Certification of Medical Necessity

1
Certification of Medical Necessity

• Sick Leave Use
• Unclassified Personnel
• Guideline 10.04(c)

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 has this requirement been added?

• To respond to public concern that was raised
  regarding the potential sick leave abuses of UW
  unclassified staff.
• To insure compliance with UWS 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.

4
What Options were Considered?

• BOR considered three options
• Provide authority to request medical
  certification regardless of the length of time of
  the absence
• Establish requirement to request medical
  certification if absence is more than 10
  consecutive work days
• Establish requirement to request medical
  certification if absence is more than 5
  consecutive work days
• Why was a more than 5 consecutive full work day
  requirement established?
• 5-day trigger option was chosen because it is a
  common practice in the private sector and, based
  on feedback, had institutional support.

5
Requesting Medical Certification

• Employees must be provided at least 15 days to
  secure their health care providers 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.
• If an employee anticipates using more than 5 days
  of sick leave, for example under the Family
  Medical Leave Act, medical certification may be
  submitted prior to the actual leave.

6
What should Medical Certification include and not
include?

• Should include Health Care Provider statement
  that absence from work is justified based on
  medical necessity.
• Should include specific time period for which an
  absence is medically necessary. At the minimum,
  a specific start date and an anticipated return
  to work date.
• Should not include any confidential medical
  information

7
Why is UPG 10.04(c) important?

• 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 may be waived providing the
  UWS meets certain policy and reporting
  requirements.
• Monthly reporting of sick leave usage is
  required by state law as
  a condition for the waiver of the
  cap.
• Compliance with UWS sick leave policies will
  help to insure the continued availability of the
  waiver on the sick leave cap.

8
Examples

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

9
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.

10
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.

11
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 on Day 6 above, which
  is more than 5 consecutive full working days.
• Remember The requirement states 5 consecutive
  full working days, not consecutive calendar days.

12
What if a Staff Member fails to submit a Medical
Certification after 15 Days?

• If a staff member fails to submit a Medical
  Certification as prescribed in UPG 10.04 (c)
  the period of the sick leave should be charged to
  Leave without Pay as an unexcused absence.

13
UW-L Procedure for Certification of Medical
Necessity

• Certification of Medical Necessity for suspected
  abuse of sick leave may be required after
  consultation with dean/division officer and HR

14
Requirements at UW-L

• Certification of Medical Necessity provided to
  supervisor to sign, date, deliver to
  dean/division officer immediately
• dean/division officer signs, dates, delivers to
  HR immediately
• HR reviews, audits the Certification of Medical
  Necessity with leave report records
• HR maintains Certification of Medical Necessity
  separately

15
Employee is responsible for . . .

• Knowing complying with guidelines
• Timely accurate monthly leave reporting
• Getting Certification of Medical Necessity from
  their health care provider
• Providing the Certification of Medical Necessity
  to their supervisor within the allotted time
  frame

16
Direct supervisor responsible for . . .

• Establishing maintaining record of employees
  schedules for leave purposes in consultation with
  dean/division officer
• Assumed to be 745 a.m. to 430 p.m.
  Monday-Friday for 100 appointments
• Consulting with dean/division officer HR as
  appropriate
• Reviewing, verifying accuracy of leave reports
  prior to signing
• Tracking the sick leave usage for the more than 5
  day rule
• Requesting Certification of Medical Necessity
  ensuring it is obtained routed
• Contacting dean/division officer HR for
  assistance if the Certification of Medical
  Necessity is not provided by the employee within
  in the timeline

17
Dean or Division Officer is responsible for . .

• Approving schedules with supervisor
• Reviewing, signing and delivering Certification
  of Medical Necessity to HR
• Consulting with HR as appropriate
• Consulting assisting supervisor, with HR

18
HR Staff are responsible for . . .

• Assisting employees, supervisors, and
  dean/division officers in understanding and
  complying with this Board of Regents policy and
  the guidelines
• Providing information on the guideline and UW-L
  procedures to the campus as appropriateat least
  each semester
• Liaison to UWSA maintaining current knowledge
• Auditing campus compliance, following up as
  needed
• Retaining Certification of Medical Necessity
  centrally

19
Use UW-L Certification of Medical Necessity Form

• Employee section
• Health Care Provider Section
• Supervisor, Dean/Division Officer Section

20
UW-La Crosse Certification of Medical Necessity1
1 Unclassified employees of UW-L are required
to provide certification of medical necessity for
sick leave absences of more than 5 consecutive
working days, within 15 days of their return to
work. Contact UW-L HR for complete explanation
of the policy and exceptions. Phone 608
785-8013
21
UW-La Crosse Certification of Medical Necessity1
1 Unclassified employees of UW-L are required
to provide certification of medical necessity for
sick leave absences of more than 5 consecutive
working days, within 15 days of their return to
work. Contact UW-L HR for complete explanation
of the policy and exceptions. Phone 608
785-8013
22
UW-La Crosse Certification of Medical Necessity1
1 Unclassified employees of UW-L are required
to provide certification of medical necessity for
sick leave absences of more than 5 consecutive
working days, within 15 days of their return to
work. Contact UW-L HR for complete explanation
of the policy and exceptions. Phone 608
785-8013
23
Questions?

• Contact UW-L Human Resource Staff
• Call 785-8013