(a) Restrictions.
  (1) An employee or an employee's immediate family must have a catastrophic illness or injury to be eligible to withdraw from the pool. The patient's health care provider must certify in writing that the illness or injury of the employee or member of the employee's immediate family is catastrophic and that the catastrophic illness is the reason the employee needs to be out of work.
  (2) A written certification from a health care provider must be submitted with all requests for withdrawals. Requests related to severe psychological conditions must be certified by a licensed psychiatrist. The certification:
    (A) shall include:
      (i) the diagnosis and prognosis of the condition or combination of conditions;
      (ii) the date the employee or employee's immediate family member will be able to return to activities of daily living;
      (iii) the amount of time the employee will be needed to provide primary care if the certification is for the employee's immediate family member; and
      (iv) if the certification is for the employee's immediate family member, the specific type of care the employee needs to provide;
    (B) shall be in a form prescribed by the pool administrator; and
    (C) is confidential, unless otherwise required by law, and may only be released to the human resources officer.
  (3) With the request for withdrawal, an employee who has been formally disciplined for abuse of leave in the 12 months preceding the date on which the leave from the pool will be needed must provide, at his or her expense, a second health care provider certification from a different doctor chosen by the department. The pool administrator will deny the request if the second health care provider does not certify that a catastrophic condition exists.
  (4) The employee must submit an updated health care provider's certification that certifies that the catastrophic illness or injury still exists, and that it is necessary for the employee to be off work to recover or assist in the recovery from the catastrophic illness or injury before an extension may be approved.
  (5) An employee's use of a transfer from the sick leave pool for family members not residing in that employee's household is strictly limited to the time necessary to provide assistance to a spouse, child, or parent of the employee who needs such care and assistance as a direct result of a documented medical condition.
  (6) The maximum number of hours that may be granted per catastrophic condition per employee is 720 hours (90 work days) or one third of the pool balance, whichever is less at the time a request is received. If there is a different but related physical catastrophic condition, an employee may receive a second grant of up to 720 hours (90 work days) or one-third of the pool balance, whichever is less at the time the request is received.
  (7) When the pool balance is below 7200 hours, an employee may not be transferred more than 340 hours (approximately two months) per request, unless unpaid leave is incurred before the request is approved. If unpaid leave is incurred, the employee may not be transferred more than the sum of the unpaid leave and 340 hours. Additionally, the pool administrator will approve or deny all requests in the order in which they are received.
  (8) The time transferred will begin on the date and time the employee exhausted all paid leave or, in cases that are eligible for workers' compensation payments, after the period covered by the last workers' compensation check distributed.
  (9) An employee who uses pool sick leave in accordance with this subchapter is not required to pay back that leave.
  (10) An employee must exhaust all paid leave before using hours approved from the sick leave pool.
  (11) All withdrawals from the pool must be used solely for the catastrophic illness or injury for which they were granted.
  (12) An employee who is in need of additional sick leave after exhausting all paid leave shall exhaust all available extended sick leave before using time granted from the sick leave pool.
  (13) An employee who is injured on the job, who is entitled to receive workers' compensation payments, and who chooses to integrate his or her sick leave, and vacation leave, or compensatory time is also eligible to receive a withdrawal in accordance with this subchapter.
  (14) Hours from the sick leave pool may be granted in a block of time and used on an as needed basis. The pool administrator may require the unused hours to be returned to the pool after such time has expired unless an immediate need for such leave still exists.
  (15) The pool administrator may require the patient's condition to be recertified by a health care provider on a monthly basis. If the employee is determined to be able to return to work sooner than indicated on a previous certification, the pool administrator may require the unused portion of a withdrawal to be returned to the pool. If the employee fails to cooperate with recertification requirements and reevaluation procedures, the pool administrator may deny the request or require the unused portion of a withdrawal be returned to the sick leave pool.
  (16) Unused sick leave from the pool shall be returned to the pool when the need for such leave ceases to exist or the pool administrator requires it in accordance with this subchapter.
  (17) The estate of a deceased employee is not entitled to payment for unused sick leave from the pool.
(b) Procedures.
  (1) The employee shall complete a request form. The human resources officer shall assist the employee by verifying all paid leave balances and the date and time all paid leave was or will be exhausted.
  (2) The employee shall submit the request and the health care provider's certification form and a copy of the employee's functional job description to his or her health care provider no earlier than 15 workdays before the need for the withdrawal. The health care provider will complete the certification form and mail it, with the completed request, directly to the employee's human resources officer.
  (3) The pool administrator will consider requests in the order in which they are received and shall approve or deny the request within five working days of that date.
  (4) If the pool administrator questions the validity of the certification completed by the employee's health care provider, based on the average expected duration or severity of the condition, the administrator may request a health care provider, contracted by the department, to review the patient's medical records. The contracted health care provider may consult with the patient's health care provider if more information is needed. If the determination of the contracted health care provider differs from the patient's health care provider, the request may be denied. If necessary, the pool administrator may request that the patient's medical records be reviewed by a third health care provider who is not under contract with the department. The pool administrator and the employee must agree on the third health care provider. The determination of the third health care provider is binding. The department will pay for both reviews. If the employee fails to cooperate with the medical records review, the pool administrator may deny the request.
  (5) The pool administrator may require that the unused portion of the withdrawal be returned to the sick leave pool if the employee:
    (A) fails to cooperate with a medical records review;
    (B) submits false information;
    (C) remains off work because the employee is not following the doctor's prescribed treatment; or
    (D) is abusing sick leave pool hours.
  (6) The pool administrator will determine the amount of sick leave transferred for each request based on:
    (A) the number of hours requested by the employee;
    (B) the health care provider's certification which indicates the approximate date the patient will be able to return to light and normal duties or the amount of time that the employee is needed to provide primary care for the immediate family member;
    (C) the date and time all paid leave was or will be exhausted; and
    (D) the balance of the pool.
  (7) The pool administrator shall approve or deny the transfer of hours from the sick leave pool to the employee's personal sick leave account.
  (8) The human resources officer shall inform the pool administrator of the amount of leave the employee used for the illness or injury at the end of each month, and, if the employee has returned to work, the total number of hours used and how many hours are being returned.
  (9) The pool administrator shall return all unused hours to the pool.

Source Note: The provisions of this §4.56 adopted to be effective October 27, 1995, 20 TexReg 8479; amended to be effective March 22, 1996, 21 TexReg 2092; amended to be effective March 24, 1997, 22 TexReg 2637; amended to be effective November 22, 1998, 23 TexReg 11657; amended to be effective November 15, 2000, 25 TexReg 11294; amended to be effective September 16, 2004, 29 TexReg 8834; amended to be effective November 1, 2008, 33 TexReg 8546; amended to be effective January 6, 2016, 41 TexReg 292