I 

118TH CONGRESS 

1ST SESSION H. R. 6534 

To establish a home-based telemental health care demonstration program 

for purposes of increasing mental health and substance use services 

in rural medically underserved populations and for individuals in farming, 

fishing, and forestry occupations. 

IN THE HOUSE OF REPRESENTATIVES 

NOVEMBER 30, 2023 

Ms. SALINAS (for herself and Mrs. HARSHBARGER) introduced the following 

bill; which was referred to the Committee on Energy and Commerce 

A BILL 

To establish a home-based telemental health care demonstration program for purposes of increasing mental health 

and substance use services in rural medically underserved 

populations and for individuals in farming, fishing, and 

forestry occupations. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Home-Based Tele5 mental Health Care Act of 2023’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds as follows: 


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1 (1) According to a 2020 report by the Centers 

2 for Disease Control and Prevention, titled ‘‘Mental 

3 Health, Substance Use and Suicidal Ideation during 

4 the COVID–19 Pandemic’’ (referred to in this sec5 tion as the ‘‘CDC report’’), elevated levels of adverse 

6 mental health conditions, substance use, and suicidal 

7 ideation were reported by adults in the United 

8 States in June 2020, after the onset of the COVID– 

9 19 pandemic. The prevalence of symptoms of anxiety 

10 disorder was 25.5 percent, compared to 8.1 percent 

11 in the second quarter of 2019. Additionally, 24.3 

12 percent of adults experienced depressive symptoms 

13 in June 2020, 4 times the 6.5 percent reported in 

14 the second quarter of 2019. 

15 (2) According to the CDC report, approximately 

16 30 percent of rural adults who responded to a survey 

17 of the Centers for Disease Control and Prevention 

18 suffered from symptoms of anxiety or depression, 

19 and approximately 10 percent of rural adults seri20 ously considered suicide in the past 30 days. 

21 (3) A 2020 study by the Centers for Disease 

22 Control and Prevention suggests that people in 

23 farming, fishing, and forestry occupations (referred 

24 to in this section as the ‘‘Triple–F’’ industry) in the 


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1 United States experienced rates of 31.4 suicides per 

2 100,000 people in 2016. 

3 (4) Such 2020 study by the Centers for Disease 

4 Control and Prevention indicates that suicide rates 

5 for farmers, ranchers, and other agricultural man6 agers were 58 percent higher than the rate for the 

7 general population in 2016. 

8 (5) According to a 2019 report of the National 

9 Survey on Drug Use and Health, 22.4 percent of 

10 residents in rural communities aged 18 or older who 

11 experienced mental illness perceived an unmet need 

12 for mental health services. Of these individuals, 17.9 

13 percent did not receive any mental health services in 

14 the prior year. 

15 (6) The COVID–19 pandemic put additional 

16 stress on people in the Triple–F population. In the 

17 early stages, the pandemic caused instability in the 

18 markets, especially as the virus caused a downturn 

19 in food service sales and closed meat processing 

20 plants across the Nation. Farmers were left with low 

21 commodity prices and loss of revenue. This commu22 nity has spent the last 2 years attempting to re23 bound from the effects of the pandemic. Additional 

24 resources are needed to support the mental health 

25 needs of this population. 


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1 (7) While the prevalence of mental illness is 

2 similar among rural and urban residents, the serv3 ices available to each population are very different. 

4 Mental health care needs are not met in rural com5 munities due to many challenges, including accessi6 bility issues due to transportation and geographic 

7 isolation, the stigma of needing or receiving mental 

8 health care, a lack of anonymity when seeking treat9 ment, shortages of mental health workforce profes10 sionals, and affordability due to a high rate of unin11 sured residents. 

12 (8) Telemental health, which is the delivery of 

13 mental health services using remote technologies 

14 when the patient and provider are separated by dis15 tance, shows promise in helping to alleviate the lack 

16 of mental health services in rural areas. Traditional 

17 telemental health models involve care delivered to a 

18 patient at an originating clinical site from a spe19 cialist working at a distant site. Having the ability 

20 to reach mental health professionals from a place of 

21 comfort, such as home, from a personal device may 

22 reduce challenges faced in rural areas and amongst 

23 Triple–F workers. 

24 (9) A clinical trial of 241 depressed elderly vet25 erans, which was conducted by the Medical UniverVerDate Sep 11 2014 07:26 Dec 07, 2023 Jkt 049200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H6534.IH H6534

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1 sity of South Carolina and the Ralph H. Johnson 

2 Veterans Affairs Medical Center and reported in the 

3 Journal of Clinical Psychiatry, found that home4 based telemental health for depression is well re5 ceived by patients and delivers as good a quality of 

6 life as in-person visits. 

7 SEC. 3. MENTAL HEALTH AND SUBSTANCE USE SERVICES 

8 DELIVERED TO RURAL UNDERSERVED POPU9 LATIONS VIA TELEMENTAL HEALTH CARE. 

10 Title III of the Public Health Service Act is amended 

11 by inserting after section 330K (42 U.S.C. 254c–16) the 

12 following: 

13 ‘‘SEC. 330K–1. MENTAL HEALTH AND SUBSTANCE USE SERV14 ICES DELIVERED TO RURAL UNDERSERVED 

15 POPULATIONS VIA TELEMENTAL HEALTH 

16 CARE. 

17 ‘‘(a) DEFINITIONS.—In this section— 

18 ‘‘(1) the term ‘covered populations’ means— 

19 ‘‘(A) health professional shortage areas (as 

20 defined in section 332(a)(1)) in rural areas; or 

21 ‘‘(B) populations engaged in a farming, 

22 fishing, or forestry industry; 

23 ‘‘(2) the term ‘eligible entity’ means a public or 

24 nonprofit private telemental health provider network 

25 that offers services that include mental health and 


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1 substance use services provided by professionals 

2 trained in mental health and substance use; 

3 ‘‘(3) the term ‘farming, fishing, or forestry in4 dustry’ means an occupation defined as a farming, 

5 fishing, or forestry occupation by the Department of 

6 Labor in accordance with the Standard Occupational 

7 Classification System; 

8 ‘‘(4) the term ‘home-based telemental’ means 

9 the use of telemental health services where the pa10 tient is in his or her own home or other place of 

11 comfort; 

12 ‘‘(5) the term ‘professional trained in mental 

13 health’ means a psychiatrist, a qualified mental 

14 health professional (as defined in section 330K), or 

15 another mental health professional acting under the 

16 direction of a psychiatrist; 

17 ‘‘(6) the term ‘rural’ has the meaning given 

18 such term by the Office of Rural Health Policy of 

19 the Health Resources and Services Administration; 

20 and 

21 ‘‘(7) the term ‘telemental health’ means the use 

22 of electronic information and telecommunications 

23 technologies to support long distance clinical health 

24 care, patient and professional health-related edu25 cation, public health, and health administration. 


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1 ‘‘(b) PROGRAM AUTHORIZED.—The Secretary, in 

2 consultation with the Rural Health Liaison of the Depart3 ment of Agriculture, shall award grants to eligible entities 

4 to establish demonstration projects for the provision of 

5 mental health and substance use services to covered popu6 lations in their homes, as delivered remotely by profes7 sionals trained in mental health and substance use using 

8 telemental health care. 

9 ‘‘(c) USE OF FUNDS.—Recipients of a grant under 

10 this section shall use the grant funds to— 

11 ‘‘(1) deliver home-based telemental health serv12 ices to covered populations; and 

13 ‘‘(2) develop comprehensive metrics to measure 

14 the quality and impact of home-based telemental 

15 health services compared to traditional in-person 

16 mental health and substance use care. 

17 ‘‘(d) REPORT.—The Secretary, in consultation with 

18 the Secretary of Agriculture, not later than 3 years after 

19 the date on which the program under this section com20 mences, and 2 years thereafter, shall submit to the appro21 priate congressional committees reports on the impact and 

22 quality of care of home-based telemental health care serv23 ices for covered populations. 

24 ‘‘(e) AUTHORIZED USE OF FUNDS.—Out of any 

25 amounts made available to the Secretary, up to 


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1 $10,000,000 for each of fiscal years 2024 through 2028 

2 may be allocated to carrying out the program under this 

3 section.’’. 

Æ 


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