A bill to amend title XIX of the Social Security Act to include podiatrists as physicians for purposes of covering physicians services under the medicaid program.

Mr. President, I rise today to speak on an important issue that holds great meaning to me--the issue of youth suicide in our country.

Youth suicide is both a public and mental health tragedy--an acute crisis that knows no geographic, racial, ethnic, cultural, or socioeconomic boundaries. According to the Centers for Disease Control and Prevention (CDC), over 3,000 young people take their lives each year, making suicide the third overall cause of death between the ages of 10 and 24. Young people under the age of 25 accounted for 15 percent of all suicides completed in 2000. In fact, more children and young adults died from their own hand than from cancer, heart disease, AIDS, birth defects, stroke and chronic lung disease combined.

Equally alarming are the numbers of young people who consider taking or attempt to take their lives. Recent CDC figures estimate that almost three million high school students, or twenty percent of young adults between the ages of 15 and 19, consider suicide every year. And over two million children and young adults actually attempt suicide. I find these figures to be staggering and simply unacceptable.

And, sadly, we rarely find these facts disseminated widely amongst public audiences. We rarely read them in newspapers or hear them on television. We know that youth suicide is intricately linked to mental health issues like depression and substance abuse. Yet, we also know all too well that both youth suicide and children's mental health continue to carry an unfortunate stigma--a stigma that all too often keeps these crucial issues unspoken and discourages children and young adults from seeking the help they so desperately need.

We have a societal obligation to break through the stigma attached to youth suicide and children's mental health. We have an obligation to reach out to our young people--to help them understand that whatever difficulties or illnesses they might be experiencing are only temporary and treatable in a comfortable setting. And, most importantly, we have an obligation to instill in our young people a sense of value, self- worth, and resilience. All too often, children and young adults considering suicide lose sight of themselves, their talents, and their potential in life. All too often they lose sight of the love their families, friends, and communities have for them.

I am pleased that our Nation has already taken several positive steps toward better understanding the tragedy of youth suicide and its emotional and behavioral risk factors. Several recent reports like the President's New Freedom Commission on Mental Health, the National Strategy for Suicide Prevention, and the Surgeon General's Call to Action To Prevent Suicide have made youth suicide a top national public and mental health priority. Today, hundreds of community-based programs across the country offer a variety of early intervention and prevention services to thousands of children and young adults--services that include comprehensive screening, assessment, and individualized counseling. Nearly thirty states, including my home State of Connecticut, have developed or already implemented statewide youth suicide early intervention and prevention strategies that coordinate appropriate services in schools, juvenile justice systems, foster care systems, mental health programs, substance abuse programs, and other youth-oriented settings. Furthermore, the Federal Government has stepped up its role in both supporting these community-based activities and conducting relevant research and data collection. Several mental and public health agencies have shown a growing interest in youth suicide, including the Substance Abuse and Mental Health Services Administration, the Health Resources Services Administration, the Centers for Disease Control and Prevention, and the National Institute of Mental Health.

However, despite these important gains, we still face significant challenges. Today, a large number of states and localities are finding themselves with unprecedented budget deficits--making the establishment of new services and the retention of existing services increasingly more difficult. Statewide strategies are often underfunded or understaffed to be properly effective. And while a number of Federal agencies have supported youth suicide

activities, there has been no comprehensive inter-agency strategy implemented to share data, disseminate research, or evaluate the efficacy of youth suicide early intervention and prevention programs.

Today, I am introducing bipartisan legislation with my colleagues Senator DeWine and Senator Smith. The Youth Suicide Early Intervention and Prevention Act of 2004 will further support the good work being done on the community level, the State level, and the Federal level with regards to youth suicide. This legislation will support, through new grant initiatives, the further development and expansion of statewide youth suicide early intervention and prevention strategies and the community-based services they seek to coordinate. It will encourage greater Federal support in the planning, implementation, and evaluation of these strategies and services. And it will create a new inter-agency collaboration that will focus on research, policy development, and the dissemination of data specifically pertaining to youth suicide.

Finding concrete, comprehensive and effective remedies to the epidemic of youth suicide cannot be done by lawmakers on Capitol Hill alone. Those remedies must also come from individuals--doctors, psychiatrists, psychologists, counselors, nurses, teachers, advocates, survivors, and affected families--who are dedicated to this issue or spend each day with children and young adults that suffer from illnesses related to suicide. I feel that we have made an important first step with this legislation today. However, I also know that our work is not done. I hope that, as a society, we can continue working collectively to both better understand the tragedy of youth suicide and develop innovative and effective public and mental health initiatives that reach every child and young adult in this country--compassionate initiatives that give them encouragement, hope, and above all, life.

I ask unanimous consent that the text of the bill be printed in the Record.

Mr. President, I am pleased to introduce, along with Senator Alexander, the High-End Computing Revitalization Act of 2004. High-end computing, also known as high performance computing or supercomputing, is a critical component to the scientific advances, defense capabilities, and commercial competitiveness of the United States in the 21st century. Several recent developments in high-end computing have stimulated a re-examination of current U.S. policies and approaches. These developments include: 1. the deployment of Japan's Earth System Simulator, which now occupies the number one position on the Top 500 list of the world's fastest computers; 2. concerns about the difficulty in achieving substantial fractions of peak hardware computational performance on high-end systems; and 3. the ongoing complexity of developing, debugging, and optimizing applications for high-end systems. In addition, there is growing recognition that a new set of scientific and engineering discoveries could be catalyzed by access to very-large-scale computer systems--those in the 100-teraflop to petaflop range. Lastly, the National Academies of Sciences and Engineering, the Office of Science and Technology Policy's High End Computing Revitalization Task Force, and the national security community have each released interim or final comprehensive reports expressing serious concern over the current U.S. position in high-end computing research. Without government support, market forces are unlikely to drive sufficient innovation in high-end computing, because the private sector would not capture the full value of its innovations on a short enough time scale.

In supercomputing, innovation is important in architecture, in software, and in application strategies and solution methods. The coupling of these aspects is equally important. Major architecture challenges stem from the uneven performance scaling of different components. In particular, as the gap between processor speeds, memory bandwidth, and memory and network latency increases, new ideas are needed to increase bandwith and mitigate latency. Additionally, as new mechanisms are introduced to address those issues, there is a need for ways to supply a stable software interface that facilitates exploiting hardware performance improvements while the changes in mechanism. A new large-scale computer system exceeding the capability of Japan's Earth Simulator would provide an excellent test-bed for promising new advancements in these areas as well as provide science, industry, and defense with an extraordinarily powerful new tool for advancing the interests of the United States.

The need for software innovation is motivated by its role as an intermediary between the application, the problem being addressed, and the architectural platform. Innovation is needed in the ways that system software manages the use of hardware resources, such as network communication. New approaches are needed for ways in which the applications programmer can express parallelism at a level high enough to reflect the application solution and without platform-specific details. Novel tools are needed to help application-level software designers development their solutions at a more abstract and problem- specific level. Software technology is also needed to lessen future dependence on legacy codes. Enough must be invested in the creation of advanced tool and environment support for new language approaches so that users can more readily adopt new software technology.

Importantly, advances in algorithms can sometimes improve performance much more than architectural and other software advances do. A center for high-end computing software would aid immensely in spurring innovation in this underdeveloped research area, an aid in coordinating the federal government's efforts with industry, academia, and between its national laboratories.

The department of Energy (DOE) and its Office of Science research programs are uniquely qualified to lead research in these fields. They have played an important role in the development of high-end computing, networking, and information technology. These capabilities have been readily accessible to the U.S. scientific community for a diverse set of grand challenge scientific computational problems. Contributions by the DOE include pioneering the concept of remote, interactive access to supercomputers (developing the first interactive operating system for supercomputers, establishing the first national supercomputer center); developing the mathematical foundations for high performance computing with numerical linear algebra libraries used worldwide; leading the transition to massively parallel supercomputing by developing software to allow processors to communicate with each other; and contributing to the development of the Internet with software that dramatically speeds up the transmission of messages.

Many challenges are associated with modeling complex physical, chemical, and biological phenomena, especially on massively parallel computers with peak speeds in hundreds of teraflops. These challenges include the management and analysis of petabyte-scale data sets. A program to address these challenges will require multi-disciplinary collaborations between theoretical and computational scientists, computer scientists, and applied mathematicians at universities, national laboratories, and industry. Such a program will enhance the ability of the DOE to meet its mission goals and advance the state of the art for the U.S. economic and industrial base in the fields of energy, genetics, pharmaceuticals, nanotechnology, chemical processing, electronics, geology, and transportation. This bill will be a major step toward addressing today's greatest needs and, to creating the high-wage jobs of the future.

I ask unanimous consent that the text of the bill be printed in the Record.

Mr. President, today I am pleased to introduce the Tribal Contract Support Cost Technical Amendments of 2004, a much- needed bill that strengthens the highly successful policy of tribal contracting and compacting under the Indian Self Determination and Education Assistance Act of 1975, Public Law 93-638.

Beginning in 1970, with President Nixon's now-famous Special Message to Congress on Indian Affairs and the 1975 enactment of the Indian Self Determination and Education Assistance Act of 1975, Public Law 93-638, Congress has systematically devolved to Indian tribes the authority and responsibility to manage Federal programs and reassume control over their own affairs.

For good reason, tribal contracting and compacting has been embraced and expanded by Congress and the Executive by repeatedly amending the 1975 Act in 1984, 1988, 1994 and 2000.

Contracting and compacting has resulted in a reduction in the Federal bureaucracy and an improvement in the quality of services delivered to tribal members. Instead of Federal micro-management, the tribes can tailor programs to unique local conditions and better serve their members.

Unfortunately, the ability of Indian tribes to continue to contract programs and services is severely hampered by the chronic under-funding of contract support costs.

Without such funding, tribes are forced to cut back on services to pay for their administrative costs.

The bill I am introducing today will require the Indian Health Service and the Bureau of Indian Affairs to provide the funds for contract support costs which those agencies negotiated and contracted to pay to their tribal contractors.

I urge my colleagues to join me in supporting this important bill.

I ask unanimous consent that the text of the bill be printed in the Record.

Mr. President, today I take great pride in introducing the Sand Creek Massacre National Historic Site Trust Act of 2004, a bill to establish the Sand Creek National Historic Site in Kiowa County, CO.

The bill I am introducing today follows the Sand Creek National Historic Site Establishment Act of 2000, Public Law 106-465, which recognized the tragic events of November 28, 1868 and made it clear that America has the strength and resolve to face its past and learn the painful lessons that come with intolerance.

Much has been written about the horrors visited upon the plains Indians in the territories of the Western United States in the latter half of the 19th century. However, what has been lost for more than a century is a comprehensive understanding of the events of that day in a grove of cottonwood trees along Sand Creek.

This bill I am introducing today builds upon the Act of 2000 and authorizes the Cheyenne and Arapaho tribes of Oklahoma to take the land on which these tragic events took place into trust for traditional, cultural, and historical purposes only.

The indisputable facts are these: 700 members of the Colorado Militia, commanded by Colonel John Chivington struck at dawn that November day, attacking an encampment of Cheyenne and Arapho Indians settled under the U.S. flag and a white flag which the Indian Chiefs Black Kettle and White Antelope were told by the U.S. would protect them from military attack.

By day's end, almost 150 Indians, many of them women, children and the elderly, lay dead. Chivington's men reportedly desecrated the bodies of the dead after the massacre, and newspaper reports from Denver at the time told of the troops displaying Indian body parts in a gruesome display as they rode through the streets of Colorado's largest city following the attack.

The 2000 legislation authorized the National Park Service to enter into negotiations with willing sellers only in an attempt to secure property inside a boundary which encompasses approximately 12,470 acres as identified by the National Park Service for a lasting memorial to events of that fateful day.

The Sand Creek Massacre National Historic Site has come into being because all of those involved have exhibited an extraordinary ability to put aside their differences, look with equal measure at the scientific evidence and the oral traditions of the Tribes, and come up with a plan that equally honors the memory of those killed and the rights of the private property owners who have been faithful and responsible stewards of this site.

I ask unanimous consent that the text of the bill be printed in the Record.

Mr. President, today I join my good friends and colleagues Senator Chris Dodd and Senator Gordon Smith in introducing the Youth Suicide Early Intervention and Prevention Expansion Act of 2004. As Chairman of the Subcommittee on Substance Abuse and Mental Health Services, I recently held a hearing on youth suicide. At that hearing, it became painfully clear that we need thorough and actionable plans to deal with this tragic issue.

Statistics tell us that approximately every 2 hours a person under the age of 25 commits suicide. We also know that from 1952 to 1995, the rate of suicide in children and young adults has tripled and that between 1980 and 1997, alone, the rate of suicide in 15 to 19 year olds increased by 11 percent. According to the National Institute of Mental Health, suicide was the 11th leading cause overall for death in the United States in 2001. However, it was the 3rd leading cause of death for youth ages 15 to 24. We also know that more boys are killing themselves than girls at a ratio of 5 to 1 in the 15 to 19 year old age group and at a ratio of 7 to 1 in the 20 to 24 year old age group. However, while boys are dying at a higher rate, girls in these age groups are attempting at a much higher rate. Estimates suggest that there may be from 8 to 25 attempts made for every suicide death.

These alarming numbers emphasize the need for early intervention and prevention efforts. Too often, the signs may be subtle or hidden until it is too late. While research has created improved medications and methods for helping those with mental health problems to recover, there is still much work to be done in the identifying those who need help.

A great deal of study has focused on identifying and categorizing the risk factors related to suicide. In children and youth, these risk factors include depression, alcohol or drug use, physical or sexual abuse, and disruptive behavior. Of people who die from and who attempt suicide, many suffer from co-occurring mental health and substance abuse disorders. Children with these risk factors, as well as children who are know to be in situations at risk for acquiring them, should be included in comprehensive state plans. Children and youth specifically addressed in State plans should include those who attend school, including colleges and universities, those already receiving substance abuse or mental health services, those involved in the juvenile justice system, and foster children.

As a result of the need for increased attention to the problem of suicide and access to help, I am pleased to join Senators Dodd and Smith in introducing the Youth Suicide Early Intervention and Prevention Expansion Act of 2004. With the establishment of a $25 million grant initiative, this bill would encourage the development of statewide youth suicide early intervention and prevention strategies that coordinate agencies and non-profits in providing mental health services to and screening of youth in a variety of settings. The settings would include schools, substance abuse and mental health service programs, the juvenile justice system, and foster care programs. The bill would also provide $5

million for relevant technical assistance and research.

Candidly, State plans for suicide intervention and prevention need to be created and expanded to help stop these heartbreaking losses. We commend the States that already have created such plans and encourage all states to take this important step. I thank Senators Dodd and Smith for their leadership on this issue, as well as others like Senator Jack Reed, who is dedicated to helping increase and improve much-needed mental health services for our Nation's youth.

Mr. President, I rise to join Senator Bunning to introduce this important bill to make sure that Medicaid patients have access to care provided by podiatrists.

This bill ensures that Medicaid patients across the country can get services provided by podiatrists. This is a simple, common sense bill. This legislation includes podiatric physicians in Medicaid's definition of physician. This means that the services of podiatrists will be covered by Medicaid, just like they are in Medicare. Podiatrists are considered physicians under Medicare. They should be under Medicaid. Medicaid covers necessary foot and ankle care services. Medicaid should allow podiatrists who are trained specifically in foot and ankle care to provide these services and be reimbursed for them.

Currently, the services of podiatrists are considered optional under Medicaid. The Medicaid programs in 43 States, including Maryland, recognize and reimburse podiatrists for providing foot and ankle care to their beneficiaries. During times of tight budgets, States may cut back on these optional services. Last year Connecticut, Michigan, Utah and Texas discontinued podiatric services. Even though podiatrist services are considered optional, Medicaid patients need foot and ankle care regardless. If podiatrists do not provide the care, patients will see providers who may not be as well trained in the care of the lower extremities as podiatrists. I want the over 560,000 Medicaid patients in Maryland to have access to the services provided by over 400 podiatrists in Maryland.

Podiatrists receive special training on the foot, ankle and lower leg. They play an important role in the recognition of systemic diseases like diabetes, and in the recognition and treatment of peripheral neuropathy, a frequent cause of diabetic foot wounds that can often lead to preventable lower extremity amputations. Over 18 million people in this country have diabetes, but an estimated more than 5 million of these people are not aware that they have the disease.

Ensuring Medicaid patient access to podiatrists could save Medicaid funds in the long term. According to the American Podiatric Medical Association, 75 percent of Americans will experience some type of foot health problem during their lives. Foot disease is the most common complication of diabetes leading to hospitalization. About 82,000 people have diabetes-related leg, foot or toe amputations each year. Foot care programs with regular examinations and patient education could prevent up to 85 percent of these amputations. Podiatrists are important providers of this care.

This bill will make sure that Medicaid patients across the country have access to care provided by podiatrists. It has the support the American Podiatric Medical Association. I urge my colleagues to cosponsor this important legislation.