Overview for Healthcare Providers
Healthcare providers will play a critical role in certifying the eligibility of patients who opt to use paid family and medical leave benefits. The process healthcare providers will use to certify patient claims for Paid Family and Medical Leave is similar to FMLA. It is the patient's responsibility to get the paperwork filled out, and their application is not considered complete if they do not have the certification for qualifying types of leave.
A healthcare provider is someone licensed to practice medicine or surgery in the country or state where they practice. It includes (but is not limited to):
- Physicians and osteopathic physicians
- Nurse practitioners
- Physician assistants
- Nurse-midwives and midwives
- Clinical social workers
- Clinical psychologists
- Physical therapists
Most people employed in Washington who work 820 hours or more in the qualifying period, which is the first four of the last five completed calendar quarters before they plan to take leave, will qualify. There are some exceptions (federal employees, for example), but many of your working patients will likely qualify.
To use their benefits, they must experience a qualifying event. Leave events can be either Family or Medical.
- Care and bond after a baby’s birth or the placement of a child younger than 18
- Care for a family member experiencing an illness or medical event
- Certain military-connected events
- Care for yourself in relation to an illness or medical event
A “serious health condition” is defined in RCW 50A.05.010.
Generally, a serious health condition could include an illness, injury, impairment, or physical or mental condition that involves:
- Inpatient care in a hospital, hospice, or residential medical care facility, including any period of incapacity; or
- Continuing treatment by a health care provider. A serious health condition involving continuing treatment by a health care provider includes any one or more of the following:
- A period of incapacity of more than three consecutive days and subsequent treatment or period of incapacity relating to the same condition.
- Any period of incapacity due to pregnancy, or for prenatal care;
- Any period of incapacity or treatment for such incapacity due to a chronic serious health condition. A chronic serious health condition is one which:
- Requires periodic visits to a health care provider
- Continues over an extended period of time, including recurring episodes of a single underlying condition; and
- May cause episodic rather than a continuing period of incapacity, including asthma, diabetes, and epilepsy;
- A period of incapacity which is permanent or long term due to a condition for which treatment may not be effective. The employee or family member must be under the continuing supervision of, but need not be receiving active treatment by, a health care provider, including Alzheimer's, a severe stroke, or the terminal stages of a disease; or
- Any period of absence to receive multiple treatments, including any period of recovery from the treatments
- Substance abuse may be a serious health condition if the treatment meets other requirements in this definition.