While there is not a CCC Plus Recipient Manual, I am left to rely on the Provider manual. The following are concerns that I have, as a Employer of Record and my daughter as the Recipient of the CCC Plus Waiver that are not addressed in the Provider Manual:

1. As a recipient, I would like to receive Explanations of Benefits, (EOB’s). If Medicaid fraud is a concern to DMAS, a good checks and balance system would include EOB’s so recipients can see what they are being billed for and what is being covered. An article that ran on the front page of The Virginian Pilot on 11/9/2019 reported that a local OB-GYN was being investigated by the Feds for health care fraud for performing surgeries on female patients without their consent. Many of his patients had Medicaid therefore did not ever receive an EOB. One particular patient tried for years to have children and eventually sought fertility treatment. Through the fertility specialist visit, she learned that her doctor had tied her tubes without her consent, nor even her knowledge. I wonder if all of the women that he performed unnecessary and life-altering surgeries on had received EOB’s, if he would have been caught sooner.
2. As a recipient, I am grateful that $5000 is granted annually for Environmental Modifications. However, I would like to suggest this be revisited as it is next to useless for me as a paraplegic recipient.  For me to be more independent in my home, I need larger-scale contract work done. For example, in my 2 story home, my bathroom is upstairs and to pull out the tub and put in a wheelchair accessible shower, that fee is over and above the annual $5000. There is a half bathroom downstairs, but to add in a wheelchair accessible shower, would be above and beyond the currently allowed $5000. Additionally, I would benefit from a minor kitchen renovation including a kitchen counter that I could roll up to and safely access a stove. Currently, I cannot cook as I cannot reach the stove top knobs nor can I see from my wheelchair what would be inside of a pot. Such a renovation in my kitchen is over and above the current annual $5000 allowance.  I would like to suggest that an either\or option be included with EM. Perhaps every 5 years, recipients can be eligible for a $25,000 EM.  That way, I could pool they annual allowance and eventually be able to make modifications to my home to make it safer and more accessible for me. Currently, with the annual $5000, there isn’t much that I can do. This year, I was only able to widen a door. While I am grateful for the annual amount, as it is better than nothing, however, it really isn’t a drop in the bucket for what my environmental needs are.
3. We are on the HIPP program therefore we are exempt from the MCO. Because we do not have a case manager, I feel like I am left floundering in many instances. For example, when I needed some Adaptive Technology, I did not know how to navigate the process. I asked my Service Facilitator however they stated their job only encompasses the Consumer-Directed portion of the CCC Plus Waiver. So I was left to my own. I contacted a few of my doctors and while they did the best they could in suggesting routes to try, there wasn’t a definite policy and procedure manual for us to follow. Additionally, when I knew that I wanted a contractor to look at my bathroom for a possible environmental modification, there wasn’t anything in print for me, the recipient, on how to access the appropriate people who could assist me in getting that ball rolling. A CCC Plus Waiver Manual would have been helpful.  This would also put all recipients on a level playing field, whether they have a case manager with an MCO or not.
4. As far as the Environmental Modifications and the Assistive Tech as mentioned above, after a few months of fumbling and bumbling and hitting many dead ends, we happened upon Ability Unlimited. They seemed like the answer to all of what we needed, and they boasted that they could do it within a matter of a few weeks. That was in the spring of 2018. They have dragged their feet, we have followed up time and time again however to date, we still do not have in place what they said would take “a few weeks”…it has been 18 months! So while we may have an annual $5000 limit for various benefits, that’s not a reality when the vendors drag their feet and take over a year to process and get all of the paperwork and resources in order. If a CCC Plus Waiver Manual existed, with specific policies and procedures printed and in place for each of the advertised benefits, a recipient would be able to advocate better for themselves. I would have liked to “fire” Ability Unlimited however not knowing any other vendors who had the qualifications that DMAS required, I felt stuck and locked into this one vendor. Still, after 18 months of waiting, I still do not know who else to approach.