DOT Physical Exam, Alcohol & Drug Testing
NRCME Description & Status
November 12 2011 Update
The Final Rule for the National Registry is undergoing an extended review at the Office of Management and Budget (OMB) at this time. The OMB announced the extended review on Thursday December 29th which was the projected 90 day deadline for clearance from the OMB. The January 2012 DOT status report did not update the projected dates for the Final Rule, however we are expecting the Final Rule to be published before the end of January 2012. Other FMCSA news is given below regarding a change to the final rule that would have allowed drivers not to carry their medical certificate when driving, and another proposed rule regarding schedule 1 drug use by drivers.
The current FMCSA projection for the NRCME Final Rule is as follows:
To: Office of Secretary of Transportation: 7/28/2011 (actual)
To: Office of Management and Budget: 9/22/2011 (actual)
Office of Management and Budget Clearance: 12/29/2011 (delayed)
NRCME Final Rule Federal Registry Publication: 12/30/2011 (delayed)
Effective Date: 2/30/2012 (estimate)
FMCSA National Registry of Certified Medical Examiners
Required by the SAFETY-LU legislation signed by President Bush in 2005, the National Registry of Certified Medical Examiners (NRCME) is an upcoming program from the Federal Motor Carrier Safety Administration (FMCSA). The intent of the NRCME is to increase highway safety by reducing accidents caused by driver medical conditions. The NRCME will improve the quality of the Commercial Motor Vehicle Driver Medical Exam thru mandatory medical examiner training and certification. Certified Medical Examiners (CMEs) will be composed primarily of Chiropractic Physicians, Advanced Nurse Practitioners, Physician Assistants, Medical and Osteopathic doctors. Although “NRCME” is the acronym used extensively on this page, the preferred term is “National Registry”.
FMCSA Public Outreach meetings were held in July and August of 2010 to address concerns of Medical Examiners, drivers and motor carriers. The presentations at those meeting can be viewed at www.nrcme.fmcsa.dot.gov
The FMCSA has is making a final review of the on-line Medical Examiner handbook which can be viewed and downloaded from the ”Medical Programs” section on the FMCSA website. At this time it has to be downloaded one page at a time.
NRCME Public Dockets:
The NRCME Proposed Rule Docket closed January ’09. Comments received were generally supportive in nature. An additional NRCME Proposed Rule and Public Docket which added a requirment for verification of the medical exam by motor carriers closed July, 2011.
Components of the NRCME Proposed Rule December 1st, 2008:
Although the Proposed Rule sought comment on several different options for development, the information below represents FMCSA “Current Thinking” as described in public meetings and presentations.
Components of the NRCME Proposed Rule include:
Those that may serve as FMCSA Certified Medical Examiners (CME) in the National Registry include but are not limited to: Chiropractic Physicians, Medical and Osteopathic doctors, Advanced Nurse Practitioners and Physician Assistants.
Completion of a NRCME “Required” training course and successful passing of a certification test will be required to be a CME in the National Registry.
Motor Carriers with 50 or more drivers will be required to use CMEs for driver medical exams 2 years after the final rule becomes effective, everyone else will have 3 years.
The “Accredited” physiciantraining is expected to be approximately 8 hours in length and must contain the minimum content of the model course. ”Required” training courses will be offered by third parties who are accredited by “Nationally recognized continuing education organization(s)”.
After completing the required training program, providers will send their licensing information to the FMCSA prior to being issued approval to take the certification test at testing centers with locations across the country. Testing centers will verify the identity of the physician, certificate of training completion, state medical license, and the physician’s assigned National Registry number.
The NRCME certification test will be a computerized test composed of questions from an expanding pool of test questions. The test will consist of 120 multiple choice questions. One hundred of the questions are graded, and 20 are being evaluated for use in future certification exams. A pass/fail report will be available immediately at the testing site. The test has a 2 hour time limit. Coats, cell-phones, electronic devices and written materials will not be allowed in the testing area.
Re-current CME training will be required every 3-5 years. These “refresher” courses can be less comprehensive than the “Required” training course. Re-certification will be required every 6 or 12 years to include re-attending the “Required” training and re-passing the certification test. On-line training is expected to be acceptable.
Each month, CMEs will report completed DOT Medical Exams to FMCSA. In addition, they will be required to have an electronic form of communication to received updates to the DOT medical exam, NRCME training, and changes in FMCSA policy.
Motor carriers will be required to verify that medical certificates for their drivers have been signed by a CME in the National Registry.
The FMCSA estimates that 40,000 CMEs will be needed initially to adequately provide the DOT medical exam for the estimated 7-14 million CMV drivers.
The FMCSA will assist drivers and motor carriers in finding CMEs by providing CME information online. CME information will include contact information and address, and may include other important information such as the availability of vehicle parking and office hours. Telephone assistance may be available for those without Internet access.
Related FMCSA Regulations:
FMCSA Medical Review Board:
MRB News: A joint meeting of the MRB and the FMCSA Highway Safety Panel has been scheduled to discuss Sleep Apnea. The meeting date and agenda can be viewed at www.mrb.fmcsa.dot.gov
The Safety-Lu legislation also called for FMCSA to establish a Medical Review Board to make recommendation for changes in FMCSA medical standards and guidelines. FMCSA review of Past Medical Review Board recommendations may be up to 2 years away. Until that time, FMCSA is encouraging Medical Examiners to use “Best Practice” when considering risks to safe driving.
State Licensing Departments to input Medical Exam into CDLIS
As discussed above, the National Registry requirement for CMEs to report completed driver medical exams to FMCSA. Driver medical certificate information obtained by state licensing agencies will make information accessable to State and Federal agencies thru CDLIS to verify medical certificate validity. Electronic access will enable the detection of certain patterns or anomaliles concerning the source of medical certificates.
January 30, 2012, state licensing departments must begin the process to include the medical certificate expiration date on the driver’s Commercial Driver License Information System (CDLIS) record. After a DOT medical examination, drivers will be required to submit a copy of their medical certificate to the State. State agencies will stamp the medical certificate and provide a receipt to the driver stating the medical certificate was received. Beginning January 2014, after 15 days of presenting their medical certificate to their state licensing agency, drivers will no longer be required to carry a copy of a current medical certificate while driving. However those with an SPE or medical exemption will still be required to carry those documents when driving. CDL holders with expired DOT medical certificates will have their CDLIS record immediately updated as “not certified” on the expiration date of their current medical certificate and will have 60 days before having their commercial license downgraded. The requirement for State agencies to monitor all CDL holders will required inactive drivers to obtain a current medical certificate. States are to begin this process by January 2012, and must have all driver medical certificate information onto the CDLIS by January 2014.
New “Specific” Proposed Rule Regarding Medical Certificate: June, 2011
Because some state licensing departments may have difficulty completing the requirements by January 2014, this “specific” proposed rule will require drivers to have a copy of their medical certificate while driving until January 2014. After that time, the final rule detailed above will be in effect.
Medical Examination Form Reviewed:
The FMCSA is reviewing panel recommendations for changes to the DOT Medical Exam Form (long form). All DOT medical exam forms must contain all of the content of the federal form. For those states that have developed their own form, their State form may need to be revised to reflect the new federal form if or when adopted.
The above information is based on FMCSA ”current thinking” obtained by Michael Megehee, DC, Member of the NRCME Education WIPT. The exact nature of NRCME Final Rule will not be available until it is published in the Federal Register. This site is updated monthly. We welcome your comments and suggestions. Please address your email input to drmegehee@yahoo.com or thru the www.TeamCME.com website.
Additional information can be found at the following links: http://www.nrcme.fmcsa.dot.gov/
