Certified Medical Examiners receive new guidance as many may face removal from the National Registry

Interstate commercial motor vehicle (CMV) drivers must be medically qualified through an exam administered by Certified Medical Examiners (CMEs) — a group not usually in the news. However, the Federal Motor Carrier Safety Administration (FMCSA) published three significant notices in the past week regarding:

1. Medical Advisory Criteria revisions;
2. Medical Examiner Handbook (MEH) updates; and
3. A proposal to remove nearly 16,000 examiners due to inactive or non-existent National Registry of Certified Medical Examiner (NRCME) accounts.

Medical Advisory Criteria

The Medical Advisory Criteria (MAC), considered current best practice guidance for CMEs when making certification decisions, have been revised. Outdated content has been removed, but the physical qualification standards in 391.41(b) remain the same.

Two changes to the MAC include

• Loss of Limb - (b)(1): Only individuals with a loss of all five fingers are considered to have a loss of a hand, which requires a skills performance evaluation (SPE) to accompany the medical certification. A person with a loss of less than five fingers should be evaluated by the CME for impairment when operating a CMV.
• Respiratory dysfunction - (b)(5): If the CME detects a possible respiratory dysfunction (sleep apnea, for example) that may hinder a driver's ability to operate a CMV safely, the CME should confer with the driver’s treating provider or be assessed by a specialist. The assessment decision is based on the CME’s judgment and is not required by regulation.

The MAC is included in the MEH and Appendix A to 49 CFR part 391.

Medical Examiner’s Handbook

In conjunction with the MAC update, FMCSA released the MEH, which provides CMEs with more in-depth guidance on each physical qualification standard than the MAC.

This revision removed prescriptive language and replaced it with considerations for the CME. The prior version of the MEH was pulled from the FMCSA website in 2015 due to CMEs taking guidance as a regulatory requirement.

Along with information about the medical certification exam and reporting procedures, some major changes included:

• Significant revisions to guidance and the removal of obsolete information in critical areas such as loss of a limb and conditions involving respiratory dysfunction (sleep apnea), cardiovascular concerns, mental health disorders, and seizures;
• Additions of the alternative vision standard (391.44) and insulin-treated diabetes mellitus (391.46) qualification processes; and
• The removal of non-regulation recommendations for the maximum length of certification.

Visit New Medical Examiner’s Handbook 2024 Edition Overview Webinar | FMCSA (dot.gov) for a short FMCSA webinar overview of the new MEH.

Potential examiner removal from the NRCME

The FMCSA proposes removing approximately 15,727 CMEs from the NRCME due to their inactive or not yet created portal accounts. These CMEs have not recently been performing exams and have until February 23, 2024, to:

• Create a login.gov account using the same email address as their NRCME account or sign into their existing account, and
• Correct all outdated information on their National Registry profile.

Removals that occur on February 26, 2024, will not invalidate any Medical Examiner’s Certificates, Form MCSA– 5876, issued by that CME before the removal date.

Carriers and drivers should verify that a CME is active on the NRCME before scheduling a medical exam. Per the FMCSA, carriers and drivers should not have issues obtaining medical exam appointments based on the 38,707 CMEs still actively providing exams.