Author: Dr. David Thorpe
On November 19th, 2018, the Federal Insulin Use Exemption Program was ended, and the Insulin Use Standard was changed. In place of the Federal Exemption, the new standard will now allow CME’s to certify drivers who use insulin. To accomplish this, a new Insulin Treated Diabetes (ITDM) form (MCSA-5870) will need to be sent to the driver’s diabetes treating provider (doctor) by the CME. The treating provider will have to fill out the form and signify that the driver is safe to drive. Then the CME would be able to certify the driver.
This change to the Diabetes Standard also required a change in the examination form (the MCSA-5875 or also known as the long form), and the certificate (MCSA-5876 also known as the medical certificate card). CME’s will be required to use the versions of the form and certificate with the dates 8/31/18 or 9/30/19.
The new ITDM form has an expiration date of 11/30/2021 and will be available within the driver’s mobile app as well as the motor carrier platform immediately. Drivers that are insulin dependent diabetics should download the ITDM form and take it to their treating provider within 45 days prior to the medical evaluation performed by the CME as this form will only be good for a maximum of for 45 days from the date that the treating clinician signs the form.
In addition, if the driver is being evaluated after a severe hypoglycemic episode (the driver requires assistance, or results in loss of consciousness, seizure or coma), the driver must retain the MCSA-5870 form and give it to the certified medical examiner at their next medical certification.
Medical examiners will not automatically be able to provide certification for all drivers taking insulin simply because they have had their treating provider fill out the form. Their decision is based on a number of different factors and even if the treating provider indicates that it is their opinion that the driver should be certified, the CME may still choose to disqualify the driver. Their decision will be based on the following information:
- The driver should have their treating provider fill out the MCSA 5870 within 45 days of the exam. This should be done prior to the medical examiner performing the certification exam.
- The driver will be disqualified if:
- The driver’s insulin regiment is unstable.
- The driver’s diabetes in not properly controlled.
- There is a diagnosis of SEVERE non-proliferative diabetic retinopathy or severe proliferative diabetic retinopathy.
Additionally, to be considered for certification, the driver must also provide 3 months of blood glucose monitoring as part of the ITDM form. If a driver does not have 3 months of records, the CME using their medical discrethion can issue a medical certificate for up to 3 months to allow the driver to generate the needed records.
Drivers that have a Federal Vision Exemption (due to a diabetic retinopathy), are not required to obtain a new medical certificate until their current medical certificate or vison exemption expires, whichever is first.
Lastly, drivers that are grandfathered by operation of 391.64 are REQUIRED to obtain a new medical certificate when their current certificate expires, or when the program is ended on November 19th, 2019, whichever is first.
If the medical examiner can certifiy the driver, the certification period is for 1 year. Also, the CME should not mark “Accompanied by a insulin waiver/exemption”, or “Qualified by operation of 49 CFR 391.64” (the old diabetic waiver). They should simply mark certified for 1 year.
The process must be fully repeated every year.
By utilizing the appropriate forms as outlined, and providing them along with your completed exam form stored within the driver’s mobile app and presenting them to the CME at the time of the exam, if all within the medical certification examination form is within normal limits, the CME should be able to certify the driver immediately without delay if they meet all of the requirements for certification.
Where to obtain a copy of the new MCSA-5870 form: