I 118th CONGRESS 1st Session H. R. 6534 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. Short title This Act may be cited as the Home-Based Telemental Health Care Act of 2023 . 2. Findings Congress finds as follows: (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 section 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 seriously 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 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 managers 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 community has spent the last 2 years attempting to rebound from the effects of the pandemic. Additional resources are needed to support the mental health needs of this population. (7) While the prevalence of mental illness is similar among rural and urban residents, the services available to each population are very different. Mental health care needs are not met in rural communities due to many challenges, including accessibility issues due to transportation and geographic isolation, the stigma of needing or receiving mental health care, a lack of anonymity when seeking treatment, shortages of mental health workforce professionals, and affordability due to a high rate of uninsured residents. (8) Telemental health, which is the delivery of mental health services using remote technologies when the patient and provider are separated by distance, 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 specialist 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 veterans, which was conducted by the Medical University 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 received by patients and delivers as good a quality of life as in-person visits. 3. Mental health and substance use services delivered to rural underserved populations 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: 330K–1. Mental health and substance use services 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 substance use services provided by professionals trained in mental health and substance use; (3) the term farming, fishing, or forestry industry 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 patient 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 education, public health, and health administration. (b) Program authorized The Secretary, in consultation with the Rural Health Liaison of the Department of Agriculture, shall award grants to eligible entities to establish demonstration projects for the provision of mental health and substance use services to covered populations in their homes, as delivered remotely by professionals trained in mental health and substance use using telemental health care. (c) Use of funds Recipients of a grant under this section shall use the grant funds to— (1) deliver home-based telemental health services to covered populations; and (2) develop comprehensive metrics to measure the quality and impact of home-based telemental health services compared to traditional in-person mental health and substance use care. (d) Report The Secretary, in consultation with the Secretary of Agriculture, not later than 3 years after the date on which the program under this section commences, and 2 years thereafter, shall submit to the appropriate congressional committees reports on the impact and quality of care of home-based telemental health care services for covered populations. (e) Authorized use of funds Out of any amounts made available to the Secretary, up to $10,000,000 for each of fiscal years 2024 through 2028 may be allocated to carrying out the program under this section. .