National Registry of Certified Medical Examiners, 73129-73147 [E8-28172]

Agencies

• Federal Motor Carrier Safety Administration
• DEPARTMENT OF TRANSPORTATION

[Federal Register Volume 73, Number 231 (Monday, December 1, 2008)]
[Proposed Rules]
[Pages 73129-73147]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E8-28172]



Federal Register / Vol. 73, No. 231 / Monday, December 1, 2008 / 
Proposed Rules

[[Page 73129]]


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DEPARTMENT OF TRANSPORTATION

Federal Motor Carrier Safety Administration

49 CFR Parts 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: Notice of proposed rulemaking (NPRM); request for comments.

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SUMMARY: The FMCSA proposes to establish and maintain a National 
Registry of Certified Medical Examiners (NRCME) and to require that all 
medical examiners who conduct medical examinations for interstate 
commercial motor vehicle drivers complete certain training concerning 
FMCSA physical qualification standards, pass a test to verify an 
understanding of those standards, and maintain competence by periodic 
training and testing. Following establishment of the NRCME and a 
transition period, FMCSA would accept as valid only medical examiners' 
certificates issued by medical examiners listed on the NRCME. The FMCSA 
is developing the NRCME program to improve highway safety and driver 
health by requiring that medical examiners be trained and certified to 
determine effectively whether a commercial motor vehicle driver's 
health meets FMCSA standards. The program implements requirements in 49 
U.S.C. 31149 and supports FMCSA's goal to improve safety and reduce 
fatalities on our Nation's highways.

DATES: Send your comments on or before January 30, 2009.

ADDRESSES: You may submit comments [identified by DOT Docket ID Number 
FMCSA-2008-0363] by any of the following methods:
     Federal eRulemaking Portal: https://www.regulations.gov. 
Follow the online instructions for submitting comments.
     Mail: Docket Management Facility: U.S. Department of 
Transportation, 1200 New Jersey Avenue, SE., West Building, Ground 
Floor, Room W12-140, Washington, DC 20590-0001.
     Hand Delivery or Courier: West Building, Ground Floor, 
Room W12-140, 1200 New Jersey Avenue, SE., between 9 a.m. and 5 p.m. 
E.T., Monday through Friday, except Federal holidays.
     Fax: 202-493-2251.
    Instructions: For detailed instructions on submitting comments and 
additional information on the rulemaking process, see the Public 
Participation heading of the SUPPLEMENTARY INFORMATION section of this 
document. Note that all comments received will be posted without change 
to https://www.regulations.gov, including any personal information 
provided. Please see the Privacy Act heading below.
    Docket: For access to the docket to read background documents or 
comments received, go to https://www.regulations.gov, and follow the 
online instructions for accessing the dockets, or go to the street 
address listed above.
    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 in the Federal Register published on 
April 11, 2000 (65 FR 19476) or you may visit https://DocketInfo.dot.gov.
    Public participation: The Federal eRulemaking Portal is available 
24 hours each day, 365 days each year. You can get electronic 
submission and retrieval help and guidelines under the ``help'' section 
of the Federal eRulemaking Portal Web site. If you want us to notify 
you that we received your comments, please include a self-addressed, 
stamped envelope or postcard, or print the acknowledgement page that 
appears after submitting comments on-line.
    Comments received after the comment closing date will be included 
in the docket and we will consider late comments to the extent 
practicable. The FMCSA may, however, issue a final rule at any time 
after the close of the comment period.

FOR FURTHER INFORMATION CONTACT: Linda Phillips, Physical 
Qualifications Division (MC-PSP), Federal Motor Carrier Safety 
Administration, 1200 New Jersey Avenue, SE., Washington, DC 20590-0001. 
Telephone (202) 366-4001. E-mail: linda.phillips@dot.gov.

SUPPLEMENTARY INFORMATION: This document is organized as follows:

I. Legal Basis for the Rulemaking
II. Background
    A. Role of Medical Examiners
    B. Prior Developments Related to Medical Examiners
III. General Discussion of the Proposals
    A. Existing Medical Requirements and the Role of the Proposed 
NRCME Program
    B. Major Elements of the Proposed NRCME Program
    C. Medical Examiner Training
    D. Medical Examiner Certification Testing
    E. Listing on the NRCME
    F. Implementation of the NRCME Program
    G. Changes in Medical Examination Procedures
    H. Removal from the NRCME and Appeal Process
IV. Section-by-Section Discussion of the Proposals
    A. Section 390.5, Definitions
    B. Subpart D of part 390, National Registry of Certified Medical 
Examiners
    1. Section 390.101, Scope
    2. Section 390.103, Eligibility requirements for medical 
examiner certification
    3. Section 390.105, Medical examiner training programs
    4. Section 390.107, Medical examiner certification testing
    5. Section 390.109, Issuance of the FMCSA medical examiner 
certification credential
    6. Section 390.111, Requirements for continued listing on the 
NRCME
    7. Section 390.113, Reasons for removal from the NRCME
    8. Section 390.115, Procedure for removal from the NRCME
    9. Appendix A to part 390, Medical examiner application data 
elements
    C. Section 391.42, Schedule for use of medical examiners listed 
on the National Registry of Certified Medical Examiners
    D. Section 391.43, Medical examination; certificate of physical 
examination
V. Regulatory Analyses and Notices

I. Legal Basis for the Rulemaking

    The primary legal basis for the National Registry of Certified 
Medical Examiners (NRCME) program comes from 49 U.S.C. 31149, enacted 
by section 4116(a) of the Safe, Accountable, Flexible, Efficient 
Transportation Equity Act: A Legacy for Users, Pub. L. 109-59, 119 
Stat. 1726 (Aug. 10, 2005) (SAFETEA-LU). Subsection (d) of this section 
provides that:

    The Secretary, acting through the Federal Motor Carrier Safety 
Administration--
    (1) shall establish and maintain a current national registry of 
medical examiners who are qualified to perform examinations and 
issue medical certificates;
    (2) 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;
    (3) shall accept as valid only medical certificates issued by 
persons on the national registry of medical examiners; and
    (4) 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 proposes to implement through this 
rulemaking certain other provisions from new section 31149 related to a 
national

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registry. First, subsection (c) requires FMCSA, with the advice of the 
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 would 
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 (D)). Second, FMCSA would also implement 
requirements for medical examiners to transmit to FMCSA on a monthly 
basis certain information about completed Medical Examination Reports 
of commercial motor vehicle (CMV) drivers. (Section 31149(c)(1)(E)). 
Third, the proposed rule would require medical examiners to provide to 
FMCSA copies of Medical Examination Reports and medical examiner's 
certificates within 48 hours of the request, 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 
proposed rule would establish 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 continues to 
require 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 its general rulemaking authority in 49 U.S.C. 
31136(a), FMCSA 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 NRCME program has 
been delegated to the Administrator of FMCSA. (Section 1.73(g) of Title 
49, Code of Federal Regulations (49 CFR)).

II. Background

A. Role of Medical Examiners

    The FMCSA's primary mission is to reduce crashes, injuries, and 
fatalities involving large trucks and buses. In carrying out its safety 
mandate, FMCSA develops and enforces regulations that enhance safety in 
the operation of CMVs. The FMCSA proposes to develop the NRCME program 
to improve highway safety and driver health by requiring that medical 
examiners be trained and certified to determine effectively whether an 
interstate CMV driver meets FMCSA physical qualification standards 
under 49 CFR part 391. Medical examiners are health care professionals 
who conduct the medical examinations as specified in subpart E of part 
391.
    With limited exceptions, all drivers who operate CMVs, as defined 
in 49 CFR 390.5, in interstate commerce must comply with the 
qualification requirements of part 391 (Sec.  391.1). Each driver 
subject to the physical qualification requirements must be examined and 
certified by a medical examiner, as defined in Sec.  390.5, at least 
once every 2 years. For certain drivers, such as those with severe 
cases of hypertension or other acute medical conditions, more frequent 
medical reexamination by a medical examiner may be required to 
determine whether the driver can still be certified.
    A medical examiner documents the results of the examination on a 
Medical Examination Report specified in Sec.  391.43(f) (also referred 
to as the ``long form''). If the medical examiner determines that a 
driver is physically qualified in accordance with Sec.  391.41(b), the 
examiner certifies that the driver meets the physical qualification 
standards by completing a medical examiner's certificate that complies 
with Sec.  391.43(g) and (h). This certificate also contains check 
boxes to indicate whether the driver is subject to any restrictions 
while operating a CMV, such as wearing corrective lenses or a hearing 
aid, or whether the driver has been granted a medical variance 
requiring the certificate to be accompanied by a medical exemption 
document or a skill performance evaluation (SPE) certificate.

B. Prior Developments Related to Medical Examiners

    National Highway Traffic Safety Administration (NHTSA) Study. 
Interest in certifying medical examiners to evaluate interstate CMV 
drivers dates back to 1978, when NHTSA commissioned a feasibility study 
on the issue [Feasibility of Certifying (Designating) Medical Examiners 
for Interstate Commercial Vehicle Drivers, National Highway Traffic 
Safety Administration, Final Report--June 1978].\1\ This study 
addressed the primary weakness in the overall medical program for CMV 
drivers--the lack of understanding by medical examiners of the 
relationship between the driver's physical condition and the task of 
operating CMVs.
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    \1\ Because of its age, FMCSA is not relying on this study in 
developing the proposed rule. However, because it is only available 
from the National Technical Information Service (NTIS Order No. PB-
293 809/0), a copy has been placed in the docket solely for the 
limited purpose of convenient access by interested parties.
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    Amendment of the Definition of ``Medical Examiner.'' In 1992, the 
Federal Highway Administration (FHWA) (which was responsible for motor 
carrier safety until the fall of 1999) amended the Federal Motor 
Carrier Safety Regulations (FMCSRs) to expand the definition of 
``medical examiner'' to allow other medical professionals such as 
physician assistants, advanced practice nurses, and doctors of 
chiropractic, in addition to medical doctors and doctors of osteopathy 
authorized previously, to perform medical examinations of CMV drivers 
(57 FR 33276; July 28, 1992). As a result of this action, the number of 
potential medical examiners increased. 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.
    Merger of Medical Certification and Commercial Drivers License 
(CDL) Processes Negotiated Rulemaking. In 1996-97, FHWA convened a 
negotiated rulemaking committee to consider merging the medical 
certification with the CDL function. Several of the proposals submitted 
included models for a national registry and for certification of 
medical examiners. (See 61 FR 18713, April 29, 1996, and 61 FR 38133, 
July 23, 1996.) However, the negotiated rulemaking committee was unable 
to reach a consensus and no rulemaking relating to a national registry 
resulted.
    Motor Carrier Safety Improvement Act of 1999. When the Motor 
Carrier Safety Improvement Act of 1999 (MCSIA) (Pub. L. 106-159, 113 
Stat. 1748 (Dec. 9, 1999)), established FMCSA in the Department of 
Transportation (DOT), the idea of a national registry was again raised. 
A Senate version of MCSIA directed the Secretary of Transportation to 
initiate rulemaking to establish a national registry of preferred 
medical providers. However, the enacted legislation did not retain this 
language. MCSIA did direct the Secretary to

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initiate rulemaking for the required medical certification to be made 
part of the CDL. The FMCSA published an NPRM to accomplish this 
combination on November 16, 2006 (71 FR 66723). The NPRM comment period 
closed on February 14, 2007, and a final rule is in development.
    National Transportation Safety Board (NTSB) Public Hearing. The 
idea of a national registry was again discussed during a January 21, 
2000, public hearing conducted by the NTSB concerning a 1999 multiple-
fatality crash. It was determined that the CMV driver in this incident 
had several life-threatening and disqualifying medical conditions. The 
NTSB concluded that medical examiners might not have the knowledge and 
information necessary to make appropriate decisions about driver 
fitness. In its ``Highway Accident Report, Motorcoach Run-Off-The-Road 
Accident, New Orleans, Louisiana, May 9, 1999'' (NTSB/HAR-01/01, PB 
2001--916201, Notation 7381, August 28, 2001), the NTSB recommended 
that FMCSA ``develop a comprehensive medical oversight program for 
interstate drivers * * * '' that includes requirements to ensure 
``individuals performing medical examinations for drivers are qualified 
to do so and are educated about occupational issues for drivers.'' 
(Recommendations H-01-017 through H-01-024)
    In 2003, NTSB added these recommendations for medical certification 
of commercial drivers to its ``Most Wanted'' list of Transportation 
Safety Improvements. In subsequent updates to this list, NTSB provided 
additional details regarding the recommendations. According to the 2008 
NTSB Most Wanted Transportation Safety Improvements brochure, FMCSA 
should act to prevent medically unqualified drivers from operating 
commercial vehicles. This task includes: Establishing a comprehensive 
medical oversight program for interstate commercial drivers; ensuring 
that examiners are qualified and know what to look for; tracking all 
medical certificate applications; enhancing oversight and enforcement 
of invalid certificates; and providing mechanisms for reporting medical 
conditions.
    SAFETEA-LU. Congress included a number of provisions in SAFETEA-LU 
to improve the quality of the medical certification of CMV drivers. 
Among those provisions is the establishment of a Medical Review Board 
and appointment of a Chief Medical Examiner to advise FMCSA on the 
qualifications and training for medical examiners to be listed on a 
national registry. When the prescribed provisions are fulfilled, all 
required medical examinations of CMV drivers would be performed only by 
trained and qualified medical examiners listed on the national 
registry, and their performance would be monitored by FMCSA. S. Rep. 
No. 109-120, at 2, 22 (2005) and H. R. Rep. No. 109-12, at 434 (2005).
    Public meetings and listening sessions. During FMCSA's 2005 and 
2006 public meetings and listening sessions,\2\ a number of medical 
providers and industry representatives expressed concern about the idea 
of an NRCME, and about the current quality of the CMV driver medical 
examinations. Representatives provided anecdotal evidence about drivers 
qualified by health care providers who were clearly unaware of the 
medical standards, guidelines, and other information needed to properly 
determine whether a driver can safely operate a CMV.
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    \2\ Notices published May 18, 2005 (70 FR 28596), and May 18, 
2006 (71 FR 28912).
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    Informal State analyses. In August 2005, informal FMCSA staff 
contacts with the State of California Department of Motor Vehicles 
(CDMV) revealed that of the 66,000 Medical Examination Reports received 
by CDMV between January and June of 2005, 10% of the drivers were 
issued certificates as physically qualified by the medical examiner 
even though the Medical Examination Report indicated that the driver 
should not have been qualified or should have received a medical 
certificate valid for a shorter time period than the certificate the 
medical examiner granted to the driver. Additionally, information 
obtained in July 2005 from the State of Indiana's CDL program indicated 
a general finding of mistakes on 28% of all Medical Examination Reports 
collected. These findings may be an indicator that some unqualified 
drivers are inappropriately being determined physically qualified.

III. General Discussion of the Proposals

A. Existing Medical Requirements and the Role of the Proposed NRCME 
Program

    The physical qualification standards and medical examination 
process currently required under Sec. Sec.  391.41 and 391.43 apply to 
drivers who operate CMVs, as defined in Sec.  390.5. In other words, 
the medical requirements apply to drivers who operate: Trucks with a 
gross vehicle weight rating or gross combination weight rating, or 
gross vehicle weight or gross combination weight, whichever is greater, 
of 10,001 pounds or more; passenger-carrying vehicles (either nine or 
more passengers for compensation or 16 or more passengers not for 
compensation); and vehicles used to transport hazardous materials that 
require placards on the vehicle.\3\ After a transition period to 
establish the NRCME program, this proposal would require interstate 
drivers of CMVs who are required by the FMCSRs to receive medical 
examinations to obtain them from examiners listed on the NRCME. Under 
current rules, all such CMV drivers are required to obtain medical 
certification at least once every 2 years, although drivers with 
certain medical conditions must obtain medical certification more 
frequently. This requirement is unchanged by the proposed rule.
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    \3\ There are several limited exceptions and exemptions from the 
medical certification requirement provided by Sec. Sec.  390.3(f), 
391.2, 391.62, and 391.68(c). However, future implementation of 
section 4136 of SAFETEA-LU limits the exception in Sec.  
390.3(f)(6)(ii) for drivers of small passenger-carrying vehicles 
within a 75 air-mile radius of the driver's normal work reporting 
location. Canadian and Mexican drivers operating in the United 
States will continue to be governed by the provisions of existing 
reciprocity agreements with Canada and Mexico, because they are not 
in conflict with 49 U.S.C. 31136(a)(3) and 31149. See 67 FR 61818, 
61819 (October 2, 2002) and 57 FR 31454, 31455 (July 16, 1992).
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    The Agency estimates that there are 3.1 million interstate CDL 
holders currently working as CMV drivers, and 1.3 million interstate 
CMV drivers who are not required to hold a CDL. The proposed rule 
applies to both categories, and would therefore apply directly to 
approximately 4.4 million active interstate commercial drivers.
    All CMV drivers must be certified at least every 2 years, and as 
previously mentioned, some drivers are certified more frequently. For 
example, some carriers contract with occupational health clinics to 
examine the drivers they employ, and these carriers often insist that 
newly-hired drivers receive an examination from one of their medical 
examiners, even if the newly-hired driver already has a current valid 
medical certification. In addition, the FMCSRs advise medical examiners 
that drivers with certain medical conditions should receive more 
frequent monitoring, and drivers who have these conditions may be 
required to be examined more frequently than every 2 years (for 
example, 49 CFR 391.43(f) and instructions on high blood pressure and 
neurological disorders). Finally, drivers whose ability to perform 
their normal driving duties has been impaired by injury or disease are 
required by Sec.  391.45 to be reexamined before resuming such duties. 
The FMCSA estimates that these exceptions to the

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biennial examination schedule increase the total number of examinations 
conducted per year by 31 percent over that which would result if all 
drivers were examined every 2 years. This increase in examinations due 
to exceptions to the biennial certification requirement is based on 
limited industry data on driver turnover and medical certifications 
issued for time periods of less than 2 years. If we assume that half of 
the 4.4 million drivers described previously in this section would 
require examination each year, that is, 2.2 million drivers, and 
increase this number by 31 percent to account for drivers who are 
examined more frequently than every 2 years, an estimated 3 million 
examinations would be conducted annually. The FMCSA requests comment on 
how frequently drivers are examined more often than every 2 years.
    Health care professionals in a general practice setting commonly 
examine 8 to 10 patients per day, and the Agency is aware of medical 
examiners who currently conduct over 1,000 medical certifications of 
drivers per year. The FMCSA estimates that 40,000 certified medical 
examiners would be sufficient to perform the estimated 3 million 
medical examinations per year. Each of these examiners would conduct an 
average of 75 examinations per year, which is a feasible volume for 
examiners in all types of practices.
    Drivers are permitted by current regulations to be examined and 
certified by medical examiners in any State, and FMCSA does not propose 
to remove this flexibility with the implementation of the NRCME 
program.

B. Major Elements of the Proposed NRCME Program

    In general, under this proposal, FMCSA would develop core 
curriculum specifications and administrative requirements for medical 
examiner training and provide these to private-sector training 
providers for their use. It would also develop a certification test for 
medical examiners and provide it to private-sector testing 
organizations. Under this proposal, training and testing would be 
delivered by these private organizations to medical examiners who meet 
specified eligibility requirements.
    After a qualified applicant completes required medical examiner 
training and passes an FMCSA certification test, FMCSA would certify 
the applicant as a medical examiner and list that person on the NRCME. 
To ensure that medical examiners remain knowledgeable about driver 
qualification requirements as they are updated, examiners would be 
required to comply with periodic training and recertification 
requirements in order to remain listed on the NRCME. When the NRCME 
program is fully implemented, FMCSA would accept as valid only medical 
certificates issued to CMV drivers by medical examiners listed on the 
NRCME.
    By implementing the NRCME program, FMCSA believes that it would 
improve the knowledge and capabilities of certified medical examiners 
about FMCSA's physical qualifications standards and guidelines for 
operators of CMVs. Medical examiners would also be more aware of the 
demands that operating a CMV can make on drivers and the impact such 
demands can have on their health. A CMV operator who does not meet the 
physical qualifications standards can have a direct impact on the 
safety of CMV operations. In addition, the demands of such operations 
may impact the health of CMV drivers. Based on its own knowledge and 
experience, FMCSA believes that the enhancement of the knowledge and 
capabilities of medical examiners would have a clear and direct 
positive impact on both safety of CMV operations and driver health. The 
FMCSA encourages commenters on this proposal to provide additional 
examples of such impacts, derived from their knowledge and experience.
    Information for drivers, employers, and medical examiners about the 
NRCME program would be available primarily through an NRCME Web site, 
and a resource center with a toll-free phone number would also be 
available. On the Web site, drivers and employers could find names and 
addresses of nearby certified medical examiners listed on the NRCME. 
The NRCME Web site would also provide program information about 
training and testing requirements to certified medical examiners and 
medical examiners who wish to become certified. The NRCME Web site 
would also disseminate information to practitioners on new medical 
discoveries, policies, or requirements relevant to the examinations. 
FMCSA seeks comment on how the NRCME Web site and toll-free phone 
number could potentially be used to deliver and/or administer medical 
examiner testing and/or examination certification.
    The FMCSA is developing the certification component of the NRCME 
program using the accreditation standards of the National Commission of 
Certifying Agencies (NCCA). NCCA is the accreditation body of the 
National Organization for Competency Assurance (NOCA). NOCA is the 
oldest and largest accreditation body for the certification industry, 
and is nationally recognized as the leader in setting quality standards 
for credentialing organizations, particularly in the healthcare 
industry. The FMCSA is considering applying for accreditation for the 
certification component of the NRCME program to demonstrate: Ongoing 
quality management for certification test development and security; 
fairness of test administration; appropriate use of test and candidate 
data; and consistency with private-sector best practices in the 
certification industry. FMCSA seeks comment on the criteria that should 
be in place for private organizations to be certified for 
administration of training and testing. FMCSA also seeks comment on 
alternative training, testing, and certification methods--taking into 
consideration applicable Federal requirements, cost-effectiveness, 
administrative simplification, and meeting performance based standards.
    A new certification program (one that has not previously received 
NCCA accreditation) 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. The primary rationale for this requirement is that 
compliance with accreditation standards cannot be determined until 
after the program has demonstrated completion of all critical program 
activities, including development and implementation of policies and 
procedures and development, administration and scoring of the 
certification test. The FMCSA must also consider other programmatic and 
legal issues prior to making a decision to apply for accreditation. 
FMCSA seeks comment on this proposal for certification and 
accreditation, and seeks potential alternatives.

C. Medical Examiner Training

    This NPRM would require that all medical examiners complete 
training conducted by a private-sector training provider accredited by 
a nationally-recognized medical profession accrediting organization to 
provide continuing education credits. The FMCSA would develop the core 
curriculum specifications and administrative requirements with the 
advice of the Medical Review Board and the Chief Medical Examiner, and 
provide these to the training providers to develop and deliver training 
for medical examiners. The FMCSA would initially base the core 
curriculum specifications on the current regulations and guidelines for 
conducting CMV driver medical examinations and would periodically 
review and update the

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requirements and core curriculum. A training provider could expand its 
course content to tailor the training to the needs of its target 
audience, but the course must include the FMCSA core curriculum 
specifications. The length of the training would vary among providers 
depending on whether a training provider expands its course to include 
additional scope and depth. The FMCSA projects that it would take one 
day to teach the FMCSA core curriculum specifications. Current private-
sector medical examiner training programs are generally one day in 
length and use the traditional classroom-based model. However, the 
training delivery method could also vary among providers and include 
self-paced, on-line training; the traditional classroom model; or a 
blended format that combines more than one model. FMCSA seeks comment 
on potential training delivery methods. FMCSA also seeks comment on how 
FMCSA could offer training directly to medical examiners in a cost-
effective manner.
    The FMCSA plans to require accreditation of the FMCSA medical 
examiner training programs because it would maximize consistency and 
quality assurance for the training and would be consistent with 
practices already embraced by the medical professions for continuing 
education. Each of the primary professions that currently perform 
medical examinations under part 391 (that is, doctors of medicine, 
doctors of osteopathy, physician assistants, advanced practice nurses, 
and doctors of chiropractic) utilizes nationally-recognized 
organizations that accredit training programs providing continuing 
education credits to licensed medical professionals. FMCSA seeks 
comment on the costs of training certification programs, and whether 
there are any alternatives to ensure consistency and quality. In 
addition, we seek comment on how certification and accreditation 
requirements would impact the cost of training for medical examiners. 
FMCSA also seeks comment on whether existing certified medical training 
programs would be able to adapt their continuing education programs to 
meet these needs.
    After the initial training, a medical examiner would be required to 
complete periodic retraining at least every 3 years to refresh his or 
her knowledge of both the medical standards for CMV drivers and any 
changes to FMCSA examination standards or guidelines. It is anticipated 
that FMCSA would provide this periodic retraining at no charge to the 
examiner, and that the retraining would be Web-based, allowing the 
medical examiner to verify completion of the training on-line. The 
proposed rule would also require the medical examiner to repeat once 
every 12 years, at a cost to be borne by the examiner, the complete 
initial training program (instead of the periodic retraining). FMCSA 
seeks comment on the cost to medical examiners, and potential training 
and re-training alternatives which would be more cost-effective.

D. Medical Examiner Certification Testing

    The FMCSA would base the medical examiner certification test on the 
results of a Role Delineation Study, a rigorous methodology regularly 
employed in the certification and medical fields when developing a 
valid, reliable, and fair certification test. The FMCSA conducted an 
initial Role Delineation Study (the Study) that identified content for 
the certification test, which is intended to focus on competencies 
common to FMCSA medical examiners from a variety of professional 
backgrounds and work settings. It was completed in April 2007. The task 
list was validated and rated, according to importance of the task, by 
surveying more than 4,000 medical examiners who currently perform CMV 
driver medical examinations. The final report on the initial Study, 
when completed, will be made publicly available. The Study provided an 
assessment of the knowledge, skills, and abilities necessary for an 
FMCSA medical examiner to competently perform CMV driver medical 
examinations in accordance with current FMCSA standards and guidelines. 
The most important information derived from the Study--identification 
of critical tasks--is necessary to create specifications for the 
certification test and forms the basis of a professionally-sound 
quality management system that would support possible future 
accreditation for the certification component of the NRCME program. 
Therefore, a Role Delineation Study will be conducted periodically to 
capture relevant changes in medical practice, standards, and guidelines 
that affect the examination of CMV drivers in order to maintain a 
current and relevant certification test.
    After completing the mandatory training, a medical examiner 
applying to be listed on the NRCME would have to pass the FMCSA medical 
examiner certification test. In addition to the initial certification 
test, medical examiners would be required to recertify by passing the 
medical examiner certification test every 6 years in order to remain 
listed on the registry.
    Before taking the certification test, an applicant would provide 
the testing organization with information such as the applicant's 
medical profession, State medical license or certificate number, 
business address and phone number, and medical examiner training 
provider. In addition, the applicant would provide several statements, 
including a statement that the applicant is capable and willing to 
comply with FMCSA requirements; that upon request he or she would 
provide copies of documents showing evidence of completion of training, 
States licenses, etc.; and an affirmation that all of the information 
provided is true. Proposed Appendix A to part 390 contains a list of 
the minimum information and statements required of an applicant. The 
testing organization would review this information to ensure that the 
applicant provided all of the required information. After an applicant 
completed the test, the testing organization would forward to FMCSA the 
results (that is, the test scores and responses) along with the 
applicant's application package information. The FMCSA would 
periodically audit a percentage of medical examiners to obtain 
verification of eligibility (for example, proof of current State 
medical licensure, registration, or certification to perform physical 
examinations, and proof of completion of required training).
    Under the proposed NRCME program model, an applicant would take a 
certification test provided by a private-sector professional testing 
organization that meets all testing criteria proposed in this NPRM, 
including test delivery and secure data handling criteria. The FMCSA 
expects that an applicant would have to travel to a testing center to 
take a proctored, secure certification test. FMCSA seeks comment on 
alternatives which would allow medical examiners to complete the 
testing requirements on-line, or in a manner which would meet testing 
criteria while reducing the cost and time burden on the medical 
examiner. FMCSA also seeks comment on whether the proposed requirements 
may deter otherwise qualified medical examiners from performing these 
types of examinations.

E. Listing on the NRCME

    The FMCSA would issue an FMCSA medical examiner certification 
credential with a unique identification number and list on the NRCME at 
least the contact information of all medical examiners that meet FMCSA 
eligibility requirements, successfully complete required training, and 
pass the FCMSA medical examiner certification test. The certification 
and listing on the NRCME would expire 6 years after the date of 
issuance of the certification credential.

[[Page 73134]]

The FMCSA would maintain the NRCME on the Web, and drivers and 
employers of drivers would be able to access, by state or zip code, the 
names and contact information (from the information provided by the 
medical examiner under proposed Appendix A to part 390) for medical 
examiners listed on the NRCME. A communications resource center created 
to support medical examiners, drivers, and motor carriers--both with 
and without Internet access--would also be available. The FMCSA 
requests public comment on what types of medical examiner information 
should or should not be made available to the public by the NRCME 
program.

F. Implementation of the NRCME Program

    The FMCSA proposes a phased approach to the required use of medical 
examiners listed on the NRCME. In the first phase, FMCSA proposes to 
require drivers who work for larger employers to have their medical 
examinations performed by medical examiners listed on the NRCME, 
because these drivers are less likely to have problems locating a 
medical examiner. The second phase would expand the requirement to the 
remaining drivers not covered in phase one. The additional time allowed 
for other drivers would allow for growth in the number of medical 
examiners who have completed the proposed certification process and 
have been listed on the NRCME. FMCSA seeks comment on ways to ensure 
that certified medical examiners are accessible to drivers in rural 
areas and areas where the demand for certification may be low, so that 
drivers do not have to travel excessive distances to locate a certified 
medical examiner. FMCSA also seeks comment on additional costs drivers 
may incur to locate and travel to a certified medical examiner for 
their periodic examinations.
    For purposes of phase one, FMCSA proposes to define large employers 
as motor carriers that employ 50 or more CMV drivers. The FMCSA 
proposes that phase one begin 2 years after the effective date of the 
final rule. Any medical examination conducted for a CMV driver employed 
by a large employer under this phase must be conducted by a medical 
examiner listed on the NRCME. The second phase would begin 3 years 
after the effective date of the final rule, would apply to all CMV 
drivers, and would expand the requirement for medical examinations to 
be conducted by medical examiners listed on the NRCME to all CMV 
drivers regardless of the size of the employer. After the applicable 
compliance dates for the affected drivers, FMCSA would accept as valid 
only medical certificates issued by medical examiners listed on the 
NRCME.

G. Changes in Medical Examination Procedures

    This NPRM also proposes implementation of the SAFETEA-LU 
requirement that medical examiners 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 Sec.  391.43. (49 U.S.C. 31149(c)(1)(E)) Additionally, 
the proposed rule would require medical examiners to retain for 3 years 
the Medical Examination Report for each examination performed. It would 
also require medical examiners 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, in order to allow for investigation of 
errors and improper certification of CMV drivers (49 U.S.C. 
31149(c)(2)).
    These requirements also establish the basis for future 
implementation of other statutory requirements for monitoring medical 
examiner performance. For example, although this rulemaking does not 
propose collection of a representative sample and storage of Medical 
Examination Reports and medical certificates in a central database (49 
U.S.C. 31149(c)(1)(E)), in the future FMCSA could begin reviewing a 
representative sample of Medical Examination Reports and medical 
certificates for errors, omissions, or other indications of improper 
certification.

H. Removal From the NRCME and Appeal Process

    This NPRM proposes to define the standards and process by which a 
medical examiner would be removed from the NRCME and the procedures 
provided for appealing such action within the Agency. Under 49 U.S.C. 
31149(c)(2), if a medical examiner issues a medical examiner's 
certificate to a driver who fails to meet the applicable standards at 
the time of the examination or falsely claims to have completed 
required training in the physical qualification standards and medical 
certification process, FMCSA may remove the medical examiner from the 
NRCME. In addition, the statute requires FMCSA to monitor medical 
examiner performance and investigate patterns of errors or improper 
certification of CMV drivers by a medical examiner (49 U.S.C. 
31149(c)(2)). The FMCSA also may remove from the NRCME any medical 
examiner who does not meet the qualification standards or otherwise 
fails to comply with section 31149 or the implementing regulations (49 
U.S.C. 31149(d)(2)).
    To monitor compliance with these statutory requirements, FMCSA may 
investigate whether medical examiners are complying with the 
requirement that they electronically transmit each month the name of 
the driver, an FMCSA numerical identifier for the driver, and the 
results of the examination to FMCSA (via an FMCSA-designated Web site, 
e-mail address, or facsimile number that will be published in the 
Federal Register) for each completed Medical Examination Report 
(including for individuals who failed to meet FMCSA medical standards).
    The proposed rule would also require the medical examiner to 
provide to an authorized representative of FMCSA or to an authorized 
State or local enforcement agency representative, a copy of any Medical 
Examination Report or medical examiner's certificate, within 48 hours 
of the request, so that enforcement personnel can identify errors, 
omissions, or other indications of improper certification by medical 
examiners.
    In addition, FMCSA would review changes submitted by medical 
examiners to their application information. These reviews, along with 
other mechanisms to be developed, would potentially identify medical 
examiners for removal from the NRCME.
    The following are some examples of grounds for removal from the 
NRCME: The medical examiner no longer has at least one valid license, 
registration, or certification to perform physical examinations in any 
State; failure to comply with training requirements; failure to comply 
with FMCSA requirements for electronic transmittal of medical 
examination information to FMCSA; a demonstrated pattern of errors, 
omissions, or other indications of improper certification; and failure 
to provide copies of Medical Examination Reports and medical examiner's 
certificates upon demand. There may also be situations where a medical 
examiner would be voluntarily removed for personal reasons, such as 
health, travel, or retirement.
    The proposed appeal process provides an opportunity for a medical 
examiner who has been proposed to be removed to correct an identified 
deficiency or request administrative review by FMCSA.

[[Page 73135]]

IV. Section-by-Section Discussion of the Proposals

A. Section 390.5, Definitions

    Section 390.5 currently defines ``medical examiner'' as a person 
licensed by a State to perform physical examinations and lists examples 
of types of medical professions authorized to perform examinations of 
CMV drivers under part 391. Section 4116(c) of SAFETEA-LU adds a 
statutory definition of ``medical examiner'' to 49 U.S.C. 31132(6) as 
``an individual licensed, certified, or registered in accordance with 
regulations issued by the Federal Motor Carrier Safety Administration 
as a medical examiner.'' The proposed revision of the definition of 
medical examiner in Sec.  390.5 in this NPRM provides for the new 
statutory definition to replace the current regulatory definition once 
the final rule is completely implemented as provided in proposed Sec.  
391.42. The eligibility requirements regarding State medical licensure, 
registration, or certification would also appear in proposed Sec.  
390.103(a), covering eligibility requirements for medical examiner 
certification.

B. Subpart D of Part 390, National Registry of Certified Medical 
Examiners

    The FMCSA proposes to establish a new subpart D in part 390 that 
would include the requirements for training and testing of medical 
examiners for listing on, and removal from, the NRCME, including appeal 
provisions. The requirements for medical examinations would remain in 
part 391.
1. Section 390.101, Scope
    Proposed Sec.  390.101 states that the new subpart would establish 
the minimum qualifications for FMCSA certification of medical examiners 
and for listing medical examiners on the NRCME. It also describes the 
NRCME program and explains that the registry itself is the component of 
the program that would provide the public with a national database 
listing certified medical examiners.
2. Section 390.103, Eligibility requirements for medical examiner 
certification
    Section Sec.  390.103 proposes the eligibility requirements for 
medical examiner certification. Paragraph (a)(1) incorporates the 
requirements from current Sec.  390.5 that applicants must be licensed, 
certified, or registered under the applicable State requirements to 
perform physical examinations. Paragraphs (a)(2) and (a)(3) state that 
applicants must also obtain training and pass a certification test, as 
specified in proposed Sec. Sec.  390.105 and 390.107, respectively. 
Proposed paragraph (b) states that to renew the certification, a 
medical examiner would have to remain licensed, registered, or 
certified by his or her State and complete additional testing and 
training as required by proposed Sec.  390.111(a)(5).
3. Section 390.105, Medical examiner training programs
    Proposed Sec.  390.105 would require an applicant for medical 
examiner certification to complete an accredited training program that 
meets the core curriculum specifications and administrative 
requirements established by FMCSA for medical examiner training. The 
training program would have to be accredited by a nationally-recognized 
medical profession accrediting organization to provide continuing 
education courses. There is at least one such accrediting organization 
for each medical specialty.
    This section clarifies that it is the sole responsibility of 
medical examiners to ensure their training meets these requirements. 
The FMCSA would maintain on the NRCME Web site a list of all training 
providers that have submitted for FMCSA review their course 
documentation that includes, but is not limited to, the course 
syllabus, sample slides, sample handouts, and a sample training module. 
A training provider included on the NRCME Web site would have to agree 
to submit documentation for future reviews to ensure continuing 
compliance with FMCSA requirements. If FMCSA finds that a particular 
training provider does not meet the core curriculum specifications and 
administrative requirements, the name of the training provider would be 
removed from the NRCME Web site. A medical examiner could arrange for 
training by an organization not included in the Web site, but the 
medical examiner would need to ensure that the training program meets 
FMCSA requirements.
4. Section 390.107, Medical examiner certification testing
    Section 390.107 contains the proposed requirements for the medical 
examiner certification test. An applicant would take the certification 
test from a private-sector professional testing organization. As part 
of the testing process, the applicant would have to provide information 
to a private-sector testing organization. Proposed Appendix A to part 
390 would list the minimum information that the applicants would be 
required to provide. The applicant would take the test at a testing 
center provided by a testing organization that meets FMCSA standards 
for delivering these tests. The testing organization would supply the 
applicant's personal application information and test results to FMCSA.
    The testing organization would: (1) Submit for FMCSA review its 
documented policies and procedures to ensure they meet FMCSA criteria; 
and (2) agree to future FMCSA reviews to ensure continuing compliance. 
The FMCSA is considering the option of listing on the NRCME Web site 
testing organizations that meet FMCSA standards. However, the medical 
examiner would need to ensure that the testing organization he or she 
chooses to use meets FMCSA requirements.
5. Section 390.109, Issuance of the FMCSA medical examiner 
certification credential
    Proposed Sec.  390.109 states that FMCSA would issue an FMCSA 
medical examiner certification credential with a unique identification 
number to each applicant found to be in compliance with the 
requirements of Sec. Sec.  390.103-390.107, and would list the medical 
examiner's name on the NRCME. In accordance with the phased-in schedule 
proposed in Sec.  391.42, FMCSA proposes to accept as valid only 
medical certificates issued by medical examiners listed on the NRCME.
    In addition, proposed Sec.  390.109 specifies that the 
certification credential and the listing on the NRCME would expire 6 
years after issuance. To maintain a listing on the NRCME and to receive 
a new credential, the medical examiner would need to comply with the 
training, testing, and other requirements of proposed Sec.  390.111.
6. Section 390.111, Requirements for continued listing on the NRCME
    Proposed Sec.  390.111 explains how a medical examiner retains a 
listing on the NRCME. Each medical examiner must continue to be 
licensed, registered, or certified, and be authorized to perform 
physical examinations in accordance with the applicable State laws and 
regulations of each State in which the examiner performs examinations. 
For continued listing on the NRCME, the medical examiner would have to 
report to FMCSA changes to any information that the examiner previously 
provided to FMCSA, for example, any information related to any 
termination, suspension, or withdrawal of the medical examiner's 
license, registration, or certificate under State law.
    The medical examiner must maintain documentation of his/her: (1) 
State

[[Page 73136]]

licensing, registration, or certification; and (2) completion of all 
training required under this notice. In addition the medical examiner 
would have to make this documentation available to an authorized 
representative of FMCSA, or an authorized representative of Federal, 
State or local government. The medical examiner would have to make the 
documentation available within 48 hours of a request for investigations 
and within 10 days of a request for regular audits.
    The medical examiner also would have to complete periodic training 
and testing according to a schedule specified in paragraph (a)(5) of 
proposed Sec.  390.111:
     Within 3 years of receiving the credential, the medical 
examiner must complete periodic training. The purpose of this training 
would be to refresh the medical examiner's knowledge of the medical 
standards for CMV drivers and to inform the medical examiner of any 
changes to FMCSA examination standards or guidelines. The FMCSA would 
monitor the results of the certification tests to identify gaps in 
knowledge, and analyze enforcement and crash data to identify other 
areas where additional training may improve the medical certification 
process.
     Within 6 years of receiving the credential, the medical 
examiner must complete the periodic training, plus repeat and pass the 
test taken for initial certification, under Sec.  390.103(a)(3). 
However, in alternating 6 year periods, instead of taking the periodic 
training, the medical examiner would need to repeat the training taken 
for initial certification, under Sec.  390.103(a)(2).
    If a medical examiner complies with the proposed training and 
testing schedule and meets the other maintenance requirements of 
proposed Sec.  390.111, FMCSA would issue a new medical examiner 
certification credential. It would be the responsibility of the medical 
examiner to ensure that he or she receives the new credential before 
the previous one expires.
7. Section 390.113, Reasons for removal from the NRCME
    Section 390.113 proposes the reasons for removal of a medical 
examiner from the NRCME. The reasons include, but are not limited to, 
the following: The medical examiner's failure to continue compliance 
with the basic requirements for inclusion on the NRCME, such as 
maintaining a current State medical license, certification, or 
registration, receiving required periodic training, or renewing the 
FMCSA certification; the medical examiner's failure to comply with the 
FMCSA operational requirements, such as issuing a certificate to 
someone not medically qualified, failure to accurately complete the 
Medical Examination Report or medical examiner's certificate, or 
failure to regularly transmit the names and other information about the 
results of examinations conducted; false claims by the medical examiner 
of completion of any required training; and failure to provide access 
to examination data upon request.
8. Section 390.115, Procedure for removal from the NRCME
    Section 390.115 proposes procedures for removal of a medical 
examiner from the NRCME, as well as the due process protections 
afforded to medical examiners subject to proposed involuntary removal. 
Any involuntary removal action must be undertaken by the FMCSA Director 
of Medical Programs (a new position to be established by the Agency).
    The proposal states that a medical examiner could be removed 
voluntarily by submitting a request to the FMCSA Director of Medical 
Programs. Such a request could be submitted either in writing or 
through a proposed secure information system. The FMCSA is considering 
developing a secure information system through Web interface in which 
each medical examiner listed on the NRCME would receive a unique login 
identification and password upon their acceptance into the NRCME. The 
unique login ID and password would be used to authenticate each request 
for voluntary removal from the NRCME. A request for voluntary removal 
would be effective immediately.
    The proposal then describes the process by which FMCSA would 
initiate and then complete the involuntary removal of a medical 
examiner from the NRMCE at the Agency's discretion. The FMCSA would 
issue to the medical examiner a notice of proposed removal, stating: 
(1) The reasons upon which the proposed removal is based under proposed 
Sec.  390.113; and (2) any corrective actions necessary, if applicable, 
for the medical examiner to remain listed on the NRCME, if he/she so 
chooses. The medical examiner would have an opportunity to submit a 
response in writing no later than 30 days after the date of issuance of 
the notice. The medical examiner could submit to the Director of 
Medical Programs an explanation of any error(s) committed in proposing 
to remove the medical examiner from the NRCME. The Director of Medical 
Programs would review the explanation and could withdraw, modify, or 
affirm the notice of proposed removal. Alternatively, the medical 
examiner could submit to the Director of Medical Programs a written 
response indicating that he or she will come into compliance, if 
possible, and complete the corrective actions identified in the notice 
of proposed removal.
    The medical examiner would have 60 days from either the date of 
issuance of the notice of proposed removal or the date the notice is 
affirmed or modified, whichever is later, to comply with the 
requirements of this subpart and complete the applicable corrective 
actions specified in the notice, as modified or affirmed. If the 
medical examiner fails to take these necessary actions, the proposed 
removal becomes effective. Additionally, if the medical examiner does 
not submit a written response in the 30-day period following issuance 
of the original notice of proposed removal, the medical examiner would 
be removed from the NRCME at the end of that 30-day period.
    Although a person may voluntarily request to be removed from the 
NRCME under proposed Sec.  390.115(a), a person may not request a 
voluntary removal from the NRCME after receiving a notice of proposed 
removal from the Director of Medical Programs. This proposed provision 
is intended to prevent the medical examiner from leaving the NRCME and 
later attempting reinstatement without meeting conditions for 
reinstatement and compliance identified in the notice of proposed 
removal. However, at any time before a notice of proposed removal 
becomes effective, the medical examiner could resolve the matter by 
mutual agreement with the Director of Medical Programs.
    A person who has been removed from the NRCME could request an 
administrative review by submitting to the FMCSA Associate 
Administrator for Policy and Program Development a written request no 
later than 30 days after the date the removal becomes final. The 
Associate Administrator may request additional data or a conference to 
discuss the removal. After completing the review, the Associate 
Administrator would issue a written decision.
    Under proposed Sec.  390.115(e), and as authorized by the 
Administrative Procedure Act, 5 U.S.C. 558(c), the Director of Medical 
Programs would reserve the right to remove a medical examiner from the 
NRCME immediately, either in cases of willfulness or cases in which 
public health, interest, or safety requires. In these cases, the 
provisions for the medical examiner to submit a response

[[Page 73137]]

and take corrective action would not apply. However, the medical 
examiner could submit to the Associate Administrator for Policy and 
Program Development a request for administrative review of the 
emergency removal. The medical examiner must request such a review no 
later than 30 days after the date of removal from the NRCME.
    Proposed Sec.  390.115(f) describes how a person removed from the 
NRCME would request reinstatement. Such a request must be submitted no 
sooner than 30 days after removal from the NRCME. The person must 
provide documentation demonstrating he or she has taken whatever 
action(s) is necessary to correct the deficiencies that resulted 
initially in removal from the NRCME, and demonstrate he or she is in 
compliance with the eligibility requirements of Sec.  390.103(a). The 
Director of Medical Programs may specify additional requirements for 
reinstatement in the notice of proposed removal. In the case of a 
voluntary removal, the person could be reinstated after providing 
documentary proof of satisfying the requirements to be listed on the 
NRCME.
    If FMCSA removes a medical examiner from the NRCME, except at the 
request of the medical examiner, the certification credential issued 
under proposed Sec.  390.109 would no longer be valid. If a medical 
examiner requests voluntary removal from the NRCME, the certification 
credential would remain valid until it expires, but that person would 
not be permitted to conduct FMCSA medical examinations until that 
person provided documentation showing proof of satisfying the 
requirements for continued listing on the NRCME. In either case, the 
removed person's information would still be publicly available on the 
NRCME Web site. A record of the removed person's previous certification 
would remain on the NRCME Web site, with the date of removal, so that 
enforcement personnel and employers of drivers could verify whether a 
medical examiner's certificate was issued by a person listed on the 
NRCME at the time of issuance.
9. Appendix A to part 390, Medical examiner application data elements
    Proposed Appendix A shows the information applicants must provide 
when they arrange with a testing organization to take the FMCSA medical 
examiner certification test. The professional testing organization 
would provide this information to FMCSA along with the results of the 
certification test. When a medical examiner is added to the NRCME, 
FMCSA would post the person's name, business address, telephone number, 
and other contact information on the NRCME Web site. The applicant 
would need to supply a street address for the business location--not a 
post office box, although a post office box could be used for the 
mailing address. The Web site would contain a search function allowing 
drivers to locate certified medical examiners in a particular location. 
The other information required from applicants by Appendix A would be 
used to document a medical examiner's eligibility to be listed on the 
NRCME or to facilitate contact with the applicant by FMCSA.

C. Section 391.42, Schedule for Use of Medical Examiners Listed on the 
National Registry of Certified Medical Examiners

    Under Sec.  391.42, FMCSA proposes a schedule for implementation of 
the requirement that drivers must be examined only by persons who have 
been trained, tested, certified, and are listed on the NRCME, as set 
out in proposed subpart D of part 390. Specifically, beginning on a 
date 2 years after the effective date of the final rule, each medical 
examination required under subpart E of part 391 must be conducted by a 
medical examiner who is listed on the NRCME if the person is employed 
by a motor carrier that employs 50 or more drivers of CMVs. 
Subsequently, beginning on a date 3 years after the effective date of 
the final rule, every medical examination required under subpart E of 
part 391 must be conducted by a medical examiner who is listed on the 
NRCME. The FMCSA requests specific comments on the proposed compliance 
schedule and on the proposed threshold of 50 CMV drivers for the first 
phase of implementation.

D. Section 391.43, Medical Examination; Certificate of Physical 
Examination

    Current Sec.  391.43 contains the requirements for performing the 
medical examination, including instructions for the medical examiner, a 
sample Medical Examination Report form, and a sample medical examiner's 
certificate form. The NPRM contains several proposed amendments to 
Sec.  391.43, including an addition to the information required on a 
medical examiner's certificate.
    First, under the proposal, paragraph (a) would be revised to 
specify that, in accordance with the complianc