Certification of Medical Necessity (UPG 10.04)

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Certification of Medical Necessity (UPG 10.04)

  1. 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. 2. Certification of Medical Necessity Requirement for Faculty, Limited Appointees, and Academic Staff use of Sick Leave Board of Regent Resolution # 9068 Effective October 7, 2005 <ul><ul><ul><ul><li>“ UPG#10.04(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. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>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. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>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.” </li></ul></ul></ul></ul>
  3. 3. Why did the Regents add this requirement? <ul><li>To respond to public concern that was raised regarding the potential for sick leave abuse. </li></ul><ul><li>To insure compliance with sick leave polices. </li></ul><ul><li>To protect a valuable component of our benefit package. </li></ul><ul><li>To provide UW supervisors and managers with a specific process for monitoring sick leave to prevent possible misuse. </li></ul><ul><li>The 5-day trigger option was chosen because it is a common practice in the private sector and, based on feedback, had institutional support. </li></ul>
  4. 4. Requesting Medical Certification <ul><li>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. </li></ul><ul><li>Employees must be provided at least 15 days, from the day of their return to work, to secure their health care provider’s medical certification. </li></ul><ul><li>The request for medical certification is separate from requests related to &quot;confidential medical information.&quot; 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. </li></ul>
  5. 5. Requesting Medical Certification <ul><li>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. </li></ul><ul><li>Please refer to UPG 10 for the definition of “immediate family member.” </li></ul>
  6. 6. Requesting Medical Certification <ul><li>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. </li></ul><ul><li>To determine who the DDR is for the school/college, please refer to EDRC’s website: http:// www.wisc.edu/edrc/disability/dlrdiv.html </li></ul>
  7. 7. What does the Request for Medical Certification form include and not include? <ul><li>The request form includes a Health Care Provider statement that absence from work is justified based on medical necessity. </li></ul><ul><li>It includes a statement of the specific time period for which an absence is medically necessary. </li></ul><ul><li>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. </li></ul><ul><li>It should not include any confidential medical information </li></ul>
  8. 8. Requesting Medical Certification <ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul>
  9. 9. Does the new requirement affect the leave provisions provided by FMLA? <ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>Information about the Family Medical Leave Acts can be found in the UPG #10.11 and Balancing Family and Work . </li></ul>
  10. 10. Failure to Return Medical Certification <ul><li>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. </li></ul><ul><li>The employee will have to use other paid leave options, or will be required to take a leave without pay. </li></ul>
  11. 11. Other changes to UW-Madison Sick Leave Policies <ul><li>The leave statement now includes a statement certifying that the leave accounting is accurate, and states that misrepresentation can lead to disciplinary action. </li></ul><ul><li>The employee’s immediate supervisor (the department chair for faculty) is responsible for signing the monthly leave statements. </li></ul><ul><li>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-implementation-msn.pdf </li></ul>
  12. 12. Why is it important for academic staff, faculty, and limited appointees to turn in monthly leave statements? <ul><li>At retirement sick leave accrued is converted to credits to pay health insurance premiums. </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>Compliance with UW sick leave policies will help to insure the continued availability of the waiver on the sick leave cap. </li></ul>
  13. 13. Role of Supervisor/Manager <ul><li>Please encourage the faculty, academic staff and limited appointees you supervise to turn in leave statements in a timely fashion. </li></ul><ul><li>Stress the importance of the sick leave cap waiver, and the potential loss of its benefits to all employees. </li></ul><ul><li>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). </li></ul>
  14. 14. Examples To assist in the administration of this policy the following examples are provided.
  15. 15. What is meant by more than 5 Consecutive Full Working Days? <ul><li>Example #1 </li></ul><ul><li>Staff member’s work schedule is Monday through Friday from 8 am to 5 pm. Staff member is out ill and uses sick leave for the entire 1 st week, returning the following Wednesday. </li></ul><ul><li>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. </li></ul><ul><li>A written Medical Certification would be required as of Monday, the 6 th day of absence. </li></ul>
  16. 16. What about Part-Time or Variable Work Schedules? <ul><li>Example #2 </li></ul><ul><li>Staff member’s 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. </li></ul><ul><li>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. </li></ul><ul><li>A written Medical Certification would be required as of Monday, the 6 th day of absence. </li></ul>
  17. 17. What about Part-Time or Variable Work Schedules? (cont.) <ul><li>Example #3 </li></ul><ul><li>Staff member’s work schedule is 8 am to 5 pm on Monday, Wednesday and Friday. </li></ul><ul><li>This individual would not have more than 5 consecutive full working days until the end of a two week period. </li></ul><ul><li>Day 1: Monday Day 4: Monday </li></ul><ul><li>Day 2: Wednesday Day 5: Wednesday </li></ul><ul><li>Day 3: Friday Day 6: Friday </li></ul><ul><li>A medical certification is required when the individual uses sick leave for more than 5 consecutive full working days. </li></ul><ul><li>Remember: The requirement states 5 consecutive full working days, not consecutive calendar days. </li></ul>
  18. 18. References <ul><li>Unclassified Personnel Guideline Chapter 10: http://www.uwsa.edu/hr/upgs/upg10rev_oct7_2005.pdf </li></ul><ul><li>Balancing Family and Work: UW-Madison Leave Related Policies for Faculty, Academic Staff, and Limited Appointees: http://www.ohr.wisc.edu/polproced/FamilyLeaveBrochure_10-05.doc </li></ul><ul><li>Information on Sick Leave Reduction for Failure to Turn in Leave Statements: http://www.bussvc.wisc.edu/ecbs/ucla-changes-implementation-msn.pdf </li></ul>
  19. 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 [email_address] Updated 7/2008

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