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.usLisaw@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.usMembardi@dbm.state.md.us Lisa Waskiewicz, Coordinator, Leave Bank Phone: 410-767-1697 Email: Lisaw@dbm.state.md.us Lisaw@dbm.state.md.us Camilla Starkey, Administrative Specialist Phone: 410-767-4627 Email: Cstarkey@dbm.state.md.us