c) requires 

FMCSA, with the advice of the Agency’s 

Medical Review Board and Chief 

Medical Examiner (established by 

subsections (a) and (b), respectively), to 

develop, as appropriate, specific courses 

and materials for training required for 

medical examiners to be listed on a 

national registry. Medical examiners 

will be required to undergo initial and 

periodic training and testing in order to 

be listed on the national registry 

(section 31149(c)(1)(A)(ii) and (c)(1)(D)). 

Second, FMCSA also implements 

requirements for medical examiners to 


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24106 Federal Register / Vol. 77, No. 77 / Friday, April 20, 2012 / Rules and Regulations 

transmit electronically, on a monthly 

basis, certain information about 

completed Medical Examination 

Reports of CMV drivers (section 

31149(c)(1)(E)). Third, the rule requires 

medical examiners to provide copies of 

Medical Examination Reports and 

medical examiner’s certificates to 

FMCSA within 48 hours of a request 

from enforcement personnel. This level 

of responsiveness is required to enable 

FMCSA to investigate patterns of errors 

or improper certification by medical 

examiners, in accordance with 49 U.S.C. 

31149(c)(2). Finally, the rule establishes 

the procedures and grounds for removal 

of medical examiners from the National 

Registry, as authorized by section 

31149(c)(2) and (d)(2). 

SAFETEA–LU also revised the 

statutory minimum standards for the 

regulation of CMV safety to ensure that 

medical examinations of CMV drivers 

are ‘‘performed by medical examiners 

who have received training in physical 

and medical examination standards and, 

after the national registry maintained by 

the Department of Transportation * * * 

is established, are listed on such 

registry’’ (49 U.S.C. 31136(a)(3), as 

amended by section 4116(b) of 

SAFETEA–LU). The statute requires 

FMCSA, in developing its regulations, 

to consider both the effect of driver 

health on the safety of CMV operations 

and the effect of such operations on 

driver health (49 U.S.C. 31136(a)). 

In addition to the general rulemaking 

authority in 49 U.S.C. 31136(a), the 

Secretary of Transportation is 

specifically authorized by section 

31149(e) to ‘‘issue such regulations as 

may be necessary to carry out this 

section.’’ Authority to establish and 

implement the National Registry 

program has been delegated to the 

Administrator of FMCSA (49 CFR 

1.73(g)). 

III. Background 

On December 1, 2008, FMCSA 

published a notice of proposed 

rulemaking (NPRM) to establish the 

National Registry (73 FR 73129). The 

public comment period for the NPRM 

closed on January 30, 2009. The FMCSA 

also proposed to require that all medical 

examiners who conduct physical 

examinations for interstate CMV drivers 

complete certain training concerning 

FMCSA physical qualification 

standards, pass a test to verify an 

understanding of those standards, and 

maintain and demonstrate competence 

through periodic training and testing. 

Following establishment of the National 

Registry and a transition period, only 

medical examiner’s certificates issued 

by medical examiners listed on the 

National Registry would be accepted as 

valid. 

IV. Discussion of Comments Received 

on the Proposed Rule 

A. Overview of Comments 

In response to the December 2008 

NPRM, FMCSA received approximately 

80 comments. Most of the commenters 

were individuals, many of whom 

identified themselves as health care 

professionals. Among other commenters 

were the following: nine health care 

provider professional associations, 

among them the American College of 

Occupational and Environmental 

Medicine (ACOEM) and the American 

Chiropractic Association; the American 

Diabetes Association; five trucking and 

other trade associations, including the 

American Trucking Associations, Inc. 

(ATA), Owner-Operator Independent 

Drivers Association (OOIDA), and 

jointly from American Bus Association 

(ABA) and Bus Industry Safety Council 

(BISC); six motor carriers; six other 

private businesses, including driver 

training and testing organizations; nine 

State agencies (from Arizona, California, 

Delaware, Florida, Illinois, Indiana, 

Iowa, Missouri, and Virginia); 

Advocates for Highway and Auto Safety 

(Advocates); and the National 

Transportation Safety Board (NTSB). 

Comments were also received from 

FMCSA’s Medical Review Board (MRB), 

an advisory group of physicians 

appointed by FMCSA to make evidencebased recommendations for the 

development of physical qualification 

standards for drivers, driver 

examination requirements, and 

materials for training Medical 

Examiners (MEs). The MRB is convened 

by FMCSA to provide information, 

advice, and recommendations to the 

Secretary of Transportation and the 

FMCSA Administrator on the 

development and implementation of 

science-based physical qualification 

standards applicable to interstate CMV 

drivers. The MRB does not hold 

regulatory development responsibilities, 

manage programs, or make decisions 

affecting such programs. 

Fourteen commenters expressed 

support for the proposed rule. However, 

nearly all of those supporting the 

proposed rule added recommendations 

or voiced concern about various parts of 

the proposed requirements, including 

increased costs and training 

requirements for MEs, the 

implementation period, and the lack of 

a developed training curriculum. Seven 

commenters explicitly opposed the 

proposed rule. Other commenters 

expressed serious concerns over specific 

requirements that they believed would 

cause the proposed rule to fail, 

including increased costs, lack of access 

to MEs, and driver privacy rights if State 

Driver Licensing Agencies (SDLAs) are 

permitted to obtain the commercial 

driver’s Medical Examination Reports. 

The following sections provide details 

regarding specific issues raised by the 

commenters. 

B. Scope of National Registry Program 

1. Eligibility To Be a Medical Examiner 

Who should be eligible? Under 49 CFR 

390.103, FMCSA proposed a 

requirement, based on the existing 

regulation at 49 CFR 390.5, that medical 

examiners must be licensed, certified, or 

registered in accordance with applicable 

State laws and regulations to perform 

physical examinations. The list of major 

health care professionals who may 

apply for ME certification included: 

Advanced Practice Nurses (APNs), 

Doctors of Chiropractic (DCs), Doctors of 

Medicine (MDs), Doctors of Osteopathy 

(DOs), Physician Assistants (PAs), or 

other health care professionals 

authorized by their States to perform 

physical examinations. Commenters 

asserted that only physicians (MDs and 

DOs), or only physicians, APNs, and 

PAs, or only health care providers who 

are permitted by their States to prescribe 

medications, should be eligible to be 

certified and be on the National 

Registry. Others argued that other health 

care professionals who are licensed by 

their States to perform physical 

examinations are qualified to perform 

the driver examinations and should be 

eligible. 

Several commenters thought that the 

proposed requirements would lead to a 

decrease in the quality of MEs. Arizona 

stated that with fewer doctors serving as 

MEs due to the time needed for training 

and testing, there would be an increase 

in the number of allied health and nonphysician medical professionals 

completing examinations. On the other 

hand, Schneider National suggested that 

the National Registry requirements will 

deter only those medical professionals 

who today may be performing 

commercial driver medical 

examinations with little or no 

knowledge of the driver physical 

requirements of FMCSA. 

FMCSA Response: The final rule 

makes no change in the regulatory text. 

In a 1992 rule, the Federal Highway 

Administration (FHWA) (which was 

responsible for administering Federal 

motor carrier safety requirements until 

1999) amended the FMCSRs to expand 

the definition of ‘‘medical examiner’’ to 

allow other health care professionals 


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such as PAs, APNs, and DCs, in 

addition to MDs and DOs authorized 

previously, to perform examinations of 

CMV drivers (57 FR 33276; July 28, 

1992). All medical examiners were 

required to be licensed, registered, or 

certified by their States to perform 

physical examinations, and to be 

proficient in the use of, and to use, 

medical protocols necessary to perform 

the examination in accordance with the 

FMCSRs. The 1992 rule acknowledged 

that should an ME discover a medical 

condition outside his or her scope of 

practice, best practice would be to refer 

the driver to an MD, DO, or specialist. 

The FHWA indicated this was 

consistent with what other medical 

practitioners do in ‘‘this age of 

specialization.’’ States determine who is 

legally qualified to perform physical 

examinations within their jurisdictions 

by setting scope of practice 

requirements, and FMCSA will continue 

to rely on State determinations. 

Qualification by Other Criteria. 

FMCSA proposed that medical 

examiner candidates be required to 

complete training that meets the core 

curriculum specifications established by 

FMCSA for medical examiner training 

and pass an FMCSA-provided 

certification test. Both the core 

curriculum specifications and the 

FMCSA-provided certification test will 

be based on FMCSA regulations and 

guidelines. 

Several commenters proposed the 

substitution of other types of training for 

the training requirements proposed in 

the NPRM. Two MDs, and the States of 

Arizona and Delaware, suggested that 

Federal Aviation Administration (FAA) 

aviation medical examiners (AMEs) 

could be certified, without further 

training or testing as FMCSA MEs. One 

physician recommended that we accept 

MD and DO board certification. The 

American Association of Occupational 

Health Nurses (AAOHN) suggested 

similarly that we should reduce 

required training for APNs and 

physicians who are experienced and 

professionally trained in occupational 

health. 

National Registry Training Systems, 

an independent entity not affiliated 

with FMCSA, and a clinician suggested 

that we should certify health care 

professionals who participated as 

subject matter experts in the 

development of the National Registry 

program training and testing 

components. Similarly, a MD suggested 

that we permit health care professionals 

to by-pass training if they have a 

working knowledge of the DOT 

requirements and guidance. 

FMCSA Response: The FMCSA 

acknowledges the specialized 

knowledge and expertise that some 

health care professionals bring to the 

driver qualification process. Physicians 

can and do serve as both MEs for CMV 

drivers and designated AMEs for pilots. 

However, the National Registry program 

has been developed with strategic 

differences from the FAA AME designee 

program, as detailed in the regulatory 

evaluation for this rulemaking, to be 

suitable for the oversight of large 

numbers of MEs performing 

examinations for large numbers of 

drivers, using medical standards and 

guidelines developed specifically for 

CMV drivers. The final rule will require 

all ME candidates to undergo the initial 

training and the certification testing that 

objectively measures candidate 

qualification and ensures that all MEs 

have the same level of working 

knowledge of the FMCSA regulations 

and guidelines. Due to the specialized 

nature of CMV driving, FMCSA retains 

the requirement that MEs must take 

training and pass its certification test to 

give driver exams. Only the specified 

training will provide pertinent 

knowledge of the FMCSA regulations 

and guidelines. 

Limitations on Performance of Driver 

Examinations. FMCSA did not propose 

any change in the regulations and 

guidelines for performance of the driver 

qualification physicals. 

The MRB’s members submitted 

comments that reiterated the Board’s 

recommendation that only physicians 

should perform examinations on drivers 

who have more severe or multiple 

medical conditions. ADA commented 

specifically on drivers with diabetes. 

Claiming that not all MEs would have 

the requisite clinical knowledge to 

complete the examination, ADA urged 

FMCSA to include physicians who treat 

individuals with diabetes, including 

endocrinologists, in the process of 

certifying drivers with diabetes. The 

commenter said that a physician or 

endocrinologist should examine drivers 

with that condition before such drivers 

are rejected. ADA also referenced the 

recommendations of FMCSA’s Medical 

Expert Panel (MEP) on Diabetes, Expert 

Panel Commentary and 

Recommendations, Diabetes and 

Commercial Motor Vehicle Driver 

Safety, September 8, 2006, available at 

http://www.fmcsa.dot.gov/rulesregulations/topics/mep/mepreports.htm and recommended that no 

denial of certification could be made for 

any reason related to diabetes without 

the review and approval of an 

endocrinologist. 

OOIDA, the American Academy of 

Nurse Practitioners (AANP), and the 

American Academy of Physician 

Assistants (AAPA) claimed that we 

should reject the recommendation to 

only allow physicians as MEs for drivers 

who have multiple active medical 

problems, claiming that this 

requirement would require most drivers 

to be examined by MEs who are 

physicians and would contribute to a 

shortage of qualified MEs. Both OOIDA 

and AAPA stated that this requirement 

would negatively affect a significant 

portion of the CMV driver population. 

OOIDA said that a large percentage of 

drivers would have to travel greater 

distances for medical exams. AAPA 

noted the results of a survey of 1,167 

drivers across the United States, which 

found 32 percent of drivers with 

hypertension and 14 percent with 

diabetes. AAPA said that the proposed 

requirement could mean a driver who 

discovers an additional condition 

during an exam with an ME, who is not 

a physician, would have to stop that 

examination and reschedule with a 

physician. 

AANP and AAPA argued that 

practitioners in their respective 

professions are well-qualified to 

perform examinations on drivers with 

multiple active medical problems. 

AANP noted that its members have been 

performing driver examinations since 

1992 without incident. AAPA similarly 

claimed that PAs have regularly been 

performing examinations on this class of 

drivers for 17 years and have 

specifically received authorization to do 

so in the FMCSRs. This commenter also 

noted that State laws and regulations do 

not preclude PAs from treating patients 

with diabetes or multiple medical 

conditions. 

AAPA stated that SAFETEA–LU and 

the Agency charge the MRB with 

making science and evidence-based 

recommendations, but the commenter 

claimed that no evidence, studies, or 

data were presented in support of 

restricting PAs from performing 

examinations on drivers with multiple 

active medical problems. AAPA argued 

that it would be unfair to eliminate PAs 

from performing these types of 

examinations since the commenter and 

many individual PAs aided FMCSA’s 

development of the National Registry 

program by participating as subject 

matter experts in the development of 

several components of the program. 

Finally, because of the potential for a 

conflict of interest in completing an 

objective examination, comments from 

the MRB and Schneider National 

recommended against allowing primary 

care or personal health care 


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24108 Federal Register / Vol. 77, No. 77 / Friday, April 20, 2012 / Rules and Regulations 

professionals to perform the 

examinations. The MRB advised 

FMCSA to allow for an exception to this 

prohibition if no other medical provider 

was located within a 200-mile radius 

from the driver’s residence or location 

of employment. In its comments, 

OOIDA recommended that the final rule 

expressly prohibit motor carriers from 

restricting the driver’s rights to be 

examined by the ME of his or her 

choice, noting that once the final rule is 

implemented, all MEs listed on the 

National Registry will be equally 

qualified to perform a driver 

examination. Therefore, there should be 

no ME quality concern on the part of the 

motor carrier. 

FMCSA Response: We do not believe 

we should impose an additional burden 

on drivers by requiring them to be 

examined by MEs who do not provide 

primary care to them. FMCSA 

anticipates that requirements for 

medical examiners to be trained and 

tested in FMCSA standards and 

guidelines will result in more 

consistency in certification decisions 

among MEs. FMCSA anticipates that 

MEs will be deterred from making 

driver qualification decisions that 

violate FMCSA standards by the 

provisions in the rule that would allow 

FMCSA to remove an ME from the 

National Registry. 

In addition, we believe that employers 

should continue to have the option to 

require their drivers to be examined by 

a ME selected and/or compensated by 

the employer, because they have an 

obligation to require drivers to comply 

with the regulations that apply to the 

driver (49 U.S.C. 31135(a) and 49 CFR 

390.11). This option is permitted by 49 

CFR 390.3(d), which states that nothing 

in the FMCSRs ‘‘shall be construed to 

prohibit an employer from requiring and 

enforcing more stringent requirements 

relating to safety of operation and 

employee safety and health.’’ 

Comments that recommended 

restricting some MEs from performing 

examinations for certain drivers or to 

include specialists in the driver 

certification decision relate to medical 

standards and guidelines for 

determining the physical qualifications 

of drivers and are therefore beyond the 

scope of this rulemaking. Moreover, the 

MRB does not have authority to 

undertake regulatory development 

responsibilities, manage programs, or 

make decisions affecting such programs. 

2. Employer and Carrier Responsibilities 

FMCSA proposed that all driver 

examinations would be performed by a 

medical examiner on the National 

Registry three years after the final rule 

implementation date, and all 

examinations for drivers who worked 

for an employer who employed 50 or 

more drivers would be required to be 

performed by a medical examiner on the 

National Registry two years after the 

final rule implementation date. FMCSA 

also proposed that medical examiners 

on the National Registry would be 

required to provide copies of the 

Medical Examination Reports and 

medical examiner’s certificates to 

FMCSA or to authorized Federal, State 

and local enforcement agency personnel 

within 48 hours of the request. 

Daecher Consulting Group and 

Comcar Industries expressed concern 

that motor carriers would be responsible 

for determining whether a driver’s 

physical qualification information was 

accurate. Asserting that the proposed 

rule was an attempt to make carriers 

responsible for ensuring that physical 

examination data are correct, Comcar 

Industries said that a carrier could not 

provide such assurances because it is 

not present for the physical examination 

and has no access to medical 

information from any previous 

employer. 

Dart Transit Company suggested that 

the ME should be required to notify the 

motor carrier if a driver fails the medical 

examination. ATA recommended that 

motor carriers should have access to an 

electronic database to obtain their 

drivers’ Medical Examination Reports. 

OOIDA opposed disclosure of sensitive 

medical information to motor carriers 

because misconceptions or prejudices 

about the driver’s medical condition 

could lead to termination of an 

employee from a job, even though the 

condition would not prevent the driver 

from doing his or her job in a safe and 

professional manner. 

Daecher Consulting Group stated that 

there was no method proposed in the 

NPRM for notifying a carrier that it 

employs a driver certified by an 

examiner who was removed from the 

National Registry. The commenter said 

that unless a notification system is 

devised and implemented (which would 

require registering Commercial Driver’s 

License (CDL)-licensed drivers in a 

database, matching them with current 

carriers employing them, and having a 

method to track any change in carriers), 

significant liability may rest with 

carriers that use a driver certified by a 

once-certified ME who has since been 

involuntarily removed from the 

National Registry. 

FMCSA Response: Although the rule 

provides for FMCSA and State and local 

law enforcement personnel to obtain 

copies of driver examination records, 

the purpose of this requirement is to 

monitor ME performance, not driver 

qualification. FMCSA is not requiring 

employers to monitor ME performance. 

In order to clarify this matter in light of 

these comments, FMCSA is making one 

change in employer responsibility under 

this rule. FMCSA is adding a 

requirement that the employer verify 

that the driver was issued a medical 

certificate by an ME on the National 

Registry and place a note to that effect 

in the driver qualification file required 

by 49 CFR 391.51. This will also be 

consistent and enhance compliance 

with 49 U.S.C. 31149(d)(3). Beyond that, 

FMCSA recognizes that employers are 

not required by the current FMCSA 

regulations to obtain copies of Medical 

Examination Reports for their drivers, 

and does not hold employers 

responsible for knowing what medical 

conditions may be recorded therein. 

FMCSA has the discretion to void any 

medical certificate issued to a driver by 

a medical examiner who has been 

removed from the National Registry (49 

U.S.C. 31149(c)(2)). The NPRM did not 

need to propose and does not include 

any provisions to implement that 

authority, which can be exercised by 

FMCSA on a case-by-case basis when 

the facts and circumstances indicate 

that it would be appropriate. 

Notification of employers of failed 

examinations is desirable, and in the 

future, FMCSA may use driver physical 

examination results data to notify 

employers. However, FMCSA modifies 

the final rule to require employers, upon 

hiring or upon expiration of a medical 

examiner’s certificate on or after 24 

months after the effective date of this 

final rule to verify the driver presenting 

a medical certificate was examined by a 

ME on the National Registry. The rule 

does not require employers to recheck 

the National Registry Web site to 

determine if the medical examiner has 

been involuntarily removed subsequent 

to conducting an examination and 

completing the certificate. 

3. State Responsibilities 

FMCSA proposed revising medical 

examiner’s certificate to include the 

National Registry number issued by 

FMCSA to identify the ME. California 

and Virginia expressed uncertainty 

about the State’s role in determining 

whether the medical examination was 

completed by an ME on the National 

Registry and expressed concern about 

the cost of re-programming the 

Commercial Driver’s License 

Information System (CDLIS) to query 

the ME database, when processing 

driver medical certifications. Indiana 

asked whether MEs would be expected 

to include the National Registry number 


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1As explained later, States that have in effect 

variances for physical qualification requirements 

for drivers operating CMVs in intrastate commerce 

will have the option of not establishing a separate 

registry of medical examiners trained and qualified 

to apply those standards. 

on any old medical examiner’s 

certificate forms or would States have to 

look up the number. 

Indiana questioned how involuntary 

removal of an ME from the National 

Registry will affect that ME’s previously 

issued certificates. Similarly, Indiana 

also requested that we clarify how we 

will notify SDLAs that an ME has been 

removed from the National Registry. 

FMCSA Response: States will not be 

required to cross-check National 

Registry numbers with the National 

Registry database when processing 

driver medical certifications. Indiana’s 

concern about entering National 

Registry numbers on old certificates is 

moot, because the final rule will not 

allow the use of any old forms. This 

final rule does not require changes to 

State driver’s license databases or CDLIS 

beyond those required by the alreadypublished final rule in Medical 

Certification Requirements as Part of the 

CDL (73 FR 73096, December 1, 2008) 

(Med. Cert./CDL). However, FMCSA 

anticipates initiating a future 

rulemaking to expand medical 

certification information exchange with 

the States. 

Certificates previously issued by a 

medical examiner who has been 

involuntarily removed are not 

automatically voided. FMCSA has the 

discretion to void any medical 

certificate issued to a driver by an ME 

who is removed from the National 

Registry (49 U.S.C. 31149(c)(2)). The 

NPRM did not need to propose and does 

not include any provisions to 

implement that authority, which can be 

exercised by FMCSA on a case-by-case 

basis when the facts and circumstances 

indicate that it would be appropriate. 

State Investigation of Driver 

Certification. Advocates criticized the 

lack of any systematic procedure in the 

proposed rule that requires State law 

enforcement agencies to compare each 

Medical Examination Report with the 

related medical examiner certificate. 

The commenter noted that in the 

preamble to the proposal we do not 

explain why and how State enforcement 

agencies would have reason to 

investigate specific Medical 

Examination Reports and medical 

certificates. On the other hand, OOIDA 

argued that Federal preemption would 

prohibit State and local agencies from 

requesting an ME to give a driver’s 

Medical Examination Report to them as 

we proposed. The commenter said that 

once we prescribe safety standards 

requiring MEs on the National Registry 

to examine and issue certificates to 

show a CMV driver’s physical condition 

is adequate for safe vehicle operations, 

those regulations would have a 

preemptive effect under section 31136. 

OOIDA cited Freightliner Corp. v. 

Myrick, 514 U.S. 280, 287 (1995), and 

Gade v. National Solid Wastes 

Management Ass’n, 505 U.S. 88, 98 

(1992), in support of implied 

preemption ‘‘when a ‘state law is in 

actual conflict with federal law * * * or 

where state law stands as an obstacle to 

the accomplishment and execution of 

the full purposes and objectives of 

Congress’.’’ OOIDA argued that allowing 

State and local authorities to access a 

driver’s personal medical information 

might dissuade drivers from openly 

discussing their health issues with an 

ME. OOIDA said unqualified State 

government personnel might apply their 

own standards to driver medical 

information and inconsistently judge 

them medically unfit for reasons that are 

erroneous or unjustifiably exceed the 

Federal medical standards being 

applied. OOIDA concluded that, at a 

minimum, we should require States to 

limit any Medical Examination Report 

(commonly called the ‘‘long-form’’) 

request to circumstances where the 

State has clearly articulated legitimate 

reasons for believing that the medical 

certificate was falsified or otherwise 

improperly issued. 

FMCSA Response: OOIDA’s comment 

does not recognize that State and local 

enforcement personnel have a role in 

enforcing the FMCSRs. The final rule 

retains the requirement for MEs to give 

State and local enforcement personnel 

access to Medical Examination Reports 

and ME certificates within 48 hours of 

a request for purposes of monitoring ME 

performance. States that receive Motor 

Carrier Safety Assistance Program 

(MCSAP) grant funds are required as a 

condition of receiving the grants to 

adopt regulations that are compatible 

with these final regulations (49 U.S.C. 

31102(a) and 49 CFR 350.201(a)). States 

receiving MCSAP grants, therefore, will 

generally have to adopt regulations 

compatible with requirements that all 

drivers be examined by an ME on a 

registry of trained and certified MEs 

applicable to both interstate and 

intrastate transportation as soon as 

practicable, but not later than 3 years 

from effective date of this rule (49 CFR 

350.331(d)).1 State government 

personnel operating under MCSAP will 

have the same authority and 

responsibility to request that an ME 

produce a driver’s Medical Examination 

Report that FMCSA personnel will have 

in accordance with this final rule. The 

States receiving MCSAP grants will be 

expected to adopt and implement 

compatible provisions and apply them 

consistently. There will be no 

inconsistency between State and 

Federal law that would require either 

express or implied preemption. 

FMCSA believes that the 

establishment of the National Registry, 

with its training and testing 

requirements will improve the 

performance of the MEs. Verification of 

the certification and listing of the MEs 

on the National Registry will be 

enhanced. In addition, the availability 

of the examiner’s records to 

enforcement personnel, when necessary 

to conduct an investigation into the 

validity of the medical certificate, is 

sufficient to deter improper medical 

certification of CMV drivers. 

4. Intrastate-Only CMV Drivers 

FMCSA proposed that MEs would 

include information on the monthly 

reports of driver examinations whether 

each driver operated only in intrastate 

commerce. OccuMedix and Missouri 

raised the issue that MEs would not be 

able to distinguish between interstate 

drivers and intrastate-only drivers 

required by their States to obtain a 

medical certification from an ME on the 

National Registry. The commenters 

suggested that the final rule should 

require all drivers—interstate and 

intrastate—to obtain medical 

examinations from examiners listed on 

the National Registry. 

Missouri said we should consider that 

many States require CMV drivers 

operating in intrastate commerce to 

follow the FMCSRs and that there 

would be confusion if we require MEs 

to examine only CDL drivers operating 

in interstate commerce. Missouri argued 

that we can promote public safety 

further if all nonexempt CDL drivers are 

required to obtain medical examinations 

from examiners listed on the National 

Registry, even when the drivers operate 

CMVs exclusively in intrastate 

commerce. 

FMCSA Response: States will 

continue to set requirements for 

intrastate drivers. States that receive 

MCSAP grant funds are required, as a 

condition of receiving the grants, to 

adopt regulations compatible with these 

final regulations (49 U.S.C. 31102(a) and 

49 CFR 350.201(a)); however, the 

Agency is including in this final rule a 

revision to 49 CFR 350.341 to make it 

clear that States that have in effect 

variances for physical qualification 

requirements for drivers operating 

CMVs in intrastate commerce will have 


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2Executive agreements have the same legal effect 

as treaties. 

the option of not establishing a separate 

registry of medical examiners trained 

and qualified to apply those intrastate 

standards, although they have the 

discretion to do so if they wish. A State 

with variances in effect under 

350.341(h)(1) and (2) that chooses to set 

up a separate registry of examiners 

qualified to apply those variances to 

intrastate drivers will not be allowed to 

use MCSAP funds for that purpose. 

Such use of MCSAP grant funds would 

not be consistent with the overall 

purpose of establishing a uniform 

standard for all CMV drivers 

nationwide. Intrastate-only CMV drivers 

in States that do not have such 

variances can utilize MEs on the 

National Registry because they will be 

trained and qualified in applying 

physical qualification standards that are 

identical for both interstate and 

intrastate drivers. All MCSAP States, 

either with or without variances, thus 

will have the option to establish their 

own registries, but FMCSA is not 

requiring them to do so as a condition 

of receiving MCSAP funds. 

The rule does not restrict MEs who 

are certified to perform physical 

examinations for interstate drivers from 

performing physical examinations for 

intrastate only drivers. MEs should ask 

drivers whether they intend to operate 

in intrastate commerce only. FMCSA 

Form MCSA–5850, CMV Driver Medical 

Examination Results Form, requires 

MEs to identify ‘‘Intrastate Only’’ 

drivers on the CMV Driver Examination 

Results so that FMCSA can distinguish 

data about intrastate-only driver 

examinations. 

5. Canadian and Mexican Drivers 

The NPRM noted that existing 

reciprocity agreements with Canada and 

Mexico will govern Canada-domiciled 

and Mexico-domiciled drivers, 

respectively, operating in the United 

States (73 FR 73131, n.3). As a result, 

Canadian and Mexican drivers do not 

need to be examined by an ME on the 

National Registry before operating a 

CMV in the United States. OOIDA said 

this language constituted an exemption 

from Federal regulations, and that we 

had no authority to grant such an 

exemption. 

FMCSA Response: OOIDA’s 

contention that 49 U.S.C. 31149 does 

not allow FMCSA to ‘‘exempt’’ 

Canadian and Mexican drivers operating 

in the United States from being 

examined by an ME is incorrect because 

two separate executive agreements 2

with Canada and Mexico remain in 

effect. A brief history of these two 

agreements is provided for clarification. 

Prior to the amendments made by 

section 4116(b) of SAFETEA–LU, the 

provisions of 49 U.S.C. 31136(a)(3) 

stated: 

The Secretary of Transportation shall 

prescribe regulations on commercial 

motor vehicle safety. The regulations 

shall prescribe minimum safety 

standards for commercial motor 

vehicles. At a minimum, the regulations 

shall ensure that— 

• The physical condition of operators 

of commercial motor vehicles is 

adequate to enable them to operate the 

vehicles safely. * * * 

For this purpose, a ‘‘commercial motor 

vehicle’’ is defined in 49 U.S.C. 

31132(1). 

FMCSA regulations generally required 

all operators of CMVs in the United 

States to be examined by an ME (as 

defined in 49 CFR 390.5) and to obtain 

from the examiner a certificate that the 

operator is physically qualified. 49 CFR 

391.11(b)(4) and 49 CFR part 391, 

subpart E. These requirements will 

continue to apply after establishment of 

the National Registry Program. 

In 1991, the Secretary and his 

counterpart in Mexico entered into an 

agreement on the matter of driver 

license reciprocity. The agreement is 

contained in a memorandum of 

understanding (MOU) that was 

reproduced as Appendix A to a final 

rule issued in 1992 by FMCSA’s 

predecessor agency, the FHWA. 

Commercial Driver’s License Reciprocity 

with Mexico, 57 FR 31454 (July 16, 

1992), affirmed, Int’l Brotherhood of 

Teamsters v. Pen ̃ a 17 F.3rd 1478 (DC 

Cir. 1994). The primary purpose of the 

MOU was to establish reciprocal 

recognition of the CDL issued by the 

States to U.S. operators and the Licencia 

Federal de Conductor (LF) issued by the 

government of the United Mexican 

States (i.e., by the national government 

of Mexico, not by the individual 

Mexican states). In light of the 

agreement, the FHWA determined that 

an LF meets the standards contained in 

49 CFR part 383 for a CDL. 49 CFR 

383.23(b)(1) and note 1. The FHWA’s 

final rule preamble also states, at 57 FR 

31455: 

It should be noted that Mexican drivers 

must be medically examined every 2 years to 

receive and retain the Licencia Federal de 

Conductor; no separate medical card 

[certificate] is required as in the United 

States for drivers in interstate commerce. As 

the Licencia Federal de Conductor cannot be 

issued to or kept by any driver who does not 

pass stringent physical exams, the Licencia 

Federal de Conductor itself is evidence that 

the driver has met medical standards as 

required by the United States. Therefore, 

Mexican drivers with a Licencia Federal de 

Conductor do not need to possess a medical 

card while driving a CMV in the United 

States. 

Implicit in the determination that 

Mexican drivers with an LF do not need 

to possess a separate medical certificate 

is an underlying determination that the 

medical examination necessary to 

obtain the LF meets the standards for an 

examination by an ME in accordance 

with FMCSA regulations, and would 

therefore meet the requirements of 49 

U.S.C. 31136(a)(3). 

The MOU does not specifically 

address medical qualifications for 

Mexican drivers operating a CMV in the 

United States that does not require a 

CDL. In order to enter the United States 

at the border crossing points (all of 

which are accessed only by federal 

highways in Mexico) a Mexican driver 

must have a Licencia Federal. FMCSA 

enforcement policy accepts a Licencia 

Federal as proof of physical 

qualification for a driver to operate a 

CMV that does not require a CDL in the 

United States. 

In 1998, a similar agreement was 

reached with Canada under the auspices 

of the Land Transportation Standards 

Subcommittee established by the North 

American Free Trade Agreement 

(NAFTA). This agreement supplements 

a 1988 agreement with Canada 

accepting the CDLs issued by Canadian 

provinces in accordance with the 

Canadian National Safety Code as valid 

for operation of a CMV in the United 

States. 49 CFR 383.23(b), note 1. The 

1998 agreement, which became effective 

on March 30, 1999, provides, with some 

exceptions, that Canadian drivers 

holding such a CDL issued in Canada 

are physically qualified to operate a 

CMV in the United States and are not 

required to possess a medical certificate 

issued by a ME. In Canada, drivers are 

required to have CDLs in order to 

operate a CMV that would not require 

a CDL to operate in the United States. 

Under the 1998 agreement, a Canadian 

CDL issued in conformity with the 

National Safety Code is accepted by 

FMCSA as proof of a driver’s physical 

qualification to operate a CMV in the 

United States. 

The substance of these two 

agreements is also reflected in a note in 

49 CFR 391.41(a)(1), as recently 

amended. Medical Certification 

Requirements as Part of the CDL, 73 FR 

73096, 73127 (December 1, 2008). 

In 2005, 49 U.S.C. 31136(a)(3) was 

amended by SAFETEA–LU section 

4116(b), which added the following at 

the end: 


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[T]he periodic physical examinations 

required of such operators are performed by 

medical examiners who have received 

training in physical and medical examination 

standards and, after the national registry 

maintained by the Department of 

Transportation under section 31149(d) is 

established, are listed on such registry. 

As explained above, section 4116(a) of 

SAFETEA–LU added a new 49 U.S.C. 

31149, which among other things, 

includes a provision that FMCSA ‘‘shall 

accept as valid only medical certificates 

issued by persons on the national 

registry of medical examiners.’’ Section 

31149(d)(3). 

OOIDA contends that this statute 

supersedes the two agreements with 

Canada and Mexico and that drivers 

from these two countries operating 

CMVs will have to be examined and 

certified by MEs on the National 

Registry. According to the cases that are 

cited in OOIDA’s comments 

subsequently enacted statutes may 

abrogate an executive agreement or 

treaty. The case law states, however, 

that ‘‘neither a treaty nor an executive 

agreement will be considered abrogated 

or modified by a later statute unless 

such purpose on the part of Congress 

has been clearly expressed.’’ Roeder v. 

Islamic Republic of Iran, 333 F.3d 228, 

237 (D.C. Cir. 2003), cert. denied, 542 

U.S. 915 (2004) (internal quotations and 

citations omitted). There is no such 

clear expression of purpose in the 

relevant statutes. Neither the amended 

statutes nor their legislative histories 

contain any provision addressing these 

two executive agreements. The 

reciprocity agreements with Canada and 

Mexico, and the implementing 

provisions in the note in 49 CFR 

391.41(a)(1), will continue to be in effect 

after issuance of this final rule. 

Accordingly, Canadian and Mexican 

drivers operating CMVs in the United 

States who hold the proper licenses will 

not be required to obtain a medical 

certificate from an ME on the National 

Registry. 

In any case, FMCSA has reviewed the 

Canadian and Mexican physical 

qualification processes. Driver medical 

examinations in Canada are performed 

only by MDs. National standards direct 

the medical examiners when to obtain 

the opinion of a medical specialist. In 

addition, in most jurisdictions, doctors, 

including family doctors, have a legal 

obligation to report any medical 

condition that may affect driving 

functions. 

The medical examinations in Mexico 

are conducted by Federal government 

doctors or Federal governmentapproved doctors. In addition, the 

medical certification for an LF is part of 

Mexico’s licensing process for 

commercial drivers. This means the 

license is not issued or renewed unless 

there is proof the driver has satisfied the 

Mexican physical qualifications 

standards. FMCSA has compared each 

of its physical qualifications standards 

with the corresponding requirements in 

Mexico and continues to believe 

acceptance of the Mexico government’s 

medical certificate is appropriate. 

C. Components of the National Registry 

Program 

1. Training of Medical Examiners 

Length of Training. In the NPRM, 

FMCSA projected it would take one day 

to cover the FMCSA core curriculum 

specifications. Two commenters 

claimed that the length of training was 

inadequate and we should consider 

increasing it. A chiropractor stated that 

training should last perhaps two long 

days followed with reading and study 

materials. NRCME Training Systems 

claimed that it would be very difficult 

in a lecture-based setting, with all of the 

class questions and discussions 

generated in a presentation of this 

nature, to complete quality training in 

one day. The commenter concluded 

that, at minimum for a 17-module 

National Registry training program to 

thoroughly provide quality training for 

examiner candidates, five to six, sixhour days of didactic lecture in an 

attended seminar format would be 

required. 

FMCSA Response: The rule does not 

prescribe how long training must be. 

The core curriculum specifications are 

limited to FMCSA regulations and 

guidelines, and the mental and physical 

demands of CMV driving. One 

advantage of the Public-Private 

Partnership, is that training can be 

expanded to meet the needs of health 

care professionals from diverse 

educational and professional 

backgrounds. 

Training Intervals. The NPRM 

proposed that the ME would be required 

to complete periodic retraining at least 

every three years and repeat the 

complete initial training program once 

every 12 years in lieu of periodic 

training. Some commenters asserted that 

repeating the initial training was not 

necessary, or suggested other 

frequencies for training. AAPA and 

ACOEM recommended that FMCSA 

eliminate the proposed requirement to 

retake the initial training course every 

12 years. AAPA stated that the 

requirement offers no benefit to MEs 

who are already required to participate 

in periodic training and recertification 

examinations. ACOEM supported 

requiring MEs to obtain 12 hours of 

advanced training every three years 

instead. Iowa recommended requiring 

MEs to attend a one-day course in 

person after the sixth year to renew 

certification. 

FMCSA Response: FMCSA agrees 

with the commenters that the proposed 

requirement for MEs to repeat the initial 

training is not necessary for those MEs 

who do not allow their certifications to 

lapse and has modified the final rule to 

require only periodic training at fiveyear intervals for recertification. MEs 

will be required to pass the test for 

recertification every 10 years. 

Training Program Accreditation. 

FMCSA proposed that medical 

examiner candidates be required to 

complete a training program accredited 

by a nationally-recognized medical 

profession accrediting organization. 

NRCME Training Systems endorsed 

having post-graduate institutions review 

and approve National Registry training 

for MEs, reasoning that these 

institutions are already certified by a 

national accrediting agency and that 

FMCSA would retain control over the 

training programs through third-party 

post-graduate programs. 

FMCSA Response: Only training 

programs that have been accredited by 

a nationally recognized medical 

profession accrediting organization to 

provide continuing education units will 

be eligible to provide the required 

training to MEs. As long as the training 

program is accredited, and is based on 

FMCSA’s core curriculum specifications 

and guidelines, the Agency does not 

seek to restrict the number or location 

of programs that provide ME training. 

Post-graduate divisions of colleges and 

universities would be eligible to provide 

training to MEs, as would other 

accredited training organizations such 

as professional association continuing 

medical education (CME) programs and 

provider network training organizations. 

Core Curriculum Specifications. 

Several commenters expressed concern 

that we did not provide the content of 

the core curriculum in the proposed 

rule and questioned how it would be 

established and implemented. 

One physician commenter was 

concerned that since the core 

curriculum specifications have not been 

developed or approved, it will likely be 

several years before there are a 

significant number of trained MEs to 

accommodate the proposed 

requirements. A certified Medical 

Review Officer (MRO) urged us to 

incorporate good scientific rationale 

into the development of the curriculum 

and commented that all sections of the 


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3http://nrcme.fmcsa.dot.gov/training.aspx, 

retrieved July 13, 2011. 

driver examination need to be 

addressed. 

ABA and BISC requested that we 

engage the private bus industry in 

developing ME curricula that are related 

to bus operations and driver wellness. 

ADA requested that the FMCSAappointed Diabetes Expert Panel (DEP) 

be consulted with regard to curriculum 

elements pertaining to diabetes and 

suggested that these core curriculum 

elements be submitted to the DEP for 

final approval. The commenter also 

suggested that the DEP’s 2006 suggested 

training module be incorporated in the 

curriculum. 

FMCSA Response: The core 

curriculum specifications are being 

issued as guidance for organizations 

delivering training for MEs who apply 

for listing on the National Registry when 

it is implemented. FMCSA published a 

notice of availability of draft guidance 

and request for comments on the core 

curriculum specifications in the Federal 

Register on May 17, 2011 (76 FR 28403). 

Additionally, FMCSA has posted these 

specifications on the National Registry 

Web site (http://nrcme.fmcsa.dot.gov) 

and in the docket for this rulemaking. 

The guidance for the core curriculum 

specifications is Appendix A to this 

Federal Register document. 

The guidance for the core curriculum 

specifications are based on current 

FMCSA regulations on physical 

qualifications published in 49 CFR part 

391, as well as guidance that is 

published in 49 CFR 391.43. The 

guidance for the core curriculum 

specifications are also based on the task 

list developed in the Role Delineation 

Study (RDS) completed in April 2007, 

as described in the NPRM. The RDS is 

a rigorous methodology regularly 

employed in the certification and 

medical fields when developing a valid, 

reliable, and fair certification test. An 

executive summary of the RDS Final 

Report and the full text of the Final 

Report are available through the 

National Registry Web site 3 and the 

docket for this rulemaking. 

The Agency does not envision 

separate medical criteria for bus drivers 

at this time. Any changes in the basic 

requirements for training specified in 49 

CFR 390.105(b) will be subject to notice 

and comment proceedings. On the other 

hand, future changes in the guidance for 

the core curriculum specifications do 

not require a notice and comment 

rulemaking proceeding because they 

will reflect only regulations and 

guidelines for performing the driver 

physical examination. FMCSA has 

provided and continues to provide for 

stakeholder input into revising the 

standards and guidelines through MRB 

meetings, and public notice of MRB 

meetings, including specific 

instructions on where to send 

comments. FMCSA will revise the 

guidance for the core curriculum 

specifications only after we have 

established new or revised existing, 

regulations and guidelines. The training 

provider could expand its course 

content to tailor training to the needs of 

its target audience but the course 

content must cover the FMCSA core 

curriculum specifications. 

FMCSA considered the 

recommendations of the DEP for ME 

training in the development of the 

guidance for the core curriculum 

specifications. At this time, FMCSA is 

not adopting the ADA’s request to 

implement the recommendation of the 

DEP on drivers with diabetes. In 

general, such MEPs are convened on an 

ad hoc basis to act in an advisory 

capacity to FMCSA in its work of 

reviewing and revising physical 

qualification standards and guidelines. 

In any event, FMCSA will consider 

recommendations from the MEP on 

standards and specifications for drivers 

with diabetes in future proceedings. 

Comments on the Notice of 

Availability of the Core Curriculum 

Specifications. 

FMCSA published a notice of 

availability and request for comments 

on the draft guidance for the core 

curriculum specifications in the Federal 

Register on May 17, 2011 (76 FR 28403). 

Additionally, FMCSA has posted this 

guidance on the National Registry Web 

site (http://nrcme.fmcsa.dot.gov) and in 

the docket for this rulemaking. FMCSA 

received five comments from interested 

parties during the public comment 

period. The Agency considered the 

public comments on the draft guidance 

and now publishes the guidance as 

Appendix A to this Federal Register 

document. 

In response to the notice of 

availability, ATA suggested that FMCSA 

needs to educate MEs about the mental 

and physical demands of driving a 

CMV. Several commenters suggested 

that the curriculum convey to MEs an 

understanding of the distinction 

between guidance and 

recommendations submitted by various 

FMCSA advisory committees and 

boards. NRCME Training Systems 

thought that FMCSA expected training 

programs to give continuing education 

credits. There was also a comment 

requesting notice and comment 

rulemaking for future changes in the 

core curriculum. There were several 

comments addressing other aspects of 

the rulemaking other than the core 

curriculum specifications, which are 

beyond the scope of the notice of 

availability. 

FMCSA Response: In response to 

ATA’s comment, MEs are, and will still 

be, required to be knowledgeable of the 

specific physical and mental demands 

associated with operating a CMV. 49 

CFR 391.43(c)(1). Section 2 of the core 

curriculum specifications addresses the 

job of CMV driving, including physical 

and emotional demands. Section 7 

includes consideration of driver ability 

to perform physical tasks associated 

with operating a CMV. 

The guidance for the core curriculum 

specifications expands the description 

of the topics to be covered in training, 

and do not provide the details that 

should be included in the actual 

training. FMCSA commercial driver 

medical certification regulations, 

advisory criteria, MRB and MEP 

functions, and other resources on the 

Web site are outside the scope of this 

notice. Nonetheless, FMCSA 

continuously reviews and updates 

information on its Web sites for content 

and clarity, and will make sure the 

difference between regulations, 

guidance, and advisory 

recommendations are made clear. 

FMCSA wants to clarify that it is not 

requiring that the training given to MEs 

qualify for continuing education credits, 

although the training organizations must 

be accredited to give continuing 

education credits. 

The Agency is making no changes to 

the draft guidance for the core 

curriculum specifications, and issues 

them as an appendix A to this Federal 

Register document. Only future changes 

in medical certification standards will 

be subject to notice and comment 

rulemaking. FMCSA will then update 

the guidance for the core curriculum 

specifications as appropriate. Because 

the core curriculum specifications are 

guidance, consideration and issuance of 

updated specifications does not require 

notice and comment in a rulemaking 

proceeding. 

2. Testing of Medical Examiners 

Certification Testing Intervals. Some 

commenters suggested different 

intervals for such testing. FMCSA 

proposed a requirement that MEs pass 

the ME certification test every 6 years in 

order to remain listed on the National 

Registry. 

FMCSA Response: FMCSA modifies 

the requirement for MEs already on the 

registry to pass the certification test 

again before 10 years instead of before 

6 years to demonstrate knowledge of 


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changes and retention of previous 

knowledge and application. This period 

was chosen as there are varying lengths 

of times utilized by medical and 

healthcare boards to issue board 

certifications. FMCSA chose 10 years 

because it is not as burdensome on the 

medical examiner, but, in FMCSA’s 

judgment, it is a short-enough period to 

verify MEs are knowledgeable about any 

changes to our physical qualifications 

standards and guidance. MEs will also 

be kept knowledgeable by completing 

refresher training every 5 years, and 

receiving updates from FMCSA by email 

and Web site postings. 

3. Accreditation of National Registry 

Program 

FMCSA asked for comment on its 

consideration of obtaining accreditation 

of the components of the National 

Registry Program that test and certify 

MEs for listing on the National Registry, 

in order to demonstrate the robustness 

of its Program. This accreditation was 

not the same as the accreditation that 

was proposed to be required for 

training. 

Several commenters commented 

regarding the process of obtaining 

National Commission of Certifying 

Agencies (NCCA) accreditation of the 

certification component of the National 

Registry Program. ATA expressed 

concern that the accreditation process 

might cause delay or increase program 

costs. Calling accreditation timeconsuming, burdensome, and costly, 

ATA said it would oppose accreditation 

of the ME certification program if the 

process delayed implementation of the 

National Registry. Instead, ATA 

recommended that we either certify the 

program through a periodic program 

evaluation and audits conducted by a 

designated oversight authority, or certify 

the program using a third-party 

certifying body. 

FMCSA Response: The Agency agrees 

that accreditation of the National 

Registry certification component could 

be expensive and delay implementation 

of the program. As stated in the NPRM, 

FMCSA proposed accrediting the testing 

and certification components of the 

National Registry Program using the 

accreditation standards of the NCCA, 

and is considering the costs and benefits 

of applying for accreditation for these 

components (which are administered by 

the Agency). A new certification 

program (one that has not previously 

received accreditation by the NCCA), 

may apply for accreditation either after 

1 year of administration of the 

certification test or when at least 500 

candidates have been assessed with that 

test instrument, whichever comes first. 

FMCSA will conduct program 

evaluations which are subject to internal 

and external audits, as well as 

Congressional oversight. 

4. Public Participation in Development 

of Components 

Advocates said FMCSA failed to 

provide the key features of the preferred 

Public-Private Partnership approach for 

evaluation through notice and comment. 

Advocates contended that the Agency 

should publish a supplementary notice 

of proposed rulemaking (SNPRM) with 

details of the major features to allow for 

public review and comment. The 

features Advocates believes are not 

covered are the core curriculum 

provided for training companies to use, 

the criteria to qualify private 

organizations to conduct training and 

testing, and the reason for choosing the 

NCCA as the accreditation organization 

for the program. Advocates asserts 

further that another feature of the 

proposal that ‘‘must be exposed to 

public comment’’ is the specific content 

of the test that would be administered 

to MEs. 

FMCSA Response: FMCSA has 

determined that it is unnecessary to 

accept Advocate’s view that an SNPRM 

is either required or appropriate. 

However, the Agency has taken steps to 

make certain components of the 

National Registry program available for 

public comment before their 

implementation. 

FMCSA has determined that the 

guidance for the core curriculum 

specifications and other similar 

documents implementing the National 

Registry program, such as information 

for testing providers, does not have to be 

a subject to a notice and comment 

rulemaking. The guidance for the core 

curriculum specifications will meet the 

minimum requirements of 49 CFR 

390.105(b), but will not establish a 

‘‘binding norm’’ for MEs for compliance 

with that provision. American Hospital 

Ass’n v. Bowen, 834 F.2d 1037, 1046 

(D.C. Cir., 1987). Organizations that will 

provide the training must have the 

flexibility to develop a particular 

training curriculum suitable for the type 

of medical professionals who intend to 

be listed on the National Registry. This 

is especially important because, as 

explained above in Section IV.B.1, 

FMCSA’s regulations will continue to 

allow several different types of medical 

professionals, with a wide range of 

different backgrounds, knowledge, and 

skills, to act as MEs. This approach is 

entirely consistent with the authority 

granted to FMCSA to ‘‘develop, as 

appropriate, specific courses and 

materials for medical examiners’’ 49 

U.S.C. 31149(c)(1)(D) (emphasis added). 

In view of the nature of the training that 

needs to be provided to applicants for 

certification and listing on the National 

Registry, and the broad discretionary 

authority delegated to the Agency to 

implement the training component, 

FMCSA has determined that it is 

appropriate to issue guidance providing 

the core curriculum specifications for 

development of training by the various 

training providers. 

Moreover, there are criteria for 

determining which organizations would 

be deemed acceptable for conducting 

the training. The requirements of 49 

CFR 390.105 that the Agency proposed 

in the NPRM set out the criteria that 

candidates for certification and listing 

on the National Registry must use in 

selecting an organization to provide 

their training. Those criteria were thus 

available for public comment. FMCSA 

has responded to those comments 

(including substantive comments by 

Advocates) in Section IV.C.1 above. 

Finally, MEs seeking to be listed on 

the National Registry will need to 

successfully complete a test 

administered in accordance with 49 

CFR 390.103 and 390.107. Like the core 

curriculum specifications, the specific 

content of the test will be based on 

current FMCSA regulations and 

guidelines on the Medical Examination 

Report applicable at the time the test is 

administered. As those underlying 

regulations and guidelines are updated, 

both the core curriculum specifications 

and the certification test will be 

modified accordingly. 

The Agency has added a requirement 

to the final rule (49 CFR 390.107(d)) to 

make it clear that any testing 

organization administering the test must 

use only the test obtained from FMCSA. 

This requirement was stated in the 

preamble to the NPRM (73 FR at 73133). 

5. Records and Recordkeeping 

Retention of Driver Examination 

Records. The NPRM proposed 

implementation of the SAFETEA–LU 

requirement that MEs electronically 

transmit to the FMCSA Chief Medical 

Examiner on a monthly basis the name 

of the CMV driver and a numerical 

identifier for any completed Medical 

Examination Report required under 49 

CFR 391.43 (49 U.S.C. 31149(c)(1)(E)). 

Additionally, the proposed rule would 

require MEs to retain for 3 years the 

Medical Examination Report for each 

examination performed and the medical 

examiner’s certificate, if the ME 

certified the driver as physically 

qualified. It would also require MEs to 

provide copies of specified Medical 

Examination Reports and medical 


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examiner’s certificates to FMCSA or to 

authorized Federal, State, and local 

enforcement agency personnel, within 

48 hours of the request, in order to 

allow for investigation of errors and 

improper certification of CMV drivers 

(49 U.S.C. 31149(c)(2)). 

ACOEM, AAOHN, and an 

occupational medicine consulting firm, 

OccuMedix, Inc., claimed that MEs 

should be required to retain driver 

examination records for longer than 3 

years to allow MEs to check their own 

records or the records of other MEs so 

that medical conditions would not be 

overlooked. The commenters noted that 

some drivers may use different MEs 

from year to year or may enter or leave 

the driver pool, so records should be 

maintained for 6 or 7 years and 

reviewed if questions arise. 

FMCSA Response: FMCSA proposed a 

minimum time of 3 years for retention 

of driver examination records because a 

driver is certified for a period of 2 years 

or less, and an additional year will 

allow FMCSA time to request driver 

examination records from MEs to assess 

ME performance by determining 

whether the ME completed the medical 

examination report accurately and did 

not certify a driver in error. Also, MEs 

are still subject to any State laws 

requiring medical records to be retained 

for longer than 3 years. Therefore, 

FMCSA will retain the requirement for 

MEs to keep the Medical Examination 

Report and the medical examiner’s 

certificate for 3 years and retains the 

words ‘‘at least’’ from the Med. Cert./ 

CDL rule to clarify that this is a 

minimum. 

Privacy of Information. 

Transportation Safety Services, a 

consulting firm, stated that Federal 

government databases established to 

monitor medical information cannot be 

adequately protected from unauthorized 

access. AAOHN, however, suggested 

that a standardized electronic database 

with appropriate safeguards is 

imperative for the confidentiality of 

personal health information and 

compliance with Health Insurance 

Portability and Accountability Act 

(HIPAA) regulations. Dart Transit 

Company encouraged us to address the 

question of possible conflicts with 

HIPAA that would be encountered in 

the industry’s attempt to comply with 

the rule. 

FMCSA Response: Pursuant to 49 CFR 

391.43(g), as revised by this final rule, 

each month MEs will be required to 

transmit on Form MCS–5850 the results 

of every physical examination 

performed on a CMV driver and the 

information from each medical 

examination certificate issued to a CMV 

driver. This form indicates whether or 

not the driver examined was issued a 

medical certificate. This information is 

necessary to satisfy the requirements of 

49 U.S.C. 31149(c)(1)(E). The form does 

not contain any personal health 

information about the driver. It does 

include information identifying each 

driver examined such as driver’s name 

and driver’s license information. 

If the Agency should find it 

appropriate in conducting any review of 

the performance of MEs on the National 

Registry, as provided by 49 U.S.C. 

31149(c)(1)(C) and (F), to obtain copies 

of the Medical Examination Reports and 

any supporting medical records for 

CMV drivers examined, it will follow 

the applicable policies and procedures 

to ensure the security and privacy of the 

personal health information about the 

drivers contained therein. FMCSA will 

also follow similar procedures in 

conducting any investigation into 

whether or not a CMV driver is or 

should be physically qualified to 

operate a CMV. Therefore, we are 

requiring submission of medical records 

through a secure Web application for 

which each certified ME will have a 

password-protected account. FMCSA 

will implement policies and procedures 

to reasonably limit the uses and 

disclosures of Protected Health 

Information (PHI). The Privacy Impact 

Assessment (PIA) supporting the final 

rule gives a full and complete 

explanation of FMCSA practices for 

protecting Personally Identifiable 

Information (PII) in general and 

specifically in relation to this rule. The 

PIA is available for review in the docket. 

On the other hand, HIPAA privacy 

regulations do not apply to the 

transmission of PHI to FMCSA because 

the Agency does not provide services on 

behalf of the ME, and therefore does not 

qualify as a business associate. The 

definition of a business associate 

requires more than receipt of PHI. As 

stated in 45 CFR 160.103, to qualify as 

a business associate the entity or person 

must perform a function or activity 

involving the use or disclosure of 

individually identifiable health 

information on behalf of such covered 

entity or of an organized health care 

arrangement. FMCSA is not providing 

services on behalf of a covered entity or 

in association with an organized health 

care arrangement. In this case, FMCSA 

is not performing services for the ME, 

but for the public by ensuring the safe 

performance of commercial vehicle 

drivers. FMCSA will monitor the 

performance of MEs in order to ensure 

they effectively determine whether CMV 

drivers are safe to drive in interstate 

commerce. 

FMCSA disagrees that there are 

possible conflicts with HIPAA that 

would be encountered by employers (or 

the MEs for that matter) in complying 

with the final rule. The Agency did not 

propose and is not making any changes 

in the existing regulations governing the 

physical qualifications of drivers and 

the responsibilities of employers to 

ensure compliance with those 

requirements, with the exception of the 

requirement for employers to verify that 

the ME is listed on the National 

Registry. The employer may validate the 

National Registry Number from the 

medical examiner’s certificate or State 

driver record, without the need to 

access any of the driver’s personal 

health information. 

Public Web site. We indicated in the 

preamble to the proposed rule that 

information about the National Registry 

Program would be available through a 

public Web site, so that drivers and 

employers could find the names and 

addresses of nearby MEs listed on the 

National Registry. Several commenters 

described other information pertaining 

to the ME that should be provided as 

well. A chiropractor and Dart Transit 

Company suggested that the Web site 

should also include information about 

parking, hours, and directions. 

Schneider National, Inc. mentioned that 

the ME’s State license number, National 

Registry Number, and certification 

expiration date should be posted. 

Schneider National, ACOEM, and 

OccuMedix expressed that the Web site 

and email notifications to MEs could be 

used for informational purposes. 

Wynne Transport Service, Inc. 

(Wynne), California, and AAOHN noted 

that the National Registry itself must be 

updated frequently so drivers and motor 

carriers always have access to the most 

current ME information. Wynne asked 

whether the ME’s unique identifier will 

be recognizable as valid. OOIDA noted 

that although we envision a resource 

center with a toll-free telephone 

number, it is not clear what information 

will be available by telephone and 

whether the Resource Center would be 

staffed by knowledgeable people who 

can answer a variety of physical 

examination-related questions. 

California urged us to ensure that the 

toll-free telephone number is staffed 

during regular business hours in the 

Pacific Time Zone. 

OOIDA also argued that reliance on 

the Internet posed an obstacle because 

long-haul drivers often spend extended 

periods of time away from home and not 

all own laptop computers that could be 

used to identify conveniently located 

MEs over the Internet. 


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4 Internal analysis of the LTCCS conducted by 

Agency data analysts. A description of the LTCCS, 

it’s methodology, and the data is available at 

http://ai.fmcsa.dot.gov/ltccs/default.asp. 

5Bordage G, Carlin B, Mazmanian PE. 

‘‘Continuing medical education effect on physician 

knowledge: Effectiveness of continuing medical 

education: American College of Chest Physicians 

Evidence-Based Educational Guidelines.’’ Chest. 

2009 and Neff JA, Weiner RV, Gaskill SP, Smith JA, 

Weiner M, Brown HP, Prihoda TJ, Newton E. 

‘‘Preliminary Evaluation of Continuing Medical 

Education-Based Versus Clinic-Based Sexually 

Transmitted Disease Education Interventions for 

Primary Care Practitioners’’ Teaching and Learning 

in Medicine. 10(2) 74–82. 1998. 

FMCSA Response: FMCSA is 

considering these ideas in the design 

and implementation of the National 

Registry Web site. FMCSA anticipates 

the National Registry will include the 

unique National Registry Number and 

the certification date for each ME. 

Information for MEs who have been 

removed from the National Registry will 

be shown with the date of removal. We 

anticipate using the public Web site and 

email notifications to MEs for 

informational updates. Callers to the 

Resource Center will be able to receive 

assistance in locating an ME on the 

National Registry and will be given 

access to knowledgeable personnel who 

can answer questions about the 

commercial driver physical 

examination. 

Access to Driver Examination 

Records. ATA, Road Ready, Inc., and 

Florida argued for a Web-based 

electronic data entry and documentstorage system for Medical Examination 

Reports. Road Ready, a company that 

electronically collects and stores 

drivers’ DOT medical examination 

information for motor carriers, argued 

that developing and maintaining such a 

system would enhance our ability to 

effectively manage and audit driver files 

and obtain required medical 

information. Florida said an FMCSA 

repository of Medical Examination 

Reports would eliminate the need to 

require and enforce monthly entry of 

separate data. 

AAOHN, Dart Transit Company, ATA, 

and an individual MD suggested that the 

ME should have access to previous 

driver physical examination records in 

order to more easily detect disqualifying 

illnesses not reported by the driver. 

FMCSA Response: The Agency 

acknowledges the potential benefits of a 

comprehensive, searchable Web-based 

database of Medical Examination 

Reports. This type of system could 

incorporate automated checks that 

would prevent the erroneous 

certification of drivers who do not meet 

certification standards and would 

facilitate the collection of driver 

examination records for monitoring ME 

performance. However, this rule will 

not require MEs to enter all data into a 

prescribed on-line Medical Examination 

Report form, because of the 

administrative burden this would place 

on MEs. 

Medical Examiner’s Certificates. The 

NPRM proposed a change in the 

medical examiner’s certificate form to 

require the ME to record his or her 

unique National Registry Number. The 

proposed rule would have allowed the 

ME to use existing medical examiner’s 

certificate forms (without a box for the 

National Registry Number) for up to 4 

years. Iowa opposed the use of obsolete 

forms. 

FMCSA Response: FMCSA agrees 

there is no need to delay 

implementation of the updated medical 

examiner’s certificate and has made 

changes to the final rule to require MEs 

to use the medical examiner’s certificate 

with the National Registry Number for 

all examinations on or after a date 24 

months after the effective date of this 

final rule. FMCSA has posted the 

current medical examiner’s certificate 

on its public Web site since 2003, so 

MEs have not had to order supplies of 

paper copies. Therefore the two-year 

implementation date will not impose 

hardship or waste with regard to 

availability of the current certificate. 

D. Costs and Benefits of the National 

Registry Program 

1. Benefits 

FMCSA requested comments on the 

costs and benefits of the proposed rule. 

The Indiana Statewide Association of 

Rural Electric Cooperatives (ISAREC) 

questioned the need for and the benefit 

of the National Registry, arguing that it 

might not be a good, targeted use of 

Agency resources. A private citizen 

questioned whether any study shows 

MEs make highways safer. Southern 

Company, a public utility company, 

opposed establishment of a National 

Registry and suggested instead that 

physicians should be given easy access 

to on-line directions and guidance to 

use any time. 

In contrast, a chiropractor reported 

that in the past year, he had disqualified 

drivers who previously had been 

improperly qualified to drive by other 

MEs or required exemptions for 

blindness in one eye, insulin use, 

psychological conditions, limb/ 

appendage loss, implanted 

defibrillators, seizure disorders, and 

cardiovascular disorders. California 

noted a 2005 study that found that 10 

percent of Medical Examination Reports 

(long forms) submitted and marked as 

qualified were actually from unqualified 

drivers, which, to the commenter, 

indicates that MEs misinterpreted the 

Agency standards. 

The American Chiropractic 

Association and a comment signed by 

147 chiropractors stated that the 

National Registry will both improve 

highway safety and reduce the number 

of erroneous driver disqualifications. 

They agreed that the ME certification 

program will raise the quality and 

conformity of the CMV driver physical 

examination. California and Iowa 

expressed similar opinions in stating 

that the training protocol will ensure 

that MEs are knowledgeable and capable 

of performing these examinations. 

FMCSA Response: FMCSA is required 

by statute to establish the National 

Registry. As described in the regulatory 

evaluation, the Large Truck Crash 

Causation Study (LTCCS) data show 

that approximately 2.2 percent of 

crashes involve a crash where the truck 

driver was assigned the critical reason 

for the crash and the main contributing 

factor was the health or physical 

condition of the truck driver.4 The 

LTCCS is the most comprehensive 

examination of truck-crash causation 

conducted in the United States. It is 

clear that driver health is a factor 

contributing to a significant number of 

crashes. Clearly, there are benefits from 

a program that would improve the 

screening of drivers, keep medically 

unqualified drivers off the road, and 

that would, therefore, in FMCSA’s 

estimation, prevent 1,219 crashes per 

year. 

It will not be possible to evaluate the 

effectiveness of training programs for 

MEs to be listed in the National Registry 

until after the training programs have 

been initiated. It is impossible to predict 

the degree to which the training 

program will improve ME screening of 

drivers. However, comments received 

from MEs who currently conduct driver 

physical evaluations, and evidence from 

the field from MEs and enforcement 

personnel indicate that many drivers 

who do not meet the Agency’s physical 

qualification standards are being 

erroneously medically certified. The 

Agency expects the National Registry 

Program to reduce the number of errors 

committed by MEs. It will depend upon 

the effectiveness of training and the 

knowledge that MEs gain about Agency 

standards and guidelines. 

CME programs have received 

extensive evaluations and have been 

shown to improve medical practitioner 

knowledge and skills, as well as patient 

outcomes.5 A comprehensive review of 

the effectiveness of CME programs 

sponsored by the U.S. Department of 

Health and Human Services 


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24116 Federal Register / Vol. 77, No. 77 / Friday, April 20, 2012 / Rules and Regulations 

6Marinopoulos, S, Dorman T, Ratanawongsa N, 

Wilson LM, Ashar BH, Magaziner JL, Miller RG, 

Thomas PA, Prokopowicz GP, Qayyum R, Bass EB. 

Effectiveness of Continuing Medical Education. 

Evidence Report/Technology Assessment Number 

149, Agency for Healthcare Research and Quality— 

U.S. Department of Health and Human Services, 

2007. Available online at: http://www.ahrq.gov/ 

downloads/pub/evidence/pdf/cme/cme.pdf. 

demonstrated that these programs are 

effective in increasing participant 

knowledge, skills, and clinical practices, 

among other improvements.6 The 

National Registry Program is more 

rigorous than many CME programs 

because it includes a post-training 

knowledge assessment. Given that other 

CME programs have been shown to be 

effective, it is reasonable to expect, 

therefore, that the National Registry 

Program would attain some level of 

effectiveness. 

2. Costs 

We proposed developing the core 

curriculum specifications and 

administrative requirements for ME 

training— referred to as the PublicPrivate Partnership Model. We asked for 

comment on alternative training 

delivery methods and the ability of 

accredited training programs to adapt 

their continuing education programs to 

ensure quality and consistency of 

training. 

We received many comments about 

the cost of ME training, testing, and 

certification. In 49 CFR 390.105, we 

require that all ME applicants complete 

training conducted by a private-sector 

training provider (administered by a 

nationally accredited medical 

professional organization that provides 

continuing education units). In 49 CFR 

390.103(a)(3), we require that after 

completing mandatory training, an ME 

applicant must pass our ME certification 

test. In 49 CFR 390.111, we list 

requirements for continued listing on 

the National Registry, including 

periodic retraining every 5 years and 

recertification every 10 years. We 

anticipate that FMCSA will provide 

Web-based, periodic retraining at no 

cost to MEs. We estimate the annual 

costs of training and testing—including 

lost time to MEs—as varying between 

$14 million and $59 million 

(undiscounted) during the initial 

training phase. 

Costs to Medical Examiners. 

Commenters presented various 

arguments concerning whether we had 

properly assessed the cost of the rule 

and which stakeholders would pay the 

cost of ME training and certification. 

Comcar Industries said we had 

‘‘significantly understated’’ the cost 

impact of this rule on the trucking 

industry. A private citizen questioned 

whether we had properly evaluated 

what costs will increase after the 

National Registry is established. 

ISAREC, OOIDA, Virginia, and Wynne 

said that MEs would pass on cost 

increases to drivers or motor carriers 

and other employers of drivers. A 

chiropractor, ATA, the National School 

Transportation Association (NSTA), 

OOIDA, and Wynne agreed that to 

recover their training investments, MEs 

in remote areas would impose higher 

physical examination fees over a smaller 

base of drivers. NSTA recommended 

that to prevent disparate examination 

fees across the country, FMCSA should 

limit the amount by which MEs can 

increase their physical examination fees 

to recover the cost of having to comply 

with the National Registry rule. 

FMCSA Response: There will likely be 

a minimal increase in the cost charged 

by MEs to reflect the cost of becoming 

certified. In the regulatory evaluation, 

we estimated that becoming certified 

would cost approximately $550 per 

examiner in out of pocket costs—$440 

for training and $110 to take the 

certification test. Fees for driver 

examinations vary, but generally fall in 

the range of $70–$100, assuming no 

specialized tests are required. As noted 

by one commenter, MEs in lower 

volume areas may already charge higher 

fees—up to $170 per examination. At 

$170 per examination, an ME would 

only have to conduct 3–4 examinations 

in order to recoup the out-of-pocket 

costs of certification. At the lower-end 

price of $70 per examination, an ME 

would need to conduct a minimum of 

approximately 8 driver examinations to 

recoup the out-of-pocket costs of 

certification. In addition, many 

occupational health consortia and other 

organizations offer training on the CMV 

driver physical, and other ME training, 

free of charge, to physicians and other 

providers in their networks. It is unclear 

how many MEs would have access to 

these free courses, but at least some 

would bear little or no out-of-pocket 

costs for obtaining the required training. 

The opportunity cost of time for an 

ME to attend certification training and 

testing was estimated at $83 per hour, 

and the time commitment for 

certification was estimated at 11.5 

hours, for a total cost of approximately 

$954. If an ME took on these costs, 

approximately 148 examinations at most 

would be needed to pay back the 

investment of time required to become 

certified. The NPRM proposed requiring 

MEs to repeat initial training every 12 

years. This final rule eliminates this 

requirement for repeating the initial 

training but substitutes refresher 

training every 5 years, thereby reducing 

the cost to MEs for maintaining 

certification. 

At a maximum, an ME would need to 

conduct approximately 26 examinations 

to compensate for the total cost of 

certification including both out-ofpocket costs and indirect costs of the 

time involved. The financial payoff for 

being able to continue conducting these 

examinations seems sufficient to induce 

most MEs who currently conduct 10 or 

more driver certifications per year to 

become certified. Based on the revenue 

generated by the examination, this 

volume would be sufficient to pay back 

both the value of time spent by an ME 

in training and out-of-pocket expenses 

in a little over 2 years. 

The initial training required by this 

certification program is a fixed cost—a 

one-time expense. This is not a marginal 

cost that is incurred with each 

examination. In competitive markets, 

the cost of a service approaches its 

marginal cost, as fixed costs are 

averaged over multiple units of 

production. Given that there are MEs 

who evaluate hundreds of CMV drivers 

per year, the amount that initial 

certification costs would contribute to 

the per-unit cost of providing 

examinations would approach zero. We 

expect these higher volume MEs to set 

the market price for driver 

examinations. Those MEs who conduct 

fewer examinations would have 

pressure to match the prevailing price, 

or most drivers would go to an ME who 

charges a lower fee. We therefore expect 

a minimal increase in the fees charged 

for these examinations. In addition, we 

expect that the MEs who choose to 

obtain training and be listed on the 

National Registry will see an increase in 

the volume of commercial driver 

examinations, because there may be 

fewer professionals eligible to conduct 

the driver examinations. Greater volume 

should help control cost increases 

because the cost of training will be 

spread across a greater number of 

examinations. As a result, a smaller 

price per examination increase would 

be necessary for MEs to recover their 

costs. 

If training costs are incorporated into 

higher medical examination fees, this 

would not result in an increase in the 

total cost of the program, although it 

would result in a pass-through of these 

costs to the industry. If MEs pass some 

or all of the costs of the training on to 

the industry, the costs passed on would 

be borne by drivers and carriers rather 

than MEs, but whether these costs are 

passed on or absorbed by MEs would 

not change the total cost of the program. 

Therefore, the Agency feels it has fully 


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accounted for the potential effects of the 

rule, although we cannot predict with a 

great deal of certainty how much of the 

associated costs would be absorbed by 

MEs rather than passed on to the 

industry. 

Finally, the Agency disagrees that we 

should put a ceiling on the fees MEs are 

allowed to charge for physical 

examinations. Commenters are 

concerned both that there will be a 

shortage of MEs and that fees will 

increase. However, the ability to charge 

a higher fee for driver examinations 

increases the incentive that MEs have to 

obtain certification. Capping the fee too 

low would exacerbate any shortage in 

MEs, because it would reduce the 

financial incentive to become certified. 

In the interest of ensuring the broadest 

geographic coverage possible for the 

National Registry, we do not agree that 

capping driver examination fees would 

be advisable. 

It must be kept in mind that once this 

program reaches full implementation, 

all MEs who choose not to participate in 

this certification program will lose all 

revenue associated with conducting 

driver physical examinations. MEs face 

the choice of becoming certified to 

retain the current revenue stream they 

receive from driver examinations, or not 

becoming certified and losing this 

revenue to other professionals who are 

certified. The Agency believes that, for 

most MEs, preserving this revenue 

stream will outweigh any costs 

associated with becoming certified. 

Scarcity of Medical Examiners. 

FMCSA requested comments on 

whether the proposed requirements may 

deter otherwise qualified MEs from 

performing these types of examinations 

and on ways to ensure that MEs are 

accessible to drivers in rural areas and 

areas where the demand for driver 

certification may be low. The Agency 

also asked for comments on additional 

costs drivers may incur to locate and 

travel to an ME for periodic 

examinations. 

AAPA, AAOHN, Advocates, 

California, Virginia, and two individuals 

said that the cost of training and testing 

would diminish the number of 

physicians and others willing to become 

MEs. However, a physician with the 

Delaware Department of Health 

suggested that most physicians would 

find the costs of training and travel, 

certification, and recertification 

acceptable. 

OOIDA also expressed concern that 

the burdensome and costly 

administrative obligations for listed MEs 

will discourage health care 

professionals from providing driver 

physical examinations. Administrative 

burdens would include the need for a 

computer system that can interface with 

the Agency and personnel available to 

provide the Medical Examination 

Reports when requested. California 

requested that MEs be given sufficient 

notice prior to an onsite inspection and 

sufficient time to comply with a request 

for information. 

Several commenters discussed the 

scarcity of MEs in rural areas and the 

resulting costs to CMV drivers. ATA, 

Arizona, Comcar Industries, ISAREC, 

National Academy of DOT Medical 

Examiners (NADME), OOIDA, Southern 

Company, Virginia, and Wynne said 

that a scarcity of MEs would burden 

truck drivers with having to travel long 

distances for physical examinations. 

ATA commented further that such 

travel likely would result in a loss of 

wages for the driver and loss of revenue 

to the motor carrier. 

Commenters also argued that scarcity 

would result in difficulties in 

scheduling physical examinations. 

Commenters said many drivers will 

experience longer wait times and no 

walk-in opportunities for physical 

examinations. According to NSTA, 

difficulties in scheduling physical 

examinations could impede school bus 

service because newly hired drivers may 

be unable to receive physical 

examinations before the start of school. 

Several commenters suggested actions 

we might take to avoid a scarcity of 

MEs. These suggestions included 

offering financial incentives to secure a 

local ME, permitting physical 

examinations by CMV drivers’ family 

doctors, though not certified, having 

motor carriers take responsibility for 

finding physicians in their areas who 

are willing to become MEs, and 

extending the rule’s implementation 

date if there are not sufficient numbers 

of MEs. 

FMCSA Response: There are 3,140 

counties or county-equivalent 

administrative units in the United 

States, according to the U.S. Census 

Bureau. Assuming the Agency reaches 

its goal of certifying 40,000 MEs, there 

would certainly be a sufficient number 

of certified MEs to provide broad 

geographic coverage. Even half that 

number of certified MEs would be 

sufficient to provide comprehensive 

national coverage. It is unlikely that 

MEs would be evenly distributed 

throughout the Nation, but coverage 

should be sufficient to ensure 

reasonably convenient access in all but 

the most remote areas of the Nation. 

Lack of access to a certified ME would 

be likely to affect only a small number 

of drivers, especially considering that 

many of these drivers from rural areas 

would be delivering loads on a regular 

basis to larger towns and cities and, 

thus, have access to the broader ME 

populations in such areas. Given the 

mobile nature of the CMV driver 

occupation and the number of MEs we 

anticipate to join the National Registry, 

we do not believe that access to certified 

MEs will be an issue once the Registry 

is fully populated. In addition, we 

anticipate that the searchable National 

Registry may make it easier for drivers 

to find health care professionals who are 

qualified to conduct the driver physical 

certification examination. It is possible 

that in some areas where MEs are in 

short supply, such as rural areas, driver 

examination costs might increase, but 

the increase is not a certainty and is not 

likely to be large. Also, travel costs to 

drivers might increase due to drivers 

traveling further to find MEs. 

Mode of Training and Testing. We 

proposed developing the core 

curriculum specifications and 

administrative requirements for ME 

training, which we would provide to 

private-sector training organizations for 

developing course content. We 

mentioned that training delivery could 

vary among providers and include selfpaced, on-line training; the traditional 

classroom model; or a blended format. 

We also envisioned private-sector 

organizations administering a proctored 

and secure certification test, with the 

ME applicant traveling to the test center. 

We asked for comment on alternative 

training and testing delivery methods 

and how FMCSA could offer training 

directly to MEs in a cost-effective 

manner. 

ATA, Comcar Industries, ISAREC, 

MRB, NADME, NRCME Training 

Systems, OOIDA, and Schneider 

National endorsed on-line training as 

efficient and cost-effective. Schneider 

National also endorsed other costefficient technologies like videoconferencing, along with traditional 

classroom training. 

A chiropractor said that live Web 

conferencing had the benefit of reducing 

costs and allowing conversation 

between a trainer and course attendees. 

Delaware noted that some physicians 

favored an initial on-line Web-based 

product designed to educate new 

examiners, followed by on-site lectures 

and then initial testing, leading to 

qualification. However, OccuMedix 

stated that in-person, classroom training 

was optimal for initial certification 

since discussing case studies and inperson interacting with other ME 

candidates and faculty would be 

extremely beneficial. 

Several of the commenters, including 

ATA, supported on-line testing. ATA 


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said that on-line testing should be the 

preferred method of administration of 

the test to reduce costs. One commenter, 

a chiropractor, said that FMCSA should 

offer the test on its Web site. 

FMCSA Response: The Agency agrees 

with comments that on-line training 

would reduce the cost associated with 

training. This rule does not preclude online training as a viable training, or the 

other suggested training formats, 

delivery methods. Allowing flexibility 

in alternative training delivery methods 

is one of the primary benefits of the 

Public-Private Partnership Model. While 

some organizations may charge for this 

training, others (larger hospital systems, 

occupational health consortiums, 

professional associations, etc.) may offer 

training that is free of charge to group 

members. The Agency is aware of 

several ME training programs that are 

offered free to members of particular 

organizations. It is therefore likely that 

under the Public-Private Partnership 

Model a percentage of MEs would be 

able to obtain on-line training with no 

out-of-pocket costs or travel costs. At 

present, the Agency cannot estimate 

with any degree of certainty the number 

of MEs who might take advantage of online training, so we leave the travel costs 

estimates at the NPRM stage unchanged 

for the Public-Private Partnership 

Model. It is expected, however, that online training will reduce travel costs 

associated with this model. 

The Agency agrees with commenters 

that allowing on-line testing will 

increase accessibility and decrease 

costs. This rule allows for secure online 

testing to be offered by testing 

organizations as an alternative or 

additional option to in-person testing. It 

requires online testing to be subject to 

specific security and privacy 

requirements due to the nature of the 

test and the need for authentication and 

security of the test. The Agency expects 

that, just as with on-line training, 

allowing for the increased flexibility 

provided by secure on-line testing in the 

final rule will reduce costs for MEs 

without adversely impacting the ability 

of the Agency to verify the 

qualifications of the MEs on the 

National Registry or compromising 

safety. 

Estimates of Frequency of Driver 

Examinations. The NPRM estimated the 

number of MEs who would need to be 

certified by estimating that 3 million 

driver examinations are performed on 

interstate CMV drivers per year. All 

CMV drivers must be certified at least 

every 2 years, and some drivers are 

certified more frequently. We 

specifically requested comments on 

how frequently drivers are examined 

more often than every 2 years. A 

chiropractor said that in 2008, his 

practice issued 41 percent of CMV 

medical certificates for less than 2 years. 

Schneider National said that of the 

approximately 650 medical 

examinations it performed each month, 

it issued about 50 percent of the medical 

certifications for less than 2 years. 

Comcar Industries reported that 39 

percent of its drivers receive medical 

certificates for less than 2 years. 

NSTA said FMCSA underestimated 

the number of drivers by not including 

intrastate drivers, because all States but 

two adopt the FMCSRs for intrastate 

drivers. NSTA also said that most States 

require school bus drivers to have a 

physical examination annually. 

FMCSA Response: The Agency agrees 

that, given the estimates of the number 

of drivers who require certification more 

than once every two years, it is likely 

that more than 3 million drivers would 

be certified in a given year. However, 

we do not believe that this increase in 

the estimated number of drivers needing 

medical examinations per year is great 

enough to require more registered MEs 

than the 40,000 we used as the baseline 

for calculating the costs of the program. 

The increase in medical certifications 

does not, therefore, impact our estimate 

of the direct costs of the rule, which are 

based on the cost of training, certifying, 

and registering a given number of MEs. 

This rule does not change the 

regulations and guidelines that MEs use 

to determine how long drivers are 

certified. 

In regard to counting intrastate-only 

driver examinations, FMCSA 

acknowledges the potential impact of 

certifying intrastate drivers and 

exempted school bus drivers on the 

number of driver examinations MEs on 

the National Registry will perform. 

However, for the purposes of estimating 

the costs of the program, as required by 

49 U.S.C. 31136(c)(2)(A) and Executive 

Order 12866 (see Section VI below), we 

considered the direct impact of the rule, 

which is limited to interstate drivers. 

E. Implementation of National Registry 

Program 

1. Phased-In Implementation 

The NPRM proposed phasing in the 

requirement for using MEs listed on the 

National Registry, with phase one 

requiring compliance for motor carriers 

with more than 50 drivers (so-called 

large carriers), and phase two requiring 

compliance for drivers not covered in 

phase one. Phase one would have begun 

2 years after the rule’s effective date; 

phase two would have begun 3 years 

after that date. 

The majority of commenters to this 

section opposed the implementation 

schedule, while some offered 

alternatives to the proposed approach. 

ATA claimed that it is unfair to require 

drivers of large motor carriers to bear 

the costs of compliance for one year 

longer than drivers of smaller motor 

carriers. A joint comment from ABA and 

BISC voiced concern that the phased-in 

implementation schedule could result 

in only a limited number of MEs 

obtaining certification, which would 

make it difficult for drivers to locate an 

ME. The commenter recommended a 

single two-year implementation period, 

which it believed would provide 

adequate time for MEs to obtain 

certification. Comcar Industries added 

that the proposed implementation 

schedule demonstrates a lack of 

understanding of the transportation 

industry and is not realistic or 

reasonable. The commenter stated that 

we did not provide any valid reasons for 

proposing the approach and are 

unjustified in forcing the motor carriers 

to be responsible for implementation by 

requiring them to search for an ME 

when one may not be available in 

certain areas. Both ATA and Comcar 

Industries urged us to ensure that the 

National Registry is sufficiently 

populated throughout the country 

before implementing the proposed 

requirements. NSTA said that the 

proposed phase-in schedule would 

cause hardships for rural school bus 

operations, because many school bus 

companies are not located in areas 

where there is easy access to MEs. 

NSTA suggested that we phase in the 

National Registry Program by either 

population density or by facility size 

from which buses are dispatched rather 

than by company size. 

OOIDA claimed that the schedule was 

developed on flawed Agency 

assumptions. First, it stated that drivers 

employed by large carriers, just as their 

smaller independent counterparts, have 

the same likelihood of living in rural 

areas where MEs will not be 

concentrated. The commenter then 

suggested that there will always be a 

shortage of MEs in rural areas or other 

areas where the demand for 

examinations is low. 

Dart Transit Company opposed the 

implementation schedule, suggesting 

that to actually improve highway safety, 

all motor carriers should be required to 

comply at the same time. California also 

recommended that the proposed 

requirements should be applicable to all 

participants on the effective date of the 

final rule. It noted that a driver could 

avoid compliance by claiming 

employment by a ‘‘small’’ carrier; a 


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claim that the State SDLAs would be 

unable to verify. 

Schneider National and a chiropractor 

suggested a ‘‘geographical’’ or 

‘‘regional’’ approach to implementation. 

Schneider National claimed that 

ensuring there are a sufficient number of 

MEs in a particular region will reduce 

the traveling burden on a driver to 

obtain his or her examination. However, 

the chiropractor noted a potential 

drawback to implementing this 

geographic or regional approach, 

suggesting that MEs and drivers may not 

receive adequate notice that they are in 

a regional area where they must follow 

the new requirements. 

Finally, Delaware suggested that 

FMCSA create a matrix that would 

allow a State to determine by date when 

they must only accept medical 

certificates issued by certified 

examiners. 

FMCSA Response: The Agency 

concurs with comments that the phasein schedule would pose some issues, 

such as limiting the number of MEs in 

the first year. Additionally, FMCSA 

does not believe this would reflect the 

reality of the industry’s distribution of 

drivers. In response, the Agency has 

eliminated the phase-in schedule from 

the final rule. The final rule will require 

that all drivers requiring certification 

under 49 CFR part 391, subpart E must 

be certified by an ME on the National 

Registry beginning 2 years after the 

effective date of this rule, regardless of 

the size of the employing carrier. The 

cost estimates based on the original 

phase-in period have been adjusted to 

account for this change in the 

accompanying regulatory evaluation. 

2. Reviews of Performance of Medical 

Examiners 

The NPRM proposed implementation 

of the SAFETEA–LU requirement that 

MEs electronically transmit to the 

FMCSA Chief Medical Examiner on a 

monthly basis the name of the CMV 

driver and a numerical identifier for any 

completed Medical Examination Report 

required under 49 CFR 391.43 (49 

U.S.C. 31149(c)(1)(E)). OccuMedix, Dart 

Transit Company, and Advocates 

supported implementing a quality 

assurance program with a detailed 

removal process for non-compliant MEs. 

Advocates asserted we must ensure MEs 

fulfill the requirement to provide 

information about completed medical 

examinations on a regular basis. The 

commenter described our proposed 

oversight as vestigial and hit-or-miss, 

expressing concern that we did not 

detail the approach to ensure that MEs 

actually are properly administering the 

physical examination. 

Transportation Safety Services 

recommended that we address the 

problem area of many physician errors 

resulting from the physician’s support 

staff incorrectly completing the 

paperwork. California requested that we 

provide a mechanism and authorize 

SDLAs to immediately report to FMCSA 

any health care professionals not on the 

National Registry who are performing 

driver examinations, and any MEs 

engaged in fraudulent or illegal activity. 

Finally, a certified MRO 

recommended that we incorporate the 

Federal Transit Administration’s 

approach for ‘‘Best Practices’’ awards for 

MEs that set model examples. 

FMCSA Response: FMCSA intends to 

ensure that MEs comply with the 

requirement in this rule to electronically 

submit a completed MCSA–5850, CMV 

Driver Medical Examination Results, 

form monthly to FMCSA. The details of 

FMCSA’s compliance and monitoring 

program will relate to FMCSA’s future 

implementation of the provision of 

SAFETEA–LU (49 U.S.C. 31149(c)(2)), 

and therefore will not be part of this 

rulemaking. 

FMCSA acknowledges that expanding 

the National Registry to include training 

and certification of auxiliary staff, 

whether health care professionals or 

administrative personnel, might be 

beneficial. However, in order to 

minimize the cost burden to the public, 

the Agency will not include these 

requirements in the final rule. MEs are 

reminded that they are responsible for 

reviewing and correcting any errors in 

the driver examination documentation. 

States, other stakeholders, or the 

public may direct complaints about the 

performance of MEs as follows: If health 

care professionals not listed in the 

National Registry are known to be 

performing required driver 

examinations on or after 24 months 

from the effective date, or if MEs are 

believed to be engaged in fraudulent or 

illegal activity, FMCSA should be 

notified by: (1) Writing the Office of 

Carrier, Driver and Vehicle Safety 

Standards, FMCSA, 1200 New Jersey 

Avenue SE., Washington, DC 20590; (2) 

sending an email to 

contactnrcme@dot.gov; or (3) calling an 

FMCSA-designated toll-free telephone 

number listed on the National Registry 

Web site. 

Finally, FMCSA does not anticipate 

creating a ‘‘best practice award’’ for MEs 

as part of the initial implementation of 

the National Registry Program. FMCSA 

may revisit this issue after the program 

has been fully implemented. 

F. Issues Outside of the Scope of the 

Rulemaking 

A number of respondents submitted 

comments on topics that were either 

outside the scope of what was proposed 

in the NPRM or were based on a 

misunderstanding of what the Agency 

proposed in this rulemaking. Many of 

these issues concern how FMCSA could 

prevent driver fraud in the medical 

certification process, track commercial 

driver examinations, require SDLAs to 

review Medical Examination Reports as 

part of the CDL, or establish specific 

medical examination requirements. 

FMCSA Response: FMCSA 

acknowledges the policy concerns of the 

commenters. However, as stated in the 

NPRM, the legal and policy direction of 

this rulemaking is limited to requiring 

drivers to be examined by MEs that have 

been trained and certified to effectively 

determine whether they meet FMCSA 

physical qualification standards under 

49 CFR part 391. FMCSA continues to 

believe this rulemaking represents a 

major step in improving oversight 

capabilities by establishing the National 

Registry, ensuring that MEs are trained 

and qualified to perform driver 

examinations, removing MEs who do 

not meet program requirements from the 

National Registry, and requiring carriers 

and drivers to use only MEs on the 

National Registry. 

The driver certification issues 

addressed by this rule complement the 

driver licensing issues that were 

addressed by the rule titled ‘‘Medical 

Certification Requirements as Part of the 

CDL’’ (December 1, 2008, 73 FR 73096), 

which established a system for interstate 

CDL drivers to provide medical 

certification status information to the 

SDLAs by providing the ME’s 

certificates. It also required the SDLA to 

post that medical certification status 

information into the CDLIS driver 

record for licensing, enforcement, and 

employment decisions. The 2008 rule 

represented a significant first step in 

improving the oversight capabilities of 

medical certification status information 

for non-excepted, interstate CDL drivers. 

Neither this final rule nor the 2008 

rule are intended to address fraud 

perpetrated by drivers regarding their 

medical certification or to update 

SDLAs on disqualified drivers. While 

we acknowledge that these are 

important issues, these comments are 

outside the scope of this rule. However, 

as previously stated, FMCSA anticipates 

initiating a future rulemaking to expand 

medical certification information 

exchange with the States. 

A third step toward improving 

oversight of the driver qualification 


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process is the review and revision, as 

necessary, of the driver physical 

qualification standards. The Agency, 

with the advice of its Medical Review 

Board and its newly appointed Chief 

Medical Examiner, has begun the 

process, which will take several years to 

complete. Changes to the standards and 

guidelines for driver qualification are 

beyond the scope of this rulemaking. 

G. Comments on the Modified 

Information Collection 

FMCSA published a request for public 

comments concerning a modification of 

the proposed information collection 

request under consideration on March 

16, 2011 (76 FR 14366). FMCSA 

proposed a new information collection 

burden related to a requirement for 

employers of CMV drivers to verify the 

National Registry Number of the ME for 

each driver required to be examined by 

an ME on the National Registry, and to 

place a note relating to verification in 

the driver qualification file. 

Comment on the information 

collection burden. One commenter, 

OOIDA, noted that the information 

collection burden would affect a large 

number of motor carriers and add to the 

already existing burden of 

recordkeeping obligations for both small 

motor carriers and owner-operators. 

FMCSA Response: The Agency’s 

regulations already require small 

carriers and owner-operators to comply 

with all of the regulations applicable to 

both carriers and drivers (see 49 CFR 

390.11). The additional information 

collection burden from this verification 

requirement on an individual employer 

is minimal, amounting to a few minutes 

per driver. The Agency adopts the 

requirement for employers to verify the 

ME’s National Registry Number for each 

of its drivers, as proposed. 

Comments beyond the scope of the 

information collection notice. Multiple 

commenters, including several State 

organizations, stated that requiring 

employers to verify the National 

Registry Number would be redundant 

and unnecessary, because they believed 

the SDLAs would or should verify the 

qualifications of the MEs as part of the 

process for posting medical status 

information on CDLIS. FMCSA is not 

requiring SDLAs to verify the National 

Registry Number. CDLIS only contains 

this information for CDL holders, and, 

as employers will be required to verify 

the ME numbers for both CDL holders 

and non-CDL holders, this would not be 

sufficient. 

Several commenters, including 

AHAS, ATA, and OOIDA, noted that the 

Agency’s proposal would not 

substantially deter driver fraud, and 

suggested alternate ways of addressing 

fraud. Several of these suggestions 

would, if adopted, increase the burden 

of this rulemaking on the employer or 

require additional public notice and 

comment rulemaking. 

FMCSA Response: This rulemaking is 

one of several incremental steps towards 

a comprehensive medical certification 

oversight process that includes the ME, 

driver, and motor carrier. FMCSA 

believes that employer verification of an 

ME National Registry Number is one of 

several steps toward improving the 

driver medical certification process. 

Eliminating opportunities for fraud from 

the process is one of the goals for the 

medical certification oversight process. 

Though the Agency is unable to 

implement these various suggestions for 

fraud reduction in this final rule, they 

have been noted, and may be considered 

in a future rulemaking. 

V. Section-by-Section Explanation of 

Changes From the NPRM 

Part 350 Commercial Motor Carrier 

Safety Assistance Program 

Section 350.341. FMCSA is revising 

this section so that States that receive 

MCSAP grants and that have in effect 

variances for physical qualification 

requirements for drivers operating 

CMVs in intrastate commerce will have 

the option of not establishing a separate 

registry of medical examiners trained 

and qualified to apply those standards. 

Without this option, in order to comply 

with the general requirement of 

compatibility established by 49 U.S.C. 

31102 and 49 CFR 350.201(a), such 

States would have the burden of 

establishing and administering a 

separate registry for such examiners 

applying different standards to 

intrastate-only CMV drivers. FMCSA 

does not believe it is necessary to place 

that burden on the States that may have 

such variances in effect. A State with 

variances in effect under 350.341(h)(1) 

and (2) that chooses to set up a separate 

registry of examiners qualified to apply 

those variances to intrastate drivers will 

not be allowed to use MCSAP funds for 

that purpose. Such use of MCSAP grant 

funds would not be consistent with the 

overall purpose of establishing a 

uniform standard for all CMV drivers 

nationwide. 

Part 383 Medical Recordkeeping 

Section 383.73(o)(1)(iii)(E). FMCSA 

revises the list of items that the State 

must post to the CDLIS driver record by 

deleting the phrase ‘‘(if the National 

Registry of Medical Examiners, 

mandated by 49 U.S.C. 31149(d), 

requires one)’’ after ‘‘Medical 

examiner’s National Registry 

identification number,’’ because the 

National Registry Program 

implementation will indeed require 

such a number for certified MEs. 

Part 390 Definitions 

Section 390.5. The NPRM contained a 

phase-in schedule for implementation. 

In the final rule, however, the proposed 

phase-in has been eliminated and the 

revised definition applies beginning 2 

years after the effective date of the final 

rule. Thereafter, every medical 

examination under subpart E of part 391 

must be conducted by an ME listed on 

the National Registry. FMCSA revises 

the proposed definition of medical 

examiner to reflect that there is no 

phase-in schedule. 

Subpart D of Part 390—National 

Registry of Certified Medical Examiners 

Section 390.103. FMCSA adds an 

introductory phrase to paragraph (b) to 

clarify that it applies to a person who 

has ME certification. FMCSA adopts 

paragraph (a)(1) as proposed. We require 

the applicant for medical certification to 

have a legally permitted scope of 

practice (i.e., license, certification, or 

registration) that allows him or her to 

perform independently the 

requirements of § 391.43. FMCSA 

eliminates the reference to Appendix A 

from paragraph (a)(3) because Appendix 

A was not adopted in the final rule. As 

originally proposed in the NPRM, 

Appendix A specified contact 

information and required statements ME 

candidates would have to submit to 

testing organizations before the testing 

organizations would permit them to take 

the ME test. In paragraph (a)(3), FMCSA 

also prohibits an applicant who does 

not pass the certification test from 

retaking the test within 30 days, and 

requires an applicant to take the 

certification test no more than three 

years after completing the training. 

Section 390.105. FMCSA deletes the 

provision on compliance with section 

508 of the Rehabilitation Act for two 

reasons. First, this section only applies 

to Federal departments and agencies 

that provide electronic and information 

technology to their employees, or who 

use such technology to provide 

information and services to members of 

the public. Second, it is unnecessary in 

light of the provisions of section 504 of 

the Rehabilitation Act and Department 

regulations in 49 CFR part 28. 

Section 390.107. FMCSA makes 

changes to proposed § 390.107 Medical 

examiner certification testing. The 

Agency adds a new paragraph (b) (and 

changes the designation of the 

subsequent paragraphs as appropriate), 


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to require additional security and 

privacy procedures for those testing 

organizations who intend to administer 

the test on-line as an alternative or 

additional option to in-person testing. 

FMCSA also eliminates the reference to 

Appendix A of this part. The NPRM had 

proposed an Appendix A, but FMCSA 

did not adopt it in the final rule. A 

provision is added to make it clear that 

the test to be administered is the 

currently authorized test developed and 

furnished by FMCSA. 

Section 390.109. FMCSA adopts 

§ 390.109 Issuance of the FMCSA 

medical examiner certification 

credential, as proposed, except to 

specify compliance with the 

requirements of § 390.103(a) or (b) 

rather than compliance with the 

requirements of §§ 390.103–390.107. 

Section 390.111. Although proposed 

paragraph (a)(5)(ii) would have required 

a certified ME to retake the initial 

training in alternating 6-year periods, 

this requirement was not adopted. 

Instead, the ME will be required to 

complete periodic training as specified 

by FMCSA every 5 years. The ME will 

still be required to take the certification 

test every 10 years in order to retain the 

certification. 

Section 390.113. The final rule adds a 

general statement of the grounds for 

removal of an ME, based on 49 U.S.C. 

31149. 

Section 390.115. In the NPRM, this 

section described procedures for 

removal from the National Registry. 

Proposed paragraph (d) addressed 

requests for administrative review after 

an ME has been removed from the 

National Registry, but did not describe 

what would happen if the 

administrative review found that the 

removal of the ME was not valid. To 

correct this oversight, FMCSA adds text 

to paragraph (d)(2), which requires 

FMCSA to reinstate the ME and reissue 

a certification credential. The reinstated 

ME essentially must follow the 

requirements of § 390.111(a), which 

describes what the ME must do to 

continue to be listed on the National 

Registry. Similarly, FMCSA adds the 

same text to paragraph (f), which 

describes applying for reinstatement on 

the National Registry after voluntary or 

involuntary removal. In addition to 

requiring a person who was 

involuntarily removed to complete 

corrective actions described in the 

notice of proposed removal, the rule 

requires reinstated MEs to follow the 

requirements of § 390.111(a). 

Proposed paragraph (g) would have 

required that if a person is removed 

from the National Registry under 

paragraph (c) or (e), or a removal is 

affirmed under paragraph (d), then that 

person’s listing is removed and the 

certification credential is no longer 

valid. FMCSA deletes the phrase ‘‘or a 

removal is affirmed under paragraph 

(d),’’ because a person who requests 

administrative review under paragraph 

(d) has already been removed from the 

National Registry under paragraph (c) or 

(e). That person’s listing has been 

removed and his or her certification 

credential is no longer valid. 

Finally, Director of Medical Programs 

is updated to Director, Office of Carrier, 

Driver and Vehicle Safety Standards 

throughout to reflect a change in 

FMCSA’s organizational structure. 

Appendix A. FMCSA does not adopt 

proposed Appendix A to part 390, 

Medical Examiner Application Data 

Elements. Instead of adopting proposed 

Appendix A, FMCSA will make 

available on its Web site the current 

minimum data elements that must be 

included in the application for medical 

examiner certification. 

Part 391 

Section 391.23. Amendments to 

paragraphs (m)(1) and (m)(2)(i)(B) of this 

section require the motor carrier to 

verify that a driver was certified by an 

ME on the National Registry beginning 

2 years after the effective date of the 

rule. 

Section 391.42. The NPRM contained 

a phase-in schedule for implementation. 

In the final rule, beginning 2 years after 

the effective date of the final rule, this 

section now requires that every medical 

examination under subpart E of part 391 

must be conducted by an ME listed on 

the National Registry. For the reasons 

explained above in Section IV.E.1, 

FMCSA does not believe a phase-in 

period is necessary. 

Section 391.43. The NPRM contained 

several proposed amendments to 

§ 391.43, including an addition to the 

information required on a medical 

examiner’s certificate. FMCSA adopts 

paragraph (a) as proposed to specify 

that, in accordance with the compliance 

schedule established in § 391.42, the 

medical examination must be performed 

by an ME listed on the National Registry 

under subpart D of part 390 of this 

chapter. 

Proposed paragraph (g) would have 

required the ME to complete a medical 

examiner’s certificate for drivers found 

to be physically qualified to drive a 

CMV. In the final rule, the paragraph is 

modified slightly to reflect the wording 

of the current paragraph, which was 

revised on December 1, 2008 (73 FR 

73096) to include providing a copy of 

the medical examiner’s certificate to the 

driver’s employer. FMCSA adopts the 

proposed new requirement in paragraph 

(g)(3) that, once every calendar month, 

the ME must electronically transmit 

certain information to the FMCSA 

Director, Office of Carrier, Driver and 

Vehicle Safety Standards. (Director of 

Medical Programs is updated to 

Director, Office of Carrier, Driver and 

Vehicle Safety Standards to reflect a 

change in FMCSA’s organizational 

structure.) The final rule specifies that 

the information must be provided on 

Form MCSA–5850 and transmitted via a 

secure FMCSA-designated Web site. 

FMCSA adopts proposed paragraph 

(h) to revise the medical examiner’s 

certificate by adding a field for the ME 

to enter his or her unique National 

Registry Number. Under the proposed 

paragraph, MEs would have been 

allowed to use printed certificates they 

have on hand until 4 years after the 

effective date of the final rule. Because 

the MEs do not need to be listed on the 

National Registry until 2 years after the 

effective date of the rule, FMCSA 

believes additional time for using up old 

certificates is unnecessary and the final 

rule does not provide for the use of 

obsolete printed certificates. 

FMCSA adopts proposed paragraph (i) 

to specify that the ME must retain the 

original (paper or electronic) completed 

Medical Examination Report and a copy 

or electronic version of the medical 

examiner’s certificate, and make them 

available, along with related medical 

documentation, to an authorized 

representative of FMCSA or an 

authorized Federal, State, or local 

enforcement agency representative, 

within 48 hours of the request. The 

proposed paragraph would have 

required the records to be retained for 

3 years, but the final rule retains the 

Med. Cert./CDL language, which 

specifies ‘‘at least 3 years from the date 

of the examination.’’ Nothing in our 3- 

year retention requirement precludes 

longer retention which, in fact, may be 

required by States. In the case of an ME 

whose practice has closed, State law 

will govern the retention of medical 

records. Some States may require the 

ME’s successor to retain drivers’ 

medical records, or in the case of a 

deceased ME, the ME’s estate may be 

responsible for retaining the records. 

Additionally, FMSCA has modified the 

medical examiner’s certificate to 

include additional information. 

Section 391.51. FMCSA amends this 

section to require the motor carrier to 

place a note in the driver qualification 

file relating to verification of ME listing 

on the National Registry beginning 2 

years after the effective date of the final 

rule. 


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VI. Regulatory Analyses and Notices 

Executive Order 12866 (Regulatory 

Planning and Review) and DOT 

Regulatory Policies and Procedures as 

Supplemented by Executive Order 

13563 

The FMCSA has determined that this 

rulemaking action is a significant 

regulatory action under Executive Order 

12866, Regulatory Planning and Review, 

as supplemented by Executive Order 

13563 (76 FR 3821, January 18, 2011), 

and that it is significant under DOT 

regulatory policies and procedures. 

This rule establishes a training, 

testing, and registration program that 

would certify medical professionals as 

qualified to conduct medical 

certification examinations of 

commercial drivers. Current regulations 

require all interstate commercial drivers 

(with certain limited exceptions) to be 

medically examined by a licensed 

health care provider to determine 

whether these drivers meet the FMCSA 

physical qualification requirements. All 

drivers must carry a medical examiner’s 

certificate as proof that they have passed 

this physical qualification examination. 

The MEs who conduct said physical 

examinations must retain copies of the 

Medical Examination Reports of all 

drivers they examine. The Medical 

Examination Report lists the specific 

results of the various medical tests used 

to determine whether a driver meets the 

physical qualification standards set 

forth in subpart E of part 391 of the 

FMCSRs. 

Before the adoption of this rule, there 

was no required training program for the 

medical professionals who conduct 

driver physical examinations, although 

the FMCSRs required MEs to be 

knowledgeable about the regulations 

(49 CFR 391.43(c)(1)). The former rules 

required that any medical professional 

licensed by his or her State to conduct 

physical examinations could conduct 

driver medical certification exams. No 

specific knowledge of the Agency’s 

physical qualification standards was 

required or verified by testing. As a 

result, some of the medical 

professionals who conduct these 

examinations may be unfamiliar with 

FMCSA physical qualification standards 

and how to apply them. These 

professionals may also be unaware of 

the mental and physical rigors that 

accompany the occupation of CMV 

driver, and how various medical 

conditions (and the therapies used to 

treat them) can affect the ability of 

drivers to safely operate CMVs. 

This rule establishes the National 

Registry to ensure that all MEs who 

conduct driver medical certifications 

have been trained in FMCSA 

qualification standards and guidelines. 

In order to be listed on the National 

Registry, MEs are required to attend an 

accredited training program and pass a 

certification test to assess their 

knowledge of the Agency’s physical 

qualification standards and guidelines 

and how to apply them to drivers. Upon 

passing this certification test, and 

meeting the other administrative 

requirements associated with the 

Program, MEs will be listed on the 

National Registry. Once this rule is fully 

implemented, only medical certificates 

issued to drivers by MEs on the National 

Registry will be considered valid by the 

Agency as proof of medical certification. 

Alternatives 

The regulatory evaluation that 

accompanied the NPRM for this rule 

considered three alternatives for 

implementing this Program. One 

alternative, referred to as the PublicPrivate Partnership Model, involved a 

partnership between the Agency and 

various private-sector training and 

testing organizations that currently exist 

to provide continuing professional 

education and credentialing to medical 

professionals. This Public-Private 

Partnership Model was the Agency’s 

preferred alternative. The majority of 

public comments to the docket during 

the notice and comment period for the 

NPRM supported the Public-Private 

Partnership Model over the other 

alternatives considered. This final rule 

implements the Public-Private 

Partnership Model. Under this 

partnership, the Agency will develop 

and provide guidance for the core 

curriculum specifications and the 

certification test and protocols. Any 

interested organization that can meet 

FMCSA requirements will be eligible to 

deliver training or testing. Training 

would therefore be delivered by privatesector professional associations, health 

care organizations, and other for-profit 

and non-profit training groups. Testing 

will be delivered by private-sector 

professional testing organizations. After 

completing one of these accredited 

training programs, passing the 

certification test, and agreeing to 

comply with FMCSA administrative 

requirements, MEs will be listed on the 

National Registry, and authorized to 

conduct CMV driver physical 

examinations. Once the National 

Registry is fully implemented, only 

physical examinations conducted by 

MEs on the National Registry will be 

recognized by FMCSA and enforcement 

personnel as proof of driver physical 

qualification. 

The second alternative considered by 

the Agency at the NPRM stage was 

based on the Federal Aviation 

Administration’s Aviation Medical 

Examiner program, referred to here as 

the Government Model. This alternative 

required the Agency to establish its own 

centralized training and testing 

program. As described in the regulatory 

evaluation accompanying the NPRM, 

this program would have required MEs 

to attend this Agency-run program and 

pass a test administered by the Agency. 

Upon completion of the test, an ME 

would be eligible for listing on the 

National Registry. This program’s 

components are essentially the same as 

the Public-Private Partnership Model, 

but all training and testing would have 

been conducted by the Agency rather 

than private-sector training and testing 

programs. This alternative would also 

have required all MEs to travel to the 

FMCSA facility or other regional 

training sites to receive the FMCSA 

training. This would have involved 

greater travel expenses for MEs when 

compared to the Public-Private 

Partnership Model, which has training 

programs distributed throughout the 

country as well as some vendors who 

would offer on-line training modules. 

However, this option would have given 

FMCSA optimal control over the 

training of MEs. 

The third alternative, referred to as 

the MRO Model, was based on the 

current MRO program requirements set 

forth in 49 CFR part 40, subpart G. The 

DOT MRO training program grew out of 

the DOT drug and alcohol program, 

which monitors use of controlled 

substances and alcohol. MROs are 

trained and certified by accredited 

training programs operated by 

professional associations in cooperation 

with DOT. Only licensed MDs or DOs 

are eligible to be MROs. MROs review 

drug and alcohol test results for other 

safety-sensitive occupations such as 

airline mechanics, train operators, and 

ship’s pilots. 

The existing program specifies that 

MROs who oversee drug and alcohol 

testing for commercial drivers must 

attend a training and certification 

program that meets DOT standards. 

Each of these programs maintains its 

own registry of graduates rather than 

contributing names to a single Federal 

database. DOT does not administer the 

training curriculum or testing protocols 

for these programs. Thus, the Agency 

would exert less control over a program 

based on the MRO model than under the 

other options discussed at the NPRM 

stage. In addition, MRO programs 

charge more for testing than would 

likely be charged for testing in the 


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National Registry program. Long 

distance travel for the initial training 

and testing would also have been 

required under this alternative. 

As noted, the Agency has chosen to 

adopt the Public-Private Partnership 

Model at the final rule stage. This 

alternative was estimated to have the 

lowest cost of the three alternatives 

considered, and would afford the 

greatest degree of flexibility, 

convenience, and training opportunity 

to MEs. Moreover, it was supported by 

the majority of comments that 

mentioned the various alternative 

models proposed in the NPRM. We 

summarize the estimated costs and 

benefits of the three models below. To 

a large extent, costs have not changed. 

However, the Agency has decided to 

drop the phase-in described in the 

NPRM in which drivers who work for 

carriers who employ 50 or more drivers 

would be required to comply with the 

rule one year earlier than drivers who 

work for smaller carriers or are owneroperators. The Agency concurs with 

comments received that the phase-in 

schedule would pose some issues, such 

as limiting the number of MEs in the 

first year. Additionally, FMCSA does 

not believe the phase-in would reflect 

the reality of the industry’s distribution 

of drivers. Under this final rule, all 

drivers, regardless of the size carrier 

they work for, are required to obtain 

medical certification from a National 

Registry-certified ME within 2 years of 

the full implementation of the Program. 

This change has advanced the date at 

which all drivers must be certified by an 

ME on the National Registry, and as a 

result, a portion of the impacts that 

would be felt by drivers and the 

industry will be felt earlier than would 

have been the case with the phase-in. 

Related cost adjustments are described 

below in detail. 

Summary of Costs and Benefits 

The costs and benefits for all three 

alternatives are analyzed in this 

regulatory evaluation. It is anticipated 

that approximately 40,000 MEs will be 

needed for the NRCME to accommodate 

the demand for an estimated 2.6 million 

medical examinations per year, and to 

provide adequate access, both in terms 

of geographic coverage and relatively 

short appointment waiting times. All 

alternatives involve an initial training 

phase in which the 40,000 MEs receive 

training. This phase is expected to last 

2 years. At the beginning of the third 

year the Agency requires drivers to be 

examined by MEs listed on the NRCME 

once their current medical certification 

expires. Under Alternative 1, the 

alternative adopted by this Final Rule, 

MEs are required to attend a training 

conducted by a private-sector 

organization. It is anticipated that this 

will result in training and testing fees 

that would have to be paid by MEs. 

Under Alternative 2, no training or 

testing fees would have been incurred 

by MEs, but the Agency would have 

borne the costs of providing the training 

and testing services. MEs would have 

borne the cost of long distance travel to 

the FMCSA training center under 

Alternative 2. Long distance travel to a 

designated training program was also 

anticipated under Alternative 3. Under 

Alternative 1 it is anticipated that 

training programs will be available 

throughout the country, and that some 

programs will offer online training 

courses, which will minimize the need 

for long distance travel. 

It is also anticipated that by screening 

out physically unqualified drivers, this 

rule may require some drivers, who 

cannot meet the physical qualification 

standards, and would no longer be able 

to evade detection, to leave the industry 

and seek an alternative occupation. 

Carriers to would bear the cost of hiring 

replacement drivers. Recruiting new 

drivers is an activity that consumes 

carrier resources, and there is therefore 

a cost associated with that activity. We 

therefore provide an estimate of the 

number of drivers who may be forced to 

retire from the occupation, and estimate 

the costs associated with recruiting an 

equal number of replacement drivers. 

The 10-year total cost of the PublicPrivate Partnership Model is estimated 

at $232 million, when discounted at a 

7 percent discount rate. Undiscounted 

annual costs vary between $14 million 

and $59 million, with ME certification 

costs (training and testing costs plus lost 

time and travel costs) being the largest 

portion of the cost at approximately 

$31.5 million in the highest-cost year. 

Alternative 2 has a total discounted 10- 

year cost of $383 million, with 

undiscounted annual costs ranging 

between $17 million and $88 million. 

Alternative 3 has a total 10-year 

discounted cost of $337 million, with 

undiscounted annual costs ranging 

between $16 million and $92 million. In 

all alternatives, the value of ME time 

spent in training is the largest portion of 

cost. The costs of the training/testing, 

including lost time and travel costs for 

MEs, is estimated to vary between $63 

million and $131 million during the 

initial training phase, depending on the 

alternative, with Alternative 1 having 

the lowest cost. The lower cost 

associated with Alternative 1 is due to 

its minimization of travel and associated 

costs, both in expenses and lost time, to 

MEs. 

Because all three alternatives are 

expected to improve the performance of 

MEs by equivalent amounts, total 

benefits are expected to be equivalent 

for all programs. These benefits are 

based on the reduction in CMV crashes 

that is likely to result from improved 

medical screening of drivers. It is 

estimated that physically impaired 

interstate drivers are responsible for 

approximately 9,687 of the roughly 

440,000 commercial motor vehicle 

crashes that occur annually. Although it 

is not anticipated that this program 

would completely eliminate these 

crashes, it is expected to prevent a 

portion of them. We estimate that this 

program may prevent up to one-fifth of 

these crashes annually, which would 

result in approximately 1,219 fewer 

crashes per year. The estimated annual 

benefit associated with avoiding these 

crashes is $189 million per year, 

undiscounted. These full benefits are 

not realized until the program is fully 

phased in, which is several years after 

the establishment of the program. 

Nevertheless, at a 7 percent discount 

rate, the 10-year net benefits of this rule 

are estimated at approximately $633.2 

million to $784.1 million over 10 years 

depending on the alternative. The 

Agency’s chosen alternative has the 

highest net benefits at $784.1 million. 

Regulatory Flexibility Act 

The Regulatory Flexibility Act of 1980 

(5 U.S.C. 601–612) requires Federal 

agencies to consider the effects of the 

regulatory action on small business and 

other small entities and to minimize any 

significant economic impact. The term 

‘‘small entities’’ comprises small 

businesses and not-for-profit 

organizations that are independently 

owned and operated and are not 

dominant in their fields, and 

governmental jurisdictions with 

populations of less than 50,000. 

Accordingly, DOT policy requires an 

analysis of the impact of all regulations 

on small entities, and mandates that 

agencies strive to lessen any adverse 

effects on these businesses. The Agency 

conducted an initial Regulatory 

Flexibility Analysis for the NPRM and 

found that the rule would not have a 

significant economic impact on a 

substantial number of small entities. No 

comments were received on that 

analysis from the public. I certify that 

this rule would not have a significant 

economic impact on a substantial 

number of small entities. 

Unfunded Mandates Reform Act of 1995 

This rulemaking will not impose an 

unfunded Federal mandate, as defined 

by the Unfunded Mandates Reform Act 


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24124 Federal Register / Vol. 77, No. 77 / Friday, April 20, 2012 / Rules and Regulations 

of 1995 (2 U.S.C. 1532, et seq.), that 

would result in the expenditure by 

State, local, and tribal governments, in 

the aggregate, or by the private sector, of 

$143.1 million or more in any 1 year. 

The $143.1 million figure was derived 

by inflation adjusting the $100 million 

cap in the original Act from 1995 to 

2010 dollars using the Consumer Price 

Index. 

Executive Order 12988 (Civil Justice 

Reform) 

This action meets applicable 

standards in sections 3(a) and 3(b)(2) of 

Executive Order 12988, Civil Justice 

Reform, to minimize litigation, 

eliminate ambiguity, and reduce 

burden. 

Executive Order 13045 (Protection of 

Children) 

FMCSA analyzed this action under 

Executive Order 13045, Protection of 

Children from Environmental Health 

Risks and Safety Risks. We determined 

that this rulemaking does not concern 

an environmental risk to health or safety 

that may disproportionately affect 

children. 

Executive Order 12630 (Taking of 

Private Property) 

This final rule does not effect a taking 

of private property or otherwise have 

taking implications under Executive 

Order 12630, Governmental Actions and 

Interference with Constitutionally 

Protected Property Rights. 

Executive Order 13132 (Federalism) 

FMCSA analyzed this rule in 

accordance with the principles and 

criteria contained in Executive Order 

13132. FMCSA has determined that this 

rulemaking will have no significant cost 

or other effect on or for States. States 

will have policy-making discretion. 

Nothing in this document will preempt 

any State law or regulation. Therefore, 

this rule does not have sufficient 

federalism implications to warrant the 

preparation of a federalism assessment. 

Executive Order 12372 

(Intergovernmental Review) 

The regulations implementing 

Executive Order 12372 regarding 

intergovernmental consultation on 

Federal programs and activities do not 

apply to this program. 

Privacy Impact Assessment 

FMCSA conducted a privacy impact 

assessment of this rule as required by 

section 522(a)(5) of division H of the 

Fiscal Year 2005 Omnibus 

Appropriations Act, Public Law 108– 

447, 118 Stat. 3268 (December 8, 2004) 

(set out as a note to 5 U.S.C. 552a). The 

assessment considers any impacts of the 

rule on the privacy of information in an 

identifiable form and related matters. 

FMCSA determined that this initiative 

will create impacts on privacy of 

information associated with 

implementation of this rule. 

FMCSA only collects PII necessary for 

official purposes as stated in the 

National Registry final rule. In addition, 

FMCSA only obtains such PII by lawful 

and fair means and, to the greatest 

extent possible, with the knowledge or 

consent of the individual. The FMCSA 

Office of Information Technology 

adheres to the Fair Information Practice 

Principles (FIPPs) to assist the Agency 

in protecting the confidentiality and 

privacy of PII associated with the 

implementation of the National Registry 

final rule. These best practices 

incorporate standards and practices 

equivalent to those required under the 

Privacy Act of 1974 (5 U.S.C. 552a) and 

other Federal laws that are consistent 

with the FIPPs. These practices include 

management, operational, and technical 

safeguards that are appropriate for the 

protection of PII. The entire privacy 

impact assessment is available for 

review in the docket. 

Paperwork Reduction Act 

This rule contains the following new 

information collection requirements. As 

required by the Paperwork Reduction 

Act of 1995 (PRA) (44 U.S.C. 3507(d)), 

FMCSA submitted the information 

requirements associated with the 

proposal to the Office of Management 

and Budget for its review. 

Title: National Registry of Certified 

Medical Examiners (National Registry). 

Summary: Under SAFETEA–LU, the 

Secretary of Transportation is required 

to establish and maintain a current 

national registry of medical examiners 

who are qualified to perform 

examinations and issue medical 

certificates that verify whether a CMV 

driver’s health meets FMCSA standards. 

In addition, section 4116(b) of 

SAFETEA–LU requires that the medical 

examinations of CMV operators be 

performed by MEs who have received 

training in physical and medical 

examination standards, and, after the 

National Registry is established, are 

listed on the National Registry. 

SAFETEA–LU also requires MEs to 

electronically transmit the name of the 

applicant and FMCSA numerical 

identifier for any completed Medical 

Examination Report required under 

§ 391.43 to the Chief Medical Examiner 

on a monthly basis. 

Once the National Registry Program is 

implemented, FMCSA will accept 

medical examinations performed only 

by certified MEs listed on the National 

Registry, as required by law. The 

National Registry Program would 

require MEs to complete training 

developed from standardized 

curriculum specifications and pass a 

national certification test. The 

procedures used to develop and 

maintain the quality of the Program are 

expected to be in accordance with 

national accreditation standards for 

certification programs established by the 

NCCA, the accreditation arm of the 

National Organization for Competency 

Assurance. 

Requirements imposed on intrastate 

drivers and employers for this 

information collection are being 

considered since State laws are 

generally in substantial conformity with 

the Federal regulations for medical 

qualifications of commercial drivers. 

Consequently, the estimate of the 

number of CMV drivers (respondents) 

covered by this information collection 

reflects both interstate drivers subject to 

the FMCSRs and intrastate drivers 

subject to compatible State regulations. 

Although Federal regulations do not 

require States to comply with the 

medical requirements in the FMCSRs, 

most States do mirror the Federal 

requirements; therefore, we are 

including intrastate drivers, which is 

consistent with other FMCSA 

information collections, to accurately 

reflect the burden of this information 

collection. 

Close tracking and monitoring of 

certification activities and medical 

outcomes are crucial, and the rule 

addresses the information collection 

aspects of National Registry 

implementation. To this end, the rule 

requires MEs to submit four types of 

data: 

(1) Medical Examiner Application 

and Test Results Data: To be listed on 

the National Registry, MEs must first 

pass a certification test to ensure they 

demonstrate an established level of 

competency. FMCSA and private-sector 

testing organizations will collect data 

from MEs as the medical professionals 

apply to take this certification test. Data 

elements required of MEs at the time of 

application will include professional 

contact and identifying information 

such as job title, address, and training 

and State licenses obtained. These data 

will be collected each time the ME 

applies to sit for the certification test 

and information will be updated with 

FMCSA as needed. Test results data will 

include total test score and responses 

for each test item. Private-sector testing 

organizations will regularly transmit 

medical examiner data and test results 


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Federal Register / Vol. 77, No. 77 / Friday, April 20, 2012 / Rules and Regulations 24125 

electronically to FMCSA for inclusion 

in a centralized, confidential database. 

(2) CMV Driver Medical Examination 

Results Data: Once every calendar 

month, each ME listed on the National 

Registry is required to complete and 

transmit to FMCSA Form MCSA–5850, 

CMV Driver Medical Examination 

Results, with the following information 

about each CMV driver examined 

during the previous month: Name, date 

of birth, driver’s license number and 

State, date of examination, an indication 

of the examination outcome (for 

example, medically qualified), whether 

intrastate driver only, and date of driver 

medical certification expiration. Data 

will be submitted electronically via a 

secure FMCSA-designated Web site. In 

order to continue to be listed on and to 

continue participation in the National 

Registry, MEs need to comply with this 

requirement on a monthly basis. MEs 

who examine drivers who operate only 

in intrastate commerce may report those 

driver examination results on the form 

and check the checkbox for ‘‘Intrastate 

Only’’. Data on intrastate only driver 

examinations will be used to provide 

information to State and local 

enforcement officials on medical 

examiner performance and driver 

physical qualifications. 

(3) Medical Examination Reports and 

Medical Examiner’s Certificates: The 

National Registry Final Rule requires 

medical examiners to provide copies of 

Medical Examination Reports and 

medical examiner’s certificates to 

authorized representatives, special 

agents, or investigators of the FMCSA or 

authorized State or local enforcement 

agency representatives. These 

documents contain the driver’s social 

security number, date of birth, driver 

license number, and health and medical 

information. 

It is necessary for medical examiners 

to provide Medical Examination Reports 

and medical examiner’s certificates to 

an authorized representative, special 

agent, or investigator of FMCSA or an 

authorized State or local enforcement 

agency representative in order to 

determine ME compliance with FMCSA 

medical standards and guidelines in 

performing CMV driver medical 

examinations. Failure to comply with 

FMCSA medical standards and 

guidelines may result in removal from 

the National Registry. Medical 

examiner’s certificates provide 

additional documentation to determine 

compliance with FMCSA medical 

standards and guidelines by linking the 

ME to both the medical examination 

and the driver medical certification 

decision. They also determine 

compliance by ensuring the certification 

decision matches the information in the 

medical examination and that the 

certificate is completed correctly. 

(4) Verification of National Registry 

Number by Motor Carriers: Motor 

carriers will be required to verify the 

National Registry Number of the 

medical examiner for each driver 

required to be examined by a medical 

examiner on the National Registry and 

place a note relating to verification in 

the driver qualification file, as required 

by provisions in 49 CFR 391.23 and 

391.51. This data collection requirement 

will also provide proof that the motor 

carrier has met its obligation to require 

drivers to comply with the regulations 

that apply to the driver (49 U.S.C. 

31135(a) and 49 CFR 390.11). 

Respondents (Including the Number 

of): The likely respondents to this 

proposed information requirement are 

40,000 MEs from medical professions 

who are believed to conduct the 

majority of current CMV driver medical 

examinations (APNs, DCs, DOs, MDs, 

and PAs) and one or more national 

private-sector testing organizations that 

deliver the certification test. We are 

unable to estimate the number of 

private-sector organizations that might 

wish to perform testing. 

Frequency: FMCSA estimates each of 

the respondents would provide ME test 

application data every 6 years and 

updated information as needed. FMCSA 

further estimates that each respondent 

would provide CMV driver examination 

data a maximum of 12 times per year. 

It is estimated that an average of 

approximately 20,000 MEs will apply to 

take the certification test annually for 

the first 2 years of National Registry 

implementation. It is estimated that one 

or more testing organizations will 

deliver the FMCSA medical examiner 

certification test to 20,000 MEs annually 

for the first 2 years following 

implementation of the National Registry 

Program. It is projected that MEs would 

file 4,623,000 medical examiner’s 

certificates per year and that authorized 

representatives of FMCSA or authorized 

State or local enforcement agency 

representatives would request MEs to 

provide copies of the Medical Report 

Form and the medical examiner’s 

certificate 2,100 times a year. 

Annual Burden Estimate: This 

proposal would result in an annual 

recordkeeping and reporting burden as 

follows: 

FMCSA estimates each of the 

respondents will provide medical 

examiner certification test results and 

application data every 6 years and 

updated information to FMCSA as 

needed. It is estimated that 20,000 

medical examiner candidates will apply 

to take the certification test annually for 

the first 2 years of National Registry 

implementation, or an average of 13,333 

applicants per year for the first 3 years 

of the program. FMCSA estimates that 

the total annual burden hours for the 

collection of the medical examiner 

application data is 1,111 hours [13,333 

applicants × 5 minutes/60 minutes per 

response = 1,111 hours]. This annual 

burden includes medical examiner 

candidate time for submitting the 

application data to the private-sector 

testing organizations. 

It is estimated that it will take privatesector testing organization personnel 5 

minutes per ME to collect and upload to 

FMCSA application data and test 

results. FMCSA estimates that the total 

annual burden hours for private-sector 

testing organizations to collect medical 

examiner application data and send ME 

application and test results data to 

FMCSA is 1,111 hours (13,333 

applicants × 5 minutes/60 minutes per 

medical examiner = 1,111 hours). 

FMCSA estimates that respondents 

would provide CMV driver examination 

data a maximum of 12 times per year 

and would file 4,623,000 medical 

examiner’s certificates per year. It is 

projected that 40,000 certified MEs will 

be needed to perform the 4,623,000 

CMV driver medical examinations 

required annually. The transmission of 

CMV driver examination data will 

require approximately 46,525 hours of 

medical examiner administrative 

personnel time on a yearly basis [40,000 

registered medical examiners × 1 

minute/60 minutes to file a report × 12 

reports per year + 4,623,000 reports × 30 

seconds/3600 seconds to enter each 

driver’s examination data elements = 

46,525 hours]. It is estimated that it will 

take medical examiner administrative 

personnel 30 seconds to file the medical 

examiner’s certificate. This will require 

approximately 38,525 hours of 

administrative personnel time on a 

yearly basis [4,623,000 examinations × 

30 seconds/3600 seconds per certificate 

= 38,525]. In addition, FMCSA estimates 

that half of motor carriers will request 

a copy of the medical examiner’s 

certificate and that it will take 

administrative personnel 1 minute to 

provide a copy of the medical 

examiner’s certificate to a motor carrier. 

The annual time burden to the 

administrative personnel for providing 

motor carriers with a copy of the 

medical examiner’s certificate is 

approximately 38,525 hours [4,623,000 

examinations × .5 (50%) × 1 minute/60 

minutes = 38,525 hours]. The annual 

time burden to medical examiner 

administrative personnel for 

transmitting CMV driver examination 


tkelley on DSK3SPTVN1PROD with RULES2
24126 Federal Register / Vol. 77, No. 77 / Friday, April 20, 2012 / Rules and Regulations 

7The accompanying supporting statement also 

reflects the correction of a minor mathematical 

error. 

data to the FMCSA, filing medical 

examiner’s certificates, and providing 

copies of the medical examiner’s 

certificates to motor carriers is 

approximately 123,575 hours [46,525 

hours to enter driver examination data 

elements and 38,525 hours for filing the 

medical examiner’s certificate and 

38,525 hours for providing medical 

examiner’s certificates to motor carriers 

= 123,575 hours]. 

FMCSA estimates that authorized 

representatives, special agents, or 

investigators of FMCSA or authorized 

State or local enforcement agency 

representatives will request MEs to 

provide copies of the Medical 

Examination Report and the medical 

examiner’s certificate 2,100 times a year. 

It is estimated that it will take ME 

administrative personnel 5 minutes to 

provide both the Medical Examination 

Report and the medical examiner’s 

certificate to FMCSA or an authorized 

State or local enforcement agency 

representative upon request, so this will 

require approximately 175 hours of 

administrative personnel time on a 

yearly basis [2,100 requests × 5 minutes/ 

60 minutes per response = 175 hours]. 

FMCSA estimates that motor carriers 

will verify the National Registry 

Number for 4,623,000 drivers per year 

who are medically certified. It is 

estimated that it will take motor carrier 

administrative personnel 4 minutes to 

verify the National Registry Number, 

write a note regarding the verification, 

and file the note in the Driver 

Qualification file, so this will require 

approximately 308,200 hours of 

administrative personnel time on a 

yearly basis [4,623,000 verifications × 4 

minutes/60 minutes per verification = 

308,200 hours]. 

The total estimated annual time 

burden to respondents for the National 

Registry components is approximately 

434,172 hours 7 [2,222 hours for 

provision of medical examiner 

application and test results data (1,111 

hours for medical examiners and 1,111 

hours for testing organizations) + 

123,575 hours for CMV driver 

examinations (46,525 hours to enter 

driver examination data elements + 

38,525 hours for filing the medical 

examiner’s certificate + 38,525 hours for 

providing medical examiner’s 

certificates to motor carriers) + 175 

hours for provision of Medical 

Examination Reports and medical 

examiner’s certificates + 308,200 hours 

for verification of National Registry 

Number]. 

National Environmental Policy Act and 

Clean Air Act 

The Agency analyzed this final rule 

for the purpose of the National 

Environmental Policy Act of 1969 

(42 U.S.C. 4321 et seq.) and determined 

under our environmental procedures 

Order 5610.1, published March 1, 2004, 

in the Federal Register (69 FR 9680), 

that this action required an 

Environmental Assessment (EA) to 

determine if a more extensive 

Environmental Impact Statement was 

required. FMCSA prepared an EA and 

placed it in the docket for this 

rulemaking. The EA found that there are 

no significant negative impacts expected 

from the actions. Although congestion 

and air emission impacts are discussed 

in the EA, the impacts are minimal and 

are not expected to alter the Nation’s 

highway congestion or air emissions 

from surface or air transportation 

vehicles. In addition, while not 

quantified in this analysis, minor 

benefits to the environment from 

reducing CMV crashes are expected. 

We have also analyzed this rule under 

the Clean Air Act, as amended (CAA), 

section 176(c) (42 U.S.C. 7401 et seq.), 

and implementing regulations 

promulgated by the Environmental 

Protection Agency. Approval of this 

action is exempt from the CAA’s general 

conformity requirement since it 

involves rulemaking and policy 

development and issuance. 

Executive Order 13211 (Energy Effects) 

We analyzed this action under 

Executive Order 13211, Actions 

Concerning Regulations That 

Significantly Affect Energy Supply, 

Distribution, or Use. We determined 

that it is not a ‘‘significant energy 

action’’ under that Executive Order 

because it will not be likely to have a 

significant adverse effect on the supply, 

distribution, or use of energy. 

Executive Order 12898 (Environmental 

Justice) 

FMCSA evaluated the environmental 

effects of this final rule in accordance 

with Executive Order 12898 and 

determined that there are no 

environmental justice issues associated 

with its provisions and no collective 

environmental impact resulting from its 

promulgation. 

Executive Order 13175 (Tribal 

Consultation) 

FMCSA analyzed this action under 

Executive Order 13175, dated November 

6, 2000, and believes that it will not 

have substantial direct effects on one or 

more Indian tribes; will not impose 

substantial compliance costs on Indian 

tribal governments; and will not 

preempt tribal law. Therefore, a tribal 

summary impact statement is not 

required. 

List of Subjects 

49 CFR Part 350 

Grant programs—transportation, 

Highway safety, Motor carriers, Motor 

vehicle safety, Reporting and 

recordkeeping requirements. 

49 CFR Part 383 

Administrative practice and 

procedure, Alcohol abuse, Drug abuse, 

Highway safety, Motor carriers 

49 CFR Part 390 

Highway safety, Intermodal 

transportation, Motor carriers, Motor 

vehicle safety, Reporting and 

recordkeeping requirements. 

49 CFR Part 391 

Alcohol abuse, Drug abuse, Drug 

testing, Highway safety, Motor carriers, 

Reporting and recordkeeping 

requirements, Safety, Transportation. 

In consideration of the foregoing, 

FMCSA amends title 49, Code of 

Federal Regulations, parts 350, 383, 390, 

and 391, as follows: 

PART 350—COMMERCIAL MOTOR 

CARRIER SAFETY ASSISTANCE 

PROVISION 

■ 1. The authority citation for part 350 

continues to read as follows: 

Authority: 49 U.S.C. 13902, 31101–31104, 

31108, 31136, 31140–31141, 31161, 31310– 

31311, 31502; and 49 CFR 1.73. 

■ 2. In § 350.341, add paragraph (h)(3) 

to to read as follows: 

§ 350.341 What specific variances from the 

FMCSRs are allowed for State laws and 

regulations governing motor carriers, CMV 

drivers, and CMVs engaged in intrastate 

commerce and not subject to Federal 

jurisdiction? 

* * * * * 

(h) * * * 

(3) The State may decide not to adopt 

laws and regulations that implement a 

registry of medical examiners trained 

and qualified to apply physical 

qualification standards or variances 

continued in effect or adopted by the 

State under this paragraph that apply to 

drivers of CMVs in intrastate commerce. 


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Federal Register / Vol. 77, No. 77 / Friday, April 20, 2012 / Rules and Regulations 24127 

PART 383—COMMERCIAL DRIVER’S 

LICENSE STANDARDS; 

REQUIREMENTS AND PENALTIES 

■ 3. The authority citation for part 383 

continues to read as follows: 

Authority: 49 U.S.C. 521, 31136, 31301 et 

seq., and 31502; secs. 214 and 215, Pub. L. 

106–159, 113 Stat. 1748, 1766, 1767; sec. 

4140, Pub. L. 109–59, 119 Stat. 1144, 1746; 

and 49 CFR 1.73. 

■ 4. Amend § 383.73 to by revising 

paragraph (o)(1)(iii)(E)to read as follows: 

§ 383.73 State procedures. 

* * * * * 

(o) * * * 

(1) * * * 

(iii) * * * 

(E) Medical examiner’s National 

Registry Number issued in accordance 

with § 390.109; 

* * * * * 

PART 390—FEDERAL MOTOR 

CARRIER SAFETY REGULATIONS; 

GENERAL 

■ 5. Revise the authority citation for part 

390 to read as follows: 

Authority: 49 U.S.C. 504, 508, 31132, 

31133, 31136, 31144, 31151, and 31502; sec. 

114, Pub. L. 103–311, 108 Stat. 1673, 1677– 

1678; secs. 212 and 217, Pub. L. 106–159, 113 

Stat. 1748, 1766, 1767; sec. 229, Pub. L. 106– 

159 (as transferred by sec. 4115 and amended 

by secs. 4130–4132, Pub. L. 109–59, 119 Stat. 

1144, 1726, 1743–1744); sec. 4136, Pub. L. 

109–59, 119 Stat. 1144, 1745; and 49 CFR 

1.73. 

■ 6. Amend § 390.5 by revising the 

definition of ‘‘medical examiner’’ to 

read as follows: 

§ 390.5 Definitions. 

* * * * * 

Medical examiner means the 

following: 

(1) For medical examinations 

conducted before May 21, 2014, a 

person who is licensed, certified, and/ 

or registered, in accordance with 

applicable State laws and regulations, to 

perform physical examinations. The 

term includes but is not limited to, 

doctors of medicine, doctors of 

osteopathy, physician assistants, 

advanced practice nurses, and doctors 

of chiropractic. 

(2) For medical examinations 

conducted on and after May 21, 2014, 

an individual certified by FMCSA and 

listed on the National Registry of 

Certified Medical Examiners in 

accordance with subpart D of this part. 

* * * * * 

■ 7. Add subpart D, consisting of 

§§ 390.101 through 390.115, to read as 

follows: 

Subpart D—National Registry of Certified 

Medical Examiners 

Sec. 

390.101 Scope. 

390.103 Eligibility requirements for 

medical examiner certification. 

390.105 Medical examiner training 

programs. 

390.107 Medical examiner certification 

testing. 

390.109 Issuance of the FMCSA medical 

examiner certification credential. 

390.111 Requirements for continued listing 

on the National Registry of Certified 

Medical Examiners. 

390.113 Reasons for removal from the 

National Registry of Certified Medical 

Examiners. 

390.115 Procedure for removal from the 

National Registry of Certified Medical 

Examiners. 

Subpart D—National Registry of 

Certified Medical Examiners 

§ 390.101 Scope. 

The rules in this subpart establish the 

minimum qualifications for FMCSA 

certification of a medical examiner and 

for listing the examiner on FMCSA’s 

National Registry of Certified Medical 

Examiners. The National Registry of 

Certified Medical Examiners Program is 

designed to improve highway safety and 

operator health by requiring that 

medical examiners be trained and 

certified to determine effectively 

whether an operator meets FMCSA 

physical qualification standards under 

part 391 of this chapter. One component 

of the National Registry Program is the 

registry itself, which is a national 

database of names and contact 

information for medical examiners who 

are certified by FMCSA to perform 

medical examinations of operators. 

§ 390.103 Eligibility requirements for 

medical examiner certification. 

(a) To receive medical examiner 

certification from FMCSA a person 

must: 

(1) Be licensed, certified, or registered 

in accordance with applicable State 

laws and regulations to perform 

physical examinations. The applicant 

must be an advanced practice nurse, 

doctor of chiropractic, doctor of 

medicine, doctor of osteopathy, 

physician assistant, or other medical 

professional authorized by applicable 

State laws and regulations to perform 

physical examinations. 

(2) Complete a training program that 

meets the requirements of § 390.105. 

(3) Pass the medical examiner 

certification test provided by FMCSA 

and administered by a testing 

organization that meets the 

requirements of § 390.107 and that has 

electronically forwarded to FMCSA the 

applicant’s completed test and 

application information no more than 

three years after completion of the 

training program required by paragraph 

(a)(2) of this section. An applicant must 

not take the test more than once every 

30 days. 

(b) If a person has medical examiner 

certification from FMCSA, then to 

renew such certification the medical 

examiner must remain qualified under 

paragraph (a)(1) of this section and 

complete additional testing and training 

as required by § 390.111(a)(5). 

§ 390.105 Medical examiner training 

programs. 

An applicant for medical examiner 

certification must complete a training 

program that: 

(a) Is conducted by a training provider 

that: 

(1) Is accredited by a nationally 

recognized medical profession 

accrediting organization to provide 

continuing education units; and 

(2) Meets the following administrative 

requirements: 

(i) Provides training participants with 

proof of participation. 

(ii) Provides FMCSA point of contact 

information to training participants. 

(b) Provides training to medical 

examiners on the following topics: 

(1) Background, rationale, mission, 

and goals of the FMCSA medical 

examiner’s role in reducing crashes, 

injuries, and fatalities involving 

commercial motor vehicles. 

(2) Familiarization with the 

responsibilities and work environment 

of commercial motor vehicle operation. 

(3) Identification of the operator and 

obtaining, reviewing, and documenting 

operator medical history, including 

prescription and over-the-counter 

medications. 

(4) Performing, reviewing, and 

documenting the operator’s medical 

examination. 

(5) Performing, obtaining, and 

documenting additional diagnostic tests 

or medical opinion from a medical 

specialist or treating physician. 

(6) Informing and educating the 

operator about medications and nondisqualifying medical conditions that 

require remedial care. 

(7) Determining operator certification 

outcome and period for which 

certification should be valid. 

(8) FMCSA reporting and 

documentation requirements. 

Guidance on the core curriculum 

specifications for use by training 

providers is available from FMCSA. 


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24128 Federal Register / Vol. 77, No. 77 / Friday, April 20, 2012 / Rules and Regulations 

§ 390.107 Medical examiner certification 

testing. 

An applicant for medical examiner 

certification or recertification must 

apply, in, accordance with the 

minimum specifications for application 

elements established by FMCSA, to a 

testing organization that meets the 

following criteria: 

(a) The testing organization has 

documented policies and procedures 

that: 

(1) Use secure protocols to access, 

process, store, and transmit all test 

items, test forms, test data, and 

candidate information and ensure 

access by authorized personnel only. 

(2) Ensure testing environments are 

reasonably comfortable and have 

minimal distractions. 

(3) Prevent to the greatest extent 

practicable the opportunity for a test 

taker to attain a passing score by 

fraudulent means. 

(4) Ensure that test center staff who 

interact with and proctor examinees or 

provide technical support have 

completed formal training, demonstrate 

competency, and are monitored 

periodically for quality assurance in 

testing procedures. 

(5) Accommodate testing of 

individuals with disabilities or 

impairments to minimize the effect of 

the disabilities or impairments while 

maintaining the security of the test and 

data. 

(b) Testing organizations that offer 

testing of examinees not at locations 

that are operated and staffed by the 

organizations but by means of remote, 

computer-based systems must, in 

addition to the requirements of 

paragraph (a) of this section, ensure that 

such systems: 

(1) Provide a means to authenticate 

the identity of the person taking the test. 

(2) Provide a means for the testing 

organization to monitor the activity of 

the person taking the test. 

(3) Do not allow the person taking the 

test to reproduce or record the contents 

of the test by any means. 

(c) The testing organization has 

submitted its documented policies and 

procedures as defined in paragraph (a) 

of this section and, if applicable, 

paragraph (b) of this section to FMCSA 

and agreed to future reviews by FMCSA 

to ensure compliance with the criteria 

listed in this section. 

(d) The testing organization 

administers only the currently 

authorized version of the medical 

examiner certification test developed 

and furnished by FMCSA. 

§ 390.109 Issuance of the FMCSA medical 

examiner certification credential. 

Upon compliance with the 

requirements of § 390.103(a) or (b), 

FMCSA will issue to a medical 

examiner applicant an FMCSA medical 

examiner certification credential with a 

unique National Registry Number and 

will add the medical examiner’s name 

to the National Registry of Certified 

Medical Examiners. The certification 

credential will expire 10 years after the 

date of its issuance. 

§ 390.111 Requirements for continued 

listing on the National Registry of Certified 

Medical Examiners. 

(a) To continue to be listed on the 

National Registry of Certified Medical 

Examiners, each medical examiner 

must: 

(1) Continue to meet the requirements 

of this subpart and the applicable 

requirements of part 391 of this chapter. 

(2) Report to FMCSA any changes in 

the application information submitted 

under § 390.103(a)(3) within 30 days of 

the change. 

(3) Continue to be licensed, certified, 

or registered, and authorized to perform 

physical examinations, in accordance 

with the applicable laws and regulations 

of each State in which the medical 

examiner performs examinations. 

(4) Maintain documentation of State 

licensure, registration, or certification to 

perform physical examinations for each 

State in which the examiner performs 

examinations and maintain 

documentation of and completion of all 

training required by this section and 

§ 390.105. The medical examiner must 

make this documentation available to an 

authorized representative of FMCSA or 

an authorized representative of Federal, 

State, or local government. The medical 

examiner must provide this 

documentation within 48 hours of the 

request for investigations and within 10 

days of the request for regular audits of 

eligibility. 

(5) Maintain medical examiner 

certification by completing training and 

testing according to the following 

schedule: 

(i) No sooner than 4 years and no later 

than 5 years after the date of issuance 

of the medical examiner certification 

credential, complete periodic training as 

specified by FMCSA. 

(ii) No sooner than 9 years and no 

later than 10 years after the date of 

issuance of the medical examiner 

certification credential: 

(A) Complete periodic training as 

specified by FMCSA; and 

(B) Pass the test required by 

§ 390.103(a)(3). 

(b) FMCSA will issue a new medical 

examiner certification credential valid 

for 10 years to a medical examiner who 

complies with paragraphs (a)(1) through 

(4) of this section and who successfully 

completes the training and testing as 

required by paragraphs (a)(5)(i) and (ii) 

of this section. 

§ 390.113 Reasons for removal from the 

National Registry of Certified Medical 

Examiners. 

FMCSA may remove a medical 

examiner from the National Registry of 

Certified Medical Examiners when a 

medical examiner fails to meet or 

maintain the qualifications established 

by this subpart, the requirements of 

other regulations applicable to the 

medical examiner, or otherwise does not 

meet the requirements of 49 U.S.C. 

31149. The reasons for removal may 

include, but are not limited to: 

(a) The medical examiner fails to 

comply with the requirements for 

continued listing on the National 

Registry of Certified Medical Examiners, 

as described in § 390.111. 

(b) FMCSA finds that there are errors, 

omissions, or other indications of 

improper certification by the medical 

examiner of an operator in either the 

completed Medical Examination 

Reports or the medical examiner’s 

certificates. 

(c) The FMCSA determines the 

medical examiner issued a medical 

examiner’s certificate to an operator of 

a commercial motor vehicle who failed 

to meet the applicable standards at the 

time of the examination. 

(d) The medical examiner fails to 

comply with the examination 

requirements in § 391.43 of this chapter. 

(e) The medical examiner falsely 

claims to have completed training in 

physical and medical examination 

standards as required by this subpart. 

§ 390.115 Procedure for removal from the 

National Registry of Certified Medical 

Examiners. 

(a) Voluntary removal. To be 

voluntarily removed from the National 

Registry of Certified Medical Examiners, 

a medical examiner must submit a 

request to the FMCSA Director, Office of 

Carrier, Driver and Vehicle Safety 

Standards. Except as provided in 

paragraph (b) of this section, the 

Director, Office of Carrier, Driver and 

Vehicle Safety Standards will accept the 

request and the removal will become 

effective immediately. On and after the 

date of issuance of a notice of proposed 

removal from the National Registry of 

Certified Medical Examiners, as 

described in paragraph (b) of this 

section, however, the Director, Office of 

Carrier, Driver and Vehicle Safety 

Standards will not approve the medical 


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Federal Register / Vol. 77, No. 77 / Friday, April 20, 2012 / Rules and Regulations 24129 

examiner’s request for voluntary 

removal from the National Registry of 

Certified Medical Examiners. 

(b) Notice of proposed removal. 

Except as provided by paragraphs (a) 

and (e) of this section, FMCSA initiates 

the process for removal of a medical 

examiner from the National Registry of 

Certified Medical Examiners by issuing 

a written notice of proposed removal to 

the medical examiner, stating the 

reasons that removal is proposed under 

§ 390.113 and any corrective actions 

necessary for the medical examiner to 

remain listed on the National Registry of 

Certified Medical Examiners. 

(c) Response to notice of proposed 

removal and corrective action. A 

medical examiner who has received a 

notice of proposed removal from the 

National Registry of Certified Medical 

Examiners must submit any written 

response to the Director, Office of 

Carrier, Driver and Vehicle Safety 

Standards no later than 30 days after the 

date of issuance of the notice of 

proposed removal. The response must 

indicate either that the medical 

examiner believes FMCSA has relied on 

erroneous reasons, in whole or in part, 

in proposing removal from the National 

Registry of Certified Medical Examiners, 

as described in paragraph (c)(1) of this 

section, or that the medical examiner 

will comply and take any corrective 

action specified in the notice of 

proposed removal, as described in 

paragraph (c)(2) of this section. 

(1) Opposing a notice of proposed 

removal. If the medical examiner 

believes FMCSA has relied on an 

erroneous reason, in whole or in part, in 

proposing removal from the National 

Registry of Certified Medical Examiners, 

the medical examiner must explain the 

basis for his or her belief that FMCSA 

relied on an erroneous reason in 

proposing the removal. The Director, 

Office of Carrier, Driver and Vehicle 

Safety Standards will review the 

explanation. 

(i) If the Director, Office of Carrier, 

Driver and Vehicle Safety Standards 

finds FMCSA has wholly relied on an 

erroneous reason for proposing removal 

from the National Registry of Certified 

Medical Examiners, the Director, Office 

of Carrier, Driver and Vehicle Safety 

Standards will withdraw the notice of 

proposed removal and notify the 

medical examiner in writing of the 

determination. If the Director, Office of 

Carrier, Driver and Vehicle Safety 

Standards finds FMCSA has partly 

relied on an erroneous reason for 

proposing removal from the National 

Registry of Certified Medical Examiners, 

the Director, Office of Carrier, Driver 

and Vehicle Safety Standards will 

modify the notice of proposed removal 

and notify the medical examiner in 

writing of the determination. No later 

than 60 days after the date the Director, 

Office of Carrier, Driver and Vehicle 

Safety Standards modifies a notice of 

proposed removal, the medical 

examiner must comply with this subpart 

and correct any deficiencies identified 

in the modified notice of proposed 

removal as described in paragraph (c)(2) 

of this section. 

(ii) If the Director, Office of Carrier, 

Driver and Vehicle Safety Standards 

finds FMCSA has not relied on an 

erroneous reason in proposing removal, 

the Director, Office of Carrier, Driver 

and Vehicle Safety Standards will affirm 

the notice of proposed removal and 

notify the medical examiner in writing 

of the determination. No later than 60 

days after the date the Director, Office 

of Carrier, Driver and Vehicle Safety 

Standards affirms the notice of proposed 

removal, the medical examiner must 

comply with this subpart and correct 

the deficiencies identified in the notice 

of proposed removal as described in 

paragraph (c)(2) of this section. 

(iii) If the medical examiner does not 

submit a written response within 30 

days of the date of issuance of a notice 

of proposed removal, the removal 

becomes effective and the medical 

examiner is immediately removed from 

the National Registry of Certified 

Medical Examiners. 

(2) Compliance and corrective action. 

(i) The medical examiner must comply 

with this subpart and complete the 

corrective actions specified in the notice 

of proposed removal no later than 60 

days after either the date of issuance of 

the notice of proposed removal or the 

date the Director, Office of Carrier, 

Driver and Vehicle Safety Standards 

affirms or modifies the notice of 

proposed removal, whichever is later. 

The medical examiner must provide 

documentation of compliance and 

completion of the corrective actions to 

the Director, Office of Carrier, Driver 

and Vehicle Safety Standards. The 

Director, Office of Carrier, Driver and 

Vehicle Safety Standards may conduct 

any investigations and request any 

documentation necessary to verify that 

the medical examiner has complied 

with this subpart and completed the 

required corrective action(s). The 

Director, Office of Carrier, Driver and 

Vehicle Safety Standards will notify the 

medical examiner in writing whether he 

or she has met the requirements to 

continue to be listed on the National 

Registry of Certified Medical Examiners. 

(ii) If the medical examiner fails to 

complete the proposed corrective 

action(s) within the 60-day period, the 

removal becomes effective and the 

medical examiner is immediately 

removed from the National Registry of 

Certified Medical Examiners. The 

Director, Office of Carrier, Driver and 

Vehicle Safety Standards will notify the 

person in writing that he or she has 

been removed from the National 

Registry of Certified Medical Examiners. 

(3) At any time before a notice of 

proposed removal from the National 

Registry of Certified Medical Examiners 

becomes final, the recipient of the 

notice of proposed removal and the 

Director, Office of Carrier, Driver and 

Vehicle Safety Standards may resolve 

the matter by mutual agreement. 

(d) Request for administrative review. 

If a person has been removed from the 

National Registry of Certified Medical 

Examiners under paragraph (c)(1)(iii), 

(c)(2)(ii), or (e) of this section, that 

person may request an administrative 

review no later than 30 days after the 

date the removal becomes effective. The 

request must be submitted in writing to 

the FMCSA Associate Administrator for 

Policy and Program Development. The 

request must explain the error(s) 

committed in removing the medical 

examiner from the National Registry of 

Certified Medical Examiners, and 

include a list of all factual, legal, and 

procedural issues in dispute, and any 

supporting information or documents. 

(1) Additional procedures for 

administrative review. The Associate 

Administrator may ask the person to 

submit additional data or attend a 

conference to discuss the removal. If the 

person does not provide the information 

requested, or does not attend the 

scheduled conference, the Associate 

Administrator may dismiss the request 

for administrative review. 

(2) Decision on administrative review. 

The Associate Administrator will 

complete the administrative review and 

notify the person in writing of the 

decision. The decision constitutes final 

Agency action. If the Associate 

Administrator decides the removal was 

not valid, FMCSA will reinstate the 

person and reissue a certification 

credential to expire on the expiration 

date of the certificate that was 

invalidated under paragraph (g) of this 

section. The reinstated medical 

examiner must: 

(i) Continue to meet the requirements 

of this subpart and the applicable 

requirements of part 391 of this chapter. 

(ii) Report to FMCSA any changes in 

the application information submitted 

under § 390.103(a)(3) within 30 days of 

the reinstatement. 

(iii) Be licensed, certified, or 

registered in accordance with applicable 


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24130 Federal Register / Vol. 77, No. 77 / Friday, April 20, 2012 / Rules and Regulations 

State laws and regulations to perform 

physical examinations. 

(iv) Maintain documentation of State 

licensure, registration, or certification to 

perform physical examinations for each 

State in which the examiner performs 

examinations maintain documentation 

of completion of all training required by 

§ 390.105 and § 390.111. The medical 

examiner must also make this 

documentation available to an 

authorized representative of FMCSA or 

an authorized representative of Federal, 

State, or local government. The medical 

examiner must provide this 

documentation within 48 hours of the 

request for investigations and within 10 

days of the request for regular audits of 

eligibility. 

(v) Complete periodic training as 

required by the Director, Office of 

Carrier, Driver and Vehicle Safety 

Standards. 

(e) Emergency removal. In cases of 

either willfulness or in which public 

health, interest, or safety requires, the 

provisions of paragraph (b) of this 

section are not applicable and the 

Director, Office of Carrier, Driver and 

Vehicle Safety Standards may 

immediately remove a medical 

examiner from the National Registry of 

Certified Medical Examiners and 

invalidate the certification credential 

issued under § 390.109. A person who 

has been removed under the provisions 

of this paragraph may request an 

administrative review of that decision as 

described under paragraph (d) of this 

section. 

(f) Reinstatement on the National 

Registry of Certified Medical Examiners. 

No sooner than 30 days after the date of 

removal from the National Registry of 

Certified Medical Examiners, a person 

who has been voluntarily or 

involuntarily removed may apply to the 

Director, Office of Carrier, Driver and 

Vehicle Safety Standards to be 

reinstated. The person must: 

(1) Continue to meet the requirements 

of this subpart and the applicable 

requirements of part 391 of this chapter. 

(2) Report to FMCSA any changes in 

the application information submitted 

under § 390.103(a)(3). 

(3) Be licensed, certified, or registered 

in accordance with applicable State 

laws and regulations to perform 

physical examinations. 

(4) Maintain documentation of State 

licensure, registration, or certification to 

perform physical examinations for each 

State in which the person performs 

examinations and maintains 

documentation of completion of all 

training required by §§ 390.105 and 

390.111. The medical examiner must 

also make this documentation available 

to an authorized representative of 

FMCSA or an authorized representative 

of Federal, State, or local government. 

The person must provide this 

documentation within 48 hours of the 

request for investigations and within 10 

days of the request for regular audits of 

eligibility. 

(5) Complete training and testing as 

required by the Director, Office of 

Carrier, Driver and Vehicle Safety 

Standards. 

(6) In the case of a person who has 

been involuntarily removed, provide 

documentation showing completion of 

any corrective actions required in the 

notice of proposed removal. 

(g) Effect of final decision by FMCSA. 

If a person is removed from the National 

Registry of Certified Medical Examiners 

under paragraph (c) or (e) of this 

section, the certification credential 

issued under § 390.109 is no longer 

valid. However, the removed person’s 

information remains publicly available 

for 3 years, with an indication that the 

person is no longer listed on the 

National Registry of Certified Medical 

Examiners as of the date of removal. 

PART 391—QUALIFICATIONS OF 

DRIVERS AND LONGER 

COMBINATION VEHICLE (LCV) 

DRIVER INSTRUCTORS 

■ 8. Revise the authority citation for part 

391 to read as follows: 

Authority: 49 U.S.C. 504, 508, 31133, 

31136, and 31502; sec. 4007(b), Pub. L. 102– 

240, 105 Stat, 1914, 2152; sec. 114, Pub. L. 

103–311, 108 Stat. 1673, 1677; sec. 215, Pub. 

L. 106–159, 113 Stat. 1748, 1767; and 49 CFR 

1.73. 

■ 9. Amend § 391.23 by: 

■ a. Revising paragraph (m)(1); 

■ b. Removing ‘‘, and’’ at the end of 

paragraph (m)(2)(i)(A) and adding in its 

place a period; 

■ c. Redesignating paragraph 

(m)(2)(i)(B) as (m)(2)(i)(C) and adding a 

new paragraph (m)(2)(i)(B). 

The revision and addition read as 

follows: 

§ 391.23 Investigation and inquiries. 

* * * * * 

(m) * * * 

(1) The motor carrier must obtain an 

original or copy of the medical 

examiner’s certificate issued in 

accordance with § 391.43, and any 

medical variance on which the 

certification is based, and, beginning on 

or after May 21, 2014, verify the driver 

was certified by a medical examiner 

listed on the National Registry of 

Certified Medical Examiners as of the 

date of issuance of the medical 

examiner’s certificate, and place the 

records in the driver qualification file, 

before allowing the driver to operate a 

CMV. 

(2) * * * 

(i) * * * 

(B) Beginning on or after May 21, 

2014, that the driver was certified by a 

medical examiner listed on the National 

Registry of Certified Medical Examiners 

as of the date of medical examiner’s 

certificate issuance. 

* * * * * 

■ 10. Add § 391.42 to read as follows: 

§ 391.42 Schedule for use of medical 

examiners listed on the National Registry of 

Certified Medical Examiners. 

On and after May 21, 2014, each 

medical examination required under 

this subpart must be conducted by a 

medical examiner who is listed on the 

National Registry of Certified Medical 

Examiners. 

■ 11. Amend § 391.43 by revising 

paragraphs (a), (g), and (h), and adding 

paragraph (i) to read as follows: 

§ 391.43 Medical examination; certificate 

of physical examination. 

(a) Except as provided by paragraph 

(b) of this section and as provided by 

§ 391.42, the medical examination must 

be performed by a medical examiner 

listed on the National Registry of 

Certified Medical Examiners under 

subpart D of part 390 of this chapter. 

* * * * * 

(g) Upon completion of the medical 

examination required by this subpart: 

(1) The medical examiner must date 

and sign the Medical Examination 

Report and provide his or her full name, 

office address, and telephone number 

on the Report. 

(2) If the medical examiner finds that 

the person examined is physically 

qualified to operate a commercial motor 

vehicle in accordance with § 391.41(b), 

he or she must complete a certificate in 

the form prescribed in paragraph (h) of 

this section and furnish the original to 

the person who was examined. The 

examiner must provide a copy to a 

prospective or current employing motor 

carrier who requests it. 

(3) Once every calendar month, 

beginning May 21, 2014, the medical 

examiner must electronically transmit to 

the Director, Office of Carrier, Driver 

and Vehicle Safety Standards, via a 

secure FMCSA-designated Web site, a 

completed Form MCSA–5850, Medical 

Examiner Submission of CMV Driver 

Medical Examination Results. The Form 

must include all information specified 

for each medical examination 

conducted during the previous month 

for any driver who is required to be 


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examined by a medical examiner listed 

on the National Registry of Certified 

Medical Examiners. 

(h) The medical examiner’s certificate 

shall be substantially in accordance 

with the following form. 

BILLING CODE 4910–EX–P 


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BILLING CODE 4910–EX–C 


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(i) Each original (paper or electronic) 

completed Medical Examination Report 

and a copy or electronic version of each 

medical examiner’s certificate must be 

retained on file at the office of the 

medical examiner for at least 3 years 

from the date of examination. The 

medical examiner must make all records 

and information in these files available 

to an authorized representative of 

FMCSA or an authorized Federal, State, 

or local enforcement agency 

representative, within 48 hours after the 

request is made. 

■ 12. Amend § 391.51 by: 

■ a. Removing ‘‘and’’ at the end of 

paragraph (b)(7)(iii); 

■ b. Removing the period at the end of 

paragraph (b)(8) and adding in its place 

‘‘; and’’; 

■ c. Removing ‘‘and’’ at the end of 

paragraph (d)(4); 

■ d. Removing the period at the end of 

paragraph (d)(5) and adding in its place 

‘‘; and’’; and 

■ e. Adding paragraphs (b)(9) and (d)(6). 

The additions read as follows: 

§ 391.51 General requirements for driver 

qualification files. 

* * * * * 

(b) * * * 

(9) A note relating to verification of 

medical examiner listing on the 

National Registry of Certified Medical 

Examiners required by § 391.23(m). 

* * * * * 

(d) * * * 

(6) The note relating to verification of 

medical examiner listing on the 

National Registry of Certified Medical 

Examiners required by § 391.23(m). 

Issued on: April 10, 2012. 

Anne S. Ferro, 

Administrator. 

Appendix A 

Guidance for the Core Curriculum 

Specifications 

The guidance for the core curriculum 

specifications is intended to assist training 

organizations in developing programs that 

would be used to fulfill the proposed 

requirements in the Federal Motor Carrier 

Safety Administration’s (FMCSA) final rule 

for the National Registry of Certified Medical 

Examiners (National Registry). The final rule 

states that a medical examiner must complete 

a training program. FMCSA explained in the 

preamble to the final rule that training 

providers and organizations must follow the 

core curriculum specifications in developing 

training programs for medical examiners who 

apply for listing on the Agency’s National 

Registry. This training prepares medical 

examiners to: 

• Apply knowledge of FMCSA’s driver 

physical qualifications standards and 

advisory criteria to findings gathered during 

the driver’s medical examination; and 

• Make sound determinations of the 

driver’s medical and physical qualifications 

for safely operating a commercial motor 

vehicle (CMV) in interstate commerce. 

The rule, 49 CFR 390.105(b), lists eight 

topics which must be covered in the core 

curriculum specifications. The core 

curriculum specifications are arranged below 

by numbered topic, followed by guidance to 

assist training providers in developing 

programs based on the core curriculum 

specifications. 

Guidance for Each of the Core Curriculum 

Specifications 

(1) Background, rationale, mission and 

goals of the FMCSA medical examiner’s role 

in reducing crashes, injuries and fatalities 

involving commercial motor vehicles. 

Mission and Goals of Federal Motor Carrier 

Safety Administration (FMCSA) 

• Discuss the history of FMCSA and its 

position within the Department of 

Transportation including its establishment by 

the Motor Carrier Safety Improvement Act of 

1999 and emphasize FMCSA’s Mission to 

reduce crashes, injuries and fatalities 

involving large trucks and buses. 

Role of the Medical Examiner 

• Explain the role of the medical examiner 

as described in 49 CFR 391.43. 

(2) Familiarization with the 

responsibilities and work environment of 

commercial motor vehicle (CMV) operations. 

The Job of CMV Driving 

• Describe the responsibilities, work 

schedules, physical and emotional demands 

and lifestyle among CMV drivers and how 

these vary by the type of driving. 

• Discuss factors and job tasks that may be 

involved in a driver’s performance, such as: 

Æ Loading and unloading trailers; 

Æ Inspecting the operating condition of the 

CMV; and 

Æ Work schedules: 

› irregular work, rest, and eating patterns/ 

dietary choices. 

(3) Identification of the driver and 

obtaining, reviewing, and documenting 

driver medical history, including 

prescription and over-the-counter 

medications. 

Driver Identification and Medical History: 

Discuss the importance of driver 

identification and review of the following 

elements of the driver’s medical history as 

related to the tasks of driving a CMV in 

interstate commerce. 

• Inspect a State-issued identification 

document with the driver’s photo to verify 

the identity of the individual being 

examined; identify the commercial driver’s 

license or other types of driver’s license. 

• Identify, query and note issues in a 

driver’s medical record and/or health history 

as available, which may include: 

Æ specific information regarding any 

affirmative responses in the history; 

Æ any illness, surgery, or injury in the last 

five years; 

Æ any other hospitalizations or surgeries; 

Æ any recent changes in health status; 

Æ whether he/she has any medical 

conditions or current complaints; 

Æ any incidents of disability/physical 

limitations; 

Æ current medications and supplements, 

and potential side effects, which may be 

potentially disqualifying; 

Æ his/her use of recreational/addictive 

substances (e.g., nicotine, alcohol, inhalants, 

narcotics or other habit-forming drugs); 

Æ disorders of the eyes (e.g., retinopathy, 

cataracts, aphakia, glaucoma, macular 

degeneration, monocular vision); 

Æ disorders of the ears (e.g., hearing loss, 

hearing aids, vertigo, tinnitus, implants); 

Æ cardiac symptoms and disease (e.g., 

syncope, dyspnea, chest pain, palpitations, 

hypertension, congestive heart failure, 

myocardial infarction, coronary 

insufficiency, or thrombosis); 

Æ pulmonary symptoms and disease (e.g., 

dyspnea, orthopnea, chronic cough, asthma, 

chronic lung disorders, tuberculosis, 

previous pulmonary embolus, 

pneumothorax); 

Æ sleep disorders (e.g., obstructive sleep 

apnea, daytime sleepiness, loud snoring, 

other); 

Æ gastrointestinal disorders (e.g., liver 

disease, digestive problems, hernias); 

Æ genitourinary disorders (e.g., kidney 

stones and other renal conditions, renal 

failure, hernias); 

Æ diabetes mellitus: 

› current medications (type, potential 

side effects, duration on current medication); 

› complications from diabetes; and 

› presence and frequency of 

hypoglycemic/hyperglycemic episodes/ 

reactions; 

Æ other endocrine disorders (e.g., thyroid 

disorders, interventions/treatment); 

Æ musculoskeletal disorders (e.g., 

amputations, arthritis, spinal surgery); 

Æ neurologic disorders (e.g., loss of 

consciousness, seizures, stroke/transient 

ischemic attack, headaches/migraines, 

numbness/weakness); or 

Æ psychiatric disorders (e.g., 

schizophrenia, severe depression, anxiety, 

bipolar disorder, or other conditions) that 

could impair a driver’s ability to safely 

function. 

(4) Performing, reviewing and 

documenting the driver’s medical 

examination. 

Physical Examination (Qualification/ 

Disqualification Standards (§ 391.41 and 

391.43)) 

• Explain the FMCSA physical 

examination requirements and advisory 

criteria in relationship to conducting the 

driver’s physical examination of the 

following: 

Æ Eyes (§ 391.41(b)(10)) 

› equal reaction of both pupils to light; 

› evidence of nystagmus and 

exophthalmos; 

› evaluation of extra-ocular movements. 

Æ Ears (§ 391.41(b)(11)) 

› abnormalities of the ear canal and 

tympanic membrane; 

› presence of a hearing aid. 

Æ Mouth and throat (§ 391.41(b)(5)) 

› conditions contributing to difficulty 

swallowing, speaking or breathing; 

Æ Neck (§ 391.41(b)(7)) 

› range of motion; 


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› soft tissue palpation/examination (e.g., 

lymph nodes, thyroid gland). 

Æ Heart (§ 391.41(b)(4) and (b)(6)) 

› chest inspection (e.g., surgical scars, 

pacemaker/implantable automatic 

defibrillator); 

› auscultation for thrills, murmurs, extra 

sounds, and enlargement; 

› blood pressure and pulse (rate and 

rhythm); 

› additional signs of disease (e.g., edema, 

bruits, diaphoresis, distended neck veins. 

Æ Lungs, chest, and thorax (§ 391.41(b)(5)) 

› respiratory rate and pattern; 

› auscultation for abnormal breath 

sounds; 

› abnormal chest wall configuration/ 

palpation. 

Æ Abdomen (§ 391.41(a)(3)(i) and 

391.43(f)) 

› surgical scars; 

› palpation for enlarged liver or spleen, 

abnormal masses or bruits/pulsation, 

abdominal tenderness, hernias (e.g., inguinal, 

umbilical, ventral, femoral or other 

abnormalities). 

Æ Spine (§ 391.41(b)(7)) 

› surgical scars and deformities; 

› tenderness and muscle spasm; 

› loss in range of motion and painful 

motion; 

› spinal deformities. 

Æ Extremities and trunk (§ 391.41(b)(1), 

(b)(4) and (b)(7)) 

› gait, mobility, and posture while 

bearing his/her weight; limping or signs of 

pain; 

› loss, impairment, or use of orthosis; 

› deformities, atrophy, weakness, 

paralysis, or surgical scars; 

› elbow and shoulder strength, function, 

and mobility; 

› handgrip and prehension relative to 

requirements for controlling a steering wheel 

and gear shift; 

› varicosities, skin abnormalities, and 

cyanosis, clubbing, or edema; 

› leg length discrepancy; lower extremity 

strength, motion, and function 

› other abnormalities of the trunk. 

Æ Neurologic status (§ 391.41(b)(7), (b)(8) 

and(b)(9)) 

› impaired equilibrium, coordination or 

speech pattern (e.g., ataxia); 

› sensory or positional abnormalities; 

› tremor; 

› radicular signs; 

› reflexes (e.g., asymmetric deep-tendon, 

normal/abnormal patellar and Babinski). 

Æ Mental status (§ 391.41(b)(9)) 

› comprehension and interaction; 

› cognitive impairment; 

› signs of depression, paranoia, 

antagonism, or aggressiveness that may 

require follow-up with a mental health 

professional. 

(5) Performing, obtaining and 

documenting diagnostic tests and obtaining 

additional testing or medical opinion from a 

medical specialist or treating physician. 

Diagnostic Testing and Further Evaluation 

• Describe the FMCSA diagnostic testing 

requirements and the medical examiner’s 

ability to request further testing and 

evaluation by a specialist. 

Æ Urine test for specific gravity, protein, 

blood and glucose (§ 391.41(a)(3)(i)); 

Æ Whisper or audiometric testing 

(§ 391.41(b)(11)); 

Æ Vision testing for color vision, distant 

acuity, horizontal field of vision and 

presence of monocular vision 

(§ 391.41(b)(10)); 

Æ Other testing as indicated to determine 

the driver’s medical and physical 

qualifications for safely operating a CMV. 

Æ Refer to a specialist a driver who 

exhibits evidence of any of the following 

disorders (§ 391.43(e) and (f)): 

› vision (e.g., retinopathy, macular 

degeneration); 

› cardiac (e.g., myocardial infarction, 

coronary insufficiency, blood pressure 

control); 

› pulmonary (e.g., emphysema, fibrosis); 

› endocrine (e.g., diabetes); 

› musculoskeletal (e.g., arthritis, 

neuromuscular disease); 

› neurologic (e.g., seizures); 

› sleep (e.g., obstructive sleep apnea); 

› mental/emotional health (e.g., 

depression, schizophrenia); or 

› other medical condition(s) that may 

interfere with ability to safely operate a CMV. 

(6) Informing and educating the driver 

about medications and non-disqualifying 

medical conditions that require remedial 

care. 

Health Counseling 

• Inform course participants of the 

importance of counseling the driver about: 

Æ possible consequences of noncompliance with a care plan for conditions 

that have been advised for periodic 

monitoring with primary healthcare provider; 

Æ possible side effects and interactions of 

medications (e.g., narcotics, anticoagulants, 

psychotropics) including products acquired 

over-the-counter (e.g., antihistamines, cold 

and cough medications or dietary 

supplements) that could negatively affect his/ 

her driving; 

Æ the effect of fatigue, lack of sleep, poor 

diet, emotional conditions, stress, and other 

illnesses that can affect safe driving; 

Æ if he/she is a contact lens user, the 

importance of carrying a pair of glasses while 

driving; 

Æ if he/she uses a hearing aid, the 

importance of carrying a spare power source 

for the device while driving; 

Æ if he/she has a history of deep vein 

thrombosis, the risk associated with 

inactivity while driving and interventions 

that could prevent another thrombotic event; 

Æ if he/she has a diabetes exemption, that 

he/she should: 

› carry a rapidly absorbable form of 

glucose while driving; 

› self-monitor blood glucose one hour 

before driving and at least once every four 

hours while driving; 

› comply with each condition of his/her 

exemption; 

› plan to submit glucose monitoring logs 

for each annual recertification; 

Æ corrective or therapeutic steps needed 

for conditions which may progress and 

adversely impact safe driving ability (e.g., 

seek follow-up from primary care physician); 

Æ steps needed for reconsideration of 

medical certification if driver is certified 

with a limited interval, e.g., the return date 

and documentation required for extending 

the certification time period. 

(7) Determining driver certification 

outcome and period for which certification 

should be valid. 

Assessing the Driver’s Qualifications and 

Disposition 

• Explain how to assess the driver’s 

medical and physical qualification to operate 

a CMV safely in interstate commerce using 

the medical examination findings weighed 

against the physical and mental demands 

associated with operating a CMV by: 

Æ Considering a driver’s ability to 

› move his/her body through space while 

climbing ladders; bend, stoop, and crouch; 

enter and exit the cab; 

› manipulate steering wheel; 

› perform precision prehension and 

power grasping; 

› use arms, feet, and legs during CMV 

operation; 

› inspect the operating condition of a 

tractor and/or trailer; 

› monitor and adjust to a complex driving 

situation; and 

› consider the adverse health effects of 

fatigue associated with extended work hours 

without breaks; 

Æ Considering identified disease or 

condition(s) progression rate, stability, and 

likelihood of gradual or sudden 

incapacitation for documented conditions 

(e.g., cardiovascular, neurologic, respiratory, 

musculoskeletal and other). 

Medical Certificate Qualification/ 

Disqualification Decision and Examination 

Intervals 

• Discuss the medical examiner’s 

obligation to consider potential risk to public 

safety and the driver’s medical and physical 

qualifications to drive safely when issuing a 

Medical Examiner’s Certificate, when to 

qualify/disqualify the driver and how to 

determine the expiration date of the 

certificate by: 

Æ using the requirements stated in the 

FMCSRs, with nondiscretionary certification 

standards to disqualify a driver 

› with a history of epilepsy; 

› with diabetes requiring insulin control 

(unless accompanied by an exemption); 

› when vision parameters (e.g., acuity, 

horizontal field of vision, color) fall below 

minimum standards unless accompanied by 

an exemption; 

› when hearing measurements with or 

without a hearing aid fall below minimum 

standards; 

› currently taking methadone; 

› with a current clinical diagnosis of 

alcoholism; or 

› who uses a controlled substance 

including a narcotic, an amphetamine, or 

another habit-forming drug without a 

prescription from the treating physician; 

Æ using clinical expertise, disqualify a 

driver when evidence shows a driver has a 

medical condition that in your opinion will 

likely interfere with the safe operation of a 

CMV; 

Æ certifying a driver for an appropriate 

duration of certification interval; 


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Æ if he/she has a condition for which the 

medical examiner is deferring the driver’s 

medical certification or disqualifying the 

driver, informing the driver of the reasons 

which may include: 

› a vision deficiency (e.g., retinopathy, 

macular degeneration); 

› the immediate post-operative period; 

› a cardiac event (e.g., myocardial 

infarction, coronary insufficiency); 

› a chronic pulmonary exacerbation (e.g., 

emphysema, fibrosis); 

› uncontrolled hypertension; 

› endocrine dysfunctions (e.g., insulindependent diabetes); 

› musculoskeletal challenges (e.g., 

arthritis, neuromuscular disease); 

› a neurologic event (e.g., seizures, stroke, 

TIA); 

› a sleep disorder (e.g., obstructive sleep 

apnea); or 

› mental health dysfunctions (e.g., 

depression, bipolar disorder). 

(8) FMCSA reporting and documentation 

requirements. 

Documentation of Medical Examination 

Findings 

Demonstrate the required FMCSA medical 

examination report forms, appropriate 

methods for recording the medical 

examination findings and the rationale for 

certification decisions including: 

• Medical Examination Report Form 

Æ identification of the driver; 

Æ use of appropriate Medical Examination 

Report form; 

Æ assurance that driver completes and 

signs driver’s portion of the Medical 

Examination Report form; 

Æ specifics regarding any affirmative 

response on the driver’s medical history; 

Æ height/weight, blood pressure, pulse; 

Æ results of the medical examination, 

including details of abnormal findings; 

Æ audiometric and vision testing results; 

Æ presence of a hearing aid and whether it 

is required to meet the standard; 

Æ if obtained, funduscopic examination 

results; 

Æ the need for corrective lenses for driving; 

Æ presence or absence of monocular vision 

and need for a vision exemption; 

Æ if driver has diabetes mellitus and is 

insulin dependent, the need for a diabetes 

exemption; 

Æ other laboratory, pulmonary, cardiac 

testing performed; and 

Æ the reason(s) for the disqualification 

and/or referral. 

• Other supporting documentation 

Æ if driver has current vision exemption, 

include the ophthalmologist’s or 

optometrist’s report; 

Æ if a driver has a diabetes exemption, 

include the endocrinologist’s and 

ophthalmologist’s/optometrist’s report; 

Æ treating physician’s work release; 

Æ if obtained, specialist’s evaluation 

report; 

Æ if the driver has a current Skill 

Performance Evaluation Certificate, include 

it; and 

Æ results of Substance Abuse Professional 

evaluations for alcohol and drug use and/or 

abuse for a driver with 

› alcoholism who completed counseling 

and treatment to the point of full recovery. 

• Medical Examiner’s Certificate 

Æ certification status, which may require: 

› waiver/exemption; 

› wearing corrective lenses; 

› wearing a hearing aid; or 

› a Skill Performance Evaluation 

Certificate; 

Æ complete and accurate documentation 

on medical certification card including: 

› the examiner’s name, examination date, 

office address, and telephone number and 

Medical Examiner signature; and 

› the driver’s signature. 

[FR Doc. 2012–9034 Filed 4–19–12; 8:45 am] 

BILLING CODE 4910–EX–P 


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