Leave Bank Submitting a Leave Bank Request l
Leave Bank
Submitting a Leave Bank Request l Provide Employee with a Leave Bank Information Packet which includes: Leave Bank Fact Sheet l Leave Bank Request Form (MS 408) l Medical Request Form (MS 402) l HIPAA Form l Examples of Medical Documentation l
Submitting a Leave Bank Request Form – Recent Revisions: l Divided into sections l Employee completes Section 1 l Leave Bank Coordinator completes Section 2 l Appointing Authority/Designee completes Section 3
Submitting a Leave Bank Request l Leave Bank Request Form – Section 2: Last Day Worked: last day employee actually worked l Employee Needs – number of hours employee needs after all accrued leave is used minus any annual and sick leave employee earns during absence l
Submitting a Leave Bank Request l Leave Bank Request Form - Section 2: Can Agency accommodate a modified duty assignment? l Is employee on FMLA? l Has employee been placed on one-day sick leave restriction within the last two years? l
Submitting a Leave Bank Request l Leave Bank Request Form - Section 2: Has employee received disciplinary action within the last year? l What is employee’s last performance rating? l Is absence due to on-the-job injury? l
Submitting a Leave Bank Request l Medical Request Form – Recent Revisions: Date of Surgery l Date of Hospitalization l Additional space for modified duty information l
Medical Documentation l Recent Revisions: We are encouraging employees to submit detailed medical information with the initial request (rather than during appeal process) In the past two years, 60% of Leave Bank Requests that were denied initially were approved on appeal because the employee provided more detailed medical documentation.
Submitting Medical Documentation Recent Revisions: Employee may submit detailed medical records to the agency or directly to DBM If employee sends records to DBM, s/he must still submit Leave Bank Request Form & Medical Request form to the Agency
Submitting a Leave Bank Requests can be submitted via fax, email or regular mail: l Fax: 410 -333 -5440 l EMAIL: Lisaw@dbm. state. md. us l Address: l Department of Budget and Management l 301 West Preston Street, Room 508 l Baltimore, MD 21201
Processing a Leave Bank Request l All requests must meet these Administrative requirements: l l Employee must have current Leave Bank membership Employee must not have been placed on one-day sick slip restriction within the last 2 calendar years Employee must not have received disciplinary action within the last year Employee must have at least “Satisfactory” rating on most recent Performance Evaluation
Processing a Leave Bank Request l If Fully Approved – only Agency is notified l If Partially Approved or Denied – Agency and employee are notified. Employee is notified of appeal rights and sent appeal forms
Processing a Leave Bank Request l If the request is denied for medical reasons, it was reviewed by State Medical Director and is denied because: Insufficient Medical Documentation was submitted to support request or l It is unlikely employee will return to work l
Membership is for two years: l Join within first 60 days of employment The first time employee joins Leave Bank, employee must wait 90 -days before requesting leave
Membership l Join during Health Benefits/Leave Bank “Open Enrollment” period: l Membership begins July 1 and expires June 30 two years later Example: July 1, 2011 – June 30, 2013
Membership l Join - by Forfeiting Leave: If employee forfeits 8 or more hours of annual and/or personal leave at end of calendar year, employee becomes Leave Bank member Example: January 12, 2011 – January 11, 2013
Membership l To join/re-enroll Leave Bank, employee must complete Leave Bank Donation Form (MS-401): Initial: check if employee is joining for the first time l Renewal: check if employee is renewing membership l Reinstatement: check if employee is “Reinstated to State Service” l
Contact Information: l Margaret Embardino, Director, Employee Medical Services Phone: 410 -767 -4483 Email: Membardi@dbm. state. md. us l Lisa Waskiewicz, Coordinator, Leave Bank Phone: 410 -767 -1697 Email: Lisaw@dbm. state. md. us l Camilla Starkey, Administrative Specialist Phone: 410 -767 -4627 Email: Cstarkey@dbm. state. md. us
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