DEPARTMENT OF TRANSPORTATION [ 67 PA. CODE CH. 83 ] Physical and Mental Criteria, Including Vision Standards Relating to the Licensing of Drivers [38 Pa.B. 3501]
[Saturday, June 28, 2008]The Department of Transportation (Department), under the authority contained in 75 Pa.C.S. §§ 1517, 1518 and 6103 (relating to Medical Advisory Board; reports on mental or physical disabilities or disorders; and promulgation of rules and regulations by department), proposes to amend §§ 83.1, 83.2 and 83.5 (relating to purpose; definitions; and other physical and medical standards).
Purpose of Chapter
Chapter 83 (relating to physical and mental criteria, including vision standards relating to the licensing of drivers) sets forth physical and mental criteria, including vision standards, for the licensing of drivers, formulated by the Medical Advisory Board (Board) under 75 Pa.C.S. §§ 1517 and 1518. In addition to their use by the Department in connection with its responsibilities under the Vehicle Code, these physical and mental criteria are to be used by medical providers in conducting physical examinations of applicants for learner permits and driver licenses, and by physicians and other persons authorized to diagnose and treat disorders and disabilities covered in Chapter 83 to determine whether a person should be reported to the Department as having a disorder affecting the ability of the person to drive safely.
Purpose of the Proposed Amendments
The purpose of these amendments to Chapter 83 is to update the medical requirements and standards for license holders that are being treated for diabetes mellitus. Diabetes management and testing continues to evolve. These proposed amendments update minimum standards to ensure that only drivers who are not at risk of suffering from severe hypoglycemia reactions, hypogly- cemia unawareness or symptomatic hyperglycemia are licensed to operate a motor vehicle.
These proposed amendments reflect consultation with the Department's Board as required by 75 Pa.C.S. §§ 1517 and 1518. The Board, after having conducted in-depth reviews and discussions, has determined that regulations require amendment to make them consistent with existing medical practice and improved technology.
Summary of Significant Amendments
The proposed amendment to § 83.1 add chiropractors to the list of individuals that are permitted to administer the physical examination required for the issuance of a driver's license, as required by Act 756 of 2004.
Section 83.2 has been amended to add the term ''chiropractor'' to the regulation as required by 75 Pa.C.S. § 1508.1(a) (relating to physical examinations) and also to correct the term ''CRNP--Certified registered nurse practitioner.'' This certification is obtained solely by the State Board of Nursing; the State Board of Medicine is no longer involved.
The proposed amendments also add the terms ''HbA1C,'' ''hyperglycemia,'' ''hypoglycemia,'' ''symptomatic hyperglycemia,'' ''Type I Diabetes mellitus'' and ''Type II Diabetes mellitus.'' In addition, ''hypoglycemia reactions'' has been categorized by different degrees of severity. These additions reflect current guidelines established by the American Diabetes Association.
A proposed amendment to § 83.2 has been amended to includes the categories of hypoglycemic reactions established by the American Diabetes Association. This section also is amended to add the requirement for drivers to submit the results of an HbA1C and a vision screening.
In addition, the proposed amendments add a waiver provision for individuals who have experienced an episode that would disqualify them from driving if the episode was as a result of a nonrecurring transient illness, toxic ingestion or metabolic imbalance as long as the treating physician verifies that it is a temporary condition or isolated incident not likely to recur.
Persons and Entities Affected
The proposed amendments affect all persons qualified or desiring to be qualified to drive and health care providers.
Fiscal Impact
Implementation of these proposed amendments will not require the expenditure of any additional funds by the Commonwealth or local municipalities. These proposed amendments will not impose any additional costs on the medical community and may reduce costs by providing clearer medical criteria and thus reduce unnecessary reporting by physicians and the need for follow-up medical examinations for drivers. The proposed amendments do not impose any additional medical examinations that are not customary for diabetic care.
Regulatory Review
Under section 5(a) of the Regulatory Review Act (71 P. S. § 745.5(a)), the Department submitted a copy of the proposed amendments, on June 18, 2008, to the Independent Regulatory Review Commission (IRRC) and to the Chairpersons of the House and Senate Transportation Committees (Committees). In addition to submitting the proposals, the Department has provided IRRC and the Committees with a copy of a detailed Regulatory Analysis Form. A copy of this material is available to the public upon request.
Under section 5(g) of the Regulatory Review Act, IRRC may convey any comments, recommendations or objections to the proposed amendments within 30 days of the close of the public comment period. The comments, recommendations or objections shall specify the regulatory review criteria that have not been met. The Regulatory Review Act specifies detailed procedures for review, prior to final-form publication of the regulations, by the Department, the General Assembly and the Governor of comments recommendation, or objections.
Sunset Provisions
The Department will make this rulemaking effective upon publication in final-form following appropriate evaluation of any comments, suggestions or objections received during the period allowed for public comment. The Department is not establishing a sunset date for this proposed rulemaking, since proposed rulemaking is needed to administer provisions required under the Vehicle Code. The Department, however, will continue to closely monitor these regulations for their effectiveness.
Public Comments
Interested persons are invited to submit written comments, suggestions or objections regarding the proposed amendments to the regulations to Janet L. Dolan, Director, Bureau of Driver Licensing, P. O. Box 68676, Harrisburg, PA 17106-8676 within 30 days of the publication of this notice in the Pennsylvania Bulletin.
Contact Person
The contact person for technical questions about the proposed amendments to the regulations is Scott Shenk, Manager, Driver Safety Division, Bureau of Driver Licensing, P. O. Box 68676, Harrisburg, PA 17106-8676, (717) 783-5958.
ALLEN D. BIEHLER, P. E.,
SecretaryFiscal Note: 18-411. No fiscal impact; (8) recommends adoption.
Annex A TITLE 67. TRANSPORTATION PART I. DEPARTMENT OF TRANSPORTATION Subpart A. VEHICLE CODE PROVISIONS ARTICLE IV. LICENSING CHAPTER 83. PHYSICAL AND MENTAL CRITERIA, INCLUDING VISION STANDARDS RELATING TO THE LICENSING OF DRIVERS § 83.1. Purpose.
Section 1517(b) of the act (relating to medical advisory board) authorizes the Department to adopt physical and mental criteria, including vision standards, for licensing of drivers under Chapter 15 of the act (relating to licensing of drivers). These physical and mental criteria have been formulated by the Medical Advisory Board under the authority of sections 1517 and 1518 of the act (relating to medical advisory board and reports on mental or physical disabilities or disorders). In addition to their use by the Department in connection with its responsibilities under Chapter 15 of the act, these physical and mental criteria shall be used by physicians, chiropractors, CRNPs and physician assistants in conducting physical examinations of applicants for learner's permits and driver's licenses and by physicians and other persons authorized to diagnose and treat disorders and disabilities covered in this chapter in determining whether a person examined by the provider should be reported to the Department as having a disorder affecting the ability of the person to drive safely.
§ 83.2. Definitions.
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
* * * * * CRNP--Certified registered nurse practitioner--A registered nurse licensed in this Commonwealth who is certified[,] by [both] the State Board of Nursing [and the State Board of Medicine,] in a particular clinical specialty area and who, while functioning in the expanded role as a professional nurse, performs acts of medical diagnosis or prescription of medical therapeutic or corrective measures in collaboration with and under the direction of a physician licensed to practice medicine in this Commonwealth.
Chiropractor--A practitioner of chiropractic as defined in 75 Pa.C.S. § 1508.1(b) (relating to physical examinations).
* * * * * HbA1C test--A Hemoglobin A1C test monitors the long-term control of diabetes mellitus.
Hyperglycemia--When the level of glucose (sugar) in the blood is too high based on current guidelines established by the American Diabetes Association.
Hypoglycemia--When the level of glucose (sugar) in the blood is too low based on current guidelines established by the American Diabetes Association.
Hypoglycemic reactions--Different degrees of hypoglycemia which are classified as follows:
(i) Mild--Hypoglycemia that signals a blood glucose drop, which the individual can self correct with oral carbohydrates.
(ii) Severe--Hypoglycemia that requires outside intervention or assistance of others, or that produces confusion, loss of attention or a loss of consciousness.
Hypoglycemia unawareness--A condition when the individual no longer recognizes the body's usual signals of low blood glucose so the first sign of hypoglycemia will often be confusion or loss of consciousness.
* * * * * Symptomatic hyperglycemia--High glucose levels in the blood that may cause a loss of consciousness or an altered state of perception, including, but not limited to, decreased reaction time, impaired vision or hearing, and confusion.
* * * * * Type I Diabetes mellitus--A chronic disease caused by the pancreas producing too little insulin to regulate blood sugar levels.
Type II Diabetes mellitus--A chronic disease marked by high levels of sugar in the blood caused by the body failing to respond correctly to natural insulin.
§ 83.5. Other physical and medical standards.
(a) General disqualifications. A person who has any of the following conditions will not be qualified to drive:
(1) Unstable [or brittle] diabetes [or hypoglycemia,] mellitus leading to severe hypoglycemic reactions, hypoglycemic unawareness or symptomatic hyperglycemia unless there has been a continuous period of at least 6 months [freedom] free from a [related syncopal attack.] disqualification in this paragraph. Individuals shall submit results of a HbA1C and vision screening as outlined in the table in subparagraph (i).
(i) Eligibility Requirements
Profile Level Diabetes Mellitus
Medical
Report
Required
Interval
for
Review
1 Stabilized diabetes mellitus with no incident of severe hypoglycemic episodes, hypoglycemic unawareness or symptomatic hyperglycemia within the last 6 months. Yes 6 months 2 Stabilized diabetes mellitus with no incident of severe hypoglycemic episodes, hypoglycemic unawareness or symptomatic hyperglycemia within the last 12 months. Yes 12 months
(*)3 Stabilized diabetes mellitus with no incident of severe hypoglycemic episodes, hypoglycemic unawareness or symptomatic hyperglycemia within the last 24 months. Yes 24 months
(*)4 Stabilized diabetes mellitus with no incident of severe hypoglycemic episodes, hypoglycemic unawareness or symptomatic hyperglycemia within the last 48 months or more. Yes 48 months
(*)(*)Eligibility determinations may be reviewed earlier if recommended by the treating physician.
(ii) A waiver may be granted if an individual has been previously free from severe hypoglycemic reactions, hypoglycemia unawareness or symptomatic hyperglycemia for the preceding 6 months and the subsequent severe hypoglycemic reaction, hypo- glycemia unawareness or symptomatic hypergly- cemia occurred while the individual was under the treating physician's care, during or concurrent with a nonrecurring transient illness, toxic ingestion or metabolic imbalance. This waiver will only be granted if the treating physician submits written certification indicating it is a temporary condition or isolated incident not likely to recur.
* * * * * [Pa.B. Doc. No. 08-1195. Filed for public inspection June 27, 2008, 9:00 a.m.]
