Quick update, from another forum:
"I just registered and received the card using an old work accommodation letter from my therapist. The bigger part was needing their NPI#, which they do provide a link to lookup...the fact that it just auto-approved once I provided all that info is weird af, you would think a 48 hour recommendation means someone human is reviewing the applications but apparently not."
Which means, essentially, than anyone with a work accommodation letter (something as little as "needs frequent breaks") could get approved. So they're adding hurdles but loosening restrictions, strange!