Before discussing the study implications, the limitations of this study must be acknowledged. First, this report encompasses the perspectives of key stakeholders in five states. While the states were selected because of their historical experience with PD-LTSS, managed care, or both, the experiences of these states may not be generalizable. Second, neither time nor resources permitted interviews with all MCOs operating PD-MLTSS programs in the five states. Thus, the MCO perspectives presented above should not be seen as reflective of all MCOs in that state.
A final limitation is the paucity of participant perspectives on PD-MLTSS in the sections above. Again, given the time and available resources, a research design decision to capture the participant perspective via interviews with advocacy groups was made. While these interviews provided some general insights regarding PD-LTSS, their overall utility for understanding how MLTSS impacts the participant's experience was limited. While the study includes four participant perspectives, only two are from our five states (New Mexico and Texas) and cannot be seen as being representative of participants in those states or of participants in general. Despite its limitations, the study has identified both promising practices and areas of concern in PD-MLTSS that are discussed in the implications section below.