I'm Donna Smith with Workforce QA, and I'm going to present this module on the DOT drug testing rules, specifically covering materials about confidentiality requirements, service agents, the differences among the DOT agencies or modes in this particular presentation. From a disclosure standpoint, I serve as the Regulatory Compliance Officer for Workforce QA, which is a third-party administrator and medical review officer firm located in Salt Lake City, Utah. So a little bit of history, the Department of Transportation issued its first drug testing regulations that required a drug-free workplace and drug testing in transportation industries back as early as 1988. The regulations published by the DOT agencies, as well as the Office of the Secretary of Transportation, were implemented in 1990. These original rules targeted illegal drug use or illicit drug use. That was a deterrence program, a prevention program, a prevention and control program that was targeted at Schedule I and Schedule II drugs. The Part 40, 49 CFR, Code of Federal Regulations Part 40, entitled Drug Testing Procedures, were modeled after the Department of Health and Human Services mandatory guidelines for federal workplace testing programs that had been issued some three years earlier. The HHS guidelines then and today form the standard, if you will, for federal drug testing, and they apply specifically to the testing of federal employees in testing-designated positions. DOT testing is required today by the agencies of the DOT, the Federal Aviation Administration, the Federal Motor Carrier Safety Administration, the Federal Transit Administration, the Federal Railroad Administration, the Pipeline and Hazardous Materials Safety Administration, and the U.S. Coast Guard. Each of those drug testing rules issued by those DOT agencies define the safety-sensitive positions that are subject to testing. They define what is prohibited drug and alcohol conduct. They specify when testing is required, such as pre-employment or post-accident, and they establish penalties in those rules for employers who do not comply with the testing mandate. Pre-employment, post-accident, reasonable suspicion, or forecaused, random, return to duty, and follow-up testing are all required under the DOT agency rules. In 1991, the scope of drug testing from these original DOT rules that were effective in 1990 was expanded, if you will, and that was as a result of the first piece of federal legislation mandating drug testing called the Omnibus Transportation Employee Testing Act, or OTIDA. It was in the OTIDA legislation that alcohol testing was added to those DOT-mandated drug testing rules, and that alcohol testing became effective for implementation in January of 1995. So, the revisions to the 1988 anti-drug rules that were published then in January of 1995 included a mandate for split-specimen drug testing, so there was always a requirement to collect a bottle A and a bottle B, if you will. It mandated, for the first time, the SAP, or the Substance Abuse Professional Evaluations, and it expanded the coverage from the 1988 rules to include intrastate transportation operations for all commercial drivers. The original regulations in 1988 for the Federal Motor Carrier Safety Administration, which at that time was the FHWA, the Federal Highway Administration, only applied to interstate trucking operations, but the Omnibus Act expanded that to intrastate trucking, bus, and other operations that required a commercial driver's license to operate a commercial motor vehicle. Oral fluid drug testing, then, is the newest thing on the DOT rules scene, and it was authorized beginning in June of 2023, and there were substantial revisions to the Part 40 regulation to include oral fluid collection procedures, laboratory procedures for analyzing an oral fluid specimen for drugs of abuse, and medical review officer procedures. It is important to note here, however, that even though we are now in past June 2023, that oral fluid testing has not yet been implemented for federal testing because we are awaiting the certification and approval of laboratories to conduct oral fluid testing. So while we have authorization in the rules, and we have a framework for the procedures in the rule, we do not yet have implementation of oral fluid testing for DOT or other federal programs. It is also a part of the medical review officer's duty, so that they can keep up with what's going on, to make sure that they subscribe to the ODAPC listserv, which is listed on this slide. ODAPC, of course, is the Office of the Secretary's Policy and Compliance Office, if you will, for all matters related to drug and alcohol testing. ODAPC stands for the Office of Drug and Alcohol Policy and Compliance. So let's take a look at this 49 CFR Part 40, Procedures for Transportation Workplace Drug and Alcohol Testing Programs. It is written for employers, for employees who are subject to DOT testing, and for the service agents that assist employers in implementing and administering their testing programs. It is formatted as a Q&A document, so it is readable. Many federal regulations are not very readable, but certainly Part 40 has done a good job of attempting to do that. So it will ask the question, you know, what reasons for testing are authorized by DOT? And then it will answer that question in terms of laying out the pre-employment testing, the random testing, et cetera. It is organized into 16 subparts by topic. Those are all listed here. I'm not going to read through them. But you can see that, again, by topic, it is covering what I call the three prongs, if you will, of drug testing. It covers the collection procedures for the specimen, whether that be, which is now, urine specimen collection, and will include, once it is implemented, oral fluid collection procedures. And it also includes laboratory procedures, which is the second prong, if you will, of forensic drug testing under the federal programs. And it includes all of the procedures and details for the review and reporting of those laboratory results by the medical review officer. Additional subtopics are the alcohol testing regulation and procedures, which are different from the drug testing procedures. And also, the return to duty process and the substance abuse professional role in assistance and rehabilitation of returning employees to work in safety-sensitive positions. So the DOT anti-drug program components of the rules were that each employer has to have a written substance abuse policy. It does have to include drug testing and also, now, alcohol testing. And it does have to have the education of employees and supervisors specified. It has to include sanctions for violations of the DOT rule. It also has to have provisions for the confidentiality of the test records and for the test results, record keeping and reporting requirements, and certainly, again, specified in its program components is the return to duty process. So here, again, are listed those DOT agencies, or often referred to as DOT modes, that require drug and alcohol testing. While the U.S. Coast Guard is no longer considered a DOT agency but is now under the Department of Homeland Security, it still follows, if you will, the DOT procedural regulation part 40 for its drug and alcohol testing requirements under the Coast Guard rule. As I mentioned, each of those DOT agency rules define who is subject to testing. And who is subject to testing under DOT are people in safety-sensitive positions. So you can see that FMCSA, for example, the only employees or applicants positions that are subject to drug and alcohol testing are those employees, those individuals who hold a commercial driver's license. In contrast, under the FAA, there are a variety of DOT or of FAA safety-sensitive positions that are subject to FAA-mandated testing to include flight crews, flight attendants, mechanics, aircraft dispatch personnel, ground security, et cetera. And so this is a listing, and all told, there's probably close to 9 to 10 million employees in the transportation sectors that are in safety-sensitive positions that are subject to DOT drug and alcohol testing. I'm going to go through now just some differences among each of the DOT modal or agency rules, specifically highlighting those differences that impact what you as a medical review officer may need to know about those regulations as you review, interpret, and report drug test results that are conducted under that agency's authority, under that agency's rule. So for example, under the FAA regulation, there are pilot medical certificate actions that take place when a pilot who holds a Part 67 medical certificate has a violation, such as a verified positive test, a refusal to test, et cetera. And it is the medical review officer that must report a drug test result violation to the federal air surgeon. And that report has to be filed with the federal air surgeon's office within two business days of when you verify a positive test or a refusal to test on a person who has a Part 67 certificate. As a part of that, you are going to be asked to make a determination, if you will, as to whether or not you think this violation represents the degree of severity, if you will, of a problem with substance abuse. Most medical review officers check that they do not know the severity. All they know is that they had a positive test for which there was no authorized medical explanation for the drugs that were found in the individual's specimen. There is a requirement under FAA for recurrent supervisory training annually or biannually, so that, and that the content of that supervisory training is pretty consistent throughout all of the DOT agency rules to include the signs and symptoms of drug and or alcohol use that would trigger a reasonable suspicion or forecaused drug or alcohol test. There is a provision in the FAA rule that for individuals who have a subsequent violation, in other words, two violations of the FAA drug and alcohol regulations, that they are permanently banned from working in aviation in that safety sensitive position for life. It is the only regulation that has the permanent ban provision. Contractors and subcontractors who perform safety sensitive functions must have FAA compliant testing programs, so you as a medical review officer may be reviewing FAA results, not for an airline or for a part 145 repair station, but in fact for a contractor or subcontractor who performs safety sensitive functions for a commercial airline or for a fixed base operation repair station. For Federal Motor Carrier Safety Administration, a couple of things that are different about their rule is that post-accident drug testing that may take place of a commercial driver who's involved in a commercial motor vehicle crash of some kind. If the police do a drug test, that can be a drug test that can be substituted for or can be used in lieu of the employer doing a separate post-accident drug test. Owner operators who have a DOT operating number under for commercial trucking must join a consortium or have a third party administrator for their DOT drug and alcohol testing program implementation. So they are in a pool, for example, with other owner operators and are notified by the third party administrator or the consortium administrator when they are selected for a random test, for example. There is no periodic drug testing required as part of the DOT driver physical examination. However, oftentimes an employer may want a drug test done as part of the DOT requalification exam or the initial DOT medical exam, in which case that drug test, however, is not a DOT test. It would be a non-DOT test. Beginning in 2020, the Federal Motor Carrier Safety Administration launched a nationwide, if you will, database of drug and alcohol violations for persons holding commercial driver's license. That clearinghouse is described and the details of its operation are listed in Part 382, which is the FMCSA anti-drug and alcohol misuse prevention rule, and it's found in subpart G of that regulation. MROs who review and report Federal Motor Carrier Safety Administration drug tests must register in the clearinghouse as a medical review officer. There's no fee for registering. There's nothing that you have to do other than to register and to affirm that you meet DOT qualifications as a medical review officer in terms of the qualification training and having successfully passed a certification examination. The medical review officer must provide the state license, the commercial driver's license information, on each test result that they are going to report as a violation to the clearinghouse. And of course, they have to, as I mentioned, certify that they meet all DOT qualification standards. So the medical review officer has to report a verified positive, adulterated, substituted, or refusal to test determination for a shy blotter with no medical explanation on all FMCSA tests. Entries are made within two business days of verification. If a result is changed because you have to reopen a case or there was some type of reporting error, you must submit that change to the clearinghouse within one day of when you become aware of the need to change the result. The data requirements for your report, which is all done online, by the way, no faxing of reports, no whatever, but it's all done online through the clearinghouse platform, is you have to report the CDL number and the state of issuance. You have to report the employer's name and address and USDOT number, if you have it, for that particular test, the driver's name and the driver's date of birth, the reason for test, pre-employment, random, et cetera, the CCF ID number, specimen ID number for that test, the date of the collection and the date that you verified this result as positive, adulterated, substituted, shy bladder, no medical explanation, et cetera. And then, of course, the result itself. You do not provide the quantitation of drug to the clearinghouse, but you would report that it is positive for cocaine or you would report that it is adulterated, elevated pH or pH greater than 11, et cetera, as appropriate. For the FRA, for the Federal Railroad Administration, they have always had, since the beginning of drug testing under FRA authority, they have had a special post-accident testing program that includes much more than just a urine drug test or a breath alcohol test. It does include taking blood samples. It does include additional drugs that are tested for, different cutoffs are used. All of the FRA post-accident drug and alcohol test specimens go to an FRA contract laboratory. They do not go to the laboratory of the railroad that the railroad uses for its other type of testing. Oral fluid drug testing, by the way, when it is implemented under DOT, cannot be used for the FRA special post-accident testing program. It will remain as it is with the specimen specified under the FRA post-accident procedures and the toxicology kit, if you will, that is used for the post-accident program. The railroad also has another category of testing besides reasonable suspicion called for-cause testing. And this is testing where you do not have to have an individual, an observed observations of an individual of the signs and symptoms of being under the influence of alcohol or drugs, but rather a person can be tested under railroad, under FRA authority for-cause because of an unexplained human error, an operating practices violation. So this is a circumstance where no individualized, if you will, reasonable suspicion is mandated, but there is an event or an action such as an operating practice violation that would subject the railroad employee to for-cause testing. Like the FAA, the FRA does take actions to suspend or revoke engineer certificates for those who hold that certification under the FRA. Again, it is the responsibility not of the MRO in this case, but of the employer to report those to the FRA. The FRA rule requires three hours of drug and alcohol supervisory training, which is different from the other five DOT agency rules that require only two hours of drug and alcohol supervisory training, one hour on the signs and symptoms that would lead to a reasonable suspicion drug test, and one hour that would lead to the signs and symptoms that would trigger a reasonable suspicion alcohol test. The FRA supervisory training adds that third hour to cover the circumstances relative to its post-accident testing program. The FRA also places a greater, I guess you would call it, a greater consequence for refusing to test than do any of the other DOT agency rules, so that if an employee who is subject to FRA testing refuses to test through adulteration or substitution or other definition of refusal to test, they will have a mandatory nine-month suspension from safety-sensitive work. So that is, again, to further discourage refusing to test under the FRA regulation, which is Part 219. The Federal Transit Administration regulation, which applies to public transit agencies or authorities, et cetera, does include a requirement for employee training, which the others do not. The others all require supervisory training, but not employee training. And again, this is one hour of awareness training on the impact of drugs or alcohol on the performance of safety-sensitive tasks that is geared toward all employees who are subject to testing under FTA. Remember that FTA not only covers the operators of transit vehicles, such as bus drivers or van drivers or other types of public transit vehicles, but also the mechanics who work on those vehicles, be it a subway system or, again, or a city bus system. It also covers everyone who has an emergency response or a dispatch role in public transit. The employers under the FTA rule, the transit authorities or transit agencies must certify compliance with the FTA drug and alcohol testing regulation, which is Part 655. They must do that in order to receive their federal transit funds. They also allow under the FTA rule, like the Federal Motor Carrier Safety Administration rule, that police-administered post-accident tests can substitute in place of the employer, the transit authority doing a test. Okay, the Pipeline Hazardous Materials Safety Administration must have a written anti-drug and alcohol misuse prevention plan. The oil and gas operators, which are subject to the Pipeline Hazardous Materials Safety Administration anti-drug and alcohol misuse prevention rule, which, again, is found as Part 199, 49 CFR Part 199. Employers must monitor their contractors' drug testing programs, alcohol testing, review their policies, and receive semi-annual testing statistical reports from those contractors. Pipeline operators must submit contractor data testing as part of their annual MIS submission. And now, in addition to that, many contractors submit their data directly to the Pipeline Hazardous Materials Safety Administration because many contractors perform work for multiple oil and gas operators. It is important to note that there is no random alcohol testing authorized or required under the Pipeline Hazardous Materials Safety Administration rule. They do require post-accident alcohol testing, reasonable suspicion alcohol testing, or provisions for return to duty and follow-up alcohol testing, but there is no requirement for random alcohol testing. The U.S. Coast Guard, its rule is perhaps the most different, if you will, of the six that we're talking about from a procedural standpoint, and I want to call your attention particularly to the role of the medical review officer in reviewing and reporting drug tests that are done under the U.S. Coast Guard rule. It is the MRO who makes a determination of the employee's risk of drug use in a return to work letter, unlike in the others where it is the SAP, who essentially the substance abuse professional, who actually does the return to work, if you will, letter, or the follow-up evaluation letter saying if this person is eligible to return to safety-sensitive duties. The return to duty process does involve, in this case, some coordination between the substance abuse professional and the medical review officer. Mariner certificate actions are taken by the U.S. Coast Guard, just like the FRA takes certificate actions on engineers, and the FAA takes certificate actions on pilots and flight crew. Periodic drug test is required at the time of license renewal under the U.S. Coast Guard rule. It is marked as an other test on the federal CCF, and there is a specific U.S. Coast Guard form for the periodic test that does require the medical review officer's signature. So in order for a mariner to get their license renewed, they're going to have to have a negative drug test, periodic drug test, and you as the medical review officer who reviewed that test result will need to sign the Coast Guard form 719P. No random alcohol testing under the Coast Guard rule, just like under the oil and gas operator's rule of the PHMSA. Part 40 procedures, while they apply to all of the drug testing required under the Coast Guard rule, there are some exceptions for Part 40 procedures on alcohol testing, largely because of the difficulty of maintaining and conducting post-accident and reasonable suspicion alcohol tests aboard a ship, so that oftentimes evidential breath testing and the requirements for the evidential breath testing devices are not appropriate for or not easily attainable for a commercial maritime vessel. And so there are provisions for other ways to accomplish the alcohol testing. Employer responsibilities under these DOT agency regulations is responsible for compliance with the DOT rules. The employer is responsible for the actions of the service agents used to implement the testing program, including the medical review officer. The DOT tests must be completely separate from non-DOT tests. And those tests, non-DOT tests, are tests that are conducted under the employer's independent authority and not governed by either Part 40 or by the agency rule. You cannot use the federal forms, the Custody and Control form or the alcohol testing form for non-DOT or for, again, tests that are conducted under the employer's independent authority. Employers are subject to civil penalties for noncompliance, such as fines, perhaps loss of an operating certificate issued by the FAA or by the DOT, et cetera. So it all comes down to employer compliance. The Department of Transportation has a requirement for random drug testing under each of the six DOT agency rules. It has a requirement for random alcohol testing under four of the DOT agency rules, again, namely the FAA, the FMCSA, the FTA, and the FRA. The annual random testing rate for each year is determined by each DOT agency based on the management information system random testing violation data, that is the positives and the refusals to test, that have been provided by the employers and their industries. So the annual random testing rate, the minimum rate, the number of tests that have to be done as a random drug test or random alcohol test is not employer to employer based on their positive rate. It is industry by industry. So the FAA says, here is the random testing rate for 2022, for example, for drugs, and here is the random alcohol testing rate for everybody that is subject to FAA testing. Likewise, the Federal Motor Carrier Administration does the same thing. So the testing rate for each of those is based on, again, the violation rate for random tests in the previous year or two years. And you can see that if the violation rate that is verified positive tests and verified refusals to test on random tests for that sector, for all FAA tests is greater than, equal to or greater than 1%, then the drug testing rate for the following year is going to be 50% annually. The alcohol testing rate is going to be 50% annually. And again, you can see the divisions, if you will, based on the positive or refusal to test rate in each industry for their random testing in the previous year or two years. Each employer then must conduct random tests for the calendar year, which is January to December, that is equal to or greater than the required annual percentages of its safety-sensitive employees. So for example, if an employer has 100 safety-sensitive employees and the random drug testing rate for that year is 50%, that employer must conduct 50 random tests, at least 50 random tests for that calendar year. Now that may represent testing only 45 employees, because remember, each employee in the random pool is in a safety-sensitive position, is subject to being selected for a random test every time the company selects from its random pool. So an individual may be selected twice or three times in a given year. Other employees may be selected not at all. But the key is, is the number of random tests related to the annual required percentage based on the pool, the number of safety sensitive individuals in the pool. The annual testing, random testing rate is published as a notice in the federal register, usually in December by each DOT agency setting the percentages for the upcoming year. So we would expect to see a federal register notices at the end of this year for what the minimum random testing rate will be for the following calendar year. Let's talk a little bit now about the confidentiality and release of information provisions that are very specifically addressed in part 40. Generally, the DOT rules prohibit the release of information to any third party without the donor's written consent. Obviously, there are authorized third party people that get the result information, such as you get a result from the laboratory. The FAA or the FRA gets information from you or from the employer as a quote, third party. Now, in general, however, release to other third parties is prohibited. The employer can release information in a legal proceeding initiated by an employee or when the employee's performance of safety sensitive duties is the issue. You as the medical review officer or the third party administrator must release information to the employer for the above purposes. Otherwise, however, you are proscribed, if you will, from releasing that to other third party people except under circumstances specifically outlined in part 40. The donor is always entitled to information concerning his or her test result. So if the donor says, I want a copy of my laboratory test result, I want a copy of your MRO verification report, whether that is MRO copy two of the CCF or a separate MRO report, then you must have that information made available to the employee within 10 days of the donor's written request. One of the provisions in 49 CFR part 40 is that the medical review officer is required to report and to share some medical information that he or she learns in the course of the drug test result verification process. And there are two circumstances where that is necessary. One is where the employee could be medically unqualified under a DOT regulation. So the DOT regulations that have medical qualification standards, of course, are for commercial driver's license, so it's for commercial pilots, for railroad engineers. So you may learn something concerning the medical qualification standards that you would need to report to the employer or to another authorized third party. The second and more common circumstance where you are required to report medical information is when the continued performance of safety-sensitive duties by the employee is likely to pose a significant risk. And this is what we often call a medication safety concern. So the medication that had been disclosed to you, including the medication perhaps that explains the positive drug test and that you have therefore verified as negative because the individual has a legitimate valid prescription for the medication, may, in your opinion, be of concern for performing safety-sensitive duties while taking that medication. And so you are to release that medical information to report it. And the third parties that you are allowed to report that to include the employer. It could be the physician, such as either the individual's personal physician or the physician who may be responsible for the medical qualification standards of the individual. Or it could be the other entities that you see listed here, although I have not known those to be third parties to which the medical review officer is likely to disclose either a medical disqualification issue or a medication safety issue. So the safety concern then is not included on your MRO drug test report, the copy of the CCF. It has to be a separate notice or a separate document that informs the employer that the concern is either related to the medications or medication, that your safety issue concern is related to a medical condition that was disclosed or that you believe that information that was disclosed may mean that the individual is medically disqualified under DOT regulations. So this disclosure of medication information in particular has a lot of detail in the Part 40 for how the medical review officer must go about that. So once you have completed the interview and the individual has identified two various medications that they are on, and if those medications you feel represent a safety concern, you have to tell the employee that you are concerned about them taking this medication and having to perform safety sensitive duties associated with their job or their position. And you must tell them that you will have to report this to the employer or to another third party, and that you will allow five business days from the date of this verification interview to have the prescribing physician contact you as the medical review officer to determine if the medication can be changed to one that does not make the employee medically unqualified or does not pose a significant safety risk. If you do not hear from the physician within five days, then, or the physician says, I'm not going to change the medication, I don't feel that there's any safety concern, then you as the medical review officer can go ahead and report the result with the safety concern. So basically what this means is that there is a pause or a delay before the MRO can report the medication safety concern to the employer or to another third party. So you're going to report a negative result the end of your verification interview, and then it could be two days later, three days later, whenever there has been either contact with the prescribing physician or the five days have elapsed without any contact from the prescribing physician, then you're going to report the safety concern. The other record keeping requirements that are identified in part 40 are listed here, and these are what apply to the medical review officer records. So you must keep for five years your records of a verified positive drug test. You must also keep for five years your documentation of any refusal to test determination that you made for an adulterated, a substituted, or a shy bladder with no medical explanation. You must also keep any SAP reports that you get for five years, although I would find that unusual. SAP reports are usually not provided to the medical review officer. The follow-up testing schedule and follow-up test results, that requirement is for the employer to keep, not for you as the medical review officer. Again, the only other one that does apply to MRO record keeping is the last one. You must keep your records and documentation of negative and canceled DOT drug test results for one year. So that's the record keeping requirements that you as the medical review officer have under DOT drug testing. You've heard me mention in other parts of my presentations for this training course that there is a service agent called a TPA, or a third-party administrator. DOT has a definition of a consortia and third-party administrator as a service agent that provides or coordinates the provision of a variety of drug and alcohol testing services to employers. So let's take a look at this concept of the TPA and what functions a TPA can perform as an agent of the employer, a service agent of the employer, and what functions they cannot perform. So the TPA may act as an intermediary in the transmission of drug and alcohol information to the employer. So you as the medical review officer can report your verified drug test results to the employer's third-party administrator. The employer decides whether to receive some or all of the information through its service agent, the TPA, rather than directly from the source, such as the medical review officer. Confidentiality and timing requirements of the third-party administrator apply as if the employer were obtaining the information directly from the source, i.e. for you. It is important to know though that the third-party administrator cannot serve as the recipient of the test results from the laboratory. The laboratory must report them to you, not to the third-party administrator. The TPA may serve as the designated agent for the Federal Motor Carrier Safety regulated employers in reporting and querying the FMCSA clearinghouse. However, the third-party administrator cannot do the MRO reporting to the clearinghouse. That has to be you or a member of your staff who reports to the FMCSA clearinghouse the verified positive drug tests on CDL holders, the adulterated or substituted refusals to test, the refusals to test determined by a shod ladder where there is no medical condition explaining the inability to provide the specimen. What are the administrative functions of the third-party administrator? They can operate and administer random testing programs in terms of the random testing pool, who has selected the actual selection through software or other applications to do random selection. They may assist with arrangements for other types of testing such as post-accident or reasonable suspicion or after hours collections. They may run the random pools, keeping those updated with new employees who have been hired into safety sensitive positions and with employees that have been terminated or no longer are working for our company and therefore need to be removed from the random pool. They can assist in follow-up testing in terms of scheduling follow-up tests in accordance with the substance abuse professionals follow-up testing program. They may receive and maintain drug and alcohol records for employers, including obviously the individual test results that you as the medical review officer are reporting. What are some principles for interacting with medical review officers in terms of the TPA? Certainly TPAs may provide MRO services. They can have MROs on their staff. They can have MROs as independent contractors. They can have MRO staff members who assist the medical review officer who are employees of the third party administrator. The MRO performs their duties, however, independently and confidentially to other portions or other members of the third party administrator staff. There has to be a physical and operational separation between TPA functions, such as random pool administration, test result record keeping, and the MRO function. Staff under direct supervision of the MRO while performing MRO functions are the only ones that can handle, if you will, the drug test results and the verification process and reporting out of either negatives or non-negative verified results. And only the MRO interviews and verifies the test results. Only the MRO, not the third party administrator, can cancel a test. What are some of the limitations on the activities of the TPA? They must not require a consent release or waiver of liability form for anybody who is being tested under DOT. They cannot receive the results from the laboratory, as I mentioned, and they cannot transmit alcohol test results from the breath alcohol technician to the employer. They cannot transmit SAP reports, substance abuse professional reports. Those have to go directly from SAP on the SAP's letterhead to the DER. The exception there, of course, is owner-operators because the owner-operators do have to belong to a consortium third party administrator for purposes of complying with all aspects of the DOT rules. They must not, that is, TPAs must not receive or transmit medical information from MROs. So if you are reporting a safety concern, a medical disqualification issue, a medical condition concern with regard to safety, that information cannot go to the TPA. That has to go directly from you to either the employer or other authorized third party. And in this case, a TPA is not an authorized third party for the receipt of medical information from you. There are no decisions for reasonable suspicion, post-accident return to duty, follow-up tests, or refusals. Those decisions with regard to when a reasonable suspicion test is done, when a post-accident test is done, those are all the responsibility of the employer and cannot be delegated to the TPA. They must not act as a designated employer representative except in circumstances for independent owner-operator entities that have to belong to a consortium of other single employee entities. They cannot place additional conditions, if you will, with regard to how the testing is done or anything that would be in contradiction to the Part 40 procedures. They may advise and provide information and they can assist an employer, but they cannot do the tasks that are prohibited for a third party administrator. And they must not delay transmission of the results based on payment for services or other disputes. So that brings us to the end of this module.

DOT drug testing

confidentiality

service agents

regulatory compliance

Schedule I and II drugs

alcohol testing

oral fluid testing

Medical Review Officers

transportation industry