The integration rule
The Medical Examiner's Certification Integration final rule (published April 23, 2015; compliance date extended in 2018 and 2021 to June 23, 2025) has FMCSA electronically transmit CDL and CLP holders' exam results from the National Registry of Certified Medical Examiners to state driver licensing agencies, which post them to the driver's CDLIS record, instead of relying on drivers to submit paper certificates. The goal is to eliminate paper-card forgery and ensure CDL records reflect current medical certification status.
FMCSA allowed paper certificates under waivers and a six-month exemption while states finished implementation. In an October 8, 2026 notice, FMCSA said 49 states and DC have implemented the rule; drivers licensed there, and their employers, may no longer rely on a paper certificate as of October 12, 2026. Alaska is the only remaining state, and FMCSA renewed an exemption for one year letting Alaska-licensed drivers rely on a paper certificate for up to 60 days after issuance.
What it means for drivers
CDL holders who took the DOT physical with a NRCME-listed examiner have their certification flow electronically to the state CDL agency. Drivers no longer need to mail or hand-deliver a paper card to the state DMV. The CDL record itself shows the active medical certification status.
Drivers should confirm that their new certification appears on their state driving record. Alaska-licensed drivers can still rely on a paper certificate for up to 60 days after issuance under FMCSA's exemption.
What it means for carriers
Carriers should pull driver MVRs annually under 49 CFR §391.25. For CDL holders, the carrier meets the medical certificate requirement by placing the CDLIS MVR showing medical certification status in the DQ file (§391.51(b)(6)(ii)); for Alaska-licensed drivers, a paper certificate can be used for up to 60 days under the exemption.
When a driver's medical certificate expires, the state must update the CDLIS record to "not certified" within 10 calendar days and complete a CDL downgrade within 60 days unless the driver is recertified (49 CFR §383.73(o)). The driver cannot legally operate a CMV in non-excepted interstate commerce until recertified, so carriers should track expiration dates rather than wait for the annual MVR.