New provider certification needed for commercial driver physicals

Physicians and other healthcare providers who perform commercial driver’s license (CDL) exams must obtain a new certification to perform these services, effective May 21, 2014. Here is what physicians need to know and do in order to stay compliant with federal rules and preserve this revenue source.

The Federal Motor Carrier Safety Administration (FMCSA), by a final rule published on April 20, 2012 established a new certification for medical providers who perform physicals for CDL exams. They are also known as interstate commercial motor vehicle (CMV) licenses. 

According to the website of the FMCSA, “The mission of the Office of Medical Programs is to promote the safety of America’s roadways through the promulgation and implementation of medical regulations, guidelines and policies that ensure commercial motor vehicle drivers engaged in interstate commerce are physically qualified to do so.”

The FMCSA also has a vision statement that reads, “All bus and truck drivers are healthy, safe and medically fit to drive. Everyone-drivers, medical examiners, bus and truck companies and the public- understands and values the importance of driver health and wellness, and our safety regulations, policies, and programs.”

This means that effective May 21, 2014, the medical providers who provide these exams will have to be listed on the National Registry of Certified Medical Examiners (NRCME).

Certification by the NRCME means a provider has been trained, tested and certified to perform medical examinations for CMV drivers in interstate commerce, and fully understands the medical standards in the FMCSA regulations, related guidance, and how they relate to the medical demands of operating a commercial motor vehicle.

The goals of the certification and training programs are to:

• ensure that medical examiners understand fully the medical standards in the federal motor carrier safety regulations (FMCSRs) and related guidance and how they apply to CMV drivers;

• maintain ongoing competency of medical examiners through training, testing, certification and recertification;

• promote public confidence in the quality of the medical examinations of CMV drivers; and

• ensure that the list of certified medical examiners is easily accessible.

In order to get listed, providers will have to jump through a few hoops. A step-by-step guide is included below.

Next: The step-by-step guide

Who is eligible

All healthcare professionals are eligible to apply to become a certified medical examiner if their scope of practice authorizes them to perform physical examinations, as defined by the state in which they practice.

Apply online

The first step is to apply for your National Registry number. This can be done online by visiting the NRCME website at: https://nationalregistry.fmcsa.dot.gov.

Take an approved training course

A training course (many offer CME credit) can be taken either online or in person.

Forty states have NRCME training organizations listed on the FMCSA website. Some of the courses may cost $600 for about 12 hours online but our small practice was able to find one taught in person at a local hospital for $400 to $475, depending on membership in a particular organization ($375 per person for groups of  three or more providers from the same facility), including breakfast and lunch. It was presented by the New England College of Occupational and Environmental Medicine.

Pass the examination

In order to pass the exam, providers must obtain 70% correct on a test with 120 multiple-choice questions given by one of the NRCME testing organizations.

The FMCSA website has a tool where you type in your city and state or zip code and a list of testing sites is generated. The fee for the exam was $79 per person at a local center. If you fail, you may repeat the exam in 30 days.

Recertification timeline

A free refresher course from FMCSA is required every five years and a re-exam must be taken within 10 years.

What the course covers

The course detailed every aspect of the medical exams.

There was emphasis on the criteria for determining commercial driver fitness, including:

• 20/40 the required corrected vision in each eye,

• 40 DB average hearing in both ears (or able to hear a whisper at a distance of 5 feet) , 

• 40% left ventricular ejection fraction for congestive heart failure, blood pressures, and urinalysis results etc.

In addition, the course covered the waiting periods to be certified after certain medical events, including:

• 1 week after coronary angioplasty,

• 2 months after an acute myocardial infarction, and

• 3 months after coronary artery bypass grafting.

Some drivers who previously would not pass may apply for certain waivers and exemptions. 

A person with diabetes who uses insulin may qualify for a FMCSA 2-year insulin exemption.

This would require annually:

• a driver medical examination,

• an endocrinologist evaluation,

• an ophthalmologist/optometrist evaluation,

• diabetes education, and monitoring blood sugars before driving and every 2 to 4 hours while driving. (The sugars must be in the range of 100-400 mg/dl).

A quarterly evaluation from an endocrinologist is also required.

Drivers with anatomical or functional deficits such as an amputation or neurologic loss may apply for a special performance evaluation certificate after seeing a psychiatrist.

Report completed physicals online

The newer CDL physical forms contain a line for your NRCME number. One last requirement after you perform a commercial driver fitness examination is to report online that you have certified the particular driver.

This task of electronic updating may be completed by an administrative assistant who you have delegated and is registered with the FMCSA website. 

Jeffrey M. Kagan, MD, is an internist in Newington, Connecticut, and a Medical Economics Editorial Board Member. Send your practice management questions to medec@advanstar.com.