Reasons for AAP changes were recoded into four categories of rate changes: (1) basic care, (2) basic and special care, (3) special care, and (4) residential care, which account for 98 percent of all rate changes.
We examined reasons for payment change during each payment change. The percentage of AAP recipients needing special care and residential care changes consistently increased from the first payment change to the fifth payment change. These data suggest it is unusual for children to have high payment changes ($500 or more) as their first payment change. Most children entering residential care do so after several payment changes requested by families to help them provide services to their children. This makes the provision of residential care seem somewhat less costly than it would be if this was a common first payment change.