[Congressional Record Volume 152, Number 12 (Monday, February 6, 2006)]
[Senate]
[Pages S729-S731]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mr. DORGAN (for himself, Mr. Conrad, Mr. Bingaman, Ms. 
        Murkowski, Mr. McCain, Mr. Johnson, and Mr. Smith):
  S. 2245. A bill to establish an Indian youth telemental health 
demonstration project; to the Committee on Indian Affairs.
  Mr. DORGAN. Mr. President, I rise today to introduce legislation 
which would deal in a small but, I hope, meaningful way, with the 
crisis of youth suicide in Indian Country. On the reservations of the 
Northern Great Plains, the rate of Indian youth suicide is 10 times 
higher than it is anywhere else in the country. This needless loss of 
young boys and girls whose whole lives lay ahead of them is a very 
serious problem.
  I am pleased that last year, the Senate Indian Affairs Committee held 
two hearings on the tragic issue of teen suicide and the urgent need 
for prevention, intervention and treatment services. We heard the 
testimony of youth and family members, representatives of the Indian 
Health Service and other agencies of the Department of Health and Human 
Services, and Indian professionals who work with young people. We 
continue to sift through their recommendations to find possible 
solutions that could be proposed in legislation.
  I believe it is urgent that solutions be put forward now to deal with 
this troubling problem. Following the Committee's second hearing on 
Indian youth suicide last summer, several more Indian young people 
attempted suicide on the Standing Rock Reservation in North and South 
Dakota. Thankfully, their lives were spared and their attempts not 
completed. But time is running out for addressing this tragic issue.
  When the Indian Affairs Committee marked up legislation to amend and 
reauthorize the Indian Health Care Improvement Act last October, I 
offered, with Senators Conrad and Smith, an amendment which had three 
components, all of which were presented as ideas at the Committee's 
hearing in Washington, DC, on June 15, 2005, on Indian youth suicide. I 
am very pleased that my amendment was unanimously adopted.

  The legislation which I introduce today parallels one part of that 
amendment to the Indian health reauthorization bill, and would 
authorize the Indian Youth Telemental Health Demonstration Project. The 
Secretary of Health and Human Services would award grants under this 4-
year demonstration project to five Indian Tribes and Tribal 
Organizations that have telehealth capabilities. Grantees would provide 
services through telemental health for such purposes as counseling of 
Indian youth for suicide prevention, intervention and treatment; 
providing medical advice and other assistance to frontline tribal 
health providers; training for tribal community members, elected 
officials, tribal educators and health workers and others who work with 
Indian youth; developing culturally-sensitive materials on suicide 
prevention and intervention; and data collection and reporting.
  My proposal has been revised since it was adopted as an amendment to 
the Indian health reauthorization bill in response to Administration 
concerns about expanding new health care programs or services to Native 
Americans living in urban areas. I will leave the Federal Government's 
obligation to provide health care to urban Indians--most of whom are in 
urban areas because they or their parents or relatives were relocated 
from their reservations or Alaska Native communities under federal 
policy--to be discussed another day.
  Many Indian reservations and Native villages in Alaska are in remote 
locations and quite isolated, and experience much more limited access 
to mental health services than in our nation's cities. The testimony 
received by the Indian Affairs Committee showed that it is particularly 
in these communities that there is a crisis among the youth. 
Accordingly, the bill I propose today is intended to provide services 
for counseling, medical advice and training and educational materials 
under this new demonstration project to Indian youth living on 
reservations and in Native villages.
  I thank my colleagues who have joined me in this initiative and who 
have added thoughtful insights for ways to address this crisis that 
deprives many tribal communities of one of the richest resources, our 
youth. I look forward to continuing our efforts and developing a more 
comprehensive legislative proposal on this sensitive and very important 
issue. I urge my colleagues to support this legislation.
  I ask unanimous consent that the text of the bill as introduced be 
printed in the Record.

                                S. 2245

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Indian Youth Telemental 
     Health Demonstration Project Act of 2006''.

     SEC. 2. FINDINGS AND PURPOSE.

       (a) Findings.--Congress finds that--
       (1) suicide for Indians and Alaska Natives is 2 \1/2\ times 
     higher than the national average and the highest for all 
     ethnic groups in the United States, at a rate of more than 16 
     per 100,000 males of all age groups, and 27.9 per 100,000 for 
     males aged 15 through 24, according to data for 2002;
       (2) according to national data for 2002, suicide was the 
     second-leading cause of death for Indians and Alaska Natives 
     aged 15 through 34 and the fourth-leading cause of death for 
     Indians and Alaska Natives aged 10 through 14;
       (3) the suicide rates of Indian and Alaska Native males 
     aged 15 through 24 are nearly 4 times greater than suicide 
     rates of Indian and Alaska Native females of that age group;
       (4)(A) 90 percent of all teens who die by suicide suffer 
     from a diagnosable mental illness at the time of death; and
       (B) more than \1/2\ of the people who commit suicide in 
     Indian Country have never been seen by a mental health 
     provider;
       (5) death rates for Indians and Alaska Natives are 
     statistically underestimated;
       (6) suicide clustering in Indian Country affects entire 
     tribal communities; and
       (7) since 2003, the Indian Health Service has carried out a 
     National Suicide Prevention Initiative to work with Service, 
     tribal, and urban Indian health programs.
       (b) Purpose.--The purpose of this Act is to authorize the 
     Secretary to carry out a demonstration project to test the 
     use of telemental health services in suicide prevention, 
     intervention, and treatment of Indian youth, including 
     through--
       (1) the use of psychotherapy, psychiatric assessments, 
     diagnostic interviews, therapies for mental health conditions 
     predisposing to suicide, and alcohol and substance abuse 
     treatment;
       (2) the provision of clinical expertise to, consultation 
     services with, and medical advice and training for frontline 
     health care providers working with Indian youth;
       (3) training and related support for community leaders, 
     family members and health and education workers who work with 
     Indian youth;
       (4) the development of culturally-relevant educational 
     materials on suicide; and
       (5) data collection and reporting.

     SEC. 3. DEFINITIONS.

       In this Act:
       (1) Demonstration project.--The term ``demonstration 
     project'' means the Indian youth telemental health 
     demonstration project authorized under section 4(a).
       (2) Department.--The term ``Department'' means the 
     Department of Health and Human Services.
       (3) Indian.--The term ``Indian'' means any individual who 
     is a member of an Indian tribe or is eligible for health 
     services under the Indian Health Care Improvement Act (25 
     U.S.C. 1601 et seq.).
       (4) Indian tribe.--The term ``Indian tribe'' has the 
     meaning given the term in section 4 of the Indian Self-
     Determination and Education Assistance Act (25 U.S.C. 450b).
       (5) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.
       (6) Service.--The term ``Service'' means the Indian Health 
     Service.
       (7) Telemental health.--The term ``telemental health'' 
     means the use of electronic information and 
     telecommunications technologies to support long distance 
     mental health care, patient and professional-related 
     education, public health, and health administration.
       (8) Traditional health care practices.--The term 
     ``traditional health care practices'' means the application 
     by Native healing practitioners of the Native healing 
     sciences (as opposed or in contradistinction to Western 
     healing sciences) that--

[[Page S730]]

       (A) embody the influences or forces of innate Tribal 
     discovery, history, description, explanation and knowledge of 
     the states of wellness and illness; and
       (B) call upon those influences or forces in the promotion, 
     restoration, preservation, and maintenance of health, well-
     being, and life's harmony.
       (9) Tribal organization.--The term ``tribal organization'' 
     has the meaning given the term in section 4 of the Indian 
     Self-Determination and Education Assistance Act (25 U.S.C. 
     450b).

     SEC. 4. INDIAN YOUTH TELEMENTAL HEALTH DEMONSTRATION PROJECT.

       (a) Authorization.--
       (1) In general.--The Secretary is authorized to carry out a 
     demonstration project to award grants for the provision of 
     telemental health services to Indian youth who--
       (A) have expressed suicidal ideas;
       (B) have attempted suicide; or
       (C) have mental health conditions that increase or could 
     increase the risk of suicide.
       (2) Eligibility for grants.--Grants described in paragraph 
     (1) shall be awarded to Indian tribes and tribal 
     organizations that operate 1 or more facilities--
       (A) located in Alaska and part of the Alaska Federal Health 
     Care Access Network;
       (B) reporting active clinical telehealth capabilities; or
       (C) offering school-based telemental health services 
     relating to psychiatry to Indian youth.
       (3) Grant period.--The Secretary shall award grants under 
     this section for a period of up to 4 years.
       (4) Maximum number of grants.--Not more than 5 grants shall 
     be provided under paragraph (1), with priority consideration 
     given to Indian tribes and tribal organizations that--
       (A) serve a particular community or geographic area in 
     which there is a demonstrated need to address Indian youth 
     suicide;
       (B) enter into collaborative partnerships with Service or 
     other tribal health programs or facilities to provide 
     services under this demonstration project;
       (C) serve an isolated community or geographic area which 
     has limited or no access to behavioral health services; or
       (D) operate a detention facility at which Indian youth are 
     detained.
       (b) Use of Funds.--An Indian tribe or tribal organization 
     shall use a grant received under subsection (a) for the 
     following purposes:
       (1) To provide telemental health services to Indian youth, 
     including the provision of--
       (A) psychotherapy;
       (B) psychiatric assessments and diagnostic interviews, 
     therapies for mental health conditions predisposing to 
     suicide, and treatment; and
       (C) alcohol and substance abuse treatment.
       (2) To provide clinician-interactive medical advice, 
     guidance and training, assistance in diagnosis and 
     interpretation, crisis counseling and intervention, and 
     related assistance to Service or tribal clinicians and health 
     services providers working with youth being served under the 
     demonstration project.
       (3) To assist, educate, and train community leaders, health 
     education professionals and paraprofessionals, tribal 
     outreach workers, and family members who work with the youth 
     receiving telemental health services under the demonstration 
     project, including with identification of suicidal 
     tendencies, crisis intervention and suicide prevention, 
     emergency skill development, and building and expanding 
     networks among those individuals and with State and local 
     health services providers.
       (4) To develop and distribute culturally-appropriate 
     community educational materials on--
       (A) suicide prevention;
       (B) suicide education;
       (C) suicide screening;
       (D) suicide intervention; and
       (E) ways to mobilize communities with respect to the 
     identification of risk factors for suicide.
       (5) To conduct data collection and reporting relating to 
     Indian youth suicide prevention efforts.
       (c) Applications.--To be eligible to receive a grant under 
     subsection (a), an Indian tribe or tribal organization shall 
     prepare and submit to the Secretary an application, at such 
     time, in such manner, and containing such information as the 
     Secretary may require, including--
       (1) a description of the project that the Indian tribe or 
     tribal organization will carry out using the funds provided 
     under the grant;
       (2) a description of the manner in which the project funded 
     under the grant would--
       (A) meet the telemental health care needs of the Indian 
     youth population to be served by the project; or
       (B) improve the access of the Indian youth population to be 
     served to suicide prevention and treatment services;
       (3) evidence of support for the project from the local 
     community to be served by the project;
       (4) a description of how the families and leadership of the 
     communities or populations to be served by the project would 
     be involved in the development and ongoing operations of the 
     project;
       (5) a plan to involve the tribal community of the youth who 
     are provided services by the project in planning and 
     evaluating the mental health care and suicide prevention 
     efforts provided, in order to ensure the integration of 
     community, clinical, environmental, and cultural components 
     of the treatment; and
       (6) a plan for sustaining the project after Federal 
     assistance for the demonstration project has terminated.
       (d) Traditional Health Care Practices.--The Secretary, 
     acting through the Service, shall ensure that the 
     demonstration project involves the use and promotion of the 
     traditional health care practices of the Indian tribes of the 
     youth to be served.
       (e) Collaboration.--The Secretary, acting through the 
     Service, shall encourage Indian tribes and tribal 
     organizations receiving grants under this section to 
     collaborate to enable comparisons about best practices across 
     projects.
       (f) Annual Report.--Each grant recipient shall submit to 
     the Secretary an annual report that--
       (1) describes the number of telemental health services 
     provided;
       (2) includes any other information that the Secretary may 
     require.
       (g) Report to Congress.--Not later than 270 days after the 
     date of termination of the demonstration project, the 
     Secretary shall submit to the Committee on Indian Affairs of 
     the Senate and the Committee on Resources and the Committee 
     on Energy and Commerce of the House of Representatives a 
     final report that--
       (1) describes the results of the projects funded by grants 
     awarded under this section, including any data available that 
     indicate the number of attempted suicides;
       (2) evaluates the impact of the telemental health services 
     funded by the grants in reducing the number of completed 
     suicides among Indian youth;
       (3) evaluates whether the demonstration project should be--
       (A) expanded to provide more than 5 grants; and
       (B) designated a permanent program; and
       (4) evaluates the benefits of expanding the demonstration 
     project to include urban Indian organizations.
       (h) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section $1,500,000 for 
     each of fiscal years 2007 through 2010.
                                 ______
                                 
      By Mr. REID (for Mr. Obama):
  S. 2247. A bill to promote greater use of information technology in 
the Federal Employees Health Benefits Program under chapter 89 of title 
5, United States Code, to increase efficiency and reduce costs; to the 
Committee on Homeland Security and Governmental Affairs.
  (At the request of Mr. Reid, the following statement was ordered to 
be printed in the Record.)
  Mr. OBAMA. Mr. President, the American people are facing two, major 
health care crises--lack of health insurance and the soaring costs of 
medical care. Nearly 46 million Americans are uninsured, and the number 
one reason is because they can't afford it. Even those with health 
insurance are struggling to pay their medical bills. Family incomes 
can't keep up with rising health costs--health premiums alone have 
increased 73 percent over the past 5 years, while wages have only risen 
15 percent. Unfortunately, we can't fix either of these crises without 
addressing the other. As health care costs rise, more employers will 
drop coverage for their employees. As the number of uninsured rise, the 
cost of their care is subsidized by those individuals that have 
insurance. It's a vicious cycle, and the longer we wait to act, the 
more difficult it will be to successfully intervene.
  There are many drivers of health care costs, but perhaps the easiest 
one to tackle is the wasteful, administrative costs associated with 
health care. Health care is one of the least efficient industries in 
America. Processing a single transaction in health care can cost as 
much as $25, whereas banks and brokerages spend less than a penny per 
transaction. Indeed, administrative costs account for 31 percent of 
total health care spending, or roughly $465 billion each and every 
year.
  Today, I am introducing a bill that would help to reduce health care 
administrative costs in the Nation's largest employer-sponsored health 
insurance program, the Federal Employees Health Benefit Program. FEHBP 
serves over 8 million Federal Government employees, retirees, and their 
families, who can choose from over 200 health plan options. The FEHBP 
Efficiency Act of 2006 would require all health plans participating in 
FEHBP to develop systems for hospitals and doctors to submit their 
bills electronically within 4 years.
  Ken Thorpe, a health economist at Emory University, has reported that 
if all FEHBP participating health plans switched to electronic systems 
for submission of bills, the program could save up to 2 percent of the 
$31 billion in

[[Page S731]]

total premiums, or over $600 million every year. That is a tremendous 
amount of savings--money that could be used to expand FEHBP benefits, 
increase the number of eligible employees, or lower premiums for FEHBP 
beneficiaries. Using its tremendous purchasing power, the Federal 
Government could help spur the health care industry to move to a 
completely paperless system for processing transactions in all 
government health programs as well as the private sector.
  I urge my colleagues to join me in this effort to increase efficiency 
and reduce costs. Every American should have access to affordable 
health care, and this bill is one step towards making that a reality.

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