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Title: Certification of Medical Necessity (UPG 10.04)


1
Certification of Medical Necessity (UPG 10.04)
Information about Changes to the Unclassified
Leave Statements
  • UW-Madison
  • Sick Leave Policy for Academic Staff, Faculty,
    and Limited Appointees

2
Certification of Medical Necessity Requirement
for Faculty, Limited Appointees, and Academic
Staff use of Sick LeaveBoard of Regent
Resolution 9068Effective October 7, 2005
  • UPG10.04(c) UW institutions shall require
    written certification from a health care provider
    of the medical necessity for use of sick leave
    for absences of more than 5 consecutive full
    working days, except where the use of sick leave
    is authorized in advance, pursuant to the
    Wisconsin or Federal Family and Medical Leave
    Acts.
  • Where an institution is aware of an emergency
    that prevents communicating with or obtaining
    information about the condition of the employee,
    such written certification shall not be required
    until such time as communication is possible and
    appropriate, given the condition of the employee.
  • In cases of suspected abuse of the sick leave
    privilege, the institution shall be authorized to
    require written certification from a health care
    provider to verify the medical necessity for the
    employee's absence regardless of the length of
    absence.

3
Why did the Regents add this requirement?
  • To respond to public concern that was raised
    regarding the potential for sick leave abuse.
  • To insure compliance with sick leave polices.
  • To protect a valuable component of our benefit
    package.
  • To provide UW supervisors and managers with a
    specific process for monitoring sick leave to
    prevent possible misuse.
  • The 5-day trigger option was chosen because it is
    a common practice in the private sector and,
    based on feedback, had institutional support.

4
Requesting Medical Certification
  • Employee should be notified by his/her supervisor
    of the need to provide medical certification.
    The Request for Medical Certification for
    Academic Staff, Faculty, and Limited Appointees
    form should be used.
  • Employees must be provided at least 15 days, from
    the day of their return to work, to secure their
    health care providers medical certification.
  • The request for medical certification is separate
    from requests related to "confidential medical
    information." Only Divisional Disability
    Representatives (DDRs) are authorized to request,
    receive and maintain medical information related
    to disability or medical condition under the ADA
    and/or WFMLA/FMLA.

5
Requesting Medical Certification
  • For leaves of absence of 5 consecutive days or
    more for care of an immediate family member, the
    Request for Medical Certification for Academic
    Staff, Faculty, and Limited Appointees form must
    be used.
  • Please refer to UPG 10 for the definition of
    immediate family member.

6
Requesting Medical Certification
  • Employees should submit the Request for Medical
    Certification for Academic Staff, Faculty, and
    Limited Appointees form to their Supervisor or
    the Divisional Disability Representatives (DDR),
    as determined by the divisional Human Resources
    Office.
  • To determine who the DDR is for the
    school/college, please refer to EDRCs website
    http//www.wisc.edu/edrc/disability/dlrdiv.html

7
What does the Request for Medical Certification
form include and not include?
  • The request form includes a Health Care Provider
    statement that absence from work is justified
    based on medical necessity.
  • It includes a statement of the specific time
    period for which an absence is medically
    necessary.
  • If the employee has the form completed prior to
    his/her return to work, the physician/practitioner
    should provide a best guess return to work
    date.
  • It should not include any confidential medical
    information

8
Requesting Medical Certification
  • When an institution is aware of an emergency that
    prevents communicating with or obtaining
    information about the condition of an employee,
    such written medical certification shall not be
    required until such time as communication is
    possible and appropriate given the condition of
    the employee.
  • Managers, Supervisors or Department Chairs are
    authorized to request medical certification for
    use of sick leave if they suspect the request for
    sick leave is inappropriate, regardless of the
    length of the absence. The department must
    consult with the divisional Human Resources
    Representative prior to making a request to the
    employee.
  • Such requests should be presented in writing to
    the employee, who must be provided at least 15
    days to secure the medical certification. The
    requested information should be provided to the
    Divisional Disability Representative.

9
Does the new requirement affect the leave
provisions provided by FMLA?
  • If the use of sick leave is authorized in
    advance, pursuant to the Wisconsin or Federal
    Family and Medical Leave Acts, additional medical
    certification is not required.
  • Departments should follow their normal process
    for documenting leave under FMLA. In the case of
    WFMLA for family leave following the
    birth/adoption of a child, medical certification
    is not required (since no person is ill) as long
    as the leave has been pre-approved.
  • Information about the Family Medical Leave Acts
    can be found in the UPG 10.11 and Balancing
    Family and Work.

10
Failure to Return Medical Certification
  • If the faculty, academic staff, or limited
    appointee does not provide the requested medical
    certification within the required timeframe,
    he/she cannot use sick leave to cover the
    absence.
  • The employee will have to use other paid leave
    options, or will be required to take a leave
    without pay.

11
Other changes to UW-Madison Sick Leave Policies
  • The leave statement now includes a statement
    certifying that the leave accounting is accurate,
    and states that misrepresentation can lead to
    disciplinary action.
  • The employees immediate supervisor (the
    department chair for faculty) is responsible for
    signing the monthly leave statements.
  • Effective with the 2007-08 year, unclassified
    employees who do not turn in all leave statements
    for a given fiscal year will have their sick
    leave reduced. For more information, refer to
    http//www.bussvc.wisc.edu/ecbs/ucla-changes-imple
    mentation-msn.pdf

12
Why is it important for academic staff, faculty,
and limited appointees to turn in monthly leave
statements?
  • At retirement sick leave accrued is converted
    to credits to pay health insurance premiums.
  • State law caps the annual sick leave accrual at
    6.4 days per year for 9 month staff and 8.5 days
    for 12 month staff.
  • The sick leave cap has been waived for
    UW-Madison based on our agreement to meet certain
    conditions, such as monthly reporting of sick
    leave usage.
  • Compliance with UW sick leave policies will
    help to insure the continued availability of the
    waiver on the sick leave cap.

13
Role of Supervisor/Manager
  • Please encourage the faculty, academic staff and
    limited appointees you supervise to turn in leave
    statements in a timely fashion.
  • Stress the importance of the sick leave cap
    waiver, and the potential loss of its benefits to
    all employees.
  • Remind unclassified employees that missing leave
    statements may be printed from their My UW
    account and completed prior to the end of the
    fiscal year (to avoid having a sick leave
    reduction).

14
Examples
  • To assist in the administration of this policy
    the following examples are provided.

15
What is meant by more than 5 Consecutive Full
Working Days?
  • Example 1
  • Staff members work schedule is Monday through
    Friday from 8 am to 5 pm. Staff member is out
    ill and uses sick leave for the entire 1st week,
    returning the following Wednesday.
  • For this individual, 8 am to 5 pm is a full work
    day. A full work day represents the period of
    time an individual is scheduled to work for that
    day. Thus the employee was out a total of 7 days.
  • A written Medical Certification would be required
    as of Monday, the 6th day of absence.

16
What about Part-Time or Variable Work Schedules?
  • Example 2
  • Staff members work schedule is Monday through
    Friday from 8 am to Noon, 4 hours per day. Staff
    member is out ill an entire 1st week, returning
    the Wednesday of the following week. Thus the
    employee was out a total of 7 days.
  • A full work day represents the period of time an
    individual is scheduled to work for that day.
    For this individual, 8 am to noon is a full work
    day.
  • A written Medical Certification would be required
    as of Monday, the 6th day of absence.

17
What about Part-Time or Variable Work Schedules?
(cont.)
  • Example 3
  • Staff members work schedule is 8 am to 5 pm on
    Monday, Wednesday and Friday.
  • This individual would not have more than 5
    consecutive full working days until the end of a
    two week period.
  • Day 1 Monday Day 4 Monday
  • Day 2 Wednesday Day 5 Wednesday
  • Day 3 Friday Day 6
    Friday
  • A medical certification is required when the
    individual uses sick leave for more than 5
    consecutive full working days.
  • Remember The requirement states 5 consecutive
    full working days, not consecutive calendar days.

18
References
  • Unclassified Personnel Guideline Chapter 10
    http//www.uwsa.edu/hr/upgs/upg10rev_oct7_2005.pdf
  • Balancing Family and Work UW-Madison Leave
    Related Policies for Faculty, Academic Staff, and
    Limited Appointees http//www.ohr.wisc.edu/polpr
    oced/FamilyLeaveBrochure_10-05.doc
  • Information on Sick Leave Reduction for Failure
    to Turn in Leave Statements http//www.bussvc.wi
    sc.edu/ecbs/ucla-changes-implementation-msn.pdf

19
Questions?
  • Managers, Supervisors, and Department Chairs
    should contact their divisional Human Resources
    Representative if they have any questions or
    compliance issues.
  • For questions about UPG 10, contact Catharine
    DeRubeis at cderubeis_at_ohr.wisc.edu
  • Updated 7/2008
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