There are several times when a client needs more time as there are significant needs that may take longer than five hours to address. For example, a client may come into services with no identified supports and require immediate linkage to various community resources to prevent a higher level of care in order to maintain safety or avoid hospitalization. Clients often times need assistance identifying the resources, navigating those resources, completing applications,etc. This would be difficult to accomplish in a 1 or 3 hour session, particularly for clients who live in areas with high volume of traffic or distance between location of home and services. A worker may also be working with a client through a 3-hour session and during the appointment, the client may be having difficulty with heightened symptoms and other safety concerns. In spite of the worker's attempts to de-escalate whatever situation has caused this, they determine the client should be assessed at the hospital. The worker persuades the client go with them to the emergency room which would cause the appointment to exceed 5 hours. Another example would be when a clinician assists a client to a new provider such as a psychiatrist or primary care physician. Many clients struggle with going to new providers due to heightened anxiety. The worker would go to the client’s home prior to the appointment to make sure the client is ready and makes it to the appointment. During the time prior to the appointment, the worker would be preparing the client for the appointment by role playing what the doctor may ask, reminding the client what questions they may have for the doctor and prompting the client to use coping skills to deal with their anxiety leading up to this appointment. During the appointment, the worker is an invaluable resource to the client, reminding the client of questions to ask, assisting them with new patient information, etc. Following the appointment, the worker may have to take the client to the pharmacy to fill or re-fill a prescription and then make sure that any prescriptions are understood, properly stored and/or placed in a medi-set box to insure proper times and dosages. This description does not include any wait time that may be required to see a doctor during which the worker would be assisting the client in managing their anxiety. In rural areas where resources are very limited, clients are required to travel long distances to receive services. For example, a person living in Danville, VA may need assistance attending their first psychiatry appointment. There are currently no psychiatrists accepting Medicaid reimbursement in the Danville area and clients must travel to Roanoke, almost 2 hours away in order to receive psychiatric services. It is easy to see how limiting the number of hours that a client may receive MHSS, could seriously limit their access to care, as it will not be feasible for providers to assist clients to their needed appointments. In addition to the examples above, this limit on daily reimbursement for services encourages seeing clients on a more frequent basis for shorter periods of time which may create more of a dependency on the service as opposed to the independence that is the goal of the service.