The integration rule
The Medical Certification Integration final rule (initially published in 2015, revised in 2021) requires state CDL agencies to receive driver medical certification data directly from the National Registry of Certified Medical Examiners (NRCME), 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.
Most states completed integration by 2024. The final rollouts target 2026–2027 for the remaining states.
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 verify their state's integration status with the state DMV. In integrated states, you can check your CDL medical-cert status online; in non-integrated states, the paper-card process still applies until the state completes integration.
What it means for carriers
Carriers should pull driver MVRs annually under 49 CFR §391.25. In integrated states, the MVR shows the active medical certification expiration date; in non-integrated states, the carrier must continue collecting and filing the paper medical card.
A driver whose medical certification expires without recertification automatically gets a CDL "non-medically-certified" status flag. The driver cannot legally operate a CMV until recertified. Carriers receive the MVR data through the §391.25 annual review.