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 demonstra-
tion 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Home-Based Tele-
mental Health Care Act of 2023’’. 
SEC. 2. FINDINGS. 
Congress finds as follows: 
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(1) According to a 2020 report by the Centers 
for Disease Control and Prevention, titled ‘‘Mental 
Health, Substance Use and Suicidal Ideation during 
the COVID–19 Pandemic’’ (referred to in this sec-
tion as the ‘‘CDC report’’), elevated levels of adverse 
mental health conditions, substance use, and suicidal 
ideation were reported by adults in the United 
States in June 2020, after the onset of the COVID– 
19 pandemic. The prevalence of symptoms of anxiety 
disorder was 25.5 percent, compared to 8.1 percent 
in the second quarter of 2019. Additionally, 24.3 
percent of adults experienced depressive symptoms 
in June 2020, 4 times the 6.5 percent reported in 
the second quarter of 2019. 
(2) According to the CDC report, approximately 
30 percent of rural adults who responded to a survey 
of the Centers for Disease Control and Prevention 
suffered from symptoms of anxiety or depression, 
and approximately 10 percent of rural adults seri-
ously considered suicide in the past 30 days. 
(3) A 2020 study by the Centers for Disease 
Control and Prevention suggests that people in 
farming, fishing, and forestry occupations (referred 
to in this section as the ‘‘Triple–F’’ industry) in the 
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United States experienced rates of 31.4 suicides per 
100,000 people in 2016. 
(4) Such 2020 study by the Centers for Disease 
Control and Prevention indicates that suicide rates 
for farmers, ranchers, and other agricultural man-
agers were 58 percent higher than the rate for the 
general population in 2016. 
(5) According to a 2019 report of the National 
Survey on Drug Use and Health, 22.4 percent of 
residents in rural communities aged 18 or older who 
experienced mental illness perceived an unmet need 
for mental health services. Of these individuals, 17.9 
percent did not receive any mental health services in 
the prior year. 
(6) The COVID–19 pandemic put additional 
stress on people in the Triple–F population. In the 
early stages, the pandemic caused instability in the 
markets, especially as the virus caused a downturn 
in food service sales and closed meat processing 
plants across the Nation. Farmers were left with low 
commodity prices and loss of revenue. This commu-
nity has spent the last 2 years attempting to re-
bound from the effects of the pandemic. Additional 
resources are needed to support the mental health 
needs of this population. 
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(7) While the prevalence of mental illness is 
similar among rural and urban residents, the serv-
ices available to each population are very different. 
Mental health care needs are not met in rural com-
munities due to many challenges, including accessi-
bility issues due to transportation and geographic 
isolation, the stigma of needing or receiving mental 
health care, a lack of anonymity when seeking treat-
ment, shortages of mental health workforce profes-
sionals, and affordability due to a high rate of unin-
sured residents. 
(8) Telemental health, which is the delivery of 
mental health services using remote technologies 
when the patient and provider are separated by dis-
tance, shows promise in helping to alleviate the lack 
of mental health services in rural areas. Traditional 
telemental health models involve care delivered to a 
patient at an originating clinical site from a spe-
cialist working at a distant site. Having the ability 
to reach mental health professionals from a place of 
comfort, such as home, from a personal device may 
reduce challenges faced in rural areas and amongst 
Triple–F workers. 
(9) A clinical trial of 241 depressed elderly vet-
erans, which was conducted by the Medical Univer-
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sity of South Carolina and the Ralph H. Johnson 
Veterans Affairs Medical Center and reported in the 
Journal of Clinical Psychiatry, found that home- 
based telemental health for depression is well re-
ceived by patients and delivers as good a quality of 
life as in-person visits. 
SEC. 3. MENTAL HEALTH AND SUBSTANCE USE SERVICES 
DELIVERED TO RURAL UNDERSERVED POPU-
LATIONS VIA TELEMENTAL HEALTH CARE. 
Title III of the Public Health Service Act is amended 
by inserting after section 330K (42 U.S.C. 254c–16) the 
following: 
‘‘SEC. 330K–1. MENTAL HEALTH AND SUBSTANCE USE SERV-
ICES DELIVERED TO RURAL UNDERSERVED 
POPULATIONS 
VIA 
TELEMENTAL 
HEALTH 
CARE. 
‘‘(a) DEFINITIONS.—In this section— 
‘‘(1) the term ‘covered populations’ means— 
‘‘(A) health professional shortage areas (as 
defined in section 332(a)(1)) in rural areas; or 
‘‘(B) populations engaged in a farming, 
fishing, or forestry industry; 
‘‘(2) the term ‘eligible entity’ means a public or 
nonprofit private telemental health provider network 
that offers services that include mental health and 
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substance use services provided by professionals 
trained in mental health and substance use; 
‘‘(3) the term ‘farming, fishing, or forestry in-
dustry’ means an occupation defined as a farming, 
fishing, or forestry occupation by the Department of 
Labor in accordance with the Standard Occupational 
Classification System; 
‘‘(4) the term ‘home-based telemental’ means 
the use of telemental health services where the pa-
tient is in his or her own home or other place of 
comfort; 
‘‘(5) the term ‘professional trained in mental 
health’ means a psychiatrist, a qualified mental 
health professional (as defined in section 330K), or 
another mental health professional acting under the 
direction of a psychiatrist; 
‘‘(6) the term ‘rural’ has the meaning given 
such term by the Office of Rural Health Policy of 
the Health Resources and Services Administration; 
and 
‘‘(7) the term ‘telemental health’ means the use 
of electronic information and telecommunications 
technologies to support long distance clinical health 
care, patient and professional health-related edu-
cation, public health, and health administration. 
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