Leave Bank

1. Leave Bank

2. Submitting a Leave Bank Request • Provide Employee with a Leave Bank Information Packet which includes: • Leave Bank Fact Sheet • Leave Bank Request Form (MS 408) • Medical Request Form (MS 402) • HIPAA Form • Examples of Medical Documentation

3. Submitting a Leave Bank Request Leave Bank Request Form – Recent Revisions: • Divided into sections • Employee completes Section 1 • Leave Bank Coordinator completes Section 2 • Appointing Authority/Designee completes Section 3

4. Submitting a Leave Bank Request • Leave Bank Request Form – Section 2: • Last Day Worked: last day employee actually worked • Employee Needs – number of hours employee needs after all accrued leave is used minus any annual and sick leave employee earns during absence

5. Submitting a Leave Bank Request • Leave Bank Request Form - Section 2: • Can Agency accommodate a modified duty assignment? • Is employee on FMLA? • Has employee been placed on one-day sick leave restriction within the last two years?

6. Submitting a Leave Bank Request • Leave Bank Request Form - Section 2: • Has employee received disciplinary action within the last year? • What is employee’s last performance rating? • Is absence due to on-the-job injury?

7. Submitting a Leave Bank Request • Medical Request Form – Recent Revisions: • Date of Surgery • Date of Hospitalization • Additional space for modified duty information

8. Medical Documentation • 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.

9. 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

10. Submitting a Leave Bank Request Leave Bank Requests can be submitted via fax, email or regular mail: • Fax: 410-333-5440 • EMAIL: Lisaw@dbm.state.md.us • Address: • Department of Budget and Management • 301 West Preston Street, Room 508 • Baltimore, MD 21201

11. Processing a Leave Bank Request • All requests must meet these Administrative requirements: • 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

12. Processing a Leave Bank Request • If Fully Approved – only Agency is notified • If Partially Approved or Denied – Agency and employee are notified. Employee is notified of appeal rights and sent appeal forms

13. Processing a Leave Bank Request • 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 • It is unlikely employee will return to work

14. Membership Membership is for two years: • Join within first 60 days of employment The first time employee joins Leave Bank, employee must wait 90-days before requesting leave

15. Membership • Join during Health Benefits/Leave Bank “Open Enrollment” period: • Membership begins July 1 and expires June 30 two years later Example: July 1, 2011 – June 30, 2013

16. Membership • 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

17. Membership • 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 • Renewal: check if employee is renewing membership • Reinstatement: check if employee is “Reinstated to State Service”

18. Contact Information: • Margaret Embardino, Director, Employee Medical Services Phone: 410-767-4483 Email:Membardi@dbm.state.md.us • Lisa Waskiewicz, Coordinator, Leave Bank Phone: 410-767-1697 Email: Lisaw@dbm.state.md.us • Camilla Starkey, Administrative Specialist Phone: 410-767-4627 Email: Cstarkey@dbm.state.md.us