What 3 FMCSA Updates Might Affect Medical Certifications?

The Federal Motor Carrier Safety Administration (FMCSA) published three significant notices over a short period that may impact your driver’s medical qualifications. 

Two address the medical standards, while the third relates to the list of approved medical providers. 

Updated Medical Advisory Criteria   

Changes were made to Medical Advisory Criteria (MAC) to remove outdated content. However, the physical qualification standards in 391.41(b) remain the same. 

The MAC are medical guidance provided by FMCSA and referenced by certified medical examiners (CMEs) during driver physicals. 

FMCSA made the following changes to current guidance:

• Loss of limb. 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 commercial motor vehicle (CMV).
• Respiratory dysfunction. Suppose the CME detects a possible respiratory dysfunction (e.g., sleep apnea) that may hinder a driver’s ability to operate a CMV safely. In that case, the CME should confer with the driver’s treating provider or request that a specialist assess the driver. The assessment decision is based on the CME’s judgment and is not required by regulation.

A Revised Medical Examiner’s Handbook

In conjunction with the MAC update, FMCSA released a revised Medical Examiner’s Handbook (MEH). The MEH provides CMEs more in-depth guidance than the MAC on each physical qualification standard.

The updated MEH 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.

Changes to the MEH include:

• Information about the medical exam and reporting procedures;
• Significant revisions to guidance and removal of obsolete information in critical areas such as:
  • Loss of a limb;
  • Conditions involving respiratory dysfunction (sleep apnea);
  • Cardiovascular concerns; 
  • Mental health disorders; and 
  • Seizures;
• Addition of qualification procedures for the alternative vision standard (391.44) and insulin-treated diabetes mellitus (391.46); and
• The removal of non-regulation recommendations for the maximum length of certification.

Confirming Active Certified Medical Examiner (CME) Accounts

Another FMCSA notice addressed the removal of almost 16,000 CMEs from the National Registry of Certified Medical Examiners (NRCME). Those affected had inactive or not-yet-created portal accounts.    

Removals occurred on February 26, 2024. However, the agency’s actions will not invalidate any Medical Examiner’s Certificates issued by those CMEs before the removal date.

Carriers and drivers should verify that a CME is active on the NRCME before scheduling a medical exam. FMCSA indicates that carriers and drivers should not have issues obtaining medical exam appointments since almost 39,000 CMEs remain on the list.