The NRII Waiver Has Ended: What Motor Carriers Need To Know Now

Updated October 13, 2026

FMCSA’s National Registry II (NRII) waiver ended on October 11, 2026. Since October 12, a paper medical examiner’s certificate (MEC), aka the Med Card, no longer counts as proof of medical certification for CDL drivers in 49 states. The one exception: drivers licensed in Alaska, the only state that hasn’t finished connecting to NRII.

Here’s what changed and what motor carriers need to do now.

What’s the background?

The NRII rule, which was published in 2015, modernizes how driver medical certification is shared, replacing the outdated paper-based process with an all digital system. Some aspects of NRII were implemented in 2015, and others went into effect in 2018. There have been several delays along the way. 

Medical examiners will now electronically transmit drivers’ medical examination results to the FMCSA, so drivers will no longer have to submit their Med Cards directly to the state themselves.

The deadline for the final requirement was June 23, 2025. This step requires FMCSA to electronically transmit driver medical examination results from its National Registry to State Driver’s Licensing Agencies (SDLAs), which will then post the information on the Commercial Driver’s License Information System (CDLIS) driver motor vehicle record (MVR). 

What is the NRII waiver & why does it keep getting extended? 

NRII requires FMCSA to send drivers' medical exam results electronically to each State Driver's Licensing Agency (SDLA), which then posts them to the driver's CDLIS motor vehicle record (MVR). Several states missed the June 23, 2025 deadline because their licensing systems weren't ready. FMCSA responded with a series of waivers that let carriers keep relying on paper MECs for up to 60 days after the exam. 

Which states haven't implemented NRII?

 Only one: Alaska. In June 2025, 12 states weren’t live. By April 2026, five remained. Today, every state except Alaska posts medical certification to the driver’s MVR electronically. Check FMCSA’s NRII Learning Center for the latest updates. 

What changed on October 12, 2026?

For CDL and CLP drivers licensed outside Alaska, the driver’s MVR is now the proof of medical certification. Medical examiners submit exam results to FMCSA electronically, FMCSA sends them to the state, and the state posts them to the driver’s MVR. You no longer need a paper Med Card for these drivers’ DQ files.

For drivers licensed in Alaska, nothing changes until October 12, 2027. Keep collecting paper MECs, which count as proof for up to 60 days after issue.

The NRII process applies only to CDL and CLP holders. Non-CDL drivers who need a medical certificate still provide a paper Med Card.

What should motor carriers do now? 

• Make the MVR your source of truth. Run an MVR two to three days after each medical exam. Medical examiners have until midnight the day after the exam to submit results.
• Follow up fast. If the MVR doesn’t show the new certification, contact the clinic and ask it to resubmit. If the state doesn’t post the certification, it can downgrade the driver’s CDL.
• Flag your Alaska drivers. Keep collecting paper MECs for drivers with Alaska-issued CDLs or CLPs through October 12, 2027.
• Keep verifying medical examiners against the National Registry.
• Add each MVR to the driver’s qualification file.

For drivers licensed in a state that hasn't implemented NRII, follow FMCSA's guidance for that state on the NRII Learning Center.

It’s also important to know that MVR monitoring services do not notify motor carriers when Med Card-related activity occurs on a driver’s motor vehicle record. For example, if a driver’s license is downgraded due to his or her MEC not being on file, you would not receive an alert, even if you were enrolled in MVR monitoring. The monitoring services do not receive these updates from the state. You must run an MVR to get news about downgraded licenses. 

Keep in mind that MVRs, which will soon become the sole source of medical certification information, are not free. That’s why we recommend running MVRs two to three days following the exam to remain compliant and avoid wasting money. Clinics have until midnight on the day following the medical exam to submit MECs electronically to the FMCSA.

How does Avatar help?

Avatar can help you comply with the NRII and associated changes in a few ways. 

First, companies that are using a physical Med Card for the time being are still required to verify the medical examiner is listed in the National Registry. The Avatar Assistant’s Med Card Scanner allows you to automatically extract data from medical cards and cross-reference medical examiner details with the registration database, saving time and preventing data-entry errors. 

Avatar also integrates with MVR and driver monitoring software powered by SambaSafety, so you can seamlessly order MVRs for any reason (pre-hire, annual, monitoring events or medical examinations) and automatically add them to DQ files. 

Finally, all Avatar customers have access to dedicated Client Success Managers, who are an extra set of eyes and ears on compliance issues just like this one. 

Avatar offers Compliance Services to help you manage your DQ files. Let our team of compliance specialists manage the process of ordering and reviewing MVRs, in addition to all other DQF documents. We are a partner, not just a platform.

See how Avatar's DOT compliance software keeps every DQ file audit-ready. 

With paper Med Cards gone for most drivers, MVR monitoring matters more than ever. DriverHub’s SambaSafety integration lets you order and review MVRs right inside DriverHub. 

If that level of support and guidance isn’t something you’re getting with your current recruiting, safety and DOT compliance software platform, contact Avatar today to book a demo.

 NRII waiver: FAQ

Has the NRII waiver ended?
Yes. The nationwide waiver ended at midnight on October 11, 2026. Only drivers licensed in Alaska, and their carriers, still have paper Med Card relief, through October 12, 2027.

Which states haven’t implemented NRII?
Only Alaska. Every other state now posts medical certification to the driver’s MVR electronically.

Can drivers still use a paper Med Card?
Not as proof of medical certification for CDL drivers licensed outside Alaska. Drivers with Alaska-issued CDLs or CLPs can still use a paper MEC for up to 60 days after issue, through October 12, 2027.

Do non-CDL drivers still need a paper Med Card?
Yes. The NRII process applies only to CDL and CLP holders, so non-CDL drivers who need a medical certificate still provide a paper copy.

How soon should I run an MVR after a DOT physical?
Two to three days after the exam. Medical examiners have until midnight the day after the exam to submit results.