The changes to the billing for mental health skill building services is concerning due to the rural area that we live in and limited mental health resources in our area.  There are few providers in the area that accept medicaid, both medical and psychiatric, so many of our clients are having to seek out providers outside of their immediate community in order to meet their physical and mental health needs.  Many of our clients also need support in these appointments, either to have advocacy or help understanding recommendations or directives from their physicians.  However, with the more recent need for our clients to travel outside of their communities to find the health care they need and deserve, the travel time to these appointments have lengthened significantly.  In order for our clients to get the support they deserve and seek our services for, the length of sessions and billable units should remain the same.  I believe that  changing the amount of billable units to only 2 units per session would deminish the ability for clinicians to meet for the amount of time it would take to travel to and accompany the client in the appointment.  This would then affect the clinicians ability to provide some of the many the services that our clients seek us out for and deserve: advocacy, support, education, and training with managing and maintaining their mental and physical health.