In its examination of how MLTSS programs have implemented participant direction in these five states, NRCPDS researchers collected information from both primary and secondary sources. To get a better sense of state expectations and the basic operating parameters of PD-MLTSS, NRCPDS staff reviewed each study state's waiver application and existing contracts with MCOs to provide PD-MLTSS.14 The contract review informed the final development of the key informant interview guides.
NRCPDS staff conducted interviews in each state with representatives of five key stakeholder groups. The stakeholders included state program staff who oversaw the PD-MLTSS program, administrators and service coordinators from MCOs providing PD-MLTSS in the study state, Financial Management Service (FMS) agency administrators providing FMS services in the study state, and advocacy groups in each state. A complete list of stakeholders that participated in this study is listed in Appendix A, Stakeholder Organizations by State. The key informant interviews took place between May and July 2013. The majority of interviews were conducted via recorded phone calls that included the representative key informant (in some cases, two representatives) and two NRCPDS staff members. One NRCPDS staff member would guide the interview while the other would take notes. The interview notes were compared with the interview recording for accuracy. The written interview notes were then sent to the key informant(s) for review and accuracy.
In addition, NRCPDS staff conducted two in-person site visits in Massachusetts and Texas. Previously (as a part of its internal professional development process) NRCPDS staff had made site visits to Arizona, Texas, and Tennessee to learn more about PD-MLTSS operations in those states. Similar to the telephone interview procedure, two NRCPDS staff members conducted the visits. One NRCPDS staff member would guide the interview while the other would take notes. The written interview notes were then sent to the key informant(s) for review and accuracy.
After interviewing participant advocacy groups in the five study states, the NRCPDS felt that the majority of the interviewees lacked specific knowledge or personal involvement with PD-MLTSS, or in some cases, were direct service providers rather than "advocates." In order to ensure the participant advocacy voice was included in this study, the NRCPDS queried the National Participant Network (NPN), a national advocacy organization for participant-directing individuals, regarding their experiences with PD-MLTSS programs. The questions used in the query of NPN members were taken from the participant advocacy group key informant interview guide. Ninety-three members were contacted but only four (n=4) responded within the time allotted. These four responses are incorporated in the Participant Perspectives on PD-MLTSS section below.