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[Senate Report 106-389]
[From the U.S. Government Publishing Office]

                                                       Calendar No. 765
106th Congress                                                   Report
                                 SENATE
 2d Session                                                     106-389

======================================================================

 
AMENDING THE NATIVE HAWAIIAN HEALTH CARE IMPROVEMENT ACT TO REVISE AND 
                            EXTEND SUCH ACT

                                _______
                                

                August 25, 2000.--Ordered to be printed

   Filed under authority of the order of the Senate of July 26, 2000

                                _______
                                

   Mr. Campbell, from the Committee on Indian Affairs, submitted the 
                               following

                              R E P O R T

                         [To accompany S. 1929]

    The Committee on Indian Affairs, to which was referred the 
bill (S. 1929) to amend the Native Hawaiian Health Care 
Improvement Act to revise and extend such Act, having 
considered the same, reports favorably thereon with an 
amendment in the nature of a substitute, and recommends that 
the bill (as amended) do pass.

                                Purpose

    The purpose of S. 1929, a bill to provide for the 
reauthorization of the Native Hawaiian Health Care Improvement 
Act, is to improve the health status of Native Hawaiians 
through the continuation of a comprehensive health promotion 
and disease prevention effort that involves health education in 
Native Hawaiian communities, and the provision of primary care 
health care services using traditional Native Hawaiian healers 
and health care providers trained in Western medicine. In areas 
where there is an underutilization of existing health care 
delivery systems that have the capacity to provide culturally-
relevant health care services, S. 1929 provides authority for 
the Secretary of the Department of Health and Human Services to 
enter into contracts with Native Hawaiian health care systems 
to provide health care referral services to Native Hawaiian 
patients. S. 1929 is intended to assure the continuity of the 
health care programs that are provided to Native Hawaiians 
under the authority of Public Law 100-579.
    As enacted in 1988, the Native Hawaiian Health Care 
Improvement Act is premised upon the findings and 
recommendations of the Native Hawaiian Health Research 
Consortium report to the Secretary of the Department of Health 
and Human Services of December, 1985. That report clearly 
indicates that the underutilization of existing health care 
services by Native Hawaiians can be traced to the absence of 
culturally-relevant services, in which traditional Native 
Hawaiian concepts of healing are lacking, as well as to a 
general perception in the Native Hawaiian community that health 
care services which are fundamentally based on concepts of 
Western medicine, will not effect the healing or cure of 
diseases and illnesses afflicting Native Hawaiian people.

                         Historical Background

    The islands that now compose the State of Hawaii were 
governed by a monarchy of Native Hawaiians until 1893. The 
Native Hawaiian government was recognized as an independent 
sovereign nation by foreign governments, and treaty 
relationships were established with the United States (Treaty 
of Friendship, Commerce, and Navigation of 1849; Treaty of 
Commercial Reciprocity, January 30, 1875.) As a result of 
expanded trade with the United States, western influence in the 
islands increased, and in 1893, the government of Queen 
Liliuokalani was overthrown in an insurrection engineered by a 
group of western businessmen in an effort to secure the 
annexation of Hawaii to the United States. The United States 
minister in Hawaii ordered one company of marines and two 
companies of sailors to be landed, and the minister then 
recognized a new provisional government even before Queen 
Liliuokalani's lines of defense had surrendered. Although the 
provisional government sought immediate annexation by the 
United States, President Grover Cleveland refused to submit a 
treaty of annexation to the Senate, finding that the 
provisional government lacked the popular support of the Native 
Hawaiian population and that the government would not have been 
established but for the lawless and unauthorized military 
intervention of the United States. Upon the inauguration of 
William McKinley as the new President of the United States in 
1897, however, the western businessmen that sought annexation 
were able to change the official U.S. position, and in 1898, 
Hawaii became a territory of the United States.
    During the first two decades of the twentieth century, the 
already depressed economic conditions of Native Hawaiians 
deteriorated further, and in 1920, the United States Congress 
legislated directly for the benefit of Native Hawaiians by 
enacting the Hawaiian Homes Commission Act, and establishing a 
land base for Native Hawaiians to provide a permanent homeland 
and to encourage agricultural pursuits. The Act placed 
approximately 200,000 acres under the jurisdiction of the 
Hawaiian Homes Commission, a branch of the territorial 
government established for the purpose of ``rehabilitating'' 
persons of at least fifty percent Native Hawaiian ancestry 
through a return to pastoral life. The Act also authorized the 
Commission to undertake ``activities having to do with the 
economic and social welfare of the homesteaders.''
    Hawaii was admitted to statehood in 1959, and the 
Admissions Act transferred the title to the lands administered 
by the Hawaiian Homes Commission from the Federal government to 
the State of Hawaii. The Admissions Act requires the State to 
hold the lands ``as a public trust * * * for the betterment of 
the conditions of Native Hawaiians * * * and their use for any 
other object shall constitute a breach of trust for which suit 
may be brought by the United States.

                               Background

    Language contained in the 1984 Supplemental Appropriations 
Act, Public Law 98-396, directed the Department of Health and 
Human Services to conduct a comprehensive study of the health 
care needs of Native Hawaiians. The study was conducted under 
the aegis of Region IX of the Department by a consortium of 
health care providers and professionals from the State of 
Hawaii in a predominantly volunteer effort, organized by Alu 
Like, Inc., a Native Hawaiian organization. An island-wide 
conference was held in November of 1985 in Honolulu to provide 
an opportunity for members of the Native Hawaiian community to 
review the study's findings. Recommended changes were 
incorporated in the final report of the Native Hawaiian Health 
Research Consortium, and the study was formally submitted to 
the Department of Health and Human Services in December of 
1985. The Department submitted the report to the Congress on 
July 21, 1986, and the report was referred to the Select 
Committee on Indian Affairs.
    Because the Consortium report's findings as to the health 
status of Native Hawaiians was compared only to other 
populations within the State of Hawaii, the Select Committee 
requested that the Office of Technology Assessment (OTA), an 
independent agency of the Congress, undertake an analysis of 
Native Hawaiian health statistics as they compared to national 
data in other United States populations. Using the same 
population projection model that was employed in OTA's April 
1986 report on Indian Health Care to American Indian and Alaska 
Native populations, and based on additional information 
provided by the Department of Health and the Office of Hawaiian 
Affairs of the State of Hawaii, the Office of Technology 
Assessment report contains the following findings:
    The Native Hawaiian population living in Hawaii consists of 
two groups, Hawaiians and part-Hawaiians, who are distinctly 
different in both age distributions and mortality rates. 
Hawaiians comprise less than five percent of the total Native 
Hawaiian population and are much older than the young and 
growing part-Hawaiian populations.
    Overall, Native Hawaiians have a death rate that is thirty-
four percent higher than the death rate for the United States 
all races, but this composite masks the great differences that 
exist between Hawaiians and part-Hawaiians. Hawaiians have a 
death rate that is 146 percent higher than the U.S. all races 
rate. Part-Hawaiians also have a higher death rate, but only 17 
percent greater. A comparison of age-adjusted death rates for 
Hawaiians and part-Hawaiians reveals that Hawaiians die at a 
rate 110 percent higher than part-Hawaiians, and this pattern 
persists for all except one of the 13 leading causes of death 
that are common to both groups.
    As in the case of the U.S. all races population, Hawaiian 
and part-Hawaiian males have higher death rates than their 
female counterparts. However, when Hawaiian and part-Hawaiian 
males and females are compared to their U.S. all races 
counterparts, females are found to have more excess deaths than 
males. Most of these excess deaths are accounted for by 
diseases of the heart and cancers, with lesser contributions 
from cerebrovascular disease and diabetes mellitus.
    Diseases of the heart and cancers account for more than 
half of all deaths in the U.S. all races population, and this 
pattern is also found in both the Hawaiian and part-Hawaiian 
populations, whether grouped by both sexes or by male or 
female. However, Hawaiians and part-Hawaiians have 
significantly higher death rates than their U.S. all races 
counterparts, with the exception of part-Hawaiian males, for 
whom the death rate from all causes is approximately equal to 
that of U.S. all races males.
    One disease that is particularly pervasive is diabetes 
mellitus, for which even part-Hawaiian males have a death rate 
128 percent higher than the rate for U.S. all races males. 
Overall, native Hawaiians die from diabetes at a rate that is 
222 percent higher than for the U.S. all races. When compared 
to their U.S. all races counterparts, deaths from diabetes 
mellitus range from 630 percent higher for Hawaiian females and 
538 percent higher for Hawaiian males, to 127 percent higher 
for part-Hawaiian females and 128 percent higher for part-
Hawaiian males.''
    There is thus little doubt that the health status of Native 
Hawaiians is far below that of other U.S. population groups, 
and that in a number of areas, the evidence in compelling that 
Native Hawaiians constitute a population group for whom the 
mortality rate associated with certain diseases exceed that for 
other U.S. populations in alarming proportions.
    Native Hawaiians premise the high mortality rates and the 
incidence of disease that far exceed that of other populations 
in the United States upon the breakdown of the Hawaiian culture 
and belief systems, including traditional healing practices, 
that was brought about by western settlement, and the influx of 
western diseases to which the native people of the Hawaiian 
Islands lacked immune systems. Further, Native Hawaiians 
predicate the high incidence of mental illness and emotional 
disorders in the Native Hawaiian population as evidence of the 
cultural isolation and alienation of the native peoples, in a 
statewide population in which they now constitute only 20 
percent. Settlement from both the east and the west have not 
only brought new diseases which decimated the Native Hawaiian 
population, but which devalued the customs and traditions of 
Native Hawaiians, and which eventually resulted in Native 
Hawaiians being prohibited from speaking their native tongue in 
school, and in many instances, at all.
    In 1998, Papa Ola Lokahi updated the health care statistics 
from the original E Ola Mau report. In addition, on an annual 
basis, Papa Ola Lokahi extrapolates the data on Native 
Hawaiians gathered yearly by the Hawaii State Department of 
Health from the Department's behavioral risk assessment and 
health surveillance survey. The findings from those assessments 
revealed that--
    With respect to cancer, Native Hawaiians have the highest 
cancer mortality rates in the State of Hawaii (231 out of every 
100,000 residents), 45 percent higher than that for the total 
State population. Native Hawaiian males have the higher cancer 
mortality rates in the State of Hawaii for cancers of the lung, 
liver and pancreas and for all cancers combined, and the 
highest years of productive life lost from cancer in the State 
of Hawaii. Native Hawaiian females ranked highest in the State 
of Hawaii for cancers of the lung, liver, pancreas, breast, 
cervix uteri, corpus uteri, stomach, and rectum, and for all 
cancers combined.
    With respect to breast cancer, Native Hawaiians have the 
highest mortality rates in the State of Hawaii, and nationally, 
Native Hawaiians have the third highest mortality rates due to 
breast cancer.
    Native Hawaiians have the highest mortality rates from 
cancer of the cervix and lung cancer in the State of Hawaii, 
and Native Hawaiian males have the second highest mortality 
rates due to prostate cancer in the State.
    For the years 1989 through 1991, Native Hawaiians had the 
highest mortality rate due to diabetes mellitus in the State of 
Hawaii, with full-blood Hawaiians having a mortality rate that 
is 518 percent higher than the rate for the statewide 
population of all other races, and Native Hawaiians who are 
less than full-blood having a mortality rate that is 79 percent 
higher than the rate for the statewide population of all other 
races.
    In 1990, Native Hawaiians represented 44 percent of all 
asthma cases in the State of Hawaii for those 18 years of age 
and younger, and 35 percent of all asthma cases reported, and 
in 1992, the Native Hawaiian rate for asthma was 73 percent 
higher than the rate for the total statewide population.
    With respect to heart disease, the death rate for Native 
Hawaiians from heart disease is 66 percent higher than for the 
entire State of Hawaii, and Native Hawaiian males have the 
greatest years of productive life lost in the State of Hawaii. 
The death rate for Native Hawaiians from hypertension is 84 
percent higher than that for the entire State, and the death 
rate from stroke for Native Hawaiians is 13 percent higher than 
for the entire State.
    Native Hawaiians have the lowest life expectancy of all 
population groups in the State of Hawaii. Between 1910 and 
1980, the life expectancy of Native Hawaiians from birth has a 
range from 5 to 10 years less than that of the overall State 
population average, and the most recent data for 1990 indicates 
that Native Hawaiian life expectancy at birth is approximately 
5 years less than that of the total State population.
    With respect to prenatal care, as of 1996, Native Hawaiian 
women have the highest prevalence of having had no prenatal 
care during their first trimester of pregnancy, representing 44 
percent of all such women statewide. Over 65 percent of the 
referrals to Healthy Start in fiscal year 1996 and 1997 were 
Native Hawaiian newborns, and in every region of the State of 
Hawaii, many Native Hawaiian newborns begin life in a 
potentially hazardous circumstance.
    In 1996, 45 percent of the live births to Native Hawaiians 
mothers were infants born to single mothers. Statistics 
indicated that infants born to single mothers have a higher 
risk of low birth weight and infant mortality. Of all low birth 
weight babies born to single mothers in the State of Hawaii, 44 
percent were Native Hawaiians.
    In 1996, Native Hawaiian fetal mortality rates comprised 15 
percent of all fetal deaths for the State of Hawaii. Thirty-two 
percent of all fetal deaths occurring in mothers under the age 
of 18 years were Native Hawaiians, and for mothers 18 through 
24 years, 28 percent were Native Hawaiians.
    These and other health status statistics contained in the 
findings section of S. 1929 make clear that the health care 
challenges that the Native Hawaiian health care systems were 
established to address require reauthorization of the Native 
Hawaiian Health Care Improvement Act.

Native Hawaiian Health Care Master Plan and Native Hawaiian Health Care 
                                Systems

    The concepts embodied in S. 1929 are the result of the 
Committee's work with Native Hawaiian health care professionals 
and others who are dedicated to improving the health status of 
Native Hawaiians. It is based on the beliefs of those with whom 
the Committee has consulted, that to insure that Native 
Hawaiians are able to achieve the healthful harmony of the self 
(body, mind and spirit) or lokahi, with others and all of 
nature, and to assure that Native Hawaiians are able to 
function effectively as citizens and leaders in their own 
homeland, there must be a restoration of cultural traditions, 
an integration of traditional healing methods in the health 
care delivery system, and a collective effort to restore to the 
Native Hawaiian, a sense of self esteem and self worth, both 
for his or her culture, as well as for the individual.
    E Ola Mau, a group of Native Hawaiian health care 
professionals, proposed that this effort begin with the 
development of a health care master plan, based on a bio-
psycho-socio-cultural-political model that would be aimed at 
identifying significant events and factors related to specific 
health care needs and issues. E Ola Mau proposed that this 
master plan be implemented at every societal level (individual, 
household, community, county and state) in the Hawaiian 
Islands. It is their goal to have this Native Hawaiian way of 
dealing with health, eventually become an institutional part of 
the State's health policy for both Native Hawaiian and Non-
Hawaiians.
    After much debate and careful consideration in the Native 
Hawaiian community and amongst those concerned with the health 
status of Native Hawaiians, a consensus wasreached that Papa 
Ola Lokahi, the Native Hawaiian Health Board, should be the mechanism 
through which Native Hawaiian health care systems were to be developed, 
coordinated, administered, monitored, and continually revised to meet 
the changing health care needs of the Native Hawaiian population. Papa 
Ola Lokahi is currently composed of five organizations: (1) the Office 
of Hawaiian Affairs, an agency of the State which was established 
pursuant to the authority of amendments make to the Constitution of the 
State of Hawaii in 1978 to assure the well-being and interests of 
Native Hawaiians; (2) E Ola Mau, a nonprofit organization of Native 
Hawaiian professionals dedicated to insuring that Native Hawaiians 
achieve a healthful harmony of self (body, mind and spirit) with others 
and all of nature, and become productive citizens and leaders in their 
homeland; (3) Alu Like, a Federally-funded Native Hawaiian agency that 
promotes vocational training and the founding of community-based 
organizations that promote health, education and economic development 
for Native Hawaiians; (4) the University of Hawaii; and (5) the Office 
of Hawaiian Health within the State Department of Health.
    Papa Ola Lokahi has assumed the primary responsibility of 
overseeing the development and maintenance of a Native Hawaiian 
Comprehensive Health Care Master Plan, and is the entity 
responsible for certifying to the Secretary the qualifications 
and capabilities of Native Hawaiian organizations that petition 
the Secretary to carry out, pursuant to contracts with the 
Secretary, the provisions of the Act.
    Public Law 100-579 authorized Papa Ola Lokahi, the Native 
Hawaiian Health Board, to--
          (1) designate a chairman and vice-chairman from among 
        its member organizations and such other officers as may 
        be deemed necessary to carry out its responsibilities 
        under the Act;
          (2) adopt bylaws and such other internal regulations 
        or procedures as may be deemed necessary to carry out 
        its responsibilities under the Act;
          (3) certify to the Secretary that a Native Hawaiian 
        organization meets the definition of ``Native Hawaiian 
        organization'' as set forth in the Act;
          (4) certify to the Secretary that a Native Hawaiian 
        organization has the qualifications and capacity to 
        provide the services or perform contract requirements 
        pursuant to a contract with the Secretary;
          (5) oversee the development of a comprehensive native 
        Hawaiian health care master plan;
          (6) assure the conduct of health status and health 
        care needs assessments of Native Hawaiian communities 
        desiring to participate in Native Hawaiian health care 
        program; and
          (7) coordinate the activities and functions of all 
        Native Hawaiian organizations operating health care 
        programs pursuant to contracts with the Secretary.
    Public Law 100-579 envisions a comprehensive health care 
system that is community-based, building upon the Native 
Hawaiian 'ohana system (The 'ohana system is based upon the 
fundamental unit of societal interaction for Native Hawaiians 
in which a family or an organization is led by a haku, the 
recognized leader, whose function is to coordinate and 
facilitate the expertise and resources of the various 
households or affiliated organizations in order to accomplish a 
task or resolve a problem. The households or affiliated 
organizations are in turn led by po'o, the head of the 
household or designated leader of the organization.) and 
incorporating traditional healing (la'au lapa'au) practices 
with western medical services to provide a health care system 
that will be culturally consistent and responsive to the needs 
of Native Hawaiian communities.
    As enacted, Public Law 100-579 authorized the establishment 
of Native Hawaiian Healing Centers on each of the islands 
comprising the State of Hawaii, upon the acceptance of and in 
consultation with the Native Hawaiian communities on those 
islands, and wherever possible, using existing health care 
facilities and health care providers now serving the Native 
Hawaiian communities on those islands. These centers were 
intended to lead and coordinate the development and 
implementation of a statewide Native Hawaiian health care 
system, which would include: (1) a research and monitoring 
staff, state-certified neighborhood counselors, outreach 
workers and health educators, traditional Native Hawaiian 
healers, and Native Hawaiian cultural educators; (2) primary 
health care providers; (3) primary health care facilities, 
using existing health care facilities where practicable and 
acceptable to the local Native Hawaiian community; (4) 
participation by the State Department of Health Office of 
Hawaiian Health in the provision of disease prevention and 
health promotion programs, as well as a multi-disciplinary 
approach to Native Hawaiian health care which would include 
nursing, dental hygiene, nutrition education, maternal and 
infant child care education; and (5) other Federal, State, 
county, community and private organizations and agencies that 
could provide services which meet the health care needs of 
their respective communities.
    The development of the master plan by Papa Ola Lokahi was 
intended to include: (1) work with Native Hawaiian communities 
which support the establishment of a Native Hawaiian Health 
Center; (2) conducting a community health needs assessment 
survey for participating communities; (3) facilitating the 
development, establishment, and effectivefunctioning of such 
Centers on the islands of O'ahu, Moloka'i, Maui, Hawai'i, Lana'i, 
Kaua'i and Ni'ihau; and (4) coordinating the work of relevant agencies 
and organizations to provide participating communities with: (a) direct 
health care services and health education, including maternal and child 
health care and mental health care; (b) instruction in the Native 
Hawaiian language, cultural beliefs and traditions with an emphasis on 
health concepts and practices; (c) training and education of health 
care providers and educators and cultural educators in health promotion 
and disease prevention; (d) basic and applied research and monitoring 
of Native Hawaiian health care approaches to validate outcomes and 
create standards of quality care; (e) development of health care 
services, training and education that would have a Native Hawaiian 
perspective as its primary focus; (f) development of Native Hawaiian 
community health counselors, outreach workers, educators, and community 
health aide training programs; (g) preventive-oriented health care 
services in medical, dental, nutrition, mental health, and in other 
designated areas as needs assessments may identify as necessary; (h) 
data collection related to prevention of diseases and illnesses among 
Native Hawaiians; (i) medical and general health-related research into 
the diseases that are most prevalent among Native Hawaiians; (j) mental 
health research in areas of mental health problems that are most 
prevalent in the Native Hawaiian population; (k) ongoing health 
planning for further development of the Native Hawaiian health care 
system; and (l) the provision of health care referral services when 
certain health care services are not available within the Native 
Hawaiian Health Center.
    Following enactment of the Native Hawaiian Health Care Act, 
the Papa Ola Lokahi Board became incorporated and began working 
with health care providers on each island toward the 
development of a master plan and an island-specific plan for 
the provision of primary health care and health care referral 
services. Those involved in the planning effort ultimately 
determined that the health care needs of Native Hawaiians would 
be better served by the establishment of five Native Hawaiian 
health care systems which could be composed of as many health 
care centers as might be necessary to serve the health care 
needs of Native Hawaiians on each island.
    Accordingly, Papa Ola Lokahi certified to the Secretary 
that five health care systems qualified as Native Hawaiian 
organizations for purposes of entering into contracts with the 
Secretary, and plans for the provision of primary health care 
services or health care referral services were submitted to the 
Secretary in 1990. The first contract awards were made in 
October of 1991, and the health care systems are now engaged 
not only in the implementation of the plans approved by the 
Secretary, but the provision of health care services. The plans 
for each health care system vary according to the availability 
of and access to existing health care resources on each island 
and the need for primary health care services. Currently, all 
five Native Hawaiian health care systems have become 
incorporated as 501(c)(3) non-profit health care organizations.
    In general, the capacity to provide critical care exists 
only on the island of O'ahu, and thus, it has long been the 
pattern that if a patient requires hospitalization and complex 
surgery or treatment, the patient would be referred to a health 
care provider on the island of O'ahu. However, it is not 
uncommon that treatment requiring advanced medical technology 
must be secured in the mainland United States.
    The Native Hawaiian Health Care Improvement Act provides 
authority for the provision of health promotion, disease 
prevention, and primary health services to Native Hawaiians who 
reside in the State of Hawai'i. Federal planning funds first 
became available in July of 1990. However, Papa Ola Lokahi 
incorporated in Federal 1989 and was able to initiate its 
organizing activities in July 1989 with funds provided by the 
Hawai'i State legislature. Between July 1989 and December 1990, 
informational meetings and organizational activities took place 
throughout the state, resulting in the establishment or 
recognition of the five Native Hawaiian health care systems 
which would take the responsibility for providing services: (1) 
Ho'ola Lahui Hawai'i for Kaua'i and Ni'ihau; (2) Ke Ola Mamo 
for O'ahu; (3) Na Pu'uwai for Moloka'i and Lana'i; (4) Hui No 
Ke Ola Pono for Maui; and (5) Hui Malama Ola Na 'Oiwi for 
Hawai'i. Papa Ola Lokahi provided planning funds and technical 
assistance to these five health care systems, who then 
developed their service plans from January through June 1991, 
applied for funding under the Native Hawaiian Health Care Act 
in July 1991, and were awarded service grants in October of 
1991.
    The basic set of services that all five health care systems 
must provide include: (1) outreach services to inform Native 
Hawaiians of the availability of health services; (2) education 
in health promotion and disease prevention of the Native 
Hawaiian population by Native Hawaiian health care 
practitioners, community outreach workers, counselors, and 
cultural educators, whenever possible; (3) services of 
physicians, physicians' assistants, nurse practitioners or, 
other health professionals; (4) immunizations; (5) prevention 
and control of diabetes, high blood pressure, and otitis media; 
(6) pregnancy and infant care; and (7) improvement of 
nutrition.
    In the initial stages, because the five health care systems 
needed to gain experience in managing health services and 
because of limited funds, each health care system concentrated 
on outreach, health assessments, case management, and disease 
prevention and health promotion activities, with the ultimate 
objective of providing the full range of health and medical 
services that are available through a typical primary care 
health center, and working with traditional healers so that 
their services will also be more readily available to Native 
Hawaiians.
    Now that the five island-wide Native Hawaiian health care 
systems are established and engaged in the provision of health 
care services, Papa Ola Lokahi's role is to provide technical 
and training support to the five health care systems to develop 
a statewide, cooperative Native Hawaiian health system, develop 
research activities and capacities within the five health care 
systems, and evaluate how well the objectives of the Native 
Hawaiian Health Care Act are being met.
    To serve the health care needs of Native Hawaiians on the 
islands of Kaua'i and Ni'ihau, Ho'ola Lahui Hawai'i (to 
preserve the Hawaiian Race) is a nonprofit organization 
dedicated to elevating the health status and overall living 
conditions of the Native Hawaiian. Ho'ola Lahui Hawai'i has 
established offices in Waimea and Anahola which serve as a base 
from which outreach is provided to the East and West sides of 
Kaua'i. Service to the island of Ni'ihau is provided through 
the office in Waimea. Ho'ola Lahui Hawai'i is working with 
existing health and health-related organizations in an effort 
to assure access to services for Native Hawaiians that were for 
some reason or another inaccessible or unacceptable. Ho'ola 
Lahui Hawai'i is organized around the concept of lokahi (unity 
in all aspects of life) in which they seek to maintain a 
balance of body, mind, and soul. As a community-based 
organization which works from the ground level up, the concern 
of Ho'ola Lahui Hawai'i for the Native Hawaiian grows out of a 
shared history, for those involved in Ho'ola Lahui Hawai'i are 
Native Hawaiian.
    At this time, Ho'ola Lahui Hawai'i provides health 
education and teaching on cancer, diabetes, hypertension, high 
cholesterol, gout, hygiene, and diet/exercise. Ho'ola Lahui 
Hawai'i also conducts monitoring on blood pressure, blood 
sugar, weight, and diet. Ho'ola Lahui Hawai'i offers 
information and referral to outside agencies through case 
management. In addition, Ho'ola Lahui Hawai'i is sponsoring the 
traditional Native Hawaiian diet regimen on the island of 
Kaua'i. Ho'ola Lahui Hawai'i completed one diet project in 
Waimea in conjunction with the State Department of Health and 
started another in Kapa'a in May of 1992.
    Traditional healing is also an area Ho'ola Lahui Hawai'i 
addresses with sponsorship of a statewide la'au lapa'u 
(training in traditional medicine) in the spring of 1992 in 
conjunction with E Ola Mau and Ka Wai Ola'o Kalani. In 
addition, Ho'ola Lahui Hawai'i offers lomi lomi (traditional 
massage therapy). Ho'ola Lahui Hawai'i intends to expand its 
services to include health education and teaching on sexually-
transmitted diseases, family planning, maternal and infant 
care, and alcohol/substance abuse. Ho'ola Lahui Hawai'i's plans 
include establishing a health education component in 
kindergarten, elementary, and high schools, tailored to the 
physical and psychological needs of the particular age group.
    Ke Ola Mamo is committed to improving the health status of 
Native Hawaiians on the island of O'ahu through the development 
of a system of culturally-competent services that use rather 
than duplicate the existing health care service delivery 
system. Through outreach referral and case consultation, Ke Ola 
Mamo's goal is the empowerment of Native Hawaiian families and 
individuals to access appropriate health care services; the 
development of partnerships with existing health care services 
in a collaborative effort to improve access to health care; and 
working with Native Hawaiian communities and neighborhoods to 
assist them in meeting their health care needs.
    In 1986, there were 137,481 Native Hawaiians living on the 
island of O'ahu, who comprise approximately two-thirds of the 
total Native Hawaiian population in the entire State of 
Hawai'i. The Native Hawaiian population living on O'ahu can be 
roughly divided into three equal groups by geographic location; 
those living on the leeward coast, including Pearl City; those 
living on the windward and north coasts; and those living in 
the urban Honolulu complex. There are estimated to be at least 
twenty distinct communities and neighborhoods where Native 
Hawaiian families reside. As a start, Ke Ola Mamo has selected 
four of these communities to develop service delivery projects. 
Three projects involve rural communities: the Waimanalo 
community, the Wai'anae community, and the Ko'olauloa 
community. A fourth project is being proposed as a community 
education and planning process for the urban Honolulu 
communities with future service implementation proposals.
    The goal of Na Pu'uwai is to raise the health status of the 
Native Hawaiian residents of the island of Moloka'i, including 
Kalaupapa, and the island of Lana'i to the highest possible 
level and to encourage the maximum participation of Native 
Hawaiians to achieve this goal. The strategy of the program is 
two-fold: (1) to develop a personalized schedule of recommended 
health care activities, referred to as a ``personalized health 
care plan'' for each client; and (2) to use case management 
methodologies as a behavioral intervention to assure client 
adherence to their ``personalized health care plan.''
    To implement this strategy, the program: (1) conducts 
screening and enrollment for those who are self-referred, 
provider-referred, or recruited by staff; (2) conducts a health 
risk appraisal on each enrollee to assess current health 
maintenance status; (3) develops a personalized health care 
plan with each client, based on recommended primary, secondary, 
and tertiary health maintenance guidelines and the client's 
concerns and needs; (4) coordinates and provides health 
promotion and disease prevention programs and health screening; 
(5) provides clinic-based primary health care services; (6) 
provides multi-disciplinary case management services as 
appropriate, to enrolled participants; and (7) reassesses 
client status as dictated in the case management plan 
andconducts ongoing followup on all clients, case management and non-
case management.
    Na' Pu'uwai's service delivery plan provides for (1) direct 
outpatient care services of a physician and nurse; (2) case 
management services of a social worker and multi-disciplinary 
case management team; (3) direct health education and health 
screening services; and (4) patient followup and outreach 
services.
    Hui No Ke Ola Pono (an association to strengthen and 
perpetuate life) is Maui's Native Hawaiian Health Care System, 
providing services that are culturally relevant to Native 
Hawaiians of Maui, including identification, treatment, 
control, and reduction of the incidence of preventable 
illnesses and conditions frequently occurring in the Native 
Hawaiian population. The services provided by Hui No Ke Ola 
Pono include health promotion and disease prevention; referrals 
for immunizations; improvement of nutrition; referrals for 
pregnancy and infant care; prevention and control of diabetes, 
high blood pressure and middle ear infections; community 
outreach services; referrals to physician and nursing services; 
and education on traditional practitioner services.
    In addition, traditional Hawaiian healers provide the 
following services: ho'oponopono (family or group counseling); 
la'au lapa'au (traditional Hawaiian herbal medicine); and lomi 
lomi (Hawaiian massage therapy).
    Hui Malama Ola Na 'Oiwi (caring for our people) is the 
Native Hawaiian health care system for Native Hawaiians on the 
Island of Hawai'i. The program mission of Hui Malama Ola Na 
'Oiwi is to assist Native Hawaiians in restoring a high quality 
health care system by creating and developing a non-threatening 
healing environment inclusive of traditional health assistance 
and to provide an facilitate a process of awareness and 
addressing the health needs, both physical and spiritual, of 
Native Hawaiians.
    Hui Malama's objectives are to (1) promote physical, 
emotional, and spiritual health and well-being of Native 
Hawaiians on the island of Hawaii; (2) assist and promote 
personal responsibility among Native Hawaiians toward making 
sound, informed decisions which would decrease unhealthy 
behaviors and reduce morbidity and mortality rates; (3) support 
and advocate the use of health care services that come from the 
traditions of the Native Hawaiian culture and of western 
science; and (4) work toward the establishment of primary 
health care centers in appropriate locations where quality 
primary care can be provided and where primary care services 
are not currently available.
    The death rates of Native Hawaiians exceed the death rates 
for all races in the United States caused by diseases of the 
heart, cancer, strokes, and diabetes. Achieving good health for 
Native Hawaiians appears difficult, but these diseases can be 
controlled through early detection, proper diet and treatment, 
regular exercise, etc.
    Hui Malama Ola Na 'Oiwi provides the following services: 
(1) Outreach--enrolling participants in the program, assessing 
their health risk factors, assisting in securing medical 
insurance where needed, assisting in access to a physician, 
providing transportation to and from the physician for those 
who are unable to do so, and making home visits when necessary; 
(2) Health promotion and disease prevention--providing 
education regarding the prevention and control of diabetes, 
high blood pressure (hypertension), misuse of tobacco, alcohol 
and other harmful drugs, sexually transmitted diseases, stress, 
cancer, the importance of sound nutrition habits, regular 
exercise, and proper material and infant care practices; (3) 
Primary health services--Hui Malama Ola Na 'Oiwi assists 
patients in securing access to the primary health care services 
of a physician, a physician's assistant, or a nurse 
practitioner where a doctor may not be available.
    Through the work of the five Native Hawaiian health care 
systems, on an annual basis, 20,000 Native Hawaiians continue 
to benefit from the range of health care services provided by 
the systems.

          Native Hawaiian Health Care Professions Scholarships

    The Native Hawaiian Health Care Improvement Act also 
provides authority for the provision of scholarships to Native 
Hawaiians who are seeking higher education opportunities in the 
health care professions. The Native Hawaiian Health Scholarship 
Program is administered by the Kamehameha Schools Bishop 
Estate, and has awarded 92 scholarships since 1991. These 
scholarships include: 10 bachelors of nursing, 2 clinical 
psychology doctoral programs, 2 dentists, 7 dental hygienists, 
one osteopathic physician, 29 allopathic physicians, 6 masters 
public health, 12 masters in social work, one nurse midwife, 3 
nurse practitioners, 4 doctors of psychology, and 5 registered 
nurses. Nineteen of the scholarship recipients have completed 
their studies and their service payback requirements and are 
practicing in the Native Hawaiian community. Seventeen are 
enrolled in advanced studies, three have completed their 
training and are awaiting placement for the service payback 
requirement, three have enrolled and completed their 
scholarships, thirteen are in residency programs, and 24 have 
completed their studies and are currently providing services to 
the Native Hawaiian community.

                        Reauthorization Process

    In order to assure the maximum involvement of Native 
Hawaiians in thedevelopment of a bill to reauthorize the Native 
Hawaiian Health Care Improvement Act, from December of 1997 through 
January of 1998, eight island 'aha's (island-wide conferences) were 
held involving more than 1,200 individuals in and effort to identify 
the principal Native Hawaiian health and wellness issues and concerns. 
In March of 1998, a statewide Native Hawaiian Health and Wellness 
Summit, Ka 'Uhane Lokahi, was held on the island of O'ahu, bringing 
together more than 600 people to identify potential health and wellness 
issues and concerns. In January of 1999, a Native Hawaiian Health Forum 
was convened to discuss major health care trends and strategies for 
health care and wellness developed by the indigenous peoples of North 
America and Aotearoa.
    In March of 1999, the Executive Directors of the Native 
Hawaiian health care systems, the members of the Papa Ola 
Lokahi Board, and the Director of the Native Hawaiian Health 
Scholarship Program met to review the Act and to incorporate 
recommendations from the 'aha's, the summit, and the health 
forum for inclusion in a bill to reauthorize the Native 
Hawaiian Health care Improvement Act. Thereafter, a series of 
public meetings were held to discuss and review a draft 
reauthorization bill and based upon the comments received, the 
bill was further refined and then circulated in the Native 
Hawaiian community. A final draft of the bill, incorporating 
and responding to recommendations received from the Native 
Hawaiian community, was submitted to the Congress.

                      Summary of Major Provisions

    S. 1929 extends the existing program authorities of the Act 
and authorizes appropriations in such sums as may be necessary 
through fiscal year 2011. The bill contains extensive findings 
on the current health status of Native Hawaiians including the 
incidence and mortality rates associated with various forms of 
cancer, diabetes, asthma, circulatory diseases, infectious 
disease and illness, and injuries, as well as statistics on 
life expectancy, maternal and child health, births, teen 
pregnancies, fetal mortality, mental health, and health 
professions education and training.
    The bill further refines the role of Papa Ola Lokahi and 
the Native Hawaiian health care systems, providing authority 
for the establishment of additional health care systems to 
serve the islands of Lana's and Ni'ihau, for a total number of 
health care systems not to exceed eight.
    In addition to those organizations that originally 
comprised the Board of Papa Ola Lokahi, S. 1929 adds the five 
Native Hawaiian health care systems to the Papa Board as well 
as the Kamehameha Schools, and the Native State Primary Care 
Association which represents the community health centers, or 
other organizations responsible for the placement of scholars 
from the Native Hawaiian Scholarship Program, the Native 
Hawaiian Physicians Association, and such other member 
organizations as the Papa Ola Lokahi Board will admit based 
upon a satisfactory demonstration of a record of contribution 
to the health and well-being of Native Hawaiians.
    The 1992 amendments to the Act adopted the relevant health 
objectives of the U.S. Surgeon General's Healthy People 2000 
objectives as goals to be met by the Native Hawaiian health 
care systems. S. 1929 establishes new objectives to be met by 
the Native Hawaiian health care systems, drawing upon the 
objectives established in the U.S. Surgeon General's Healthy 
People 2010 objectives.
    S. 1929 proposes that the providers of health care 
services, including the providers of traditional Native 
Hawaiian healing services, who provide services under the 
auspices of the Native Hawaiian health care systems shall be 
treated as members of the Public Health Service for purposes of 
Federal Tort Claims Act coverage.
    The bill also provides authorization for Papa Ola Lokahi to 
carry out Native Hawaiian demonstration projects of national 
significance in areas such as the education of health 
professionals, the integration of Western medicine with 
complementary health practices including traditional Native 
Hawaiian healing practices, the use of tele-wellness and 
telecommunications in chronic disease management and health 
promotion and disease prevention, the development of an 
appropriate model of health care of Native Hawaiians and other 
indigenous people, the development of a centralized data base 
and information system relating to the health care status, 
health care needs, and wellness of Native Hawaiians, and the 
establishment of a Native Hawaiian Center of Excellence for 
Nursing at the University of Hawaii at Hilo, a Native Hawaiian 
Center of Excellence for Mental Health at the University of 
Hawaii at Manoa, a Native Hawaiian Center of Excellence for 
Maternal Health and Nutrition at the Waimanalo Health Center, a 
Native Hawaiian Center of Excellence for Research, Training, 
and Integrated Medicine at Molokai General Hospital, and a 
Native Hawaiian Center of Excellence for Complementary Health 
and Health Education and Training at the Waianae Coast 
Comprehensive Health Center.
    S. 1929 also provides authorization for the establishment 
for a 21-member National Bipartisan Native Hawaiian Health Care 
Entitlement Commission which would in turn be authorized to 
establish a 10-member study committee to collect and compile 
data necessary to understand the extend of Native Hawaiian 
needs with regard to the provision of health services, and to 
make recommendations to the Commission for legislation that 
would provide for the culturally-competent and appropriate 
provision of health services for Native Hawaiians as an 
entitlement.

         The Provision of Federal Programs to Native Hawaiians

    In the exercise of the plenary power vested in the Congress 
in Article I, section 8, clause 3 of the United States 
Constitution, the Congress has exercised its authority to 
address the conditions of the aboriginal, indigenous, native 
people of the United States, including the aboriginal, 
indigenous, native people of the states of Alaska and Hawaii. 
Numerous federal laws have been enacted to address the 
conditions of American Indians, Alaska Natives and Native 
Hawaiians.
    One hundred and sixty Federal laws have been enacted to 
address the conditions of Native Hawaiians. Those laws are set 
forth as an appendix to this report (Appendix A).

                      Section-by-Section Analysis

Section 1. Short title

    The title of the Act is the Native Hawaiian Health Care 
Improvement Act Reauthorization of 1999.

Section 2. Findings

    Section (a) sets forth Congress' findings which are as 
follows:
    Subsection (a)(1): Congress finds that Native Hawaiians 
begin their story with the Kumulipo which details the creation 
and inter-relationship of all things, including their 
evolvement as healthy and well people.
    Subsection (a)(2): Congress finds that Native Hawaiians are 
a distinct and unique indigenous people with historical 
continuity to the original inhabitants of the Hawaiian 
archipelago within Ke Moananui, the Pacific Ocean, and have a 
distinct society organized almost 2,000 years ago.
    Subsection (a)(3): Congress finds that the health and well-
being of the Native Hawaiians are connected to their feelings 
and attachment to their lands and sea.
    Subsection (a)(4): Congress finds that the economic and 
social changes in Hawai'i over the 19th and early 20th 
centuries have been devastating to the health and well being of 
Native Hawaiians.
    Subsection (a)(5): Congress finds that Native Hawaiians 
have never directly relinquished to the United States their 
claims to their inherent sovereignty as a people or over their 
national territory, either through their monarchy or through a 
plebiscite or referendum.
    Subsection (a)(6): Congress finds that Native Hawaiians are 
determined to preserve and transit to future generations their 
ancestral territory, and cultural identity.
    Subsection (a)(7): Congress finds that the constitution and 
statutes of the State of Hawai'i acknowledge land rights of 
Native Hawaiian people as beneficiaries of public lands trust 
and protect the right of Native Hawaiian people to practice 
their cultural and religious practices.
    Subsection (a)(8): Congress finds that in 1778 at the time 
of first contact between non-indigenous people and Native 
Hawaiians, that Native Hawaiians were a highly organized, self-
sufficient, subsistence social system based on communal land 
tenure. Native Hawaiians also had developed a sophisticated 
language, culture, and religion.
    Subsection (a)(9): Congress finds that a unified monarchial 
government of the Hawaiian Islands was established in 1810 
under Kamehameha I, the first King of Hawai'i.
    Subsection (a)(10): Congress finds that throughout the 19th 
century and until 1893, the United States recognized the 
independence of the Hawaiian Nation; extended full diplomatic 
recognition to the Hawaiian Government; and entered into 
treaties and conventions with the Hawaiian monarchs to govern 
commerce and navigation in 1826, 1842, 1849, and 1875 and 1887.
    Subsection (a)(11): Congress finds that in 1892, the United 
States Minister, which was assigned to the sovereign and 
independent Kingdom of Hawai'i, conspired with a small group of 
non-Hawaiian residents of the Kingdom along with some residents 
of the United States to overthrow the indigenous and lawful 
government of Hawai'i.
    Subsection (a)(12): Congress finds that the United States 
Minister and the United States representative caused its armed 
naval forces of the United States to invade the sovereignty of 
the Hawaiian Nation in support of the overthrow of the 
indigenous and lawful Government of Hawai'i. In addition, 
United States Minister extended diplomatic recognition of a 
provisional government formed by the conspirators without the 
consent of the native people of Hawai'i or the lawful 
Government of Hawai'i in violation of treaties between the two 
nations and of international law.
    Subsection (a)(13): Congress finds that on December 18, 
1893, President Grover Cleveland reported fully on the 
conspiracy actions and described them as acts of war which the 
United States should endeavor to repair.
    Subsection (a)(14): Congress finds that Queen 
Lili'uokalani, the lawful monarch of Hawai'i, and the Hawaiian 
Patriotic League, representing the aboriginal citizens of 
Hawai'i, promptly petitioned the United States for redress of 
the wrongs and for restoration of the indigenous government of 
the Hawaiian nation, but the United States did not act upon the 
petition.
    Subsection (a)(15): Congress finds that in 1993 the United 
States enacted Public Law 103-150 which acknowledges the 
overthrow of the Kingdom of Hawai'i through the participation 
of agents and citizens of the United States and apologizes to 
native Hawaiians for the resulting deprivation of their right 
to self-determination.
    Subsection (a)(16): Congress finds that in 1898, the United 
States annexed Hawai'i through the Newlands Resolution without 
the consent of or compensation to the indigenous people of 
Hawai'i or their sovereign government who were thereby denied 
the mechanism for expression of their inherent sovereignty 
through self-government and self-determination, their lands and 
ocean resources.
    Subsection (a)(17): Congress finds that through the 
Newlands Resolution and the 1900 Organic Act, the Congress 
received 1,750,000 acres of lands formerly owned by the Crown 
and Government of the Hawaiian Kingdom and exempted the lands 
from then existing public land laws of the United States by 
mandating that the revenue and proceeds from these lands be 
``used solely for the benefit of the inhabitants of the 
Hawaiian Islands for education and other public purposes'', 
thereby establishing a special trust relationship between the 
United States and the inhabitants of Hawai'i.
    Subsection (a)(18): Congress finds that it enacted the 
Hawaiian Homes Commission Act, 1920, which designated 
approximately 200,000 acres of ceded public lands for Native 
Hawaiian homesteads was in response to the sharp decline in the 
Native Hawaiian population and reaffirms the trust relationship 
between the United States and Native Hawaiians.
    Subsection (a)(19): Congress finds that in 1938 they again 
acknowledged the unique status of the Native Hawaiian people by 
including the Act of June 20, 1938, a provision to lease lands 
within the extension to Native Hawaiians and to permit fishing 
in the area ``only by native Hawaiian residents of said area or 
of adjacent villages and by visitors under their guidance''.
    Subsection (a)(20): Congress finds that under the Act 
entitled ``An Act to provide for the admission of the State of 
Hawai'i into the Union'', approved March 18, 1959 the United 
States transferred responsibility for administration of the 
Hawaiian Home Lands to the State of Hawai'i but reaffirmed the 
trust relationship which existed between the United States and 
the Native Hawaiian people by retaining the exclusive power to 
enforce the trust, including the power to approve land 
exchanges and legislative amendments affecting the rights of 
beneficiaries under such Act.
    Subsection (a)(21): Congress finds that under the Act 
entitled ``An Act to provide for the admission of the State of 
Hawai'i into the Union'', approved March 18, 1959, the United 
States transferred responsibility for administration over 
portions of the ceded public lands trust not retained by the 
United States to the State of Hawai'i but reaffirmed the trust 
relationship which existed between the United States and the 
native Hawaiian people by retaining legal responsibility of the 
State for the betterment of the conditions of the Native 
Hawaiians under that Act.
    Subsection (a)(22): Congress finds that in 1978 the people 
of Hawai'i amended their Constitution to establish the Office 
of Hawaiian Affairs and assigned to that body the authority to 
accept and hold real and personal property in trust for Native 
Hawaiian people and to receive payments from the state. The 
Office of Hawaiian affairs is to act as the lead State agency 
for matters affecting the Native Hawaiian people, and to 
formulate policy on affairs relating to the Native Hawaiian 
people.
    Subsection (a)(23): Congress finds that it has the 
authority under the Constitution to legislate in matters 
affecting the aboriginal or indigenous peoples of the United 
States, including the authority to legislate in matters 
affecting native peoples of Alaska and Hawai'i.
    Subsection (a)(24): Congress finds that it has recognized 
the authority of the Native Hawaiian people to work towards an 
appropriate form of sovereignty as defined by the Native 
Hawaiian people themselves in provisions set forth in 
legislation returning the Hawaiian Island of Kaho'olawae to 
custodial management by the State of Hawai'i in 1994.
    Subsection (a)(25): Congress finds that the United States 
furthered the trust responsibility to better the conditions of 
Native Hawaiians by establishing programs to provide 
comprehensive health promotion and disease prevention services 
to maintain and improve the health status of the Native 
Hawaiian people. Federal assistance and health initiatives 
conducted by the Native Hawaiian Health Care Systems, the 
Native Hawaiian Health Scholarship Program, Papa Ola Lokahi, 
and other health institutions, accomplished through the Native 
Hawaiian Health Care Act of 1988 and its reauthorization, have 
been responsible for reducing the century-old morbidity and 
mortality rates of native Hawaiians.
    Subsection (a)(26): Congress finds that the United States 
has recognized and confirmed its special relationship with 
Native Hawaiians through theinclusion of Native Hawaiians in 
laws affecting Native Americans. These acts include the Native American 
Programs Act of 1974, the American Indian Religious Freedom Act, the 
National Museum of the American Indian Act, and the Native American 
Graves Protection and Repatriation Act.
    Subsection (a)(27): Congress finds that the United States 
has also recognized its special political relationship with 
Native Hawaiians through the inclusion of Native Hawaiians 
under the following legislation: the Older Americans Act of 
1965, the Developmental Disabilities Assistance and Bill of 
Rights Act Amendments of 1987, the Veterans' Benefits and 
Services Act of 1988, the Rehabilitation Act of 1973, the 
Native Hawaiian Health Care Act of 1988, the Health Professions 
Reauthorization Act of 1988, the Nursing Shortage Reduction and 
Education Extension Act of 1988, the Handicapped Programs 
Technical Amendments Act of 1988, the Indian Health Care 
Amendments of 1988, and the Disadvantaged Minority Health 
Improvement Act of 1990.
    Subsection (a)(28): Congress finds that the United States 
has again affirmed the historical and unique relationship to 
the Native Hawaiian people by authorizing the provision of 
services to Native Hawaiians to address problems of alcohol and 
drug abuse under the Anti-Drug Abuse Act of 1986 (Public Law 
99-570).
    Subsection (a)(29): Congress finds that the United States 
has recognized that Native Hawaiians, as aboriginal, 
indigenous, native people of Hawai'i, are a distinctive 
population group in Hawai'i and in the continental United 
States as has been articulated in Office of Management and 
Budget Circular 15 in 1997 and Presidential Executive Order No. 
13125, dated June 7, 1999.
    Subsection (a)(30): Congress finds that despite the United 
States' repeated expression of its commitment to a policy of 
reconciliation with the Native Hawaiian people for past 
grievances, the unmet health needs of the Native Hawaiian 
people remain severe and their health status continues to be 
below that of the general United States population.
    Subsection (2)(b) describes the unmet needs and health 
disparities that adversely affect Native Hawaiians.
    Subsection (b)(1) discusses chronic diseases and illnesses 
affecting Native Hawaiians. It includes the following:
    (A) Cancer. Native Hawaiian women have the highest cancer 
mortality rates in the State (including breast, lung, and 
cervix cancer) which is 45 percent higher than that for the 
total State population. Native Hawaiian males have the highest 
cancer mortality rates in the State for cancers of the lung, 
liver and pancreas and for all cancers combined (including the 
second highest mortality rates due to prostate cancer in the 
State). Native Hawaiian females ranked highest in the State for 
cancers of the lung, liver, pancreas, breast, cervix uteri, 
corpus uteri, stomach, and rectum, and for all cancers 
combined. Native Hawaiian males have the highest years of 
productive life lost from cancer in the State, and Native 
Hawaiian females have 8.2 years of productive life lost from 
cancer in the State.
    (B) Diabetes. With respect to diabetes, for the years 1989 
through 1991, Native Hawaiians had the highest mortality rate 
due to diabetes mellitis in the State which is 130 percent 
higher than the statewide rate for all other races, with full-
blood Hawaiians having a mortality rate of 93.3 out of every 
100,000 residents, which is 518 percent higher than the rate 
for the statewide population of all other races. Native 
Hawaiians who are less than full-blood had a mortality rate of 
27.1 out of every 100,000 residents, which is 79 percent higher 
than the rate for the statewide population of all other races.
    (C) Asthma. In 1990, Native Hawaiians comprised 44 percent 
of all asthma cases in the State for those 18 years of age and 
younger, and 35 percent of all asthma cases reported, and in 
1992 the Native Hawaiian rate for asthma was 81.7 out of every 
1,000 residents, which was 73 percent higher than the rate for 
the total statewide population.
    (D) Circulatory diseases. The death rate for Native 
Hawaiians from heart disease is 66 percent higher than for the 
entire State. The death rate for Native Hawaiians from 
hypertension is 84 percent higher than that for the entire 
State. The death rate for Native Hawaiians from stroke is 13 
percent higher than that for the entire State.
    Subsection (b)(2) describes infectious diseases and 
illnesses affecting Native Hawaiians. The incidence of AIDS for 
Native Hawaiians is at least twice as high per 100,000 
residents than that for any other non-Caucasian group in the 
State.
    Subsection (b)(3) describes that the death rate for Native 
Hawaiians from accidents is 45 percent higher than that for the 
entire State, with Native Hawaiian males losing an average of 
14 years of productive life lost from accidents and Native 
Hawaiian females losing an average of 4 years of productive 
life lost from accidents.
    Subsection (b)(4) describes that Native Hawaiian children 
exhibit among the highest rates of dental caries in the nation 
and State. The average number ofdecayed or filled primary teeth 
for Native Hawaiian children ages 5 through 9 years was 4.3 as compared 
with 3.7 for the entire State. The proportion of Native Hawaiian 
children ages 5 through 12 years with unmet treatment needs (defined as 
having active dental caries requiring treatment) is 40 percent as 
compared with 33 percent for all other races in the State.
    Subsection (b)(5) describes that Native Hawaiians have the 
lowest life expectancy of all population groups in the State of 
Hawai'i. The most recent tables for 1990 show Native Hawaiian 
life expectancy at birth to be about 5 years less than that of 
the total State population.
    Subsection (b)(6) describes the statistics for Native 
Hawaiian maternal and child health. Since 1996, Native Hawaiian 
women have the highest prevalence of having had no prenatal 
care during their first trimester of pregnancy, and of mothers 
in the State who received no prenatal care throughout their 
pregnancy in 1996, 44 percent were Native Hawaiian. In 1996, of 
the births to Native Hawaiian single mothers, 8 percent were 
low birth weight and of all low birth weight babies born to 
single mothers in the State, 44 percent were Native Hawaiian. 
In 1993 and 1994 Native Hawaiians had the highest percentage of 
teen births compared to the rate for all other races in the 
State, and for births to mothers age 14 years and younger in 
Hawai'i, Native Hawaiians comprised 66% in 1995 and 48 percent 
in 1996.
    Subsection (b)(7) describes the level of alcohol and drug 
abuse. Native Hawaiians represent 38 percent of the total 
admissions to substance abuse treatment programs in the 
Department of Health, Alcohol, Drugs and Other Drugs. In 1997, 
the prevalence of smoking by Native Hawaiians was 28.5 percent, 
a rate that is 53 percent higher than that for all other races 
in the State. Native Hawaiians have the highest prevalence 
rates of acute drinking, a rate that is 79 percent higher than 
that for all other races in the State. The chronic drinking 
rate among Native Hawaiians is 54 percent higher than that for 
all other races in the State. In 1991, 40 percent of the Native 
Hawaiian adults surveyed reported having used marijuana and 
nine percent of the Native Hawaiian adults surveyed reported 
that they are current users (within the past year) of 
marijuana. In 1996, with respect to crime, 5,944 arrests were 
made for property crimes in the State with Native Hawaiian 
arrests comprising 20 percent of that total, with Native 
Hawaiian juveniles comprised a third of all juvenile arrests. 
In 1996, Native Hawaiians represented 21 percent of the 8,000 
adults arrested for violent crimes in the State of Hawai'i, and 
38 percent of the 4,066 juvenile arrests. In 1995 and 1996 
Native Hawaiians comprised 36.5 percent of the sentenced felon 
prison population in Hawai'i, comprised 45.4 percent of the 
technical violator population, and constituted 51.6 percent of 
all detainees at the Hawai'i Youth Correctional Facility in 
1997.
    Subsection (b)(8) describes that with respect to health 
professions education and training, Native Hawaiians age 25 
years and older have a comparable rate of high school 
completion, but the rates of baccalaureate degree achievement 
amongst Native Hawaiians are less than the norm in the State. 
Native Hawaiian physicians make up 4 percent of the total 
physician workforce in the State. Native Hawaiians comprise 8 
percent of individuals who earned Bachelor's Degrees, 14 
percent of individuals who earned professional diplomas, 6 
percent of individuals who earned Master's Degrees, and less 
than 1 percent of individuals who earned doctoral degrees at 
the University of Hawai'i.

Section 3. Definitions

    This section sets forth the definitions of terms used in 
the Act.
    Section 3(1) defines ``Department'' to mean the Department 
of Health and Human Services.
    Section 3(2) provides that for purposes of the Act, the 
term ``disease prevention'' includes immunizations, control of 
high blood pressure, control of sexually transmittable 
diseases, the prevention and control of chronic diseases, 
control of toxic agents, occupational safety and health, injury 
prevention, fluoridation of water, control of infectious 
agents, and provision of mental health care.
    Section 3(3) provides that for the purposes of the Act, the 
term ``health promotion'' includes pregnancy and infant care, 
including prevention of fetal alcohol syndrome, cessation of 
tobacco smoking, reduction in the misuse of alcohol and harmful 
illicit drugs, improvement of nutrition, improvement in 
physical fitness, family planning, control of stress, reduction 
of major behavioral risk factors, and promotion of healthy 
lifestyle practices, and integration of cultural approaches to 
health and well-being.
    Section 3(4) provides that for purposes of the Act, the 
term ``Native Hawaiian'' means any individual who is a 
descendant of the aboriginal people who, prior to 1778, 
occupied and exercised sovereignty in the area that now 
constitutes the State of Hawai'i as evidenced by genealogical 
records, or kama'aina (long-term community residents) witness 
verification by Native Hawaiian kupuna (elders), or birth 
records of the State of Hawai'i or any state or territory of 
the United States.
    Section 3(5) provides that for purposes of the Act, the 
term ``Native Hawaiian health care system'' means an entity 
which
          (A) is organized under the laws of the State of 
        Hawai'i;
          (B) which provides or arranges for health care 
        services through practitionerslicensed by the State of 
Hawai'i where licensure requirements are applicable;
          (C) which is a public or nonprofit private entity;
          (D) in which Native Hawaiian health practitioners 
        significantly participate in the planning, management, 
        monitoring and evaluation of health care services;
          (E) which may be composed of eight Native Hawaiian 
        health care systems; and
          (F) which Papa Ola Lokahi recognizes for the purpose 
        of planning, conducting, or administering programs (or 
        portions of programs) under the authority of the Act 
        for the benefit of Native Hawaiians and which is 
        certified by Papa Ola Lokahi as having the 
        qualifications and the capacity to provide the services 
        and meet the requirements under the contract or the 
        grant the Native Hawaiian health care system enters 
        into with or receives from the Secretary under the Act.
    Section 3(6) provides that for purposes of the Act, the 
term ``Native Hawaiian Health Center'' means an organization 
which provides primary care and which Papa Ola Lokahi has 
recognized has met the following criteria: a governing board 
that is fifty-percent (50%) or more Native Hawaiians; has 
demonstrated cultural competency in a predominantly Native 
Hawaiian community; has a patient population that is either 
fifty-percent Native Hawaiian or number not less than 2,500 
Native Hawaiian clients annually.
    Section 3(7) provides that for purposes of the Act, 
``Native Hawaiian Health Task Force'' means a task force the 
State Council of Hawaiian Homestead Association establishes 
that implements health and wellness strategies in Native 
Hawaiian communities in Hawai'i.
    Section 3(8) provides that for purposes of the Act, 
``Native Hawaiian organization'' means a public or nonprofit 
organization that serves Native Hawaiian interests which Papa 
Ola Lokahi has recognized for planning, conducting, or 
administering programs (or portions of programs) authorized 
under this Act.
    Section 3(9) provides that for purposes of the Act, 
``Office of Hawaiian Affairs'' and ``OHA'' means the 
governmental entity established under the Hawai'i State 
Constitution which is charged with the responsibility to 
formulate policy relating to Native Hawaiian affairs.
    Section 3(10) provides that for purposes of the Act, the 
term ``Papa Ola Lokahi'' means an organization composed of 
public agencies and private organizations focusing on improving 
the health status of Native Hawaiians. Board members may 
include representatives from the following: E Ola Mau; the 
Office of Hawaiian Affairs; Alu Like, Inc.; the University of 
Hawai'i; the Hawai'i State Department of Health; the Kamehameha 
Schools (or other Native Hawaiian organization that administers 
the Native Hawaiian health scholarship program); the Hawai'i 
State Primary Care Association or Native Hawaiian health 
scholarship program); the Hawai'i State Primary Care 
Association or Native Hawaiian Health Centers whose patient 
populations are predominantly Native Hawaiian; 'Ahahui O Na 
Kauka (the Native Hawaiian Physicians Association); Ho'ola 
Lahui Hawai'i or a health care system serving the islands of 
Kaua'i or Ni'ihau; Ke Ola Mamo, or a health care system serving 
the island of O'ahu; Na Pu'uwai or a health care system serving 
the islands of Moloka'i and Lana'i; Hui No Ke Ola Pono, or a 
health care system serving the island of Maui; Hui Malama Ola 
Na 'Oiwi or a health care system serving the island of Hawai'i; 
other native Hawaiian health care systems that Papa Ola Lokahi 
certifies and recognizes; and such other member organizations 
as the Board of Papa Ola Lokahi may admit from time to time, 
based upon a satisfactory demonstration of a record of 
contribution to the health and well-being of Native Hawaiians, 
but with the proviso that organizations will not be part of 
Papa Ola Lokahi if the Secretary determines that an 
organization has not developed a mission statement with clearly 
defined goals and objectives for the contributions the 
organization will make to the Native Hawaiian health care 
systems and an action plan for carrying out those goals and 
objectives.
    Section 3(11) provides that for purposes of the Act, the 
term ``primary health services'' means: the services of 
physicians, physicians' assistants, nurse practitioners, and 
other health care professionals; diagnostic laboratory and 
radiologic services; preventive health services, including 
perinatal services, well child services, and family planning 
services, nutrition services, home health services, and other 
wellness services; emergency medical services; transportation 
services as required for adequate patient care; preventive 
dental services; and pharmaceutical and medicament services; 
primary care services which may lead to specialty and/or 
tertiary care; and complementary healing practices, including 
those performed by traditional Native Hawaiian healers.
    Section 3(12) provides that for purposes of the Act, the 
term ``Secretary'' means the Secretary of the U.S. Department 
of Health and Human Services.
    Section 3(13) provides that for purposes of the Act, the 
term ``traditional Native Hawaiian healer'' means a 
practitioner who is of Hawaiian ancestry and has the knowledge, 
skills, and experience in direct personal health care of 
individuals, and whose knowledge, skills, and experience are 
based on demonstrated learning of Native Hawaiian healing 
practices acquired by direct practical association with Native 
Hawaiian elders andoral traditions passed from generation to 
generation.

Section 4. Declaration of National Native Hawaiian Health Policy

    This section establishes the policy of the Act.
    Section 4 (a) and (b) establish that it is the United 
States' policy, in fulfilling its special responsibilities and 
legal obligations to the indigenous people of Hawai'i which 
results from the unique and historical relationship between the 
United States and the government of the indigenous people of 
Hawai'i, to raise the health status of Native Hawaiians to the 
highest possible level and to provide existing Native Hawaiian 
health care programs with the resources necessary to effectuate 
this policy. Section 4 also expresses Congress' intent to raise 
Native Hawaiians' health status by 2010 to at least the 
standards contained within Healthy People 2010 or successor 
standards, and to incorporate the following activities within 
health programs: integration of cultural approaches to health 
and well-being; increasing the number of health and allied-
health care providers who can provide culturally competent 
care; increasing the use of traditional Native Hawaiian foods 
in peoples' diets and dietary preferences including those of 
students and the use of traditional foods in school feeding 
programs; identifying and instituting Native Hawaiian cultural 
values and practices within the ``corporate cultures'' of 
organizations and agencies providing health services to Native 
Hawaiians; facilitating the provision of Native Hawaiian 
healing practices by Native Hawaiian healers for those clients 
desiring such assistance; and supporting training and education 
activities and programs in traditional Native Hawaiian healing 
practices by Native Hawaiian healers.
    Section 4(c) directs the Secretary of Health and Human 
Services to include in his report to the Congress, as required 
under section 12, a report on the progress made towards meeting 
the national policy of the Act.

Section 5. Comprehensive Health Care Master Plan for Native Hawaiians

    Section 5(a)(1) authorizes the Secretary to make a grant or 
enter into a contract with Papa Ola Lokahi for the purpose of 
coordinating, implementing, and updating the Native Hawaiian 
comprehensive health care master plan which is designed to 
promote comprehensive health promotion and disease prevention 
services and to maintain and improve the Native Hawaiians' 
health status.
    Section 5(a)(2) is amended to require Papa Ola Lokahi and 
the Office of Hawaiian Affairs to consult with the Native 
Hawaiian health care systems, the Native Hawaiian health care 
centers, and the Native Hawaiian community in carrying out 
section 5, and authorizes Papa Ola Lokahi and the Office of 
Hawaiian Affairs to enter into memoranda of understanding or 
agreement to acquire joint funding and for other issues to 
accomplish the objectives of this section
    Section 5(a)(3) requires that within eighteen months of the 
Act's promulgation, that Papa Ola Lokahi cooperate with the 
Office of Hawaiian Affairs and other appropriate agencies of 
the State of Hawai'i, and prepare and submit a report to 
Congress detailing the impact of current Federal and State 
health care financing mechanisms and policies on the health and 
well-being of Native Hawaiians. The study is to include the 
impact of cultural competency, risk assessment data, 
eligibility requirements and exemptions, reimbursement policies 
and capitation rates currently in effect for service providers, 
and any other information that may be important to improving 
the health status of Native Hawaiians as it relates to health 
care financing, including barriers to health care. These 
recommendations will also be submitted to the Secretary for 
review and consultation with Native Hawaiians.
    Section 5(b) authorizes the appropriation of such sums as 
may be necessary to carry out subsection (a).

Section 6. Functions of Papa Ola Lokahi and Office of Hawaiian Affairs

    This section sets forth the functions of Papa Ola Lokahi 
and is amended to include the Office of Hawaiian Affairs.
    Section 6(a) makes Papa Ola Lokahi responsible for the 
following:
          (1) coordinating, implementing, and updating the 
        comprehensive health care master plan developed 
        pursuant to the authority contained in section 5;
          (2) training of Native Hawaiian health care 
        practitioners, community outreach workers, and 
        counselor and cultural educators who will be involved 
        in providing health promotion and disease prevention 
        education;
          (3) identifying and researching the diseases that are 
        most prevalent among Native Hawaiians, including 
        behavioral, biomedical, epidemiological, and health 
        services;
          (4) developing and maintaining an institutional 
        review board for all research projects involving all 
        aspects of Native Hawaiian health; and
          (5) maintaining an action plan outlining the 
        contributions that each member ofPapa Ola Lokahi will 
make in carrying out the Act's policy.
    Section 6(b) authorizes Papa Ola Lokahi to receive special 
project funds that may be appropriated for the purpose of 
conducting research on the health status of Native Hawaiians or 
for the purpose of addressing the health care needs of Native 
Hawaiians.
    Section 6(c)(1) authorizes Papa Ola Lokahi to serve as a 
clearinghouse for the collection and maintenance of data 
associated with the health status of Native Hawaiians; the 
identification and research into diseases affecting Native 
Hawaiians; the availability of Native Hawaiian project funds, 
research projects and publications; the collaboration of 
research in Native Hawaiian health; and the timely 
dissemination of information pertinent to the Native Hawaiian 
health care systems.
    Section 6(c)(2) requires the Secretary to provide Papa Ola 
Lokahi and the Office of Hawaiian Affairs with at least one 
annual accounting of funds and services that the Department of 
Health and Human Services provided to states and non-profit 
groups and organizations in carrying out the Act's policy. This 
accounting will include, but not be limited to, the following: 
the amount of funds expended explicitly for and benefiting 
Native Hawaiians; the number of Native Hawaiians impacted by 
these funds; the identification of collaborations made with 
Native Hawaiian groups and organizations in the expenditure of 
these funds; and the amount of funds used for federal 
administrative purposes and for the provision of direct 
services to Native Hawaiians.
    Section 6(d)(1) requires that Papa Ola Lokahi provide 
annual recommendations to the Secretary regarding the 
allocation of all amounts appropriated under this Act.
    Section 6(d)(2) requires Papa Ola Lokahi, to the extent 
possible, to coordinate and assist the health care programs and 
services to Native Hawaiians.
    Section 6(d)(3) requires the Secretary to consult with Papa 
Ola Lokahi and make recommendations for Native Hawaiian 
representation on the President's Advisory Commission on Asian 
Americans and Pacific Islanders.
    Section 6(e) authorizes Papa Ola Lokahi to act as a 
statewide infrastructure to provide technical support and 
coordination of training and technical assistance to the Native 
Hawaiian health care systems and the Native Hawaiian health 
care centers.
    Section 6(f)(1) authorizes Papa Ola Lokahi to enter into 
agreements or memoranda of understanding with relevant 
institutions, agencies, or organizations that are capable of 
providing health-related resources or services to the Native 
Hawaiians and the Native Hawaiian health care systems or 
providing resources or services to implement the national 
policy of this Act as set forth in section 4.
    Section 6(f)(2) addresses health care financing as follows:
    Subsection (A) requires federal agencies that provide 
health care financing and health care programs to consult with 
Native Hawaiians and with organizations providing Native 
Hawaiian health care services before adopting any policy or 
regulation that may impact on the provision of services or 
health insurance coverage. The consultation is to include but 
not be limited to the identification of the impact of proposed 
policies, rules, or regulations.
    Subsection (B) requires that the State of Hawai'i engage in 
meaningful consultation with Native Hawaiians and organizations 
providing Native Hawaiian health care services before making 
changes or initiating new programs.
    Subsection (C) authorizes the Office of Hawaiian Affairs, 
in collaboration with Papa Ola Lokahi, to develop consultative, 
contractual, or other arrangements including memoranda of 
understanding or agreement with the following: the Health Care 
Financing Administration; the agency of the State of Hawai'i 
that administers or supervises the administration of the State 
plan or waiver approved under title XVIII, XIX, or XII of the 
Social Security Act for payment of all or part of the health 
care services to Native Hawaiians who are eligible for medical 
assistance under such a State plan or waiver; or any other 
Federal agency or agencies providing Native Hawaiians with full 
or partial health insurance. Such arrangements may include 
appropriate reimbursement for health care services including 
capitation and fee for service rates for Native Hawaiians who 
are entitled to or eligible for insurance; the scope of 
services provided, or other mattes which enable Native 
Hawaiians to maximize health insurance benefits provided by 
Federal and State health insurance programs.
    Section 6(f)(3) provides that the provision of health care 
services by the department and other federal agencies may 
include the services of traditional ``Native Hawaiian healers'' 
and ``traditional healers'' providing ``traditional health care 
practices'' as defined in section 4(r) of Public Law 94-437. 
Such services are exempt from national accreditation reviews, 
including reviews conducted by the Joint Accreditation 
Commission on Health Organizations and the Rehabilitation 
Accreditation Commission.

Section 7. Native Hawaiian health care systems

    This section addresses the authority of the Secretary to 
enter into contracts and grants with Native Hawaiian healthcare 
systems for the provision of health care services and health care 
referral services to Native Hawaiians and the responsibilities of the 
Native Hawaiian health care systems.
    Section 7(a) authorizes the Secretary of Health and Human 
Services to consult with Papa Ola Lokahi and make grants to or 
enter into contracts with any qualified entity for the purpose 
of providing comprehensive health promotion, disease prevention 
services, and primary health care services provide to Native 
Hawaiians. The Secretary may enter into up to eight grants or 
contracts with preference given to Native Hawaiian health care 
systems and Native Hawaiian organizations. To the extent 
feasible, health promotion and disease prevention services 
shall be performed through Native Hawaiian health care systems. 
A ``qualified entity'' for purposes of subsection 7(a) means a 
Native Hawaiian health care system or a Native Hawaiian Health 
Care Center.
    Section 7(b) authorizes the Secretary to also make a grant 
to, or enter into a contract with, Papa Ola Lokahi for purposes 
of planning Native Hawaiian health care systems to serve the 
health needs of Native Hawaiian communities on the islands of 
O'ahu, Moloka'i, Maui, Hawai'i, Lana'i, Kaua'i, and Ni'ihau in 
the State of Hawai'i.
    Section 7(c) specifies that each Native Hawaiian health 
care system will ensure that the following services are 
provided or arranged: outreach services to inform Native 
Hawaiians of the availability of health services; health 
promotion and disease prevention education of Native Hawaiians 
by, wherever possible, Native Hawaiian health care 
practitioners, community outreach workers, counselors, and 
cultural educators; services of physicians, physicians' 
assistants, nurse practitioners, and other health 
professionals; immunizations; prevention and control of 
diabetes, high blood pressure, and otitis media; pregnancy and 
infant care; improvement of nutrition, identification, 
treatment, control and reduction of the incidences of 
preventable illnesses and conditions endemic to Native 
Hawaiians; collection of data related to the prevention of 
diseases and illnesses among Native Hawaiians; services within 
the meaning of the terms ``health promotion'', ``disease 
prevention'', and ``primary health services''; and support of 
culturally appropriate activities that enhance health and 
wellness including land-based, ocean-based, water-based, and 
spiritual-based projects and programs. Any of these services 
may be provided by traditional Native Hawaiian healers.
    Section 7(d) provides that individuals who provide medical, 
dental, or other services under subsection (a)(1) for Native 
Hawaiian health care systems shall be treated as if they were 
members of the Public Health Service and shall be covered under 
the provisions of section 224 of the Public Health Service Act.
    Section 7(e) requires that a Native Hawaiian health care 
system that receives funds under subsection 7(a) provide a 
designation area and appropriate staff to serve as a Federal 
loan repayment facility. This facility must be designed to 
enable health and allied-health professionals to remit payments 
to loans provided to such professionals under any Federal loan 
program.
    Section 7(f) specifies that the Secretary may not make a 
grant or enter into a contract as authorizes under subsection 
7(a) unless the qualified entity agrees that the grant or 
contract amount will not, directly or through contract, be 
expended for: services other than services described in section 
(c)(1); the purchase or improvement of real property (other 
than minor remodeling of existing improvements to real 
property); or the purchase of major medical equipment.
    Section 7(g) provides that the Secretary may not make a 
grant or enter into a contract with any qualified entity under 
subsection 7(a) unless the qualified entity agrees that, 
whether health services are provided directly or through 
contract, health services under the grant or contract will be 
provided without regard to ability to pay for the health 
services and the entity will impose a change for the delivery 
of health services which will be made according to a schedule 
of charges that is made publically available and will be 
adjusted to reflect the income of the individual involved.
    Section 7(h) authorizes the appropriation of sums as may be 
necessary to carry out activities under subsections 7(a) and 
7(b) for fiscal years 2001 and 2011.

Section 8. Administrative grant for Papa Ola Lokahi

    This section authorizes the Secretary to make a grant or 
enter into a contract with Papa Ola Lokahi for its 
administrative functions.
    Section 8(a) authorizes the Secretary to make grants to or 
enter into contracts with Papa Ola Lokahi for: the 
coordination, implementation, and appropriate updating of the 
comprehensive health care master plan developed under the 
authority of section 5; training for persons described in 
section 7(c)(1); identification of and research into the 
diseases that are most prevalent among Native Hawaiians, 
including behavioral, biomedical, epidemiological and health 
services; the maintenance of an action plan outlining the 
contributions that each member organization of Papa Ola Lokahi 
will make in carrying out the Act's policy; a clearinghouse 
function for the collection and maintenance of data associated 
with the health status of Native Hawaiians, the identification 
of research into diseases affecting Native Hawaiians, and the 
availability of Native Hawaiian project funds, research 
projects, and publications; the establishment and maintenance 
of an institutional review board for all health-related 
research involving Native Hawaiians; the coordination of the 
health care programs and services provided toNative Hawaiians; 
and the administration of special project funds.
    Section 8(b) authorizes the appropriation of sums as may be 
necessary to carry out the activities in subsection 8(a) for 
each of fiscal years 2001 through 2011.

Section 9. Administration of grants and contracts

    This section sets forth the terms and conditions under 
which the Secretary makes grants or enter into contracts.
    Section 9(a) specifies that within any grants made or 
contracts entered that the Secretary include terms and 
conditions the Secretary considers necessary or appropriate to 
ensure that the grant or contract objectives are achieved.
    Section 9(b) requires that the Secretary periodically 
evaluate the performance of and compliance with grants and 
contracts under this Act.
    Section 9(c) prohibits the Secretary from making any grant 
or entering into any contract with an entity unless the entity:
          (1) agrees to establish such procedures for fiscal 
        control and fund accounting as may be necessary to 
        ensure proper disbursement and accounting with respect 
        to the grant or contract;
          (2) agrees to ensure the confidentiality of records 
        maintained on individuals receiving health services 
        under the grant or contract;
          (3) with respect to health services provided to any 
        Native Hawaiian population, which substantial portion 
        has a limited ability to speak the English language, 
        develops and has the ability to carry out a reasonable 
        plan to provide health services under the grant or 
        contract through individuals who are able to 
        communicate with that population in the language and in 
        the most appropriate cultural context, and has 
        designated at least one individual, fluent in both 
        English and the appropriate language, to assist in 
        carrying out the plan;
          (4) with respect to health services covered under 
        programs under titles XVIII, XIX, or XXI of the Social 
        Security Act, including any State plan, or under any 
        other Federal health insurance plan if the entity will 
        provide under the grant or contract any such health 
        services directly, has entered into a participation 
        agreement under such plans and the entity is qualified 
        to receive payments under such plan. Also, if the 
        entity will provide under the grant or contract any 
        such health services through a contract with an 
        organization, the organization has entered into a 
        participation agreement under such plan, and the 
        organization is qualified to receive payments under 
        such plan; and
          (5) agrees to submit an annual report to the 
        Secretary and to Papa Ola Lokahi that describes the use 
        and costs of health services provided under the grant 
        or contract, including the average cost of health 
        services per user, and that provides such other 
        information the Secretary determines to be appropriate.
    Section 9(d) addresses the Secretary's evaluation of 
contracts entered into by the Secretary.
    Subsection (1) provides that when the Secretary's 
evaluation reveals that an entity has not complied with or 
satisfactorily performed a contract entered into under section 
7, that before the contract is renewed the Secretary must 
attempt to resolve the areas of noncompliance or unsatisfactory 
performance and modify the contract to prevent future 
noncompliance or unsatisfactory performance.
    Subsection (2) provides that if the Secretary determines 
that the noncompliance or unsatisfactory performance cannot be 
resolved and prevented in the future, the Secretary shall not 
renew that entity's contract and is authorized to enter into a 
new section 7 contract with a qualified entity, as defined in 
section 7(a)(3), that provides services to the same population 
of Native Hawaiians that was served by the entity whose 
contract was not renewed.
    Subsection (3) specifies that in determining whether to 
renew an entity's contract under the Act the Secretary shall 
consider the results of the evaluations undertaken under the 
authority of this section.
    Subsection (4) specifies that the contracts the Secretary 
enters under this Act must be in accordance with all Federal 
contracting laws and regulations, but that the Secretary has 
the discretion to negotiate contracts without advertising and 
may be exempt from the provisions of the Act of August 24, 1935 
(40 U.S.C. 270a et seq.).
    Subsection (5) specifies that payments made under any 
contract entered into under this Act may be made in advance, by 
means of reimbursement or installments, and shall be made on 
such conditions as the Secretary deems necessary to carry out 
the purposes of this Act.
    Subsection (9)(e) provides that for each fiscal year during 
which any entity receives or expends funds pursuant to a grant 
or contract under the Act, such entity is to submit anannual 
report to the Secretary and to Papa Ola Lokahi on the entity's 
activities under the grant or contract, the amounts and purposes for 
which Federal funds were expended, and such other information as the 
Secretary may request. The reports and records of any entity concerning 
any grant or contract under this Act shall be subject to audit by the 
Secretary, the Inspector General of the Department of Health and Human 
Services, and the Comptroller General of the United States.
    Section 9(f) provides that the Secretary shall allow as a 
cost of any grant made or contract entered into under this Act, 
the cost of an annual private audit by a certified public 
accountant.

Section 10. Assignment of personnel

    This section addresses the assignment of personnel by the 
Secretary.
    Section 10(a) specifies that where the Secretary may make 
assignments of Department of Health and Human Services 
personnel, the Secretary may enter into an agreement with any 
entity to such personnel with the expertise the entity 
identifies, to provide comprehensive health promotion and 
disease prevention services to Native Hawaiians.
    Section 10(b) specifies that under the authority of 
subsection 10(a) is to be treated as an assignment of Federal 
personnel to a local government that is made in accordance with 
subchapter VI of chapter 33 of title 5 of the United States 
Code.

Section 11. Native Hawaiian health scholarships and fellowships

    Section 11(a) specifies that, subject to the availability 
of funds appropriated under the authority of subsection 11(c), 
the Secretary is to provide funds through a direct grant to or 
a cooperative agreement with the Kamehamedha Schools as another 
Native Hawaiian organization or health care organization with 
experience in administering education scholarship or placement 
services for the purpose of providing scholarship assistance to 
Native Hawaiian students who meet the requirements of section 
338A of the Public Health Service Act, except for assistance 
provided for under section 11(b)(2) of this Act.
    Section 11(b) specifies employees of the Native Hawaiian 
Health Care Systems and the Native Hawaiian Health Centers may 
be given priority for scholarships.
    Section 11(c)(1) specifies that subsection 11(a) is to be 
provided under the same terms and subject to the same 
conditions, regulations, and rules that apply to scholarship 
assistance provided under section 338A of the Public Health 
Service Act, except as follows:
    Subsection (A) specifies that the provision of scholarships 
in each type of health care profession training shall 
correspond to the need for each type of health care 
professional to serve the Native Hawaiian community as Papa Ola 
Lokahi identifies.
    Subsection (B) specifies that to the maximum extent 
practicable, the Secretary is to select scholarship recipients 
from a list of eligible applicants submitted by the Kamehameha 
Schools (or the Native Hawaiian organization administering the 
program).
    Subsection (C) specifies that the obligated service 
requirement for each scholarship recipient is to be fulfilled 
through service in the following order of priority: in any one 
of the Native Hawaiian health care systems or Native Hawaiian 
health centers; health professions shortage areas, medically 
underserved areas, or geographic areas or facilities similarly 
designated by the United States Public Health Service in the 
State of Hawai'i; or a geographical area, facility, or 
organization that serves a significant Native Hawaiian 
population.
    Subsection (D) specifies that the scholarship program's 
placement services shall assign scholarship recipients to 
appropriate sites for service.
    Subsection (E) specifies that counseling, retention, and 
other support services will be available to any scholarship 
recipient and other scholarship and financial aid programs 
recipient enrolled in appropriate health professions training 
programs.
    Subsection (F) specifies that financial assistance may be 
provided to scholarship recipients in the health professions, 
designated in section 338A of the Public Health Service Act, 
while they are fulfilling their service requirement in any one 
of the Native Hawaiian health care systems or community health 
centers.
    Section 11(c)(2) specifies that the financial aid through 
fellowships may be provided to Native Hawaiian community health 
representatives, outreach workers, health program 
administrators in professional training programs, and Native 
Hawaiians in certificated programs provided by traditional 
Native Hawaiian healers using traditional Native Hawaiian 
healing practices. The financial assistance may include a 
stipend and/orreimbursement for costs associated with 
participating in the program.
    Section 11(c)(3) specifies that scholarship recipients in 
health professions designated in section 338A of the Public 
Health Service Act shall have the same rights and benefits as 
members of the National Health Service Corps while fulfilling 
their service requirements.
    Section 11(c)(4) provides that the financial assistance 
provided under section 11 of this Act shall be deemed 
``Qualified Scholarships'' for purposes of section 117, title 
26, United States Code.
    Section 11(d) authorizes the appropriation of such sums as 
may be necessary for the purpose of funding the scholarship 
assistance under subsection (a) and fellowship assistance under 
subsection (c)(2) for fiscal years 2001 through 2011.

Section 12. Report

    This section provides that at the time the budget is 
submitted under section 1105 of title 31 of the United States 
Code, the President is to transmit a report to Congress for 
each fiscal year on the progress made in meeting the Act's 
objectives, including a review of programs established or 
assisted pursuant to the Act and an assessment and 
recommendations of additional programs or assistance necessary 
to provide health services to Native Hawaiians and to ensure a 
health status for Native Hawaiians which are on par with the 
general population's health services and health status.

Section 13. Use of Federal Government facilities and sources of supply

    This section authorizes organizations that receive grants 
or contracts to have access to federal property and supplies.
    Section 13(a) authorizes the Secretary to allow 
organizations, in carrying out their grants or contracts 
authorized under the Act, to use existing facilities and 
equipment therein or under the Secretary's jurisdiction, under 
such terms and conditions as may be agreed upon for their use 
and maintenance.
    Section 13(b) authorizes the Secretary to donate any 
personal or real property determined to be in excess of the 
needs of the Department or the General Services Administration 
to organizations that receive contracts or grants for purposes 
of carrying out such contract or grants.
    Section 13(c) authorizes the Secretary to acquire excess or 
surplus Federal government real and personal property for 
donation to organizations that receive grants or contracts 
under this Act, provided that the Secretary determines that the 
organization's property use is appropriate for the purpose 
which a contract or grant is authorized under this Act.

Section 14. Demonstration projects of national significance

    This section authorizes demonstration projects to improve 
the health status of Native Hawaiians.
    Section 14(a) authorizes the Secretary to consult with Papa 
Ola Lokahi and allocate appropriated amounts under this or any 
other Act to carry out Native Hawaiian demonstration projects 
of national significance. The project areas of interest may 
include the following:
          (1) the development of a centralized database and 
        information system relating to Native Hawaiian health 
        care status, health care needs, and wellness;
          (2) the education of health professionals, and other 
        individuals in higher learning institutions, in health 
        and allied health programs in healing practices, 
        including Native Hawaiian healing practices;
          (3) the integration of Western medicine with 
        complementary healing practices including traditional 
        Native Hawaiian healing practices;
          (4) the use of tele-wellness and telecommunications 
        in chronic disease management and health promotion and 
        disease prevention;
          (5) the development of appropriate models of Native 
        Hawaiian health care and other indigenous people, 
        including the provision of culturally competent health 
        services, related activities focusing on wellness 
        concepts, the development of appropriate kupuna care 
        programs, and the development of financial mechanisms 
        and collaborative relationships leading to universal 
        access to health care; and
          (6) the establishment of Native Hawaiian Centers of 
        Excellence for Nursing at the University of Hawai'i at 
        Hilo; for Mental Health at the University of Hawai'i at 
        Manoa; for Maternal Health and Nutrition at the 
        Waimanalo Health Center; and for Research, Training, 
        Integrated Medicine at Moloka'i General Hospital; and 
        for Complimentary Health and Health Education and 
        Training at the Waianae Coast Comprehensive Health 
        Center.
    Section 14(b) specifies that funds allocated for 
demonstration projects under subsection 14(a) shall not result 
in a reduction on funds required by the Native Hawaiianhealth 
care systems, the Native Hawaiian Health centers, the Native Hawaiian 
Health Scholarship Program, or Papa Ola Lokahi to carry out their 
respective responsibilities under this Act.

Section 15. National Bipartisan Commission on Native Hawaiian health 
        care entitlement

    This section authorizes the establishment of a commission 
for the purpose of examining and making recommendations to the 
Congress as to whether the provision of health care services to 
Native Hawaiians should be an entitlement program.
    Section 15(a) establishes a National bipartisan Native 
Hawaiian Health Care Entitlement Commission (the 
``Commission'').
    Section 15(b) specifies that the Commission will be 
comprised of twenty-one (21) members who are appointed as 
follows:
    (1) The Majority and Minority Leaders of the House of 
Representatives and of the Senate will each appoint two 
members. These congressional commission members must also be 
members of congressional committees that consider legislation 
affecting the provision of health care to Native Hawaiians and 
other Native Americans. Commission members appointed under this 
subsection will elect the Commission's chairperson and vice-
chairperson.
    (2) The Native Hawaiian health care systems will appoint 
five embers, and the Hawai'i State Primary Care Association, 
Papa Ola Lokahi, Native Hawaiian Health Task Force, and the 
Office of Hawaiian Affairs will each appoint one member. The 
Association of Hawaiian Civic Clubs shall appoint two members 
who will represent Native Hawaiian populations residing in the 
continental United States.
    (3) The Secretary shall appoint two members who possess 
knowledge of Native Hawaiian health concerns and wellness.
    Section 15(c) provides that Commission members shall serve 
for the life of the Commission. Initial Commission members are 
to be appointed not later than 90 days after the Act's 
enactment, with the remaining Commission members appointed not 
later than 60 days after the members are appointed under 
subsection 15(b)(1). This section also specifies that vacancies 
will be filled in the manner which original appointments were 
made.
    Section 15(d) specifies that the Commission's duties and 
functions are as follows:
          (1) reviewing and analyzing the recommendations of 
        the report of the study committee establishes under 
        subsection 15(d)(3).
          (2) making recommendations to Congress for the 
        provision of health services to Native Hawaiian 
        individuals as an entitlement, giving due regard to the 
        effects of a program on existing health care delivery 
        systems for Native Hawaiians and the effect of such 
        programs on self-determination and the reconciliation 
        of their relationship with the United States;
          (3) establish a study committee composed of at least 
        ten Commission members, with four appointed under 
        subsection (b)(1), five members appointed under 
        subsection (b)(2), and one member the Secretary 
        appointed under subsection 15(b)(3). The study 
        committee will conduct the following activities:
                  (A) to the extent necessary to carry out its 
                duties, collect, compile, qualify, and analyze 
                data necessary to understand the extent of 
                Native Hawaiian needs with regard to the 
                provision of health services, including holding 
                hearings and soliciting the views of Native 
                Hawaiians and Native Hawaiian organizations, 
                and which may include authorizing and funding 
                feasibility studies of various models for all 
                Native Hawaiian beneficiaries and their 
                families, including those living in the 
                continental United States;
                  (B) make recommendations to the Commission 
                for legislation that will provide for the 
                culturally-competent and appropriate provision 
                of health services to Native Hawaiians as an 
                entitlement which shall, at a minimum, address 
                issues of eligibility and benefits to be 
                provided, including recommendations regarding 
                from whom such health services are to be 
                provided and the cost and mechanisms for 
                funding of the health services to be provided;
                  (C) determine the effect of the enactment of 
                such recommendations on the existing system of 
                delivery of health services for Native 
                Hawaiians;
                  (D) determine the effect of a health service 
                entitlement program for Native Hawaiian 
                individuals on their self-determination and the 
                reconciliation of their relationship with the 
                United States;
                  (E) within twelve months after the 
                appointment of the Commission members, make a 
                written report of its findings and 
                recommendations to the Commission which shall 
                include statements from the minority and 
                majoritypositions of the committee and which 
will be disseminated to Native Hawaiian organizations, agencies, and 
health organizations referred to in subsection 15(b)(2) for comment to 
the Commission; and
                   (F) report regularly to the full Commission 
                regarding the findings and recommendations 
                developed by the committee in the course of 
                carrying out its duties under this section.
           (4) specifies that not later than eighteen months 
        after the appointment of the Commission members, submit 
        a written report to Congress containing a 
        recommendation of policies and legislation to implement 
        a policy that would establish a health care system for 
        Native Hawaiians, grounded in their culture and based 
        on the delivery of health services as an entitlement, 
        together with a determination of the implications of 
        such an entitlement system on existing health care 
        delivery systems for Native Hawaiians and their self-
        determination and the reconciliation of their 
        relationship with the United States.
     Section 15(e)(1) specifies that Commission members 
appointed under subsection 15(b)(1) will not receive any 
additional compensation, allowances, or benefits for serving on 
the Commission, but may receive travel expenses and per diem in 
lieu of subsistence in accordance with sections 5702 and 5703 
of title 5, United States Code. Commission members appointed 
under subsections 15 (b)(2) and (b)(3) may receive compensation 
while performing Commission business at the per diem equivalent 
of the rate provided for individuals under level IV of the 
Executive Schedule under section 5315 of title 5, United States 
Code, and while serving away from home or regular place of 
business, be allowed travel expenses as the Commission 
chairperson authorizes. for purposes of compensation (except 
for Commission members), and for employment benefits, rights, 
and privileges, Commission personnel will be treated as if they 
were Senate employees.
     Section 15(e)(2) specifies that the Commission chairperson 
shall call Commission meetings. This subsection further 
specifies that a quorum must consist of not less than twelve 
members, with not less than four members appointed under 
subsection 15(b)(1), with not less than seven members appointed 
under subsection 15(b)(2), and with not less than one (1) 
member appointed under subsection 15(b)(3).
     Section 15(e)(3) authorizes Commission members to appoint 
an executive director who shall be paid the rate of basic pay 
equal to level V of the Executive Schedule under section 5316 
of title 5, United States Code. The executive director, with 
the Commission's approval, may appoint such personnel as the 
executive director deems appropriate. The Commission staff 
shall be appointed without regard to title 5 provision of the 
United States Code governing appointments in the competitive 
service, and shall be paid without regard to the provisions of 
chapter 51 and subchapter III of chapter 53 of such title 
(relating to classification and General Schedule pay rates). 
This subsection also specifies that the executive director, 
with the Commission's approval, may procure temporary and 
intermittent services under section 3109(b) of title 5, United 
States Code. This subsection further authorizes the General 
Services Administration Administrator to locate suitable office 
space for Commission headquarters in Washington, DC and a 
Commission liaison office in the State of Hawai'i. Both offices 
shall include all necessary equipment and incidentals required 
for the Commission's proper functioning.
     Section 15(f)(1) authorizes the Commission to hold 
hearings and to undertake other activities the Commission 
determines to be necessary to carry out its duties, except that 
at least eight hearings shall be held on each of the Hawaiian 
Islands and three hearings in the continental United States in 
areas where a significant population of Native Hawaiians 
reside. Such hearings shall be held to solicit the views of 
Native Hawaiians regarding the delivery of health care services 
to Native Hawaiians. At least four Commission members, 
including at least one congressional member, must be present to 
constitute a hearing. Study committee hearings, authorized 
under subsection 15(d)(3) may be counted towards the number of 
hearings this paragraph requires.
     Section 15(f)(2) authorizes the Comptroller General, at 
the Commission's request, to conduct such studies or 
investigations as the Commission determines to be necessary to 
carry out its duties.
     Section 15(f)(3) specifies that, upon the Commission's 
request, the Director of the Congressional Budget Office and/or 
the Chief Actuary of the Health Care Financing Administration 
shall provide cost estimates the Commission determines to be 
necessary to carry outs its duties. The Commission shall 
reimburse the Director of the Congressional Budget Office for 
expenses relating to the employment in the office of the 
Director of such additional staff as may be necessary for the 
Director to comply with requests by the Commission under 
subsection 15(f)(3)(A).
     Section 15(f)(4) specifies that, at the Commission's 
request, the head of any Federal agency may detail its 
personnel to the Commission, without reimbursement, to assist 
in carrying out the Commission's duties. Such detail will not 
interrupt or otherwise affect the civil service status or 
privileges of the Federal employees.
     Section 15(f)(5) specifies that, at the Commission's 
request, the head of any Federal agency shall provide such 
technical assistance to the Commission as the Commission 
determines to be necessary to carry out its duties.
    Section 15(f)(6) authorizes the Commission to use the 
United States mails in the same manner and under the same 
conditions as Federal agencies and shall, for purposes of the 
frank, be considered a commission of Congress as described in 
section 3215 of title 39, United States Code.
    Section 15(f)(7) authorizes the Commission to secure 
directly from any Federal agency information necessary to 
enable the Commission to carry out its duties, if the 
information may be disclosed under section 552 of title 5, 
United States Code. Upon request of the Commission chairperson, 
the head of such agency shall furnish such information to the 
Commission.
    Section 15(f)(8) authorizes the Administrator of General 
Services, at the Commission's request, to provide the 
Commission with administrative support services which are 
provided on a reimbursable basis.
    Section 15(f)(9) specifies that the Commission shall be 
treated as a congressional committee for purposes of costs 
relating to printing and binding (including the cost of 
personnel detailed from the Government Printing Office).
    Section 15(g) authorizes appropriations of such sums as may 
be necessary to carry out this section. This appropriated 
amount shall not result in a reduction in any other 
appropriation for health care or health services for Native 
Hawaiians.

Section 16. Rule of construction

    This section specifies that nothing in this Act will be 
construed to restrict the authority of the State of Hawaii to 
license health practitioners.

Section 17. Compliance with Budget Act

    This section provides that any new spending authority 
described in sections 401(c)(2) (A) or (B) of the Congressional 
Budget At of 1974 which is provided under the authority of this 
Act is to be effective for any fiscal year only to the extent 
or in such amounts as are provided in appropriation Acts.

Section 18. Severability

    This section provides that if any provision of the Act or 
the application of any provision of the Act to any person or 
circumstances is held to be invalid, the remainder of the Act, 
and the application of a provision or amendment to persons or 
circumstances other than those to which it is held invalid, 
will be unaffected.

                          Legislative History

    S. 1929 was introduced on November 16, 1999, by Senator 
Inouye for himself and Senator Akaka, and was referred to the 
Committee on Indian Affairs. Hearings on S. 1929 were held on 
the islands of Moloka'i and Kaua'i on January 18, 2000, on the 
island of Maui on January 19, 2000, at Hilo, Hawaii on January 
20, 2000, on the island of O'ahu on January 21, 2000, and at 
Kona, Hawaii and on the island of Lana'i on March 16, 2000.

            Committee Recommendation and Tabulation of Vote

    The Committee on Indian Affairs, on May 3, 2000, in an open 
business meeting, by a unanimous vote, recommended that the 
Senate pass an amendment in the nature of a substitute to S. 
1929, a bill to reauthorize and amend the Native Hawaiian 
Health Care Act.

                   Cost and Budgetary Considerations

    The cost estimate of the Congressional Budget Office on S. 
1929 is set forth below.

               CONGRESSIONAL BUDGET OFFICE COST ESTIMATE

S. 1929--Native Hawaiian Health Care Improvement Act Reauthorization of 
        1999

    Summary: S. 1929 would reauthorize the Native Hawaiian 
Health Care Improvement Act. It would amend the act to reflect 
how current programs are operated and to treat the Native 
Hawaiian health systems in a manner similar to health centers 
authorized under the Public Health Service Act. In addition, it 
would create a Commission to advise the Congress whether the 
provision of health care services to Native Hawaiians should be 
an entitlement program. It also would require Federal agencies 
to consult with Native Hawaiians and organizations providing 
health care services to Native Hawaiians before adopting any 
policy or regulation which may impact their health services or 
health insurance coverage.
    The act is administered through the Health Resources and 
Services Administration. Assuming the appropriation of the 
necessary amounts, CBO estimates that implementing S. 1929 
would cost $1 million in 2001 and a total of $19 million from 
2001 through 2005. (That total assumes that the annual 
appropriation level is not adjusted to reflect anticipated 
inflation. If such adjustments are made, the five-year outlay 
total would be $20 million.) The legislation would not affect 
direct spending or receipts; therefore, pay-as-you-go 
procedures would not apply.
    S. 1929 contains no private-sector mandates as defined in 
the Unfunded Mandates Reform Act (UMRA). It does contain an 
intergovernmental mandate, but CBO estimates that the costs of 
the mandate would be minimal and would not exceed the threshold 
established in UMRA ($55 million in 2000, adjusted annually for 
inflation).
    Estimated Cost to the Federal Government: The estimated 
budgetary impact of S. 1929 is shown in the following table. 
The costs of this legislation fall within budget function 550 
(health).

----------------------------------------------------------------------------------------------------------------
                                                                  By fiscal year, in millions of dollars--
                                                           -----------------------------------------------------
                                                              2000     2001     2002     2003     2004     2005
----------------------------------------------------------------------------------------------------------------
                                       SPENDING SUBJECT TO APPROPRIATIONS

Spending Under Current Law:
    Budget Authority\1\...................................        5        5        0        0        0        0
    Estimated Outlays.....................................        5        5        2    (\2\)        0        0
Proposed Changes:
    Estimated Authorization Level.........................        0        2        5        5        5        5
    Estimated Outlays.....................................        0        1        3        5        5        5
Spending Under S. 1929:
    Estimated Authorization Level\1\......................        5        7        5        5        5        5
    Estimated Outlays.....................................        5        6        5        5        5        5
----------------------------------------------------------------------------------------------------------------
\1\The 2000 level is the amount appropriated for that year for activities conducted under the Native Hawaiian
  Health Care Improvement Act.
\2\Less than $500,000.

    Basis of Estimate: For this cost estimate, CBO assumes that 
the bill will be enacted by or near the start of fiscal year 
2001, that the necessary amounts will be appropriated each 
year, and that outlays will follow historical spending rates 
for the authorized activities.
    Current programs in the act were authorized at such sums as 
necessary through 2001. S. 1929 would reauthorize the 
administrative grant for Papa Ola Lokahi, extending it through 
2010. It also would reauthorize the Native Hawaiian health 
systems and the scholarship assistance programs, extending 
their authorization through 2011. Because these activities are 
currently authorized through 2001, this provision would not 
affect spending until 2002.
    S. 1929 would amend the requirements for Native Hawaiian 
health systems to remove differences in treatment between them 
and health centers which perform similar functions, but are 
authorized under the Public Health Service Act. It would remove 
the requirement that health systems provide matching funds to 
receive the full amount of the cost of providing health 
services under a grant or contract. Providers of services in 
health systems could be treated as if they were members of the 
Public Health Service and covered under section 224 of the 
Public Health Service Act, which provides for defense and 
payment of claims in certain malpractice and negligence suits. 
In addition, it would enable health systems, like health 
centers, to receive and use surplus buildings and equipment 
owned by the federal government. CBO estimates these provisions 
would have a negligible impact on federal spending.
    S. 1929 would create a commission composed of members of 
the Congress, individuals appointed by Hawaiian health 
entities, and individuals appointed by the Secretary of the 
Department of Health and Human Services. The initial members 
would be appointed within 90 days after enactment. Not later 
than 18 months after the last members was appointed, the 
commission would submit a written report to the Congress 
containing a recommendation of policies and legislation to 
establish a health care system for native Hawaiians based on 
the delivery of health care services as an entitlement. The 
bill would authorize $1.5 million in appropriations to carry 
out this section.
    S. 1929 would require federal agencies providing health 
care financing and carrying out health care programs to consult 
with Native Hawaiians and organizations providing health care 
services to Native Hawaiians prior to adopting any policy or 
regulation which may impact the provision of health services or 
health insurance coverage for Native Hawaiians. The 
consultation would include, but not be limited to, the 
identification of the impact of proposed policies, rules, or 
regulations. Depending on how the consultation would be 
defined, this provision could have budgetary implications. 
Should the consultation require a significant amount of work 
and time, it would delay the promulgation of rules and 
regulations affecting federal payment for programs such as 
Medicare and Medicaid. CBO cannot estimate the budgetary impact 
of this provision since it would depend on the rule or 
regulation being considered and the time necessary to perform 
the consultation.
    Pay-as-you-go considerations: None.
    Estimated impact on state, local, and tribal governments: 
The bill would require the state of Hawaii to consult with 
Native Hawaiians and health care organizations that provide 
services to Native Hawaiians before making policy changes or 
initiating new programs. That requirement would be an 
intergovernmental mandate as defined in UMRA, but CBO estimates 
that the costs of the mandate would be minimal and would not 
exceed the threshold established in UMRA ($55 million in 2000, 
adjusted annually for inflation).
    Estimated impact on the private sector: The bill contains 
no private-sector mandates as defined in UMRA.
    Estimate prepared by: Federal Costs: Cyndi Dudzinski; 
Impact on State, Local, and Tribal Governments: Leo Lex; and 
Impact on the Private Sector: Jennifer Bullard.
    Estimate approved by: Pete H. Fontaine, Deputy Assistant 
Director for Budget Analysis.

                        Executive Communications

    The Committee received no communications from the Executive 
branch of government of S. 1929.

                    Regulatory and Paperwork Impact

    Paragraph 11(b) of rule XXVI of the Standing Rules of the 
Senate requires each report accompanying a bill to evaluate the 
regulatory and paperwork impact that would be incurred in 
carrying out the bill. The Committee believes that the 
amendment in the nature of a substitute to S. 1929 will have a 
minimal impact on regulatory or paperwork requirements.

                        Changes in Existing Law

                      UNITED STATES CODE ANNOTATED

                TITLE 42--THE PUBLIC HEALTH AND WELFARE

                CHAPTER 122--NATIVE HAWAIIAN HEALTH CARE

Sec. 11701. Findings

    [The Congress finds that:] (a) General Findings.--Congress 
makes the following findings:
          (1) Native Hawaiians begin their story with the 
        Kumulipo which details the creation and inter-
        relationship of all things, including their evolvement 
        as healthy and well people.
          [(1)] (2) Native Hawaiians [comprise] are a distinct 
        and unique indigenous people with a historical 
        continuity to the original inhabitants of the Hawaiian 
        archipelago [whose society was organized as a Nation 
        prior to the arrival of the first nonindigenous people 
        in 1778.] within Ke Moananui, the Pacific Ocean, and 
        have a distinct society organized almost 2,000 years 
        ago.
          (3) The health and well-being of Native Hawaiians are 
        intrinsically tied to their deep feelings and 
        attachment to their lands and seas.
          (4) The long-range economic and social changes in 
        Hawaii over the 19th and early 20th centuries have been 
        devastating to the health and well-being of Native 
        Hawaiians.
          (5) Native Hawaiians have never directly relinquished 
        to the United States their claims to their inherent 
        sovereignty as a people or over their national lands, 
        either through their monarchy or through a plebiscite 
        or referendum.
          [(2)] (6) The Native Hawaiian people are determined 
        to preserve, develop and transmit to future generations 
        their ancestral territory, and their cultural identity 
        in accordance with their own spiritual and traditional 
        beliefs, customs, practices, language, and social 
        institutions. In referring to themselves, Native 
        Hawaiians use the term ``Kanaka Maoli'', a term 
        frequently used in the 19th century to describe the 
        native people of Hawaii.
          [(3)] (7) The constitution and statutes of the State 
        of Hawaii--
                  (A) acknowledge the distinct land rights of 
                Native Hawaiian people as beneficiaries of the 
                public lands trust; and
                  (B) reaffirm and protect the unique right of 
                the Native Hawaiian people to practice and 
                perpetuate their cultural and religious 
                customs, beliefs, practices, and language.
          [(4)] (8) At the time of the arrival of the first 
        nonindigenous people in Hawaii in 1778, the Native 
        Hawaiian people lived in a highly organized, self-
        sufficient, subsistence social system based on communal 
        land tenure with a sophisticated language, culture, and 
        religion.
          [(5)] (9) A unified monarchical government of the 
        Hawaiian Islands was established in 1810 under 
        Kamehameha I, the first King of Hawaii.
          [(6)] (10) Throughout the 19th century and until 
        1893, the United States--
                  (A) recognized the independence of the 
                Hawaiian Nation;
                  (B) extended full and complete diplomatic 
                recognition to the Hawaiian Government; and
                  (C) entered into treaties and conventions 
                with the Hawaiian monarchs to govern commerce 
                and navigation in 1826, 1842, 1849, 1875 and 
                1887.
          [(7)] (11) In [the year] 1893, John L. Stevens, the 
        United States Minister assigned to the sovereign and 
        independent Kingdom of Hawaii, [John L. Stevens,] 
        conspired with a small group of non-Hawaiian residents 
        of the Kingdom, including citizens of the United 
        States, to overthrow the indigenous and lawful 
        Government of Hawaii.
          [(8)] (12) In pursuance of that conspiracy, the 
        United States Minister and the naval representative of 
        the United States caused armed naval forces of the 
        United States to invade the sovereign Hawaiian Nation 
        in support of the indigenous andlawful Government of 
Hawaii and the United States Minister thereupon extended diplomatic 
recognition of a provisional government formed by the conspirators 
without the consent of the native people of Hawaii or the lawful 
Government of Hawaii in violation of treaties between the two nations 
of international law.
          [(9)] (13) In a message to Congress on December 18, 
        1893, then President Grover Cleveland reported fully 
        and accurately on these illegal actions, and 
        acknowledged that by these acts, described by the 
        President as acts of war, the government of a peaceful 
        and friendly people was overthrown, and the President 
        concluded that a ``substantial wrong has thus been done 
        which a due regard for our national character as well 
        as the rights of the injured people required that we 
        should endeavor to repair''.
          [(10)] (14) Queen Lili'uokalani, the lawful monarch 
        of Hawaii, and the Hawaiian Patriotic League, 
        representing the aboriginal citizens of Hawaii, 
        promptly petitioned the United States for redress of 
        these wrongs and for restoration of the indigenous 
        government of the Hawaiian nation, but this petition 
        was not acted upon.
          (15) The United States has acknowledged the 
        significance of these events and has apologized to 
        Native Hawaiians on behalf of the people of the United 
        States for the overthrow of the Kingdom of Hawaii with 
        the participation of agents and citizens of the United 
        States, and the resulting deprivation of the rights of 
        Native Hawaiians to self-determination in legislation 
        enacted into law in 1993 (Public Law 103-150; 107 Stat. 
        1510).
          [(11)] (16) In 1898, the United States annexed Hawaii 
        through the Newlands Resolution without the consent of 
        or compensation to the indigenous people of Hawaii or 
        their sovereign government who were thereby denied the 
        mechanism for expression of their inherent sovereignty 
        through self-government and self-determination, their 
        lands and ocean resources.
          [(12)] (17) Through the Newlands Resolution and the 
        1900 Organic Act, the United States Congress received 
        [1.75 million] 1,750,000 acres of lands formerly owned 
        by the Crown and Government of the Hawaiian Kingdom and 
        exempted the lands from then existing public land laws 
        of the United States by mandating that the revenue and 
        proceeds from these lands be ``used solely for the 
        benefit of the inhabitants of the Hawaiian Islands for 
        education and other public purposes'', thereby 
        establishing a special trust relationship between the 
        United States and the inhabitants of Hawaii.
          [(13)] (18) In 1921, Congress enacted the Hawaiian 
        Homes Commission Act, 1920 which designated 200,000 
        acres of the ceded public lands for exclusive 
        homesteading by Native Hawaiians, thereby affirming the 
        trust relationship between the United States and the 
        Native Hawaiians, as expressed by then Secretary of the 
        interior Franklin K. Lane who was cited in the 
        Committee Report of the United States House of 
        Representatives Committee on Territories as stating, 
        ``One thing that impressed me . . . was the fact that 
        the natives of the islands [who are wards, I should 
        say, and] for whom in a sense we are trustees, are 
        falling off rapidly in number and many of them are in 
        poverty.''.
          [(14)] (19) In 1938, [the United States] Congress 
        again acknowledged the unique status of the Native 
        Hawaiian people by including in the Act of June 20, 
        1938 (52 Stat. 781 et seq.), a provision to lease lands 
        within the extension to Native Hawaiians and to permit 
        fishing in the area ``only by native Hawaiian residents 
        of said area or of adjacent villages and by visitors 
        under their guidance''.
          [(15)] (20) Under the Act entitled ``An Act to 
        provide for the admission of the State of Hawaii into 
        the Union'', approved March 18, 1959 (73 Stat. 4), the 
        United States transferred responsibility for the 
        administration of the Hawaiian Home Lands to the State 
        of Hawaii but reaffirmed the trust relationship which 
        existed between the United States and the Hawaiian 
        people by retaining the exclusive power to enforce the 
        trust, including the power to approve land exchanges, 
        and legislative amendments affecting the rights of 
        beneficiaries under such Act.
          [(16)] (21) Under the Act entitled ``An Act to 
        provide for the admission of the State of Hawaii into 
        the Union'', approved March 18, 1959 (73 Stat. 4), the 
        United States transferred responsibility for 
        administration over portions of the ceded public lands 
        trust not retained by the United States to the State of 
        Hawaii but reaffirmed the trust relationship which 
        existed between the United States and the Hawaiian 
        people by retaining the legal responsibility of the 
        State for the betterment of the conditions of Native 
        Hawaiians under section 5(f) [of the Act entitled ``An 
        Act to provide for the admission of the State of Hawaii 
        into the Union'', approved March 18, 1959 (73 Stat. 4, 
        6).] of such Act.
          (22) In 1978, the people of Hawaii amended their 
        Constitution to establish the Office of Hawaiian 
        Affairs and assigned to that body the authority to 
        accept and hold real and personal property transferred 
        from any source in trust for the Native Hawaiian 
        people, to receive payments from the State of Hawaii 
        due to the Native Hawaiian people in satisfaction of 
        the pro rata share of the proceeds of the Public Land 
        Trust created under section 5 of the Admission Act of 
        1959 (Public Law 83-3), to act as the lead State agency 
        for matters affecting the Native Hawaiian people, and 
        to formulate policy on affairs relating to the Native 
        Hawaiian people.
          [(17)] (23) The authority of the Congress under the 
        United States Constitution to legislate in matters 
        affecting the aboriginal or indigenous peoples of the 
        United States includes the authority to legislate in 
        matters affecting the native peoples of Alaska and 
        Hawaii.
          (24) Further, the United States has recognized the 
        authority of the Native Hawaiian people to continue to 
        work towards an appropriate form of sovereignty as 
        defined by the Native Hawaiian people themselves in 
        provisions set forth in legislation returning the 
        Hawaiian Island of Kaho'olawe to custodial management 
        by the State of Hawaii in 1994.
          [(18)] (25) In furtherance of the trust 
        responsibility for the betterment of the conditions of 
        Native Hawaiians, the United States has established a 
        program for the provision of comprehensive health 
        promotion and disease prevention services to maintain 
        and improve the health status of the Hawaiian people. 
        This program is conducted by the Native Hawaiian Health 
        Care Systems, the Native Hawaiian Health Scholarship 
        Program and Papa Ola Lokahi. Health initiatives from 
        these and other health institutions and agencies using 
        Federal assistance have begun to lower the century-old 
        morbidity and mortality rates of Native Hawaiian people 
        by providing comprehensive disease prevention, health 
        promotion activities and increasing the number of 
        Native Hawaiians in the health and allied health 
        professions. This has been accomplished through the 
        Native Hawaiian Health Care Improvement Act of 1988 
        (Public Law 100-579) and its reauthorization in section 
        9168 of Public Law 102-396 (106 Stat. 1948).
          [(19)] (26) This historical and unique legal 
        relationship has been consistently recognized and 
        affirmed by the Congress through the enactment of 
        Federal laws which extend to the Hawaiian people the 
        same rights and privileges accorded to American Indian, 
        Alaska Native, Eskimo, and Aleut communities, including 
        the Native American Programs Act of 1974 (42 U.S.C.A. 
        Sec. 2991 et seq.); the American Indian Religious 
        Freedom Act (42 U.S.C.A. Sec. 1996); the National 
        Museum of the American Indian Act (20 U.S.C.A. Sec. 80q 
        et seq.); and the Native American Graves Protection and 
        Repatriation Act (25 U.S.C.A. Sec. 3001 et seq.).
          [(20)] (27) The United States has also recognized and 
        reaffirmed the trust relationship to the Hawaiian 
        people through legislation which authorizes the 
        provision of services to Native Hawaiians, 
        specifically, the Older Americans Act of 1965 (42 
        U.S.C.A. Sec. 3001 et seq.), the Developmental 
        Disabilities Assistance and Bill of Rights Act 
        Amendments of 1987, the Veterans' Benefits and Services 
        Act of 1988, the Rehabilitation Act of 1973 (29 
        U.S.C.A. Sec. 701 et seq.), the Native Hawaiian Health 
        Care Act of 1988, the Health Professions 
        Reauthorization Act of 1988, the Nursing Shortage 
        Reduction and Education Extension Act of 1988, the 
        Handicapped Programs Technical Amendments Act of 1988, 
        the Indian Health Care Amendments of 1988, and the 
        Disadvantaged Minority Health Improvement Act of 1990.
          [(21)] (28) The United States has also affirmed the 
        historical and unique legal relationship to the 
        Hawaiian people by authorizing the provision of 
        services to Native Hawaiians to address problems of 
        alcohol and drug abuse under the Anti-Drug Abuse Act of 
        1986 (Public Law 99-570).
          (29) Further, the United States has recognized that 
        Native Hawaiians, as aboriginal, indigenous, native 
        people of Hawaii, are a unique population group in 
        Hawaii and in the continental United States and has so 
        declared in Office of Management and Budget Circular 15 
        in 1997 and Presidential Executive Order No. 13125, 
        dated June 7, 1999.
          [(22)] (30) Despite [such services,] the United 
        States having expressed its commitment to a policy of 
        reconciliation with the Native Hawaiian people for past 
        grievances in Public Law 103-150 (107 Stat. 1510) the 
        unmet health needs of the Native Hawaiian people [are] 
        remain severe and [the] their health status [of Native 
        Hawaiians] continues to be far below that of the 
        general population of the United States.
    (b) Unmet Needs and Health Disparities.--Congress finds 
that the unmet needs and serious health disparities that 
adversely affect the Native Hawaiian people include the 
following:
          (1) Chronic disease and illness.--
                  (A) Cancer.--
                          (i) In general.--With respect to all 
                        cancer--
                                  (I) Native Hawaiians have the 
                                highest cancer mortality rates 
                                in the State of Hawaii (231.0 
                                out of every 100,000 
                                residents), 45 percent higher 
                                than that for the total State 
                                population (159.7 out of every 
                                100,000 residents);
                                  (II) Native Hawaiian males 
                                have the highest cancer 
                                mortality rates in the State of 
                                Hawaii for cancers of the lung, 
                                liver and pancreas and for all 
                                cancers combined;
                                  (III) Native Hawaiian females 
                                ranked highest in the State of 
                                Hawaii for cancers of the lung, 
                                liver, pancreas, breast, cervix 
                                uteri, corpus uteri, stomach, 
                                and rectum, and for all cancers 
                                combined;
                                  (IV) Native Hawaiian males 
                                have the highest years of 
                                productive life lost from 
                                cancer in the State of Hawaii 
                                with 8.7 years compared to 6.4 
                                years for other males; and
                                  (V) Native Hawaiian females 
                                have 8.2 years of productive 
                                life lost from cancer in the 
                                State of Hawaii as compared to 
                                6.4 years for other females in 
                                the State of Hawaii;
                          (ii) Breast cancer.--With respect to 
                        breast cancer--
                                  (I) Native Hawaiians have the 
                                highest mortality rates in the 
                                State of Hawaii from breast 
                                cancer (37.96 out of every 
                                100,000 residents), which is 25 
                                percent higher than that for 
                                Caucasian Americans (30.25 out 
                                of every 100,000 residents) and 
                                106 percent higher than that 
                                for Chinese Americans (18.39 
                                out of every 100,000 
                                residents); and
                                  (II) nationally, Native 
                                Hawaiians have the third 
                                highest mortality rates due to 
                                breast cancer (25.0 out of 
                                every 100,000 residents) 
                                following African Americans 
                                (31.4 out of every 100,000 
                                residents) and Caucasian 
                                Americans (27.0 out of every 
                                100,000 residents).
                          (iii) Cancer of the cervix.--Native 
                        Hawaiians have the highest mortality 
                        rates from cancer of the cervix in the 
                        State of Hawaii (3.82 out of every 
                        100,000 residents) followed by Filipino 
                        Americans (3.33 out of every 100,000 
                        residents) and Caucasian Americans 
                        (2.61 out of every 100,000 residents).
                          (iv) Lung cancer.--Native Hawaiians 
                        have the highest mortality rates from 
                        lung cancer in the State of Hawaii 
                        (90.70 out of every 100,000 residents), 
                        which is 61 percent higher than 
                        Caucasian Americans, who rank second 
                        and 161 percent higher than Japanese 
                        Americans, who rank third.
                          (v) Prostate cancer.--Native Hawaiian 
                        males have the second highest mortality 
                        rates due to prostate cancer in the 
                        State of Hawaii (25.86 out of every 
                        100,000 residents) with Caucasian 
                        Americans having the highest mortality 
                        rate from prostate cancer (30.55 out of 
                        every 100,000 residents).
                  (B) Diabetes.--With respect to diabetes, for 
                the years 1989 through 1991--
                          (i) Native Hawaiians had the highest 
                        mortality rate due to diabetes mellitis 
                        (34.7 out of every 100,000 residents) 
                        in the State of Hawaii which is 130 
                        percent higher than the statewide rate 
                        for all other races (15.1 out of every 
                        100,000 residents);
                          (ii) full-blood Hawaiians had a 
                        mortality rate of 93.3 out of every 
                        100,000 residents, which is 518 percent 
                        higher than the rate for the statewide 
                        population of all other races; and
                          (iii) Native Hawaiians who are less 
                        than full-blood had a mortality rate of 
                        27.1 out of every 100,000 residents, 
                        which is 79 percent higher than the 
                        rate for the statewide population of 
                        all other races.
                  (C) Asthma.--With respect to asthma--
                          (i) in 1990, Native Hawaiians 
                        comprised 44 percent of all asthma 
                        cases in the State of Hawaii for those 
                        18 years of age and younger, and 35 
                        percent of all asthma cases reported; 
                        and
                          (ii) in 1992, the Native Hawaiian 
                        rate for asthma was 81.7 out of every 
                        1000 residents, which was 73 percent 
                        higher than the rate for the total 
                        statewide population of 47.3 out of 
                        every 1000 residents.
                  (D) Circulatory diseases.--
                          (i) Heart disease.--With respect to 
                        heart disease--
                                  (I) the death rate for Native 
                                Hawaiians from heart disease 
                                (333.4 out of every 100,000 
                                residents) is 66 percent higher 
                                than for the entire State of 
                                Hawaii (201.1 out of every 
                                100,000 residents); and
                                  (II) Native Hawaiian males 
                                have the greatest years of 
                                productive life lost in the 
                                State of Hawaii where Native 
                                Hawaiian males lose an average 
                                of 15.5 years and Native 
                                Hawaiian females lose an 
                                average of 8.2 years due to 
                                heart disease, as compared to 
                                7.5 years for all males in the 
                                State of Hawaii and 6.4 years 
                                for all females.
                          (ii) Hypertension.--The death rate 
                        for Native Hawaiians from hypertension 
                        (3.5 out every 100,000 residents) is 84 
                        percent higher than that for the entire 
                        State (1.9 out of every 100,000 
                        residents).
                          (iii) Stroke.--The death rate for 
                        Native Hawaiians from stroke (58.3 out 
                        of every1000,000 residents) is 13 
percent higher than that for the entire State (51.8 out of every 
100,000 residents).
          (2) Infectious disease and illness.--The incidence of 
        AIDS for Native Hawaiians is at least twice as high per 
        100,000 residents (10.5 percent) than that for any 
        other non-Caucasian group in the State of Hawaii.
           (3) Accidents.--With respect to accidents--
                   (A) the death rate for Native Hawaiians from 
                accidents (38.8 out of every 100,000 residents) 
                is 45 percent higher than that for the entire 
                State (26.8 out of every 100,000 residents);
                   (B) Native Hawaiian males lose an average of 
                14 years of productive life lost from accidents 
                as compared to 9.8 years for all other males in 
                Hawaii; and
                   (C) Native Hawaiian females lose an average 
                of 4 years of productive life lost from 
                accidents but this rate is the highest rate 
                among all females in the State of Hawaii.
           (4) Dental health.--With respect to dental health--
                   (A) Native Hawaiian children exhibit among 
                the highest rates of dental caries in the 
                nation, and the highest in the State of Hawaii 
                as compared to the 5 other major ethnic groups 
                in the State;
                   (B) the average number of decayed or filled 
                primary teeth for Native Hawaiian children ages 
                5 through 9 years was 4.3 as compared with 3.7 
                for the entire State of Hawaii and 1.9 for the 
                United States; and
                   (C) the proportion of Native Hawaiian 
                children ages 5 through 12 years with unmet 
                treatment needs (defined as having active 
                dental caries requiring treatment) is 40 
                percent as compared with 33 percent for all 
                other races in the State of Hawaii.
           (5) Life expectancy.--With respect to life 
        expectancy--
                   (A) Native Hawaiians have the lowest life 
                expectancy of all population groups in the 
                State of Hawaii;
                   (B) between 1910 and 1980, the life 
                expectancy of Native Hawaiians from birth has 
                ranged from 5 to 10 years less than that of the 
                overall State population average; and
                   (C) the most recent tables for 1990 show 
                Native Hawaiian life expectancy at birth (74.27 
                years) to be about 5 years less than that of 
                the total State population (78.85 years).
           (6) Maternal and child health.--
                   (A) Prenatal care.--With respect to prenatal 
                care--
                           (i) as of 1996, Native Hawaiian 
                        women have the highest prevalence (21 
                        percent) of having had no prenatal care 
                        during their first trimester of 
                        pregnancy when compared to the 5 
                        largest ethnic groups in the State of 
                        Hawaii;
                           (ii) of the mothers in the State of 
                        Hawaii who received no prenatal care 
                        throughout their pregnancy in 1996, 44 
                        percent were Native Hawaiian;
                           (iii) over 65 percent of the 
                        referrals to Healthy Start in fiscal 
                        years 1996 and 1997 were Native 
                        Hawaiian newborns; and
                           (iv) in every region of the State of 
                        Hawaii, many Native Hawaiian newborns 
                        begin life in a potentially hazardous 
                        circumstance, far higher than any other 
                        racial group.
                   (B) Births.--With respect to births--
                           (i) in 1996, 45 percent of the live 
                        births to Native Hawaiian mothers were 
                        infants born to single mothers which 
                        statistics indicate put infants at 
                        higher risk of low birth weight and 
                        infant mortality;
                           (ii) in 1996, of the births to 
                        Native Hawaiian single mothers, 8 
                        percent were low birth weight (under 
                        2500 grams); and
                           (iii) of all low birth weight babies 
                        born to single mothers in the State of 
                        Hawaii, 44 percent were Native 
                        Hawaiian.
                   (C) Teen pregnancies.--With respect to 
                births--
                           (i) in 1993 and 1994, Native 
                        Hawaiians had the highest percentage of 
                        teen (individuals who were less than 18 
                        years of age) births (8.1 percent) 
                        compared to the rate for all other 
                        races in the State of Hawaii (3.6 
                        percent);
                          (ii) in 1996, nearly 53 percent of 
                        all mothers in Hawaii under 18 years of 
                        age were Native Hawaiian;
                          (iii) lower rates of abortion (a 
                        third lower than for the statewide 
                        population) among Hawaiian women may 
                        account in part, for the higher 
                        percentage of live births;
                          (iv) in 1995, of the births to 
                        mothers age 14 years and younger in 
                        Hawaii, 66 percent were Native 
                        Hawaiian; and
                          (v) in 1996, of the births in this 
                        same group, 48 percent were Native 
                        Hawaiian.
                  (D) Fetal mortality.--In 1996, Native 
                Hawaiian fetal mortality rates comprised 15 
                percent of all fetal deaths for the State of 
                Hawaii. However, for fetal deaths occurring in 
                mothers under the age of 18 years, 32 percent 
                were Native Hawaiian, and for mothers 18 
                through 24 years of age, 28 percent were Native 
                Hawaiians.
          (7) Mental health.--
                  (A) Alcohol and drug abuse.--With respect to 
                alcohol and drug abuse.--
                          (i) Native Hawaiians represent 38 
                        percent of the total admissions to 
                        Department of Health, Alcohol, Drugs 
                        and Other Drugs, funded substance abuse 
                        treatment programs;
                          (ii) in 1997, the prevalence of 
                        smoking by Native Hawaiians was 28.5 
                        percent, a rate that is 53 percent 
                        higher than that for all others races 
                        in the State of Hawaii which is 18.6 
                        percent;
                          (iii) Native Hawaiians have the 
                        highest prevalence rates of acute 
                        drinking (31 percent), a rate that is 
                        79 percent higher than that for all 
                        other races in the State of Hawaii;
                          (iv) the chronic drinking rate among 
                        Native Hawaiians is 54 percent higher 
                        than that for all other races in the 
                        State of Hawaii;
                          (v) in 1991, 40 percent of the Native 
                        Hawaiian adults surveyed reported 
                        having used marijuana compared with 30 
                        percent for all other races in the 
                        State of Hawaii; and
                          (vi) nine percent of the Native 
                        Hawaiian adults surveyed reported that 
                        they are current users (within the past 
                        year) of marijuana, compared with 6 
                        percent for all other races in the 
                        State of Hawaii.
                  (B) Crime.--With respect to crime--
                          (i) in 1996, of the 5,944 arrests 
                        that were made for property crimes in 
                        the State of Hawaii, arrests of Native 
                        Hawaiians comprised 20 percent of that 
                        total;
                          (ii) Native Hawaiian juveniles 
                        comprised a third of all juvenile 
                        arrests in 1996;
                          (iii) In 1996, Native Hawaiians 
                        represented 21 percent of the 8,000 
                        adults arrested for violent crimes in 
                        the State of Hawaii, and 38 percent of 
                        the 4,066 juvenile arrests;
                          (iv) Native Hawaiians are over-
                        represented in the prison population in 
                        Hawaii;
                          (v) in 1995 and 1996 Native Hawaiians 
                        comprised 36.5 percent of the sentenced 
                        felon prison population in Hawaii, as 
                        compared to 20.5 percent for Caucasian 
                        Americans, 3.7 percent for Japanese 
                        Americans, and 6 percent for Chinese 
                        Americans;
                          (vi) in 1995 and 1996 Native 
                        Hawaiians made up 45.4 percent of the 
                        technical violator population, and at 
                        the Hawaii Youth Correctional Facility, 
                        Native Hawaiians constituted 51.6 
                        percent of all detainees in fiscal year 
                        1997; and
                          (vii) based on anecdotal information 
                        from inmates at the Halawa Correction 
                        Facilities, Native Hawaiians are 
                        estimated to comprise between 60 and 70 
                        percent of all inmates.
          (8) Health professions education and training.--With 
        respect to health professions education and training--
                  (A) Native Hawaiians age 25 years and older 
                have a comparable rate of high school 
                completion, however, the rates of baccalaureate 
                degree achievement amongst Native Hawaiians are 
                less than the norm in the State of Hawaii (6.9 
                percent and 15.76 percent respectively).
                  (B) Native Hawaiian physicians make up 4 
                percent of the total physician workforce in the 
                State of Hawaii; and
                  (C) in fiscal year 1997, Native Hawaiians 
                comprised 8 percent of those individuals who 
                earned Bachelor's Degrees, 14 percent of those 
                individuals who earned professional diplomas, 6 
                percent of those individuals who earned 
                Master's Degrees, and less than 1 percent of 
                individuals who earned doctoral degrees at the 
                University of Hawaii.

Sec. 11702. Declaration of National Native Hawaiian Health P[p]olicy

    (a) Congress.--The Congress hereby declares that it is the 
policy of the United States in fulfillment of its special 
responsibilities and legal obligations to the indigenous people 
of Hawaii resulting from the unique and historical relationship 
between the United States and the [Government of the] 
indigenous peoples of Hawaii--
          (1) to raise the health status of Native Hawaiians to 
        the highest possible health level; and
          (2) to provide existing Native Hawaiian health care 
        programs with all resources necessary to effectuate 
        this policy.
    (b) Intent of Congress.--It is the intent of the Congress 
that--[the nation meet the following health objectives with 
respect to Native Hawaiians by the year 2000:]
          (1) [Reduce coronary heart disease deaths to no more 
        than 100 per 100,000.] health care programs having a 
        demonstrated effect of substantially reducing or 
        eliminating the over-representation of Native Hawaiians 
        among those suffering from chronic and acute disease 
        and illness and addressing the health needs, including 
        perinatal, early child development, and family-based 
        health education, of Native Hawaiians shall be 
        established and implemented; and
          (2) [Reduce stroke deaths to no more than 20 per 
        100,000.] the Nation raise the health status of Native 
        Hawaiians by the year 2010 to at least the levels set 
        forth in the goals contained within Healthy People 2010 
        or successor standards and to incorporate within health 
        programs, activities defined and identified by Kanaka 
        Maoli which may include--
                  (A) incorporating and supporting the 
                integration of cultural approaches to health 
                and well-being, including programs using 
                traditional practices relating to the 
                atmosphere (lewa lani), land ('aina), water 
                (wai), or ocean (kai);
                  (B) increasing the number of health and 
                allied-health care providers who are trained to 
                provide culturally competent care to Native 
                Hawaiians;
                  (C) increasing the use of traditional Native 
                Hawaiian foods in peoples' diets and dietary 
                preferences including those of students and the 
                use of these traditional foods in school 
                feeding programs;
                  (D) identifying and instituting Native 
                Hawaiian cultural values and practices within 
                the ``corporate cultures'' of organizations and 
                agencies providing health services to native 
                Hawaiians;
                  (E) facilitating the provision of Native 
                Hawaiian healing practices by Native Hawaiian 
                healers for those clients desiring such 
                assistance; and
                  (F) supporting training and education 
                activities and programs in traditional Native 
                Hawaiian healing practices by native Hawaiian 
                healers.
          [(3) Increase control of high blood pressure to at 
        least 50 percent of people with high blood pressure.
          [(4) Reduce blood cholesterol to an average of no 
        more than 200 mg/dl.
          [(5) Slow the rise in lung cancer deaths to achieve a 
        rate of no more than 42 per 100,000.
          [(6) Reduce breast cancer deaths to no more than 20.6 
        per 100,000 women.
          [(7) Increase Pap tests every 1 to 3 years to at 
        least 85 percent of women age 18 and older.
          [(8) Increase fecal occult blood testing every 1 to 2 
        years to at least 50 percent of people age 50 and 
        older.
          [(9) Reduce diabetes-related deaths to no more than 
        34 per 100,000.
          [(10) Reduce the most severe complications of 
        diabetes as follows:
                  [(A) end-stage renal disease to no more than 
                1.4 in 1,000;
                  [(B) blindness to no more than 1.4 in 1,000;
                  [(C) lower extremity amputation to no more 
                than 4.9 in 1,000;
                  [(D) perinatal mortality to no more than 2 
                percent; and
                  [(E) major congenital malformations to no 
                more than 4 percent.
          [(11) Reduce infant mortality to no more than 7 
        deaths per 1,000 live births.
          [(12) Reduce low birth weight to no more than 5 
        percent of live births.
          [(13) Increase first trimester prenatal care to at 
        least 90 percent of live births.
          [(14) Reduce teenage pregnancies to no more than 50 
        per 1,000 girls age 17 and younger.
          [(15) Reduce unintended pregnancies to no more than 
        30 percent of pregnancies.
          [(16) Increase to at least 60 percent the proportion 
        of primary care providers who provide age-appropriate 
        preconception care and counseling.
          [(17) Increase years of healthy life to at least 65 
        years.
          [(18) Eliminate financial barriers to clinical 
        preventive services.
          [(19) Increase childhood immunization levels to at 
        least 90 percent of 2-year- olds.
          [(20) Reduce the prevalence of dental caries to no 
        more than 35 percent of children by age 8.
          [(21) Reduce untreated dental caries so that the 
        proportion of children with untreated caries (in 
        permanent or primary teeth) is no more than 20 percent 
        among children age 6 through 8 and no more than 15 
        percent among adolescents age 15.
          [(22) Reduce edentulism to no more than 20 percent in 
        people age 65 and older.
          [(23) Increase moderate daily physical activity to at 
        least 30 percent of the population.
          [(24) Reduce sedentary lifestyles to no more than 15 
        percent of the population.
          [(25) Reduce overweight to a prevalence of no more 
        than 20 percent of the population.
          [(26) Reduce dietary fat intake to an average of 30 
        percent of calories or less.
          [(27) Increase to at least 75 percent the proportion 
        of primary care providers who provide nutrition 
        assessment and counseling or referral to qualified 
        nutritionists or dieticians.
          [(28) Reduce cigarette smoking prevalence to no more 
        than 15 percent of adults.
          [(29) Reduce initiation of smoking to no more than 15 
        percent by age 20.
          [(30) Reduce alcohol-related motor vehicle crash 
        deaths to no more than 8.5 per 100,000 adjusted for 
        age.
          [(31) Reduce alcohol use by school children age 12 to 
        17 to less than 13 percent.
          [(32) Reduce marijuana use by youth age 18 to 25 to 
        less than 8 percent.
          [(33) Reduce cocaine use by youth aged 18 to 25 to 
        less than 3 percent.
          [(34) Confine HIV infection to no more than 800 per 
        100,000.
          [(35) Reduce gonorrhea infections to no more than 225 
        per 100,000.
          [(36) Reduce syphilis infections to no more than 10 
        per 100,000.
          [(37) Reduce significant hearing impairment to a 
        prevalance of no more than 82 per 1,000.
          [(38) Reduce acute middle ear infections among 
        children age 4 and younger, as measured by days of 
        restricted activity or school absenteeism, to no more 
        than 105 days per 100 children.
          [(39) Reduce indigenous cases of vaccine-preventable 
        diseases as follows:
                  [(A) Diphtheria among individuals age 25 and 
                younger to 0;
                  [(B) Tetanus among individuals age 25 and 
                younger to 0;
                  [(C) Polio (wild-type virus) to 0;
                  [(D) Measles to 0;
                  [(E) Rubella to 0;
                  [(F) Congenital Rubella Syndrome to 0;
                  [(G) Mumps to 500; and
                  [(H) Pertussis to 1,000; and
          [40) Reduce significant visual impairment to a 
        prevalence of no more other than 30 per 1,000.]
    (c) Report.--The Secretary shall submit to the President, 
for inclusion in each report required to be transmitted to the 
Congress under section [11710 of this title] 12, a report on 
the progress made in each area toward meeting [each of the 
objectives described in subsection (b) of this section.] the 
National policy as set forth in this section.

Sec. 11703. Comprehensive health care master plan for Native Hawaiians

    (a) Development.--
          (1) In general.--The Secretary may make a grant to, 
        or enter into a contract with, Papa Ola Lokahi for the 
        purpose of coordinating, implementing and updating a 
        Native Hawaiian comprehensive health care master plan 
        designed to promote comprehensive health promotion and 
        disease prevention services and to maintain and improve 
        the health status of Native Hawaiians[. The master plan 
        shall be based upon an assessment of the health care 
        status and health care needs of Native Hawaiians. To 
        the extent practicable, assessments made as of the date 
        of such grant or contract shall be used by Papa Ola 
        Lokahi, except that any such assessment shall be 
        updated as appropriate.] and to support community-based 
        initiatives that are reflective of holistic approaches 
        to health.
          (2) Consultation.--
                  (A) In general.--Papa Ola Lokahi and the 
                Office of Hawaiian Affairs shall consult with 
                the Native Hawaiian health care systems, Native 
                Hawaiian health centers, and the Native 
                Hawaiian community in carrying out this 
                section.
                  (B) Memoranda of understanding.--Papa Ola 
                Lokahi and the Office of Hawaiian Affairs may 
                enter into memoranda of understanding or 
                agreement for the purposes of acquiring joint 
                funding and for other issues as may be 
                necessary to accomplish the objectives of this 
                section.
          (3) Health care financing study report.--Not later 
        than 18 months after the date of enactment of this Act, 
        Papa Ola Lokahi in cooperation with the Office of 
        Hawaiian Affairs and other appropriate agencies of the 
        State of Hawaii, including the Department of Health and 
        the Department of Human Services and the Native 
        Hawaiian health care systems and Native Hawaiian health 
        centers, shall submit to Congress a report detailing 
        the impact of current Federal and State health care 
        financing mechanisms and policies on the health and 
        well-being of Native Hawaiians. Such report shall 
        include--
                  (A) information concerning the impact of 
                cultural competency, risk assessment data, 
                eligibility requirements and exemptions, and 
                reimbursement policies and capitation rates 
                currently in effect for service providers;
                  (B) any other such information as may be 
                important to improving the health status of 
                Native Hawaiians as such information relates to 
                health care financing including barriers to 
                health care; and
                  (C) the recommendations for submission to the 
                Secretary for review and consultation with 
                Native Hawaiians.
    (b) Authorization of Appropriations.--There are authorized 
to be appropriated such sums as may be necessary to carry out 
subsection (a) [of this section].

Sec. 11704. Functions of Papa Ola Lokahi

    (a) Responsibility.--Papa Ola Lokahi shall be responsible 
for the--
          (1) coordination, implementation, and updating, as 
        appropriate, of the comprehensive health care master 
        plan developed pursuant to section [11703 of this 
        title] 5;
          (2) training for the persons described in [section 
        11705(c)(1)(B) of this title] subparagraphs (B) and (C) 
        of section 7(c)(1);
          (3) identification of and research into the diseases 
        that are most prevalent among Native Hawaiians, 
        including behavioral, biomedical, epidemiological, and 
        health services; and
          (4) development and maintenance of an institutional 
        review board for all research projects involving all 
        aspects of Native Hawaiian health, including 
        behavioral, biomedical, epidemiological, and health 
        services studies; and
          [(4)] (5) the [development] maintenance of an action 
        plan outlining the contributions that each member 
        organization of Papa Ola Lokahi will make in carrying 
        out the policy of this [chapter] Act.
    (b) Special Project Funds.--Papa Ola Lokahi [is authorized 
to] may receive special project funds that may be appropriated 
for the purpose of research on the health status of Native 
Hawaiians or for the purpose of addressing the health care 
needs of Native Hawaiians.
    (c) Clearinghouse.--
          (1) In general.--Papa Ola Lokahi shall serve as a 
        clearinghouse for:
                  [(1)] (A) the collection and maintenance of 
                data associated with the health status of 
                Native Hawaiians;
                  [(2)] (B) the identification and research 
                into diseases affecting Native Hawaiians;
                  [(3)] (C) the availability of Native Hawaiian 
                project funds, research projects and 
                publications;
                  [(4)] (D) the collaboration of research in 
                the area of Native Hawaiian health; and
                  [(5)] (E) the timely dissemination of 
                information pertinent to the Native Hawaiian 
                health care systems.
    [(d) Coordination of Programs and Services.]
          (2) Consultation.--The Secretary shall provide Papa 
        Ola Lokahi and the Office of Hawaiian Affairs at least 
        one annually, an accounting of funds and services 
        provided to States and to nonprofit groups and 
        organizations from the department for the purposes set 
        forth in section 4. Such accounting shall include--
                  (A) the amount of funds expended explicitly 
                for the benefiting Native Hawaiians;
                  (B) the number of Native Hawaiians impacted 
                by these funds;
                  (C) the identification of collaborations made 
                with Native Hawaiian groups and organizations 
                in the expenditure of these funds; and
                  (D) the amount of funds used for Federal 
                administration purposes and for the provision 
                of direct services to Native Hawaiians.
    (d) Fiscal Allocation and Coordination of Programs and 
Services.--
          (1) Recommendations.--Papa Ola Lokahi shall provide 
        annual recommendations to the Secretary with respect to 
        the allocation of all amounts appropriated under this 
        Act.
          (2) Coordination.--Papa Ola Lokahi shall, to the 
        maximum extent possible, coordinate and assist the 
        health care programs and services provided to Native 
        Hawaiians.
          (3) Representation on commission.--The Secretary, in 
        consultation with Papa Ola Lokahi, shall make 
        recommendations for Native Hawaiian representation on 
        the President's Advisory Commission on Asian Americans 
        and Pacific Islanders.
    (e) Technical Support.--Papa Ola Lokahi shall act as a 
statewide infrastructure to provide technical support and 
coordination of training and technical assistance to the Native 
Hawaiian health care systems.
    (f) Relations With Other Agencies.--
          (1) Authority.--Papa Ola Lokahi is authorized to 
        enter into agreements or memoranda ofunderstanding with 
relevant institions, agencies or organizations that are capable of 
providing health-related resources or services to Native Hawaiians and 
the Native Hawaiian health care systems or of providing resources or 
services for the implementation of the National policy as set forth in 
section 4.
          (2) Health care financing.--
                  (A) Federal consultation.--Federally 
                providing health care financing and carrying 
                out health care programs, including the Health 
                Care Financing Administration, shall consult 
                with Native Hawaiians and organizations 
                providing health care services to Native 
                Hawaiians prior to the adoption of any policy 
                or regulation that may impact on the provision 
                of service or health insurance coverage. Such 
                consultation shall include the identification 
                of the impact of any proposed policy, rule, or 
                regulation.
                  (B) State consultation.--The State of Hawaii 
                shall engage in meaningful consultation with 
                Native Hawaiians and organizations providing 
                health care services to Native Hawaiians in the 
                State of Hawaii prior to making any changes or 
                initiating new programs.
                  (C) Consultation on federal health insurance 
                programs.--
                          (i) The Office of Hawaiians Affairs, 
                        in collaboration with Papa Ola Lokahi, 
                        may develop consultative, contractual 
                        or other arrangements including 
                        memoranda of understanding or 
                        agreement, with--
                                  (I) the Health Care Financing 
                                Administration;
                                  (II) the agency of the State 
                                of Hawaii that administers or 
                                supervises the administration 
                                of the State plan or waiver 
                                approved under titles XVIII, 
                                XIX, or XII of the Social 
                                Security Act for the payment of 
                                all or part of the health care 
                                services provided to Native 
                                Hawaiians who are eligible for 
                                medical assistance under the 
                                State plan or waiver; or
                                  (III) any other Federal 
                                agency or agencies providing 
                                full or partial health 
                                insurance to Native Hawaiians.
                          (ii) Such arrangements may address--
                                  (I) appropriate reimbursement 
                                for health care services 
                                including capitation rates and 
                                fee-for-service rates for 
                                Native Hawaiians who are 
                                entitled to or eligible for 
                                insurance;
                                  (II) the scope of services; 
                                or
                                  (II) other matters that would 
                                enable Native Hawaiians to 
                                maximize health insurance 
                                benefits provided by Federal 
                                and State health insurance 
                                programs.

           *       *       *       *       *       *       *

          (4) Traditional healers.--The provision of health 
        services under any program operated by the Departmental 
        of another Federal agency including Department of 
        Veterans Affairs, may include the services of 
        ``traditional Native Hawaiian healers'' as defined in 
        this Act or ``traditional healers'' providing 
        ``traditional health care practices'' as defined in 
        section 4(r) of Pubic Law 94-437. Such services shall 
        be exempt from national accreditation reviews, 
        including reviews conducted by the Joint Accreditation 
        Commission on Health Organizations and the 
        Rehabilitation Accreditation Commission.

Sec. 11705. Native Hawaiian health care [systems]

    (a) Comprehensive Health Promotion, Disease Prevention, and 
Primary Health Services.--
          (1)[(A)] Grants and contracts.--The Secretary, in 
        consultation with Papa Ola Lokahi, may make grants to, 
        or enter into contract with, any qualified entity for 
        the purpose of providing comprehensive health promotion 
        and disease prevention services as well as primary 
        health services to Native Hawaiians who desire and are 
        committed to bettering their own health.
          [(B)] (2) Preference.--In making grants and entering 
        into contracts under this [paragraph] subsection, the 
        Secretary shall give preference to Native Hawaiian 
        health care systems and Native Hawaiian organizations 
        and, to the extent feasible, health promotion and 
        disease prevention services shall be performed through 
        Native Hawaiian health care systems.
          (3) Qualified entity.--Any entity is a qualified 
        entity for purposes of paragraph (1) if the entity is a 
        Native Hawaiian health care system.
          (4) Limitation on number of entities.--The Secretary 
        may make a grant to, or enter into a contract with, not 
        more than 8 Native Hawaiian care systems under this 
        subsection during any fiscal year.
    (b) Planning Grant or Contract.--[(2) In addition to 
paragraph (1)] In addition to grants and contracts under 
subsection (a), the Secretary may make a grant to, or enter 
into a contract with, Papa Ola Lokahi for the purpose of 
planning Native Hawaiian health care systems to serve the 
health needs of Native Hawaiian communities on each of the 
islands of O'ahu, Moloka'i, Maui, Hawai'i, Lana'i, Kaua'i, and 
Ni'ihau in the State of Hawaii.
    [(b) Qualified Entity.--An entity is a qualified entity for 
purposes of subsection (a)(1) of this section if the entity is 
a Native Hawaiian health care system.]
    (c) Services to be Provided.--
          (1) In general.--Each recipient of funds under 
        subsection (a)[(1)] of this section shall [provide the 
        following services:] ensure that the following services 
        either are provided or arranged for:
                  (A) outreach services to inform Native 
                Hawaiians of the availability of health 
                services;
                  (B) education in health promotion and disease 
                prevention of the Native Hawaiian population 
                by, wherever possible, Native Hawaiian health 
                care practitioners, community outreach workers, 
                counsels, and cultural educations;
                  (C) services of physicians, physicians' 
                assistants, nurse practitioners or other health 
                professionals;
                  (D) immunizations;
                  (E) prevention and control of diabetes, high 
                blood pressure, and otitis media;
                  (F) pregnancy and infant care; and
                  (G) improvement of nutrition.
          [(2) In addition to the mandatory services under 
        paragraph (1), the following services may be provided 
        pursuant to subsection (a)(1) of this section:]
                  [(A)] (H) identification, treatment, control, 
                and reduction of the incidence of preventable 
                illnesses and conditions endemic to Native 
                Hawaiians;
                  [(B)] (I) collection of data related to the 
                prevention of diseases and illnesses among 
                Native Hawaiians; [and]
                  [(C)] (J) services within the meaning of the 
                terms ``health promotion'', ``disease 
                prevention'', and ``primary health services'', 
                as such terms are defined in section [11711] 3 
                of this title, which are not specifically 
                referred to in [paragraph (1) of this] 
                subsection (a)[.]; and
                  (K) support of culturally appropriate 
                activities enhancing health and wellness 
                including land-based, water-based; ocean-based, 
                and spiritually-based projects and programs.
          [(3)] (2) Traditional healers.--The health care 
        services referred to in paragraphs (1) and (2) which 
        are provided under grants or contracts under subsection 
        (a)[(1)] of this section may be provided by traditional 
        Native Hawaiian healers.
    [(d) Limitation of Number of Entities.--]
    (d) Federal Tort Claims Act.--Individuals that provide 
medical, dental, or other services referred to in subsection 
(a)(1) for Native Hawaiian health care systems, including 
providers of traditional Native Hawaiian healing services, 
shall be treated as if such individuals were members of the 
Public Health Service and shall be covered under the provisions 
of section 224 of the Public Health Service Act.
    (e) Site for Other Federal Payments.--A Native Hawaiian 
health care system that receives funds under subsection (a) 
shall provide a designated area and appropriate staff to serve 
as a Federal loan repayment facility. Such facility shall be 
designed to enable health and allied-health professionals to 
remit payments with respect to loans provided to such 
professionals under any Federal loan program.
    [During a fiscal year, the Secretary under this chapter may 
make a grant to, or hold a contract with, not more than 5 
Native Hawaiian health care systems.]
    [(e) Matching Funds.--]
          [(1) The Secretary may not make a grant or provide 
        funds pursuant to a contract under subsection (a)(1) of 
        this section to a Native Hawaiian health care system--
                  [(A) in an amount exceeding 83.3 percent of 
                the costs of providing health services under 
                the grant or contract; and
                  [(B) unless the Native Hawaiian health care 
                system agrees that the Native Hawaiian health 
                care system or the State of Hawaii will make 
                available, directly or through donations to the 
                Native Hawaiian health care system, non-Federal 
                contributions toward such costs in an amount 
                equal to not less than $1 (in cash or in kind 
                under paragraph (2) for each $5 of Federal 
                funds provided in such grant or contract.
          [(2) Non-Federal contributions required in paragraph 
        (1) may be in cash or in kind, fairly evaluated, 
        including plant, equipment, or services. Amounts 
        provided by the Federal Government or services assisted 
        or subsidized to any significant extent by the Federal 
        Government may not be included in determining the 
        amount of such non-Federal contributions.
          [(3) The Secretary may waive the requirement 
        established in paragraph (1) if--
                  [(A) the Native Hawaiian health care system 
                involved is a nonprofit private entity 
                described in subsection (b) of this section; 
                and
                  [(B) the Secretary, in consultation with Papa 
                Ola Kokahi, determines that it is not feasible 
                for the Native Hawaiian health care system to 
                comply with such requirement.]
    (f) Restriction on Use of Grant and Contract Funds.--The 
Secretary may not make a grant to, or enter into a contract 
with, any entity under subsection 9a)(1) of this section unless 
the entity agrees that, amounts received pursuant to such 
subsection will not, directly or through contract, be 
expended--
          (1) for any purpose other than the purposes described 
        in subsection (c) [of this section] (1);
          [(2) to provide inpatient services;
          [(3) to make cash payments to intended recipients of 
        health services; or]
          [(4)] (2) to purchase or improve real property (other 
        than minor remodeling of existing improvements to real 
        property) or to purchase major medical equipment.
    (g) Limitation on Charges for Services.--The Secretary may 
not make a grant, or enter into a contract with, any entity 
under subsection (a)[(1) of the section] unless the entity 
agrees that, whether health services are provided directly or 
through contract--
          (1) health services under the grant or contract will 
        be provided without regard to ability to pay for the 
        health services; and
          (2) the entity will impose a charge for the delivery 
        of health services, and such charge--
                  (A) will be made according to a schedule of 
                charges that is made available to the public, 
                and
                  (B) will be adjusted to reflect the income of 
                the individual involved.
    (h) Authorization of Appropriation.--
          (1) General grants.--There are authorized to be 
        appropriated such sums as may be necessary for fiscal 
        years [1993] 2001 through [2001] 2011 to carry out 
        subsection [(a)(1) of this section] (b).
          (2) Planning grants.--There [are] is authorized to be 
        appropriate such sums as may be necessary for each of 
        fiscal years 2001 through 2011 to carry out subsection 
        [(a)(2) of this section] (b).

Sec. 11706. Administrative grant for Papa Ola Kokahi

    (a) In General.--In addition to any other grant or contract 
under this [chapter] Act, the Secretary may make grants to, or 
enter into contracts with, Papa Ola Lokahi for--
          (1) coordination, implementation, and updating (as 
        appropriate) of the comprehensive health care master 
        plan developed pursuant to section [11703 of this 
        title];
          (2) training for the persons described in section 
        [11705(c)(1)(B) of this title] 7(c)(1);
          (3) identification of and research into the diseases 
        that are most prevalent among Native Hawaiians, 
        including behavioral, biomedical, epidemiological, and 
        health services;
          (4) the [development] maintenance of an action plan 
        outlining the contributions that each member 
        organization of Papa Ola Lokahi will make in carrying 
        out the policy of this [chapter] Act;
          (5) a clearinghouse function for--
                  (A) the collection and maintenance of date 
                associated with the health status of Native 
                Hawaiians;
                  (B) the identification and research into 
                diseases affecting Native Hawaiians; and
                  (C) the availability of Native Hawaiian 
                project funds, research projects and 
                publications;
          (6) [the coordination of the health care programs and 
        services provided to Native Hawaiians] the 
        establishment and maintenance of an institutional 
        review board for all health-related research involving 
        Native Hawaiians;
          (7) [the administration of special project funds.] 
        the coordination of the health care programs and 
        services provided to Native Hawaiians; and
          (8) the administration of special project funds.
    (b) Authorization of Appropriations.--There are authorized 
to be appropriated such sums as may be necessary for fiscal 
years [1993] 2001 through [2001] 2011 to carry out subsection 
(a) [of this section].

Sec. 11707. Administration of grants and contracts

    (a) Terms and Conditions.--The Secretary shall include in 
any grant made or contract entered into under this [chapter] 
Act such terms and conditions as the Secretary considers 
necessary or appropriate to ensure that the objectives of such 
grant or contract are achieved.
    (b) Periodic Review.--The Secretary shall periodically 
evaluate the performance of, and compliance with, grants and 
contracts under this [chapter] Act.
    (c) Administrative Requirements.--The Secretary may not 
make a grant or enter into a contract under this [chapter] Act 
with an entity unless the entity--
          (1) agrees to establish such procedures for fiscal 
        control and fund accounting as may be necessary to 
        ensure proper disbursement and accounting with respect 
        to the grant or contract;
          (2) agrees to ensure the confidentiality of records 
        maintained on individuals receiving health services 
        under the grant or contract;
          (3) with respect to providing health services to any 
        population of Native Hawaiians, a substantial portion 
        of which has a limited ability to speak the English 
        language--
                  (A) has developed and has the ability to 
                carry out a reasonable plan to provide health 
                services under the grant or contract through 
                individuals who are able to communicate with 
                the population involved in the language and 
                cultural context that is most appropriate; and
                  (B) has designated at least one individual, 
                fluent in both English and the appropriate 
                language, to assist in carrying out the plan;
          (4) with respect to health services that are covered 
        [in the plan of the State of Hawaii approved] under 
        programs under titles XVIII, XIX, or XXI of the Social 
        Security Act, including any State plan, or under any 
        other Federally health insurance plan--[42 U.S.C.A. 
        Sec. 1396 et seq.--]
                  (A) if the entity will provide under the 
                grant or contract any such health services 
                directly--
                          (i) the entity has entered into a 
                        participation agreement under such 
                        plans; and
                          (ii) the entity is qualified to 
                        receive payments under such plan; and
                  (B) if the entity will provide under the 
                grant or contract any such health services 
                through a contract with an organization--
                          (i) the organization has entered into 
                        a participation agreement under such 
                        plan; and
                          (ii) the organization is qualified to 
                        receive payments under such plan; and
          (5) agrees to submit to the Secretary and to Papa Ola 
        Lokahi an annual report that describes the [utilization 
        and] use and costs of health services provided under 
        the grant or contract (including the average cost of 
        health services per user) and that provides such other 
        information as the Secretary determines to be 
        appropriate.
    (d) Contrary Evaluation.--
          (1) Determination of noncompliance.--If, as a result 
        of evaluations conducted by the Secretary, the 
        Secretary determines that an entity has not complied 
        with or satisfactorily performed a contract entered 
        into under section [11705 of this title] 7, the 
        Secretary shall, prior to renewing such contract, 
        attempt to resolve the areas of noncompliance or 
        unsatisfactory performance and modify such contract to 
        prevent future occurrences of such noncompliance or 
        unsatisfactory performance. [If the Secretary 
        determines that such noncompliance or unsatisfactory 
        performance cannot be resolved and prevented in the 
        future, the Secretary shall not renew such contract 
        with such entity and is authorized to enter into a 
        contract under section 11705 of this title with another 
        entity referred to in section 11705(b) of this title 
        that provides services to the same population of Native 
        Hawaiians which is served by the entity whose contract 
        is not renewed by reason of this subsection].
          (2) Nonrenewal.--If the Secretary determines that the 
        noncompliance or unsatisfactory performance described 
        in paragraph (1) with respect to an entity cannot be 
        resolved and prevented in the future, the Secretary 
        shall not renew the contract with such entity and may 
        enter into a contract under section 7 with another 
        entity referred to in subsection (a)(3) of such section 
        that provides services to the same population of Native 
        Hawaiians which is served by the entity whose contract 
        is not renewed by reason of this paragraph.
          [(2)] (3) Consideration of results._In determining 
        whether to renew a contract entered into with an entity 
        under this [chapter] Act, the Secretary shall consider 
        the results of the evaluation under this section.
          [(3)] (4) Application of federal laws._All contracts 
        entered into by the Secretary under this [chapter] Act 
        shall be in accordance with all Federal contracting 
        laws and regulations except that,in the discretion of 
the Secretary, such contracts may be negotiated without advertising and 
may be exempted from the provisions of the Act of August 24, 1935 (40 
U.S.C. 270a et seq.).
          [(4)] (5) Payments made under any contract entered 
        into under this [chapter] Act may be made in advance, 
        by means of reimbursement, or in installments and shall 
        be made on such conditions as the Secretary deems 
        necessary to carry out the purposes of this [chapter] 
        Act.
    (e) [Limitations on Use of Funds for Administrative 
Expenses] Report._
    [Except for grants and contracts under section 11706 of 
this title, the Secretary may not grant to, or enter into a 
contract with, an entity under this chapter unless the entity 
agrees that the entity will not expend more than 10 percent of 
amounts received pursuant to this chapter for the purpose of 
administering the grant or contract.]
    [(f) Report.--]
          (1) For each fiscal year during which an entity 
        receives or expends funds pursuant to a grant or 
        contract under this [chapter] Act, such entity shall 
        submit to the Secretary and to Papa Ola Lokahi a 
        [quarterly] annual report on--
                  (A) activities conducted by the entity under 
                the grant or contract;
                  (B) the amounts and purposes for which 
                Federal funds were expended; and
                  (C) containing such other information as the 
                Secretary may request.
          (2) The reports and records of any entity which 
        concern any grant or contract under this chapter shall 
        be subject to audit by the Secretary, the Inspector 
        General of the Department of Health and Human Services, 
        and the Comptroller General of the United States.
    (g) Annual Private Audit.--The Secretary shall allow as a 
cost of any grant made or contract entered into under this 
chapter the cost of an annual private audit conducted by a 
certified public accountant.

Sec. 11708. Assignment of personnel

    (a) In General.--The Secretary is authorized to enter into 
an agreement with any entity under which the Secretary is 
authorized to assign personnel of the Department of Health and 
Human Services with expertise identified by such entity to such 
entity on detail for the purposes of providing comprehensive 
health promotion and disease prevention services to Native 
Hawaiians.
    (b) Applicable Federal Personnel Provisions.--Any 
assignment of personnel made by the Secretary under any 
agreement entered into under the authority of subsection (a) of 
this section shall be treated as an assignment of Federal 
personnel to a local government that is made in accordance with 
subchapter VI of chapter 33 of Title 5, United States Code.

Sec. 11709. Native Hawaiian health scholarships and fellowships

    (a) Eligibility.--Subject to the availability of [funds] 
amounts appropriated under the authority of subsection (c) [of 
this section,] the Secretary shall provide funds through a 
direct grant or a cooperative agreement to Kamehameha Schools[/
Bishop Estate] or another Native Hawaiian organization or 
health care organization with experience in the administration 
of educational scholarships or placement services for the 
purpose of providing scholarship assistance to students who--
          (1) meet the requirements of section [254l of this 
        title,] 338A of the Public Health Service Act, except 
        for assistance as provided for under subsection (b)(2); 
        and
          (2) are Native Hawaiians.
    (b) A priority for scholarships may be provided to 
employees of the Native Hawaiian Health Care Systems and the 
Native Hawaiian Health Centers.
    [(b)] (c) Terms and Conditions.--
          (1) In general.--The scholarship assistance provided 
        under subsection (a) [of this section] shall be 
        provided under the same terms and subject to the same 
        conditions, regulations, and rules [that] as apply to 
        scholarship assistance provided under section [254l of 
        this title, provided that--] 338A of the Public Health 
        Service Act (except as provided for in paragraph (2)), 
        except that--
                  (A) the provision of scholarships in each 
                type of health care profession training shall 
                correspond to the need for each type of health 
                care professional [identified in the Native 
                Hawaiian comprehensive health care master plan 
                implemented under section 11703 of this title] 
                to serve the [Native Hawaiian health care 
                systems] Native Hawaiian Community as 
                identified by Papa Ola Lokahi;
                  [(B) the primary health services covered 
                under the scholarship assistance program under 
                this section shall be the services included 
                under the definition of that term under section 
                11711(8) of this title;]
                  [(C)] (B) to the maximum extent practicable, 
                the Secretary shall select scholarship 
                recipients from a list of eligible applicants 
submitted by the Kamehameha Schools[/Bishop Estate] or the Native 
Hawaiian organization administering the program;
                  [(D)] (C) the obligated service requirement 
                for each scholarship recipient (except for 
                those receiving assistance under paragraph (2)) 
                shall be fulfilled through [the full-time 
                clinical or nonclinical practice of the health 
                profession of the scholarship recipient, in an 
                order of priority that would provide for 
                practice--] service, in order of priority, in--
                          (i) [first,] in any one of the [five] 
                        Native Hawaiian health care systems; 
                        and
                          (ii) [second, in--] a health 
                        professional shortage area or medically 
                        underserved areas, or geographic areas 
                        or facilities similarly designated by 
                        the United States Public Health Service 
                        in the State of Hawaii; or
                                  [(I) a health professional 
                                shortage area or medically 
                                underserved area located in the 
                                State of Hawaii; or]
                          [(II)] (iii) a geographic area or 
                        facility [that is--], or organization 
                        that serves a significant Native 
                        Hawaiian population;
                  (D) the scholarship's placement services 
                shall assign scholarship recipients to 
                appropriate sites for service.
                          [(aa) located in the State of Hawaii; 
                        and]
                          [(bb) has a designation that is 
                        similar to a designation described in 
                        subclause (I) made by the Secretary, 
                        acting through the Public Health 
                        Service;]
                  (E) the provision of counseling, retention 
                and other support services shall not be limited 
                to scholarship recipients, but shall also 
                include recipients of other scholarship and 
                financial aid programs enrolled in appropriate 
                health professions training programs,
                  (F) [the obligated service of a scholarship 
                recipient shall not be performed by the 
                recipient through membership in the National 
                Health Service Corps; and] financial assistance 
                may be provided to scholarship recipients in 
                those health professions designated in such 
                section 338A of the Public Health Service Act 
                while they are fulfilling their service 
                requirement in any one of the Native Hawaiian 
                health care systems or community health 
                centers.
          (2) Fellowships.--Financial assistance through 
        fellowships may be provided to Native Hawaiian 
        community health representatives, outreach workers, and 
        health program administrators in professional training 
        programs, and to Native Hawaiians in certificated 
        programs provided by traditional Native Hawaiian 
        healers in any of the traditional Native Hawaiian 
        healing practices including lomi-lomi, la'au lapa'au, 
        and ho'oponopono. Such assistance may include a stipend 
        or reimbursement for costs associated with 
        participation in the program.
          (3) Rights and benefits.--Scholarship recipients in 
        health professions designated in section 338A of the 
        Public Health Service Act while fulfilling their 
        service requirements shall have all the same rights and 
        benefits of members of the National Health Service 
        corps during their period of service.
          (4) No inclusion of assistance in gross income.--
        Financial assistance provided under section 11 of this 
        Act shall be deemed ``Qualified Scholarships'' for 
        purposes of 26 U.S.C. section 117.
                  [(G) the requirements of sections 254d 
                through 254k of this title, section 254m of 
                this title, other than subsection (b)(5) of 
                that section, and section 254n of this title 
                applicable to scholarship assistance provided 
                under subsection (a) of this section.
          [(2) The Native Hawaiian Health Scholarship program 
        shall not be administered by or through the Indian 
        Health Service.
    [(c)] (d) Authorization of Appropriations.--There are 
authorized to be appropriated such sums as may be necessary for 
fiscal years [1993] 2001 through [2001] 2011 for the purpose of 
funding the scholarship assistance provided under subsection 
(a) [of this section] and fellowship assistance under 
subsection (c)(2).

 Sec. 11710. Report

    The President shall, at the time the budget is submitted 
under section 1105 of Title 31, for each fiscal year transmit 
to the Congress a report on the progress made in meeting the 
objectives of this chapter, including a review of programs 
established or assisted pursuant to this chapter and an 
assessment and recommendations of additional programs or 
additional assistance necessary to, at a minimum, provide 
health services to Native Hawaiians, and ensure a health status 
for Native Hawaiians, which are at a parity with the health 
services available to, and the health status of, the general 
population.

 SEC. 13. USE OF FEDERAL GOVERNMENT FACILITIES AND SOURCES OF SUPPLY.

    (a) In General.--The Secretary shall permit organizations 
that receive contracts or grants under this Act, in carrying 
out such contracts or grants, to use existing facilities and 
all equipment therein or under the jurisdiction of the 
Secretary under such terms and conditions as may be agreed upon 
for the use and maintenance of such facilities or equipment.
    (b) Donation of Property.--The Secretary may donate to 
organizations that receivecontracts or granst under this Act 
any personal or real property determined to be in excess of the needs 
of the Department or the General Services Administration for purposes 
of carrying out such contracts or grants.
    (c) Acquisition of Surplus Property.--The Secretary may 
acquire excess of surplus Federal Government personal or real 
property for donation to organizations that receive contracts 
or grants under this Act if the Secretary determines that the 
property is appropriate for the use by the organization for the 
purpose for which a contract or grant is authorized under this 
Act.

SEC. 14. DEMONSTRATION PROJECTS OF NATIONAL SIGNIFICANCE.

    (a) Authority and Areas of Interest.--The Secretary, in 
consultation with papa Ola Lokahi, may allocate amounts 
appropriated under this Act, or any other Act, to carry out 
Native Hawaiian demonstration projects of national 
significance. The areas of interest of such projects may 
include--
          (1) the development of a centralized database and 
        information system relating to the health care status, 
        health care needs, and wellness of Native Hawaiians;
          (2) the education of health professionals, and other 
        individuals in institutions of higher learning, in 
        health and allied health programs in healing practices, 
        including Native Hawaiian healing practices;
          (3) the integration of Western medicine with 
        complementary healing practices including traditional 
        Native Hawaiian healing practices;
          (4) the use of tele-wellness and telecommunications 
        in chronic disease management and health promotion and 
        disease prevention;
          (5) the development of appropriate models of health 
        care for Native Hawaiians and other indigenous peoples 
        including the provision of culturally competent health 
        services, related activities focusing on wellness 
        concepts, the development of appropriate kupuna care 
        programs, and the development of financial mechanisms 
        and collaborative relationships leading to universal 
        access to health care; and
          (6) the establishment of a Native Hawaiian Center of 
        Excellent for Nursing at the University of Hawaii at 
        Hilo, a Native Hawaiian Center of Excellence for Mental 
        Health at the University of Hawaii at Manoa, a Native 
        Hawaiian Center of Excellence for Maternal health and 
        Nutrition at the Waimanalo Health Center, and a Native 
        Hawaiian Center of Excellence for Research, Training, 
        Integrated Medicine at Molokai General Hospital and a 
        Native Hawaiian Center of Excellence for Complimentary 
        Health and Health Education and Training at the Waianae 
        coast Comprehensive Health Center.
    (b) Nonreduction in Other Funding.--The allocation of funds 
for demonstration projects under subsection (a) shall not 
result in a reduction in funds required by the Native Hawaiian 
health care systems, the Native Hawaiian Health Centers, the 
Native Hawaiian Health Scholarship Program, or Papa Ola Lokahi 
to carry out their respective responsibilities under this Act.

SEC. 15. NATIONAL BIPARTISAN COMMISSION ON NATIVE HAWAIIAN HEALTH CARE 
                    ENTITLEMENT.

    (a) Establishment.--There is hereby established a National 
Bipartisan Native Hawaiian Heath Care Entitlement Commission 
(referred to in this Act as the ``Commission'').
    (b) Membership.--The Commission shall be composed of 21 
members to be appointed as follows:
          (1) Congressional members.--
                  (A) Appointment.--Eight members of the 
                Commission shall be members of Congress, of 
                which--
                          (i) two members shall be from the 
                        House of Representatives and shall be 
                        appointed by the Majority Leader;
                          (ii) two members shall be from the 
                        House of Representatives and shall be 
                        appointed by the Minority Leader; and
                          (iii) two members shall be from the 
                        Senate and shall be appointed by the 
                        Majority Leader;
                          (iv) two members shall be from the 
                        Senate and shall be appointed by the 
                        Minority Leader.
                  (B) Relevant committee membership.--The 
                members of the Commission appointed under 
                subparagraph (A) shall each be members of the 
                committees of Congress that consider 
                legislation affecting the provision of health 
                care to Native Hawaiians and other Native 
                Americans.
                  (C) Chairperson.--The members of the 
                Commission appointed under subparagraph (A) 
                shall elect the chairperson and vice-
                chairperson of the Commission.
          (2) Hawaiian health members.--Eleven members of the 
        Commission shall be appointed by Hawaiian health 
        entities, of which--
                  (A) five members shall be appointed by the 
                Native Hawaiian Health Care Systems;
                  (B) one member shall be appointed by the 
                Hawaii State Primary Care Association;
                  (C) one member shall be appointed by Papa Ola 
                Lakahi;
                  (D) one member shall be appointed by the 
                Native Hawaiian Health Task Force;
                  (E) one member shall be appointed by the 
                Office of Hawaiian Affairs; and
                  (F) two members shall be appointed by 
                Association of Hawaiian Civic Clubs and shall 
                represent Native Hawaiian populations residing 
                in the continental United States.
          (3) Secretarial members.--Two members of the 
        Commission shall be appointed by the Secretary and 
        shall possess knowledge of Native Hawaiian health 
        concerns and wellness.
    (c) Terms.--
          (1) In general.--The members of the Commissions shall 
        serve for the life of the Commission.
          (2) Initial appointment of members.--The members of 
        the Commission shall be appointed under subsection 
        (b)(1) not later than 90 days after the date of 
        enactment of this Act, and the remaining members of the 
        Commission shall be appointed not later than 60 days 
        after the date on which the members are appointed under 
        such subsection (b)(1).
          (3) Vacancies.--A vacancy in the membership of the 
        Commission shall be filled in the manner in which the 
        original appointment was made.
    (d) Duties of the Commission.--The Commission shall carry 
out the following duties and functions:
          (1) Review and analyze the recommendations of the 
        report of the study committee established under 
        paragraph (3).
          (2) Make recommendations to Congress for the 
        provision of health services to Native Hawaiian 
        individuals as an entitlement, giving due regard to the 
        effects of a program on existing health care delivery 
        systems for Native Hawaiians and the effect of such 
        programs on self-determination and the reconciliation 
        of their relationship with the United States.
          (3) Establish a study committee to be composed of at 
        least 10 members from the Commission, including 4 
        members of the members appointed under subsection 
        (b)(1), 5 of the members appointed under subsection 
        (b)(2), and 1 of the members appointed by the Secretary 
        under subsection (b)(3), which shall--
                  (A) to the extent necessary to carry out its 
                duties, collect, compile, qualify, and analyze 
                data necessary to understand the extent of 
                Native Hawaiian needs with regard to the 
                provision of health services, including holding 
                hearings and soliciting the views of Native 
                Hawaiians and Native Hawaiian organizations, 
                and which may include authorizing and funding 
                feasibility studies of various models for all 
                Native Hawaiian beneficiaries and their 
                families, including those that live in the 
                continental United States;
                  (B) make recommendations to the Commission 
                for legislation that will provide for the 
                culturally-competent and appropriate provision 
                of health services for Native Hawaiians as an 
                entitlement, which shall, at a minimum, address 
                issues of eligibility and benefits to be 
                provided, including recommendations regarding 
                from whom such health services are to be 
                provided and the cost and mechanisms for 
                funding of the health services to be provided;
                  (C) determine the effect of the enactment of 
                such recommendations on the existing system of 
                delivery of health services for Native 
                Hawaiians;
                  (D) determine the effect of a health service 
                entitlement program for Native Hawaiian 
                individuals on their self-determination and the 
                reconciliation of their relationship with the 
                United States;
                  (E) not later than 12 months after the date 
                of the appointment of all members of the 
                Commission, make a written report of its 
                findings and recommendations to the Commission, 
                which report shall include a statement of the 
                minority and majority position of the committee 
                and which shall be disseminated, at a minimum, 
                to Native Hawaiian organizations and agencies 
                and health organizations referred to in 
                subsection (b)(2) for comment to the 
                Commission; and
                  (F) report regularly to the full Commission 
                regarding the findings and recommendations 
                developed by the committee in the course of 
                carrying out its duties under this section.
          (4) Not later than 18 months after the date of the 
        appointment of all members of the Commission submit a 
        written report to Congress containing a recommendation 
        of policies and legislation to implement a policy that 
        would establish a health care system for Native 
        Hawaiians, grounded in their culture, and based on the 
        delivery of health services as an entitlement, together 
        with a determination of the implications of such an 
        entitlement system on existing health care delivery 
        systems for Native Hawaiians and their self-
        determination and the reconciliation of their 
        relationship with the United States.
    (e) Administrative Provisions.--
          (1) Compensation and expenses.--
                  (A) Congressional members.--Each member of 
                the Commission appointed under subsection 
                (b)(1) shall not receive any additional 
                compensation, allowances, or benefits by reason 
                of their service on the Commission. Such 
                members shall receive travel expenses and per 
                diem in lieu ofsubsistence in accordance with 
sections 5702 and 5703 of title 5, United States Code.
                  (B) Other members.--The members of the 
                Commission appointed under paragraphs (2) and 
                (3) of subsection (b) shall, while serving on 
                the business of the Commission (including 
                travel time), receive compensation at the per 
                diem equivalent of the rate provided for 
                individuals under level IV of the Executive 
                Schedule under section 5315 of title 5, United 
                States Code, and while serving away from their 
                home or regular place of business, be allowed 
                travel expenses, as authorized by the 
                chairperson of the Commission.
                  (C) Other personnel.--For purposes of 
                compensation (other than compensation of the 
                members of the Commission) and employment 
                benefits, rights, and privileges, all personnel 
                of the Commission shall be treated as if they 
                were employees of the Senate.
          (2) Meetings and quorum.--
                  (A) Meetings.--The Commission shall meet at 
                the call of the chairperson.
                  (B) Quorum.--A quorum of the Commission shall 
                consist of not less than 12 members, of which--
                          (i) not less than 4 of such members 
                        shall be appointees under subsection 
                        (b)(1);
                          (ii) not less than 7 of such members 
                        shall be appointees under subsection 
                        (b)(2); and
                          (iii) not less than 1 of such members 
                        shall be an appointee under subsection 
                        (b)(3).
          (3) Director and staff.--
                  (A) Executive director.--The members of the 
                Commission shall appoint an executive director 
                of the Commission. The executive director shall 
                be paid the rate of basic pay equal to that 
                under level V of the Executive Schedule under 
                section 5316 of title 5, United States Code.
                  (B) Staff.--With the approval of the 
                Commission, the executive director may appoint 
                such personnel as the executive director deems 
                appropriate.
                  (C) Applicability of civil service laws.--The 
                staff of the Commission shall be appointed 
                without regard to the provisions of title 5, 
                United States Code, governing appointments in 
                the competitive service, and shall be paid 
                without regard to the provisions of chapter 51 
                and subchapter III of chapter 53 of such title 
                (relating to classification and General 
                Schedule pay rates).
                  (D) Experts and consultants.--With the 
                approval of the Commission, the executive 
                director may procure temporary and intermittent 
                services under section 3109(b) of title 5, 
                United States Code.
                  (E) Facilities.--The Administrator of the 
                General Services Administration shall locate 
                suitable office space for the operations of the 
                Commission in Washington, D.C. and in the State 
                of Hawaii. The Washington, D.C. facilities 
                shall serve as the headquarters of the 
                Commission while the Hawaii office shall serve 
                a liaison function. Both such offices shall 
                include all necessary equipment and incidentals 
                required for the proper functioning of the 
                Commission.
    (f) Powers.--
          (1) Hearings and other activities.--For purposes of 
        carrying out its duties, the Commission may hold such 
        hearings and undertake such other activities as the 
        Commission determines to be necessary to carry out its 
        duties, except that at least 8 hearings shall be held 
        on each of the Hawaiian Islands and 3 hearings in the 
        continental United States in areas where a significant 
        population of Native Hawaiians reside. Such hearings 
        shall be held to solicit the views of Native Hawaiians 
        regarding the delivery of health care services to such 
        individuals. To constitute a hearing under this 
        paragraph, at least 4 members of the Commission, 
        including at least 1 member of Congress, must be 
        present. Hearings held by the study committee 
        established under subsection (d)(3) may be counted 
        towards the number of hearings required under this 
        paragraph.
          (2) Studies by the general accounting office.--Upon 
        the request of the Commission, the Comptroller General 
        shall conduct such studies or investigations as the 
        Commission determines to be necessary to carry out its 
        duties.
          (3) Cost estimates.--
                  (A) In general.--The Director of the 
                Congressional Budget Office or the Chief 
                Actuary of the Health Care Financing 
                Administration, or both, shall provide to the 
                Commission, upon the request of the Commission, 
                such cost estimates as the Commission 
                determines to be necessary to carry out its 
                duties.
                  (B) Reimbursements.--The Commission shall 
                reimburse the Director of the Congressional 
                budget Office for expenses relating to the 
                employment in the office of the Director of 
                such additional staff as may be necessary for 
                the Director to comply with requests by the 
                Commission under subparagraph (A).
          (4) Detail of federal employees.--Upon the request of 
        the Commission, the head of any Federal agency is 
        authorized to detail, without reimbursement, any of the 
        personnel of such agency to the Commission to assist 
        the Commission in carrying out its duties. Any such 
        detail shall not interrupt or otherwise affect the 
        civil service status or privileges of the Federal 
        employees.
          (5) Technical assistance.--Upon the request of the 
        Commission, the head for any Federal agency shall 
        provide such technical assistance to the Commission as 
        the Commission determines to be necessary to carry out 
        its duties.
          (6) Use of mails.--The Commission may use the United 
        States mails in the same manner and under the same 
        conditions as Federal agencies and shall, for purposes 
        of the frank, be considered a commission of Congress as 
        described in section 3215 of title 39, United States 
        Code.
          (7) Obtaining information.--The Commission may secure 
        directly from any Federal agency information necessary 
        to enable the Commission to carry out its duties, if 
        the information may be disclosed under section 552 of 
        title 5, United States Code. Upon request of the 
        chairperson of the Commission, the head of such agency 
        shall furnish such information to the Commission.
          (8) Support services.--Upon the request of the 
        Commission, the Administrator of General Services shall 
        provide to the Commission on a reimbursable basis such 
        administrative support services as the Commission may 
        request.
          (9) Printing.--For purposes of costs relating to 
        printing and binding, including the cost of personnel 
        detailed from the Government Printing Office, the 
        Committee shall be deemed to be a committee of 
        Congress.
    (g) Authorization of Appropriations.--There is authorized 
to be appropriated such sums as may be necessary to carry out 
this section. The amount appropriated under this subsection 
shall not result in a reduction in any other appropriation for 
health care of health services for Native Hawaiians.

SEC. 16. RULE OF CONSTRUCTION.

    Nothing in this Act shall be construed to restrict the 
authority of the State of Hawaii to license health 
practitioners.

SEC. 17. COMPLIANCE WITH BUDGET ACT.

    Any new spending authority (described in subparagraph (A) 
of (B) of section 401(c)(2) of the Congressional Budget Act of 
1974 (2 U.S.C. 651 (c)(2)(A) or (B))) which is provided under 
this Act shall be effective for any fiscal year only to such 
extent or in such amounts as are provided for in appropriation 
Acts.

SEC. 18. SEVERABILITY.

    If any provision of this Act, or the application of any 
such provision to any person or circumstances is held to be 
invalid, the remainder of this Act, and the application of such 
provision or amendment to persons or circumstances other than 
those to which it is held invalid, shall not be affected 
thereby.

Sec. 11711. Definitions

    For purposes of this chapter:
          (1) Department.--The term ``department'' means the 
        Department of Health and Human Services.
          [(1)] (2) Disease prevention.--The term ``disease 
        prevention'' includes--
                  (A) immunizations,
                  (B) control of high blood pressure,
                  (C) control of sexually transmittable 
                diseases,
                  (D) prevention and control of diabetes,
                  (E) control of toxic agents,
                  (F) occupational safety and health,
                  (G) accident prevention,
                  (H) fluoridation of water,
                  (I) control of infectious agents, and
                  (J) provision of mental health care.
          [(2)] (3) Health promotion.--The term ``health 
        promotion'' includes--
                  (A) pregnancy and infant care, including 
                prevention of fetal alcohol syndrome,
                  (B) cessation of tobacco smoking,
                  (C) reduction in the misuse of alcohol and 
                harmful illicit drugs,
                  (D) improvement of nutrition,
                  (E) improvement in physical fitness,
                  (F) family planning, [and]
                  (G) control of stress[.],
                  (H) reduction of major behavioral risk 
                factors and promotion of health lifestyle 
                practices, and
                  (I) integration of cultural approaches to 
                health and well-being, including traditional 
                practices relating to the atmosphere (lewa 
                lani), land ('aina), water (wai), and ocean 
                (kai).
          [(3)] (4) Native hawaiian.--The term ``Native 
        Hawaiian'' means any individual who is Kanaka Maoli (a 
        descendant of the aboriginal people, who prior to 1778, 
        occupied and exercised sovereignty in the area that now 
        constitutes the State of Hawaii) as evidenced by--
                  (A) [a citizen of the United States, and] 
                genealogical records,
                  (B) [a descendant of the aboriginal people, 
                who prior to 1778, occupied and exercised 
                sovereignty in the area that now constitutes 
                the State of Hawaii, as evidenced by--] Kama' 
                aina witness verification from Native Hawaiian 
                Kupuna (elders); or
                          [(i) genealogical records,
                          [(ii) Kupuna (elders) or Kama'aina 
                        (long-term community residents) 
                        verification, or
                  [(iii)] (C) birth records of the State of 
                Hawaii or any State or territory of the United 
                States.
          [(4)] (5) Native hawaiian health [center] care 
        system.--The term ``Native Hawaiian health [center] 
        care system'' means an entity--
                  (A) which is organized under the laws of the 
                State of Hawaii,
                  (B) which provides or arranges for health 
                care services through practitioners licensed by 
                the State of Hawaii, where licensure 
                requirements are applicable,
                  (C) which is a public or nonprofit private 
                entity, and
                  (D) in which Native Hawaiian health 
                practitioners significantly participate in the 
                planning, management, monitoring, and 
                evaluation of the care services;
                  (E) Which may be composed of as many as 8 
                Native Hawaiian health care systems as 
                necessary to meet the health care needs of each 
                island's Native Hawaiians; and
                  (F) which is--
                          (i) recognized by Papa Ola Lokahi for 
                        the purpose of planning, conducting or 
                        administering programs, or portions of 
                        programs, authorized by this chapter 
                        for the benefit of Native Hawaiians' 
                        and
                          (ii) certified by Papa Ola Lokahi as 
                        having the qualifications and capacity 
                        to provide the services, and meet the 
                        requirements, under the contract the 
                        organization enters into with, or grant 
                        the organization receives from, the 
                        Secretary pursuant to this Act.
          [(5)] (6) [Native hawaiian organization] Native 
        hawaiian health center.--The term ``Native Hawaiian 
        [organization''] Health Center'' means any organization 
        that is a primary care provider and that--
                  (A) [which serves the interests of Native 
                Hawaiians,] has a governing board that is 
                composed of individuals, at least 50 percent of 
                whom are Native Hawaiians;
                  (B) [which is--] has demonstrated cultural 
                competency in a predominately Native Hawaiian 
                community;
                  (C) services a patient population that--
                          (i) [recognized by Papa Ola Lokahi 
                        for the purpose of planning, 
                        conducting, or administering programs 
                        (or portions of programs) authorized 
                        under this chapter for the benefit of 
                        Native Hawaiians, and] is made up of 
                        individuals at least 50 percent of whom 
                        are Native Hawaiian; or
                          (ii) [certified by Papa Ola Lokahi as 
                        having the qualifications and capacity 
                        to provide the services, and meet the 
                        requirements, under the contract the 
                        organization enters into with, or grant 
                        the organization receives from, the 
                        Secretary under this chapter,] has not 
                        less that 2,500 Native Hawaiians as 
                        annual users of services; and
                  [(C) in which Native Hawaiian health 
                practitioners significantly participate in the 
                planning, management, monitoring, and 
                evaluation of health services, and]
                  (D) [which is a public or nonprofit private 
                entity.] is recognized by Papa Ola Lokahi has 
                having met all the criteria of this paragraph.
          [(6)] (7) Native hawaiian health [care system] task 
        force.--The term ``Native Hawaiian health [care system] 
        Task Force'' means [an entity--] a task force 
        established by the State Council of Hawaiian Homestead 
        Associations to implement health and wellness 
        strategies in Native Hawaiian communities.
                  [(A) which is organized under the laws of the 
                State of Hawaii,
                  [(B) which provides or arranges for health 
                care services through practitioners licensed by 
                the State of Hawaii, where licensure 
                requirements are applicable,
                  [(C) which is a public or nonprofit private 
                entity,
                  [(D) in which Native Hawaiian health 
                practitioners significantly participate in the 
                planning, management, monitoring, and 
                evaluation of health care services,
                  [(E) which may be composed of as many Native 
                Hawaiian health centers as necessary to meet 
                the health care needs of each island's Native 
                Hawaiians, and
                  [(F) which is--
                          [(i) recognized by Papa Ola Lokahi 
                        for the purpose of planning, 
                        conducting, or administering programs, 
                        or portions of programs, authorized by 
                        this chapter for the benefit of Native 
                        Hawaiians, and
                          [(ii) certified by Papa Ola Lokahi as 
                        having the qualifications and the 
                        capacity to provide the services and 
                        meet the requirements under the 
                        contract the Native Hawaiian health 
                        care system enters into with the 
                        Secretary or the grant the Native 
                        Hawaiian health care system receives 
                        from the Secretary pursuant to this 
                        chapter.]
          [(7)] (8) [Papa ola lokahi.--] Native hawaiian 
        organization._The term ``Native Hawaiian organization'' 
        means any organization--
                  (A) [The term ``Papa Ola Lokahi'' means an 
                organization composed of--] which serves the 
                interests of Native Hawaiians; and
                          [(i) E Ola Mau;
                          [(ii) the Office of Hawaiian Affairs 
                        of the State of Hawaii;
                          [(iii) Alu Like Inc.;
                          [(iv) the University of Hawaii;
                          [(v) the Office of Hawaiian Health of 
                        the Hawaii State Department of Health;
                          [(vi) Ho'ola Lahui Hawaii, or a 
                        health care system serving the islands 
                        of Kaua'i and Ni'ihau, and which may be 
                        composed of as many health care centers 
                        as are necessary to meet the health 
                        care needs of the Native Hawaiians of 
                        those islands;
                          [(vii) Ke Ola Mamo, or a health care 
                        system serving the island of O'ahu, and 
                        which may be composed of as many health 
                        care centers as are necessary to meet 
                        the health care needs of the Native 
                        Hawaiians of that island;
                          [(viii) Na Pu'uwai or a health care 
                        system serving the islands of Moloka'i 
                        and Lana'i, and which may be composed 
                        of as many health care centers as are 
                        necessary to meet the health care needs 
                        of the Native Hawaiians of those 
                        islands;
                          [(ix) Hui No Ke Ola Pono, or a health 
                        care system serving the island of Maui, 
                        and which may be composed of as many 
                        health care centers as are necessary to 
                        meet the health care needs of the 
                        Native Hawaiians of that island;
                          [(x) Hui Malama Ola Ha'Oiwi or a 
                        health care system serving the island 
                        of Hawaii, and which may be composed of 
                        as many health care centers as are 
                        necessary to meet the health care needs 
                        of the Native Hawaiians of that island; 
                        and
                          [(xi) such other member organizations 
                        as the Board of Papa Ola Lokahi may 
                        admit from time to time, based upon 
                        satisfactory demonstration of a record 
                        of contribution to the health and well-
                        being of Native Hawaiians, and upon 
                        satisfactory development of a mission 
                        statement in relation to this chapter, 
                        including clearly defined goals and 
                        objectives, a 5-year action plan 
                        outlining the contributions that each 
                        organization will make in carrying out 
                        the policy of this chapter, and an 
                        estimated budget.]
                  (B) [Such term does not include any such 
                organization identified in subparagraph (A) if 
                the Secretary determines that such organization 
                has not developed a mission statement with 
                clearly defined goals and objectives for the 
                contributions the organization will make to the 
                Native Hawaiian health care systems, and an 
                action plan for carrying out those goals and 
                objectives.] which is--
                          (i) recognized by Papa Ola Lokahi for 
                        the purpose of planning, conducting or 
                        administering programs (or portions of 
                        programs) authorized under this Act for 
                        the benefit of Native Hawaiians; and
                          (ii) a public or non profit private 
                        entity.
          [(8)] (9) [Primary health services] Office of 
        hawaiian affairs._The terms ``Office of Hawaiian 
        Affairs'' and ``OHA'' mean the governmental entity 
        established under Article XII, sections 5 and 6 of the 
        Hawaii State Constitution and charged with the 
        responsibility to formulate policy relating to the 
        affairs of Native Hawaiians.
          [The term ``primary health services'' means--
                  [(A) services of physicians, physicians' 
                assistants, nurse practitioners, and other 
                health professionals;
                  [(B) diagnostic laboratory and radiologic 
                services;
                  [(C) preventive health services (including 
                children's eye and ear examinations to 
                determine the need for vision and hearing 
                correction, perinatal services, well child 
                services, and family planning services);
                  [(D) emergency medical services;
                  [(E) transportation services as required for 
                adequate patient care;
                  [(F) preventive dental services; and
                  [(G) pharmaceutical service, as may be 
                appropriate for particular health centers.]
          [(9)] (10) [Secretary] Papa ola lokahi.--[The term 
        ``Secretary'' means the Secretary of Health and Human 
        Services.]
                  (A) In general.--The term ``Papa Ola Lokahi'' 
                means an organization that is composed of 
                public agencies and private organizations 
                focusing on improving the health status of 
                Native Hawaiians. Board members of such 
                organization may include representation from--
                          (i) E Ola Mau;
                          (ii) the Office of Hawaiian Affairs 
                        of the State of Hawaii;
                          (iii) Alu Like, Inc.;
                          (iv) the University of Hawaii;
                          (v) the Hawaii State Department of 
                        Health;
                          (vi) the Kamehameha Schools, or other 
                        Native Hawaiian organization 
                        responsible for the administration of 
                        the Native Hawaiian Health Scholarship 
                        Program;
                          (vii) the Hawaii State Primary Care 
                        Association, or Native Hawaiian Health 
                        Centers whose patient populations are 
                        predominantly Native Hawaiian;
                          (viii) Ahahui O Na Kauka, the Native 
                        Hawaiian Physicians Association;
                          (ix) Ho'ola Lahui Hawaii, or a health 
                        care system serving the islands of 
                        Kaua'i or Ni'ihau, and which may be 
                        composed of as many health care centers 
                        as are necessary to meet the health 
                        care needs of the Native Hawaiians of 
                        those islands;
                          (x) Ke Ola Mamo, or a health care 
                        system serving the island of O'ahu and 
                        which may be composed of as many health 
                        care centers as are necessary to meet 
                        the health care needs of the Native 
                        Hawaiians of that island;
                          (xi) Na Pu'uwai or a health care 
                        system serving the islands of Moloka'i 
                        or Lana'i, and which may be composed of 
                        as many health care centers as are 
                        necessary to meet the health care needs 
                        of the Native Hawaiians of those 
                        islands;
                          (xii) Hui No Ke Ola Pono, or a health 
                        care system serving the island of Maui, 
                        and which may be composed of as many 
                        health care centers as are necessary to 
                        meet the health care needs of the 
                        Native Hawaiians of that island;
                          (xiii) Hui Malama Ola Na'Oiwi, or a 
                        health care system serving the island 
                        of Hawaii, and which may be composed of 
                        as many health care centers as are 
                        necessary to meet the health care needs 
                        of the Native Hawaiians of that island;
                          (xiv) other Native Hawaiian health 
                        care systems as certified and 
                        recognized by Papa Ola Lokahi in 
                        accordance with this Act; and
                          (xv) such other member organizations 
                        as the Board of Papa Ola Lokahi will 
                        admit from time to time, based upon 
                        satisfactory demonstration of a record 
                        of contribution to the health and well-
                        being of Native Hawaiians.
                  (B) Limitation.--Such term does not include 
                any organization described in subparagraph (A) 
                if the Secretary determines that such 
                organization has not developed a mission 
                statement with clearly defined goals and 
                objectives for the contributions the 
                organization will make to the Native Hawaiian 
                health care systems, the national policy as set 
                forth in section 4, and an action plan for 
                carrying out those goals and objectives.
          [(10)] (11) [Traditional native hawaiian healer--] 
        Primary health services.--The term ``primary health 
        services'' means--[The term ``traditional Native 
        Hawaiian healer'' means a practitioner--]
                  (A) [who--] services of physicians, 
                physicians' assistants, nurse practitioners, 
                and other health professionals;
                          [(i) is of Hawaiian ancestry, and
                          [(ii) has the knowledge, skills, and 
                        experience in direct personal health 
                        care of individuals, and]
                  (B) [whose knowledge, skills, and experience 
                are based on demonstrated learning of Native 
                Hawaiian healing practices acquired by--] 
                diagnostic laboratory and radiologic services;
                          [(i) direct practical association 
                        with Native Hawaiian elders, and
                          [(ii) oral traditions transmitted 
                        from generation to generation.]
                  (C) preventive health services including 
                perinatal services, well child services, family 
                planning services, nutrition services, home 
                health services, and, generally, all those 
                services associated with enhanced health and 
                wellness;
                  (D) emergency medical services;
                  (E) transportation services as required for 
                adequate patient care;
                  (F) preventive dental services;
                  (G) pharmaceutical and medicament services;
                  (H) primary care services that may lead to 
                specialty or tertiary care; and
                  (I) complimentary healing practices, 
                including those performed by traditional Native 
                Hawaiian healers.
          (12) Secretary.--The term ``Secretary'' means the 
        Secretary of Health and Human Services.
          (13) Traditional native hawaiian healer.--The term 
        ``traditional Native Hawaiian healer'' means a 
        practitioner--
                  (A) who--
                          (i) is of Native Hawaiian ancestry; 
                        and
                          (ii) has the knowledge, skills and 
                        experience in direct personal health 
                        care of individuals; and
                  (B) whose knowledge, skills, and experience 
                are based on demonstrated learning of Native 
                Hawaiian healing practices acquired by--
                          (i) direct practical association with 
                        Native Hawaiian elders; and
                          (ii) oral traditions transmitted from 
                        generation to generation.

Sec. 11712. Rule of construction

    Nothing in this chapter shall be construed to restrict the 
authority of the State of Hawaii to license health 
practitioners.

Sec. 11713. Compliance with Budget Act

    Any new spending authority (described in [subsection 
(c)(2)] subparagraph (A) [or] of (B) of section [651] 401(c)(2) 
of [Title 2)] the Congressional Budget Act of 1974 (2 U.C. C. 
651 (c)(2) (A) or (B))) which is provided under this [chapter] 
Act shall be effective for any fiscal year only to such extent 
or in such amounts as are provided in appropriation Acts.

Sec. 11714. Severability

    If any provision of this chapter, or the application of any 
such provision to any person or circumstances is held to be 
invalid, the remainder of this chapter, and the application of 
such provision or amendment to persons or circumstances other 
than those to which it is held invalid, shall not be affected 
thereby.
     APPENDIX A.--TABLE OF FEDERAL ACTS AFFECTING NATIVE HAWAIIANS

------------------------------------------------------------------------
       Federal act name          Session law cite         Summary
------------------------------------------------------------------------
Act of June 21, 1910..........  Pub. L. No. 61-    Authorizes
                                 266, 36 Stat.      appropriations for
                                 703, 718 (1910).   the Smithsonian
                                                    Institute for
                                                    ethnological
                                                    research of American
                                                    Indians and Native
                                                    Hawaiians.
Act of Mar. 4, 1911...........  Pub. L. No. 62-    Authorizes
                                 525, 36 Stat.      appropriations for
                                 1363, 1395         the Smithsonian
                                 (1911).            Institute for
                                                    ethnological
                                                    research of American
                                                    Indians and Native
                                                    Hawaiians.
Act of Aug. 24, 1912..........  Pub. L. No. 63-    Authorizes
                                 302, 37 Stat.      appropriations for
                                 417, 436 (1912).   the Smithsonian
                                                    Institute for
                                                    ethnological
                                                    research of American
                                                    Indians and Native
                                                    Hawaiians.
Act of June 23, 1913..........  Pub. L. No. 63-3,  Authorizes
                                 38 Stat. 4, 26     appropriations for
                                 (1913).            the Smithsonian
                                                    Institute for
                                                    ethnological
                                                    research of American
                                                    Indians and Native
                                                    Hawaiians.
Act of Aug. 1, 1914...........  Pub. L. No. 63-    Authorizes
                                 161, 38 Stat.      appropriations for
                                 609, 625 (1914).   the Smithsonian
                                                    Institute for
                                                    ethnological
                                                    research of American
                                                    Indians and Native
                                                    Hawaiians.
Act of Mar. 3, 1915...........  Pub. L. No. 63-    Authorizes
                                 623, 38 Stat.      appropriations for
                                 822, 838 (1915).   the Smithsonian
                                                    Institute for
                                                    ethnological
                                                    research of American
                                                    Indians and Native
                                                    Hawaiians.
Act of July 1, 1916...........  Pub. L. No. 64-    Authorizes
                                 132, 39 Stat.      appropriations for
                                 262, 279 (1916).   the Smithsonian
                                                    Institute for
                                                    ethnological
                                                    research of American
                                                    Indians and Native
                                                    Hawaiians.
Act of June 12, 1917..........  Pub. L. No. 65-    Authorizes
                                 21, 40 Stat 105,   appropriations for
                                 122 (1917).        the Smithsonian
                                                    Institute for
                                                    ethnological
                                                    research of American
                                                    Indians and Native
                                                    Hawaiians.
Act of July 19, 1919..........  Pub. L. No. 66-    Authorizes
                                 21, 41 Stat.       appropriations for
                                 163, 181 (1919).   the Smithsonian
                                                    Institute for
                                                    ethnological
                                                    research of American
                                                    Indians and Native
                                                    Hawaiians.
Act of July 1, 1918...........  Pub. L. No. 65-    Authorizes
                                 181, 40 Stat.      appropriations for
                                 634, 651 (1918).   the Smithsonian
                                                    Institute for
                                                    ethnological
                                                    research of American
                                                    Indians and Native
                                                    Hawaiians.
Act of June 5, 1920...........  Pub. L. No. 66-    Authorizes
                                 246, 41 Stat.      appropriations for
                                 874, 891 (1920).   the Smithsonian
                                                    Institute for
                                                    ethnological
                                                    research of American
                                                    Indians and Native
                                                    Hawaiians.
Act of Mar. 4 1921............  Pub. L. No. 66-    Authorizes
                                 388, 41 Stat.      appropriations for
                                 1367, 1383         the Smithsonian
                                 (1921).            Institute for
                                                    ethnological
                                                    research of American
                                                    Indians and Native
                                                    Hawaiians.
Act of July 9, 1921...........  Pub. L. No. 66-    Creates a
                                 34, 42 Stat. 108   homesteading program
                                 (1921).            for Native
                                                    Hawaiians.
Act of June 12, 1922..........  Pub. L. No. 67-    Authorizes
                                 240, 42 Stat.      appropriations for
                                 635, 643 (1922).   the Smithsonian
                                                    Institute for
                                                    ethnological
                                                    research of American
                                                    Indians and Native
                                                    Hawaiians.
Act of Feb. 3, 1923...........  Pub. L. No. 67-    Amends Hawaiian Homes
                                 403, 42 Stat.      Commission Act by
                                 1221 (1923).       increasing dollar
                                                    limits for
                                                    residential loans
                                                    and other
                                                    provisions.
Act of Feb. 13, 1923..........  Pub. L. No. 67-    Authorizes
                                 409, 42 Stat.      appropriations for
                                 1227, 1235         the Smithsonian
                                 (1923).            Institute for
                                                    ethnological
                                                    research of American
                                                    Indians and Native
                                                    Hawaiians.
Act of June 7, 1924...........  Pub. L. No. 68-    Authorizes
                                 214, 43 Stat.      appropriations for
                                 521, 528 (1924).   the Smithsonian
                                                    Institute for
                                                    ethnological
                                                    research of American
                                                    Indians and Native
                                                    Hawaiians.
Act of Mar. 3, 1925...........  Pub. L. No. 68-    Authorizes
                                 586, 43 Stat.      appropriations for
                                 1198, 1206         the Smithsonian
                                 (1925).            Institute for
                                                    ethnological
                                                    research of American
                                                    Indians and Native
                                                    Hawaiians.
Act of Apr. 22, 1926..........  Pub. L. No. 69-    Authorizes
                                 141, 44 Stat.      appropriations for
                                 305, 315 (1926).   the Smithsonian
                                                    Institute for
                                                    ethnological
                                                    research of American
                                                    Indians and Native
                                                    Hawaiians.
Act of Feb. 11, 1927..........  Pub. L. No. 69-    Authorizes
                                 600, 44 Stat.      appropriations for
                                 1069, 1079         the Smithsonian
                                 91927).            Institute for
                                                    ethnological
                                                    research of American
                                                    Indians and Native
                                                    Hawaiians.
Act of Mar. 7, 1928...........  Pub. L. No. 70-    Amends the Hawaiian
                                 105, 45 Stat.      Homes Commission Act
                                 246 (1928).        by requiring an
                                                    annual area disposal
                                                    limit and increases
                                                    the dollar amount
                                                    within the Hawaiian
                                                    Home Loan fund.
Act of May 16, 1928...........  Pub. L. No. 70-    Authorizes
                                 400, 45 Stat.      appropriations for
                                 573, 583 (1928).   the Smithsonian
                                                    Institute for
                                                    ethnological
                                                    research of American
                                                    Indians and Native
                                                    Hawaiians, including
                                                    excavation and
                                                    preservation of
                                                    archaeologic
                                                    remains.
Act of Feb. 20, 1929..........  Pub. L. No. 70-    Authorizes
                                 778, 45 Stat.      appropriations for
                                 1230, 1241         the Smithsonian
                                 (1929).            Institute for
                                                    ethnological
                                                    research of American
                                                    Indians and Native
                                                    Hawaiians.
Act of Apr. 19, 1930..........  Pub. L. No. 71-    Authorizes
                                 158, 46 Stat.      appropriations for
                                 229, 241 (1930).   the Smithsonian
                                                    Institute for
                                                    ethnological
                                                    research of American
                                                    Indians and Native
                                                    Hawaiians.
Act of July 26, 1935..........  Pub. L. No. 74-    Requires three of
                                 223, 49 Stat.      five Hawaiian Homes
                                 504 (1935).        Commission members
                                                    to be at least one-
                                                    quarter Native
                                                    Hawaiian.
Act of July 10, 1937..........  Pub. L. No. 75-    Amends Hawaiian Homes
                                 200, 50 Stat.      Commission Act by
                                 497, 503 (1937).   establishing age
                                                    minimum for lessee
                                                    and adding more
                                                    lands under the Act.
Act of June 20, 1938..........  Pub. L. No. 75-    Authorizes leasing
                                 680, Sec.  3, 52   land within the
                                 Stat. 784, 784-    Hawai'i National
                                 85 (1938).         Park to Native
                                                    Hawaiians and
                                                    recognizes limited
                                                    Native Hawaiian
                                                    fishing rights in
                                                    the area.
Act of Nov. 26, 1941..........  Pub. L. No. 77-    Amends Hawaiian Homes
                                 325, Sec.  3, 55   Commission Act by
                                 Stat. 782, 782     creating a Home
                                 (1941).            Development fund and
                                                    allowing investing
                                                    of loan fund.
Act of May 31, 1944...........  Pub. L. No. 78-    Amends Hawaiian Homes
                                 320, 58 Stat.      Commission Act by
                                 260, 264 (1944).   returning lands
                                                    under the
                                                    Commissions's
                                                    jurisdiction to the
                                                    Territory of
                                                    Hawai'i.
Act of June 14, 1948..........  Pub. L. No. 80-    Amends Hawaiian Homes
                                 638, 62 Stat.      Commission Act by
                                 390 (1948).        authorizing
                                                    churches, hospitals,
                                                    schools, theaters,
                                                    and the Federal
                                                    government to use
                                                    the land.
Act of July 9, 1952...........  Pub. L. No. 82-    Amends Hawaiian Homes
                                 481, 66 Stat.      Commission Act by
                                 511, 514 (1952).   adding lands to the
                                                    Commission's
                                                    jurisdiction.
Act of July 9, 1952...........  Pub. L. No. 82-    Amends Hawaiian Homes
                                 482, 66 Stat.      Commission Act by
                                 514 (1952).        increasing dollar
                                                    amounts in the
                                                    Hawaiian Homes Land
                                                    Fund and the
                                                    Hawaiian Homes
                                                    Development Fund.
Act of June 18, 1954..........  Pub. L. No. 83-    Amends Hawaiian Homes
                                 417, 68 Stat.      Commission Act by
                                 263 (1954).        authorizing leases
                                                    for irrigated
                                                    pastoral lands.
Hawai'i Admission Act, Act of   Pub. L. No. 86-3,  Admits Hawai'i as a
 Mar. 18, 1959.                  Sec.  5(f), 73     State and
                                 Stat. 4, 6         establishes a public
                                 (1959).            trust for the
                                                    betterment of the
                                                    conditions of Native
                                                    Hawaiians, as
                                                    defined by the
                                                    Hawaiian Homes
                                                    Commission Act.
Act of Dec. 23, 1963..........  Pub. L. No. 88-    Protects the corpus
                                 233, 77 Stat.      of the public lands
                                 472 (1963).        trust, whose
                                                    intended
                                                    beneficiaries are
                                                    Native Hawaiians, by
                                                    revising procedures
                                                    under the Hawai'i
                                                    Statehood Act.
Act of July 11, 1972..........  Pub. L. No. 92-    Designates Honokohau
                                 346, 86 Stat.      as a National
                                 457 (1972).        Historical Landmark
                                                    and authorizes
                                                    preservation of the
                                                    site, giving
                                                    employment
                                                    preference to and
                                                    providing training
                                                    for Native
                                                    Hawaiians.
Native American Programs Act    Pub. L. No. 93-    Promotes Native
 of 1074.                        644, Sec.  801,    Hawaiian, American
                                 88 Stat. 2291,     Indian, and Alaska
                                 2324 (1975).       Native Economic and
                                                    social self-
                                                    sufficiency through
                                                    financial assistance
                                                    to agencies serving
                                                    Native Hawaiians.
Departments of Labor and        Pub. L. No. 94-    Appropriates funds
 Health, Education, and          2006, 90 Stat. 3   for Native American
 Welfare Appropriation Act,      (1975).            programs (includes
 1976.                                              Native Hawaiians).
Act of Oct. 17, 1976..........  Pub. L. No. 94-    Preserves Kalaupapa
                                 518, Sec.  401-    Settlement and
                                 405, 90 Stat.      authorizes a
                                 2447, 2447, 2449   preference for
                                 (1976).            former patients and
                                                    Native Hawaiians to
                                                    manage the site.
Act of Aug. 5, 1977...........  Pub. L. No. 95-    Amends the
                                 93, sec. 303,      comprehensive
                                 Sec.  701(a), 91   Employment Training
                                 Stat. 627, 650     Act of 1973 to
                                 (1977).            include employment
                                                    training programs
                                                    for Native
                                                    Hawaiians.
Joint Resolution, American      Pub. L. No. 95-    Recognizes the rights
 Indian Religious Freedom.       341, 92 Stat.      of American Indians,
                                 469 (1977).        Eskimos, Aleuts, and
                                                    Native Hawaiians to
                                                    practice their
                                                    traditional
                                                    religions.
Act of Nov. 20, 1979..........  Pub. L. No. 96-    Appropriates funds
                                 123, 93 Stat.      for Native Hawaiian
                                 923 (1979).        health and human
                                                    services programs as
                                                    allowed under
                                                    authorizing
                                                    legislation,
                                                    including assistance
                                                    to research
                                                    institutions with
                                                    Indian, Alaska
                                                    Native, Native
                                                    Hawaiian, Hispanic,
                                                    and Black students.
Education Amendments of 1980..  Pub. L. No. 96-    Creates Advisory
                                 374, Sec.  1331,   Council on Native
                                 94 Stat. 1367,     Hawaiian Education
                                 1449 (1980).       to study the
                                                    effectiveness of
                                                    State and Federal
                                                    education programs
                                                    for Native
                                                    Hawaiians.
Act of Dec. 22, 1980..........  Pub. L. No. 96-    Establishes Kalaupapa
                                 565, Sec. Sec.     National Historic
                                 101-110, 94        Park which shall be
                                 Stat. 3321, 3321-  administered by
                                 23 (1980).         Hansen's Disease
                                                    patients and Native
                                                    Hawaiians.
Urgent Supplemental             Pub. L. No. 97-    Appropriates funds
 Appropriations Act, 1982.       216, 96 Stat.      for nursing research
                                 180 (1982).        grants and
                                                    encourages that
                                                    priority be given to
                                                    Native Hawaiians,
                                                    other Native
                                                    Americans, native
                                                    American Pacific
                                                    Islanders, and
                                                    Hispanics.
Supplemental Appropriations     Pub. L. No. 97-    Appropriates funds to
 Act, 1982.                      257, 96 Stat.      promote economic and
                                 818 (1982).        social self-
                                                    sufficiency of
                                                    Native Americans,
                                                    including Native
                                                    Hawaiians; also
                                                    appropriates funds
                                                    for Native Hawaiian
                                                    education and health
                                                    programs as allowed
                                                    under authorizing
                                                    legislation.
Act of July 30, 1983..........  Pub. L. No. 98-    Appropriates funds to
                                 63, 97 Stat. 301   address the unique
                                 (1983).            health needs of
                                                    Native Americans,
                                                    including Native
                                                    Hawaiians; also
                                                    urges the National
                                                    Cancer Institute to
                                                    give greater
                                                    attention to the
                                                    Native Hawaiian
                                                    population.
Native Hawaiian Study           Pub. L. No. 96-    Establishes Native
 Commission Act.                 565, Sec. Sec.     Hawaiian Study
                                 301-307, 94        Commission to study
                                 Stat. 3321, 3324-  the culture, needs,
                                 27 (1980).         and concerns of
                                                    Native Hawaiians.
Department of Health and Human  Pub. L. No. 98-    Appropriates funds to
 Services Appropriations Act,    139, 97 Stat.      the Administration
 1984.                           871 (1983).        for Native Americans
                                                    which promotes
                                                    social and economic
                                                    self-sufficiency for
                                                    Native Americans,
                                                    including Native
                                                    Hawaiians; also
                                                    appropriates funds
                                                    to combat alcoholism
                                                    among Native
                                                    Hawaiians and
                                                    declares Native
                                                    Hawaiian cancer
                                                    research a priority.
Department of Labor             Pub. L. No. 98-    Appropriates funds
 Appropriations Act, 1984.       139, 97 Stat.      for vocational
                                 871 (1983).        training and other
                                                    labor services for
                                                    Native Hawaiians and
                                                    other Native
                                                    Americans.
Department of Education         Pub. L. No. 98-    Appropriates funds
 Appropriation Act, 1984.        139, 97 Stat.      for Native Hawaiian
                                 871 (1983).        education programs
                                                    as allowed under
                                                    authorizing
                                                    legislation.
Act of Dec. 21, 1982..........  Pub. L. No. 97-    Appropriates funds to
                                 377, 96 Stat.      address alcohol
                                 1830 (1982).       abuse among Native
                                                    Hawaiians.
Act of Aug. 22, 1984..........  Pub. L. No. 98-    Appropriates funds
                                 396, 99 Stat.      for a Native
                                 1369 (1984).       Hawaiian health
                                                    study and report.
Act of Oct. 12, 1984..........  Pub. L. No. 98-    Appropriates funds
                                 473, 99 Stat.      for historic
                                 1837 (1984).       preservation of
                                                    marine resources,
                                                    including the
                                                    Hawaiian voyaging
                                                    canoe Hokule'a.
Department of Health and Human  Pub. L. No. 98-    Appropriates funds
 Services Appropriation Act,     619, 99 Stat.      for Native Hawaiian
 1985.                           3305 (1984).       programs to promote
                                                    economic and social
                                                    self-sufficiency;
                                                    also appropriates
                                                    funds for parent-
                                                    child centers and
                                                    for Native Hawaiian
                                                    cancer research.
Department of Education Act,    Pub. L. No. 98-    Appropriates funds
 1985.                           619, 99 Stat.      for Native Hawaiian
                                 3305 (1984).       education programs
                                                    as allowed under
                                                    authorizing
                                                    legislation.
Act of Dec. 19, 1985..........  Pub. L. No. 90-    Appropriates funds
                                 190, 99 Stat.      for education
                                 1185 (1985).       assistance to health
                                                    profession students
                                                    who will serve
                                                    geographical
                                                    concentrations of
                                                    Native Hawaiians and
                                                    Indian reservations.
American Indian, Alaska Native  Pub. L. No. 99-    Authorizes grants to
 and Native Hawaiian Culture     498, Sec. Sec.     support a program
 and Art Development Act.        1501-1503, 1521-   for Native Hawaiian
                                 1522, 100 Stat.    culture and arts
                                 1268, 1600, 1610-  development.
                                 11 (1986).
Anti-Drug Abuse Act of 1986...  Pub. L. No. 99-    Authorizes the Health
                                 570, Sec.  4134,   and Human Services
                                 100 Stat. 3207,    Secretary to
                                 3207-134 (1986).   contract with
                                                    organizations that
                                                    provide drug abuse
                                                    prevention,
                                                    education,
                                                    treatment, and
                                                    rehabilitation
                                                    services to Native
                                                    Hawaiians.
Act of July 11, 1987..........  Pub. L. No. 100-   Appropriates funds
                                 71, 101 Stat.      for the Native
                                 391 (1987).        Hawaiian Culture and
                                                    Arts Development
                                                    Program.
Native American Programs Act    Pub. L. No. 100-   Establishes Native
 Amendments of 1987.             175, sec. 506,     Hawaiian Revolving
                                 Sec.  803A, 101    loan fund for Native
                                 Stat. 926, 926-    Hawaiian
                                 75 (1987).         organizations and
                                                    Native Hawaiians to
                                                    promote economic
                                                    development.
Department of Health and Human  Pub. L. No. 100-   Appropriates funds
 Services Appropriations Act,    202, 101 Stat.     for Native Hawaiian
 1988.                           1329-263 (1987).   health programs
                                                    under authorizing
                                                    legislation.
Jacob K. Javits Gifted and      Pub. L. No. 100-   Authorizes grants or
 Talented Students Education     297, sec. 1001,    contracts with
 Act of 1988.                    Sec. Sec.  4101-   institutions
                                 4108, 102 Stat.    (including Indian
                                 130, 237 (1988).   tribes and Native
                                                    Hawaiian
                                                    organizations) to
                                                    carry out programs
                                                    or projects designed
                                                    to meet the
                                                    educational needs of
                                                    gifted and talented
                                                    students.
Drug-Free Schools and           Pub. L. No. 100-   Authorizes education
 Communities Act of 1986.        297, sec. 1001,    grants, cooperative
                                 Sec. Sec.  5112,   agreements, or
                                 5134, 102 Stat.    contracts with
                                 130, 253, 261      organizations that
                                 (1988).            primarily serve and
                                                    represent Native
                                                    Hawaiians; also
                                                    appropriates funds
                                                    for drug abuse
                                                    education and
                                                    preventive programs
                                                    for Native
                                                    Hawaiians.
Augustus F. Hawkins-Robert T.   Pub. L. No. 100-   Recognizes the
 Stafford Elementary and         297, Sec. Sec.     Federal government's
 Secondary School Improvement    4001-4009, 102     legal responsibility
 Amendments of 1988.             Stat. 130, 358     to enforce Hawai'i's
                                 (1988).            trust
                                                    responsibilities to
                                                    Native Hawaiians and
                                                    creates new
                                                    education programs
                                                    targeting a model
                                                    curriculum, family
                                                    based education
                                                    centers, gifted and
                                                    talented, and
                                                    special education
                                                    programs.
Veterans' Benefits and          Pub. L. No. 100-   Adds Native Hawaiians
 Services Act of 1988.           322, Sec.  413,    to the Advisory
                                 102 Stat. 487,     Committee on Native
                                 487 (1988).        American Veterans
                                                    which evaluates
                                                    programs for Native
                                                    American veterans.
Indian Housing Act of 1988....  Pub. L. No. 100-   Requires assessment
                                 358, sec. 2,       of the housing and
                                 Sec.  204, 102     mortgage needs of
                                 Stat. 676, 679     Native Hawaiians.
                                 (1988).
National Science Foundation     Pub. L. No. 100-   Reserves percentage
 University Infrastructure Act   418, Sec.  6402,   of appropriation for
 of 1988.                        102 Stat. 1107,    institutions of
                                 1543 (1988).       higher learning that
                                                    serve Native
                                                    Americans (including
                                                    Native Hawaiians)
                                                    and specific ethnic
                                                    groups.
Department of Health and Human  Pub. L. No. 100-   Appropriates funds
 Service Appropriations Act,     436, 102 Stat.     for Native Hawaiian
 1989.                           1688 (1988).       health programs
                                                    under authorizing
                                                    legislation.
Native Hawaiian Health Care     Pub. L. No. 100-   Authorizes programs
 Act of 1988.                    579, 102 Stat.     to improve the
                                 2916 (1988);       health status of
                                 Pub. L. No. 100-   Native Hawaiians;
                                 690, Sec.  2301-   authorizes grants or
                                 2312, 102 Stat.    contracts with Papa
                                 4181, 4223         Ola Lokahi to
                                 (1988).            develop
                                                    comprehensive health
                                                    care mater plan to
                                                    improve Native
                                                    Hawaiian health.
Health Professions              Pub. L. No. 100-   Provides health
 Reauthorization Act of 1988.    607, sec. 604,     professionals with
                                 Sec.  751,102      incentives to staff
                                 Stat. 3048, 3126   health centers
                                 (1988).            serving Native
                                                    Hawaiians, Indians,
                                                    and rural areas.
Nursing Shortage Reduction and  Pub. L. No. 100-   Authorizes grants to
 Education Extension Act of      607, sec. 714-     nursing schools,
 1888.                           715, Sec.          loan repayment
                                 836(h), 102        incentives to
                                 Stat. 3048, 3161   encourage work with
                                 (1988).            Native Hawaiians,
                                                    Indians, or in rural
                                                    areas, and
                                                    scholarship grants
                                                    to nursing schools
                                                    whose students serve
                                                    two years at an
                                                    Indian Health
                                                    Service facility or
                                                    a Native Hawaiian
                                                    health center.
Handicapped Programs Technical  Pub. L. No. 100-   Amends the Education
 Amendments Act of 1988.         630, sec. 102,     of the Handicapped
                                 Sec.  616, 102     Act which provides
                                 Stat. 3289, 3296   handicapped Native
                                 (1988).            Hawaiian (and other
                                                    native Pacific
                                                    basin) children with
                                                    a free appropriate
                                                    public education.
Business Opportunity            Pub. L. No. 100-   Amends the Small
 Development Reform Act of       656, sec. 207,     Business Act by
 1988 Small Business.            Sec.  8(a), 102    including
                                 Stat. 3853, 3861   economically-
                                 (1988).            disadvantaged Native
                                                    Hawaiian
                                                    organizations as
                                                    socially and
                                                    economically
                                                    disadvantaged small
                                                    business concerns.
Comprehensive Alcohol Abuse,    Pub. L. No. 100-   Amends the Public
 Drug Abuse, and Mental Health   690, sec. 2022,    Health Service Act
 Amendments Act of 1888.         Sec.  1912A, 102   by establishing the
                                 Stat. 4181, 4194   formula to fund
                                 (1988).            comprehensive
                                                    substance abuse and
                                                    treatment programs
                                                    for Native
                                                    Hawaiians.
Indian Health Care Amendments   Pub. L. No. 100-   Amends the Public
 of 1988.                        713, sec. 106,     Health Service Act
                                 Sec.  338J, 102    by creating a Native
                                 Stat. 4784, 4787   Hawaiian Health
                                 (1988).            Professions
                                                    Scholarship program.
Department of Health and Human  Pub. L. No. 101-   Appropriates funds
 Services Appropriations Act,    166, 103 Stat.     for Native Hawaiian
 1990.                           1166 (1989).       health programs
                                                    under authorizing
                                                    legislation.
Department of Education         Pub. L. No. 101-   Appropriates funds
 Appropriations Act, 1990.       166, 103 Stat.     for Native Hawaiian
                                 1179 (1989).       education programs
                                                    under authoring
                                                    legislation.
National Museum of the          Pub. L. No. 101-   Establishes the
 American Indian Act.            185, 103 Stat.     National Museum of
                                 1336 (1989).       the American Indian
                                                    which will study
                                                    Native Americans,
                                                    collect, preserve,
                                                    and exhibit Native
                                                    American objects,
                                                    provide a Native
                                                    American research
                                                    and study program,
                                                    and authorizes the
                                                    return of
                                                    Smithsonian-held
                                                    Native American
                                                    human remains and
                                                    funerary objects;
                                                    Native Americans
                                                    includes Native
                                                    Hawaiians.
Department of Housing and       Pub. L. No. 101-   Establishes
 Urban Development Reform Act    235, Sec. Sec.     commission to study
 of 1989.                        601-605, 103       and propose
                                 Stat. 1987, 2052   solutions to Indian,
                                 (1989).            Alaska Native, and
                                                    Native Hawaiian
                                                    housing problems.
Veterans' Benefits Amendments   Pub. L. No. 101-   Authorizes the study
 of 1989.                        237, sec. 312,     of Native Hawaiian
                                 Sec.  3102, 103    veterans' and other
                                 Stat. 2062         Native American
                                 (1989).            veterans'
                                                    participation in
                                                    Veterans Affairs'
                                                    home loan guaranty
                                                    program.
Dire Emergency Supplemental     Pub. L. No. 101-   Authorizes
 Appropriation for Disaster      302, 104 Stat.     appropriations for
 Assistance, Food Stamps,        213, 239 (1990).   the National
 Unemployment Compensation                          Commission on
 Administration, and other                          American Indian,
 urgent Needs, and Transfers,                       Alaska Native, and
 and Reducing Funds Budgeted                        Native Hawaiian
 for Military Spending Act of                       housing and provides
 1990.                                              grant money to
                                                    Indian and Hawaiian
                                                    Native youth for the
                                                    Drug-Free Schools
                                                    and Communities Act.
Native American Languages Act.  Pub. L. No. 101-   Adopts the policy to
                                 477, Sec. Sec.     preserve, protect,
                                 101-104, 104       and promote the
                                 Stat. 1152, 1154   rights and freedom
                                 (1990).            of Native Americans
                                                    to use, practice,
                                                    and develop Native
                                                    American languages;
                                                    Native Americans
                                                    include Native
                                                    Hawaiians.
Department of Health and Human  Pub. L. No. 101-   Authorizes
 Services Appropriations Act,    517, 104 Stat.     appropriations for
 1991.                           2190 (1990).       the Native Hawaiian
                                                    Health Care Act of
                                                    1988.
Department of Education         Pub. L. No. 101-   Authorizes
 Appropriation Act, 1991.        517, 104 Stat.     appropriations for
                                 2190 (1990).       Native Hawaiian
                                                    education programs
                                                    under authorizing
                                                    legislation.
Disadvantaged Minority Health   Pub. L. No. 101-   Authorizes grants to
 Improvement Act of 1990.        527, sec. 4,       health profession
                                 Sec.  782, 104     schools to assist
                                 Stat. 2311, 2321   programs of
                                 (1990).            excellence for
                                                    Native Hawaiians,
                                                    other Native
                                                    Americans, and
                                                    specified ethnic
                                                    groups.
Native American Graves          Pub. L. No. 101-   Provides for the
 Protection and Repatriation     601, 104 Stat.     protection of Native
 Act.                            3048 (1990).       American graves and
                                                    repatriation of
                                                    funerary objects,
                                                    human remains, and
                                                    objects of cultural
                                                    patrimony; Native
                                                    Americans include
                                                    Native Hawaiians.
Cranston-Gonzalez National      Pub. L. No. 101-   Authorizes
 Affordable Housing Act.         625, sec. 917,     appropriations for
                                 Sec.  109, 104     the Neighborhood
                                 Stat. 4079, 4398   Reinvestment
                                 (1990).            Corporation which
                                                    serves rural
                                                    communities, Native
                                                    Americans, Native
                                                    Hawaiians, and other
                                                    communities in need.
Act of Nov. 29, 1990..........  Pub. L. No. 101-   Amends the Public
                                 644, sec. 401,     Health Service Act
                                 Sec.  338J(a),     by providing
                                 104 Stat. 4662,    scholarship
                                 4668 (1990).       assistance to Native
                                                    Hawaiian students.
Act of Nov. 29, 1990..........  Pub. L. No. 101-   Amends the American
                                 644, sec. 501-     Indian, Alaska
                                 502, Sec. Sec.     Native, and Native
                                 1507, 1510, 104    Hawaiian Culture and
                                 Stat. 4662, 4668   Art Development Act
                                 (1990).            by allowing interest
                                                    and earnings to be
                                                    used to carry out
                                                    the Institute's
                                                    responsibilities.
National Dropout Prevention     Pub. L. No. 102-   Amends the Carl D.
 Act of 1991.                    103, sec. 311,     Perkins Vocational
                                 Sec.  103(b),      and Applied
                                 105 Stat. 497,     Technology Education
                                 505 (1991).        Act by providing
                                                    stipends to Native
                                                    Hawaiian vocational
                                                    students.
Departments of Veterans         Pub. L. No. 102-   Authorizes
 Affairs and Housing and Urban   139, 105 Stat.     appropriations for
 Development, and Independent    736 (1991).        the National
 Agencies Appropriations Act,                       Commission on
 1992.                                              American Indian,
                                                    Alaska Native, and
                                                    Native Hawaiian
                                                    Housing.
Department of Health and Human  Pub. L. No. 102-   Appropriates funds
 Services Appropriations Act,    170, 105 Stat.     for Native Hawaiian
 1992.                           1107 (1991).       health programs
                                                    under authorizing
                                                    legislation.
Department of Education         Pub. L. No. 102-   Appropriates funds
 Appropriations Act, 1992.       170, 105 Stat.     for Native Hawaiian
                                 1107 (1991).       education programs
                                                    under authorizing
                                                    legislation.
Department of Defense           Pub. L. No. 102-   Amends the National
 Appropriations Act 1992.        172, 105 Stat.     Defense
                                 1150 (1991).       Authorization Act so
                                                    that a disadvantaged
                                                    small business
                                                    concern includes a
                                                    small business
                                                    concern owned and
                                                    controlled by
                                                    socially and
                                                    economically
                                                    disadvantaged
                                                    individuals, an
                                                    Indian tribe, a
                                                    Native Hawaiian
                                                    organization, or an
                                                    organization
                                                    employing the
                                                    severely disabled.
Act of Dec. 11, 1991..........  Pub. L. No. 102-   Amends title 38
                                 218, sec. 1,       (Veterans' Benefits)
                                 Sec.  317, 105     to designate the
                                 Stat. 1671         Chief Minority
                                 (1991).            Affairs Officer as
                                                    an adviser on the
                                                    effect of policies,
                                                    regulations, and
                                                    programs on Native
                                                    Hawaiians, other
                                                    Native Americans,
                                                    women, and minority
                                                    groups.
ADAMHA Reorganization Act       Pub. L. No. 102-   Amends the Public
 (Alcohol, Drug Abuse, and       321, sec. 203,     Health Services Act
 Mental Health Administration).  Sec.  1953, 106    by requiring the
                                 Stat. 323, 409     State of Hawaii to
                                 (1992).            contract with
                                                    organizations which
                                                    plan, conduct, and
                                                    administer
                                                    comprehensive
                                                    substance abuse and
                                                    treatment programs
                                                    for Native
                                                    Hawaiians.
Higher Education Amendments of  Pub. L. No. 102-   Amends the Higher
 1992.                           325, sec. 305      Education Amendments
                                 Sec. Sec.  357(b   of 1965 by
                                 )(7), 1406, 106    authorizing Federal
                                 Stat. 448, 479,    repayment of loan
                                 818 (1992).        for nurses working
                                                    in a Native Hawaiian
                                                    Health Center (also
                                                    in Indian Health
                                                    Service); gives
                                                    preference to
                                                    Teacher Corps
                                                    applicants intending
                                                    to teach on Indian
                                                    reservations or in
                                                    Alaska Native
                                                    villages or in areas
                                                    with high
                                                    concentrations of
                                                    Native Hawaiians;
                                                    also, authorizes
                                                    biennial education
                                                    survey on Native
                                                    Hawaiians, other
                                                    Native Americans,
                                                    and other groups
                                                    including the
                                                    disabled,
                                                    disadvantaged, and
                                                    minority students.
Higher Education Facilities     Pub. L. No. 102-   Amends the Higher
 Act of 1992.                    325, sec. 422,     Education Act of
                                 Sec.  428J(a),     1965 by authorizing
                                 106 Stat. 448,     grants and
                                 541 (1992).        fellowships to
                                                    promote higher
                                                    education of
                                                    Indians, Alaska
                                                    Natives, and Native
                                                    Hawaiians, along
                                                    with specified
                                                    ethnic groups.
Job Training Reform Amendments  Pub. L. No. 102-   Authorizes employment
 of 1992.                        367, sec. 401,     and recruitment
                                 Sec.  401, 106     preference for
                                 Stat. 1021, 1074   Native Hawaiians,
                                 (1992).            Indians, and Alaska
                                                    Natives for a new
                                                    office that will
                                                    administer Native
                                                    American programs;
                                                    also creates a
                                                    Native American
                                                    Employment and
                                                    Training Council
                                                    with membership of
                                                    Indians, Alaska
                                                    Natives, and Native
                                                    Hawaiians that will
                                                    solicit views on
                                                    issues program
                                                    operation and
                                                    administration.
Older Americans Act Amendment   Pub. L. No. 102-   Amends the Older
 of 1992.                        375, sec. 201,     Americans Act
                                 Sec.  201(c)(3),   Amendment of 1965 by
                                 106 Stat. 1195,    creating an advocate
                                 1203 (1992).       for older Indians,
                                                    Alaskan Natives, and
                                                    Native Hawaiians to
                                                    promote enhanced
                                                    delivery of services
                                                    and grants, and
                                                    authorizes
                                                    appropriations for
                                                    these activities.
Native American Programs Act    Pub. L. No. 102-   Amends Native
 Amendments of 1992.             375, sec. 811,     American Programs
                                 822, Sec. Sec.     Act by requiring the
                                 803A, 811A, 106    filing of annual
                                 Stat. 1195,        report on the social
                                 1295, 1296         and economic
                                 (1992).            conditions of
                                                    American Indians,
                                                    Native Hawaiians,
                                                    other Native
                                                    American Pacific
                                                    Islanders (including
                                                    American Samoan
                                                    Natives), and Alaska
                                                    Natives, and
                                                    authorizes
                                                    appropriations for
                                                    the Native American
                                                    programs.
Department of the Interior and  Pub. L. No. 102-   Authorizes
 Related Agencies                381, 106 Stat.     appropriations for
 Appropriations Act, 1993.       1374 (1993).       the Alaska Native
                                                    Culture and Arts
                                                    Development Act
                                                    which also provides
                                                    funds for Native
                                                    Hawaiians.
Departments of Veterans         Pub. L. No. 102-   Provides for
 Affairs and Housing and Urban   389, 106 Stat.     appropriations for
 Development, and Independent    1571 (1992).       the National
 Agencies Appropriations Act,                       Commission on
 1993.                                              American Indian,
                                                    Alaska Native, and
                                                    Native Hawaiian
                                                    Housing in carrying
                                                    out functions under
                                                    the Department of
                                                    Housing and Urban
                                                    Development Reform
                                                    Act of 1989.
Department of Health and Human  Pub. L. No. 102-   Specifies funding
 Services Appropriations Act,    394, 106 Stat.     guidelines for the
 1993.                           1792 (1992).       Native Hawaiian
                                                    Health Care Act of
                                                    1988.
Department of Education         Pub. L. No. 102-   Appropriates funds
 Appropriations Act, 1993.       394, 106 Stat.     for Native Hawaiian
                                 1792 (1992).       education programs
                                                    under authorizing
                                                    legislation.
Department of Defense           Pub. L. No. 102-   Amends the Native
 Appropriations Act, 1993.       396, 106 Stat.     Hawaiian Health Care
                                 1876 (1993).       Act of 1988 by
                                                    establishing health
                                                    goals for Native
                                                    Hawaiians and
                                                    scholarships for
                                                    Native Hawaiian
                                                    health students.
Joint Resolution to consent to  Pub. L. No. 102-   Agrees to the
 certain amendments enacted by   398, 106 Stat.     adoption of
 the legislature of the State    1953 (1992).       amendments enacted
 of Hawai'i to the Hawaiian                         by the State of
 Homes Commission Act, 1920.                        Hawai'i to the
                                                    Hawaiian Homes
                                                    Commission Act of
                                                    1920.
Veterans' Medical Programs      Pub. L. No. 102-   Requires development
 Amendments of 1992.             405, Sec.  123,    of a plan to treat
                                 106 Stat. 1972,    veterans' post-
                                 1982 (1992).       traumatic stress
                                                    disorder, especially
                                                    the needs of Native
                                                    Hawaiians, other
                                                    Native Americans,
                                                    women, and ethnic
                                                    minorities.
Health Professions Education    Pub. L. No. 102-   Amends the Public
 Extension Amendments of 1992.   408, sec. 102,     Health Services Act
                                 Sec.  739, 106     by authorizing
                                 Stat. 1992, 2055   grants to health
                                 (1992).            professions schools
                                                    to support programs
                                                    of excellence in
                                                    health professions
                                                    education for Native
                                                    Hawaiians, other
                                                    Native Americans,
                                                    and minority
                                                    individuals.
Nurse Education and Practice    Pub. L. No. 102-   Amends the Public
 Improvement Amendments of       408, sec. 102,     Health Service Act
 1992.                           Sec.  846, 106     by authorizing the
                                 Stat. 1992, 2031   repayment of school
                                 (1992).            loans for nurses who
                                                    work two years in an
                                                    Indian Health
                                                    Service health
                                                    center, in a Native
                                                    Hawaiian health
                                                    center, in a public
                                                    hospital, in a
                                                    migrant health
                                                    center, in a
                                                    community health
                                                    center, in a rural
                                                    health clinic, or in
                                                    a public or
                                                    nonprofit private
                                                    health facility.
Veterans' Home Loan Program     Pub. L. No. 102-   Amends Title 38 by
 Amendments of 1992.             547, sec. 8,       providing direct
                                 Sec. Sec.  3761-   housing loans to
                                 3764, 106 Stat.    Native American
                                 3633, 3639         veterans (including
                                 (1992).            Native Hawaiians)
                                                    and includes the
                                                    Department of
                                                    Hawaiian Homelands
                                                    in the definition of
                                                    ``tribal
                                                    organization.''
Housing and Community           Pub. L. No. 102-   Authorizes
 Development Act of 1992.        550, sec. 128,     appropriations for
                                 Sec.  605, 106     National Commission
                                 Stat. 3672         on American Indians,
                                 (1992).            Alaska Natives, and
                                                    Native Hawaiian
                                                    housing.
Hawai'i Tropical forest         Pub. L. No. 102-   Establishes the
 Recovery Act.                   574, Sec.  4,      Hawai'i Tropical
                                 106 Stat. 4593,    Forest Recovery Task
                                 4597 (1992).       Force which will
                                                    make recommendations
                                                    for rejuvenating
                                                    Hawaii's tropical
                                                    forests, including
                                                    the traditional
                                                    practices, uses, and
                                                    needs of Native
                                                    Hawaiians in
                                                    tropical forests.
National Historic Preservation  Pub. L. No. 102-   Amends the National
 Act Amendments of 1992.         575, sec. 4002,    Historic
                                 4006, Sec. Sec.    Preservation Act to
                                 2, 101, 106        protect Native
                                 Stat. 4600, 4753   Hawaiian, Indian,
                                 (1992).            and Alaska Native
                                                    religious and
                                                    cultural sites,
                                                    including
                                                    authorizing direct
                                                    grants to Indian
                                                    tribes and Native
                                                    Hawaiian
                                                    organizations to
                                                    preserve, stabilize,
                                                    restore, or
                                                    rehabilitate
                                                    religious
                                                    properties.
Veterans Health Care Act of     Pub. L. No. 102-   Authorizes Native
 1992.                           585, sec. 602,     Hawaiian Health
                                 Sec.  340B, 106    centers to purchase
                                 Stat. 4943, 4967   pharmaceuticals at
                                 (1992).            the Federal
                                                    government-
                                                    negotiated price.
Department of Health and Human  Pub. L. No. 103-   Authorizes
 Services Appropriations Act,    112, Stat. 1082    appropriations for
 1994.                           (1993).            the Native Hawaiian
                                                    Health Care Act of
                                                    1988.
Department of Education         Pub. L. No. 103-   Authorizes
 Appropriations Act, 1994.       112, Stat. 1082    appropriations for
                                 (1993).            Native Hawaiian
                                                    education programs
                                                    under authorizing
                                                    legislation.
100th Anniversary of the        Pub. L. No. 103-   Acknowledges and
 Overthrow of the Hawaiian       150, 107 Stat.     apologizes for the
 Kingdom.                        1510 (1993).       United States' role
                                                    in the overthrow of
                                                    the Kingdom of
                                                    Hawai'i.
Goals 2000: Educate America     Pub. L. No. 103-   Establishes National
 Act.                            227, sec. 2-3,     Education Goals for
                                 108 Stat. 125,     schools and students
                                 129 (1994).        from diverse
                                                    backgrounds,
                                                    including Indians,
                                                    Alaska Natives, and
                                                    Native Hawaiians,
                                                    the disabled, and
                                                    limited English-
                                                    speakers.
School-to-Work Opportunities    Pub. L. No. 103-   Establishes school-to-
 Act of 1994.                    239, sec. 3-4,     work activities to
                                 108 Stat. 568,     improve the
                                 572 (1994).        knowledge and skills
                                                    of youths from
                                                    various backgrounds
                                                    and circumstances,
                                                    including
                                                    disadvantaged
                                                    students, students
                                                    with diverse racial,
                                                    ethnic, or cultural
                                                    backgrounds,
                                                    American Indians,
                                                    Alaska Natives,
                                                    Native Hawaiians,
                                                    students with
                                                    disabilities,
                                                    students with
                                                    limited-English
                                                    proficiency, migrant
                                                    children, school
                                                    dropouts, and
                                                    academically
                                                    talented students.
Alaska Native Culture and Arts  Pub. L. No. 103-   Amends the Higher
 Development Act.                239, sec. 721,     Education Act of
                                 Sec.  1521, 108    1986 by authorizing
                                 Stat. 568, 572     grants to
                                 (1994).            organizations that
                                                    primarily serve and
                                                    represent Native
                                                    Hawaiians or Alaska
                                                    Natives to support
                                                    Native culture and
                                                    art programs.
Department of Health and Human  Pub. L. No. 103-   Authorizes
 Services Appropriations Act,    333, 108 Stat.     appropriations for
 1995.                           2539 (1994).       Native Hawaiian
                                                    health.
Department of Education         Pub. L. No. 103-   Authorizes
 Appropriations Act, 1995.       333, 108 Stat.     appropriations for
                                 2539 (1994).       Native Hawaiian
                                                    education.
Department of Defense           Pub. L. No. 103-   Authorizes preference
 Appropriations Act, 1995.       335, 108 Stat.     to Native Hawaiian
                                 2599 (1994).       contractors
                                                    restoring
                                                    Kaho'olawe's
                                                    environment.
Safe and Drug-Free Schools and  Pub. L. No. 103-   Authorizes grants for
 Communities Act of 1994.        382, sec. 101,     Native Hawaiian-
                                 Sec. Sec.  4004,   serving institutions
                                 4011, 4118, 108    to plan, conduct,
                                 Stat. 3518,        and administer
                                 3674, 3685         violence and drug
                                 (1994).            prevention programs.
Native Hawaiian Education Act.  Pub. L. No. 103-   Recognizes that
                                 382, sec. 101,     Native Hawaiians are
                                 Sec.  9201-9212,   indigenous people
                                 108 Stat. 3518,    and authorizes,
                                 3794 (1994).       among other things,
                                                    grants to assist
                                                    Native Hawaiians in
                                                    achieving national
                                                    education goals.
Jacob K. Javits Gifted and      Pub. L. No. 103-   Authorizes grants and/
 Talented Students Education     382, sec. 101,     or contracts to
 Act of 1994.                    Sec.  10201, 108   Native Hawaiian
                                 Stat. 3518, 3820   organizations and
                                 (1994).            Indian tribes to
                                                    assist in carrying
                                                    out programs or
                                                    projects for gifted/
                                                    talented students.
Improving America's Schools     Pub. L. No. 103-   Provides support,
 Act of 1994.                    382, sec. 101,     training, assistance
                                 Sec.  13102, 108   to grant recipients
                                 Stat. 3518, 3878   to improve the
                                 (1994).            quality of education
                                                    for immigrants,
                                                    migrants, the poor,
                                                    American Indian,
                                                    Alaska Natives, and
                                                    Native Hawaiians.
Bilingual Education Act.......  Pub. L. No. 103-   Authorizes grants to
                                 382, sec.          implement new
                                 101Sec. Sec.  71   comprehensive
                                 01, 7104, 7136,    bilingual education
                                 108 Stat. 3518,    programs for Native
                                 3716, 3718, 3732   American and Native
                                 (1994).            Hawaiian languages.
Improving America's Schools,    Pub. L. No. 103-   Authorizes subgrants
 Act of 1994 (Part E).           382, sec. 101,     from State and local
                                 Sec.  7501, 108    governments to
                                 Stat. 3518, 3745   implement a
                                 (1994).            bilingual education
                                                    program for the
                                                    ancestral languages
                                                    of American Indians,
                                                    Alaska Natives, and
                                                    Native Hawaiians.
Native American Veterans'       Pub. L. No. 103-   Establishes memorial
 Memorial Establishment Act of   384, Sec.  2,      to recognize
 1994.                           108 Stat. 4067,    contributions of
                                 4067 (1994).       Native American
                                                    Veterans (American
                                                    Indians, Native
                                                    Alaskans, and Native
                                                    Hawaiians).
Veterans' Benefits              Pub. L. No. 103-   Authorizes creation
 Improvements Act of 1994.       446, sec. 510,     of a Center for
                                 Sec.  544, 108     Minority Veterans
                                 stat. 4645, 4669   and Advisory
                                 (1994).            Committee on
                                                    Minority Veterans to
                                                    be more responsive
                                                    to the needs of
                                                    Native Hawaiian,
                                                    American Indian,
                                                    Alaska Native, and
                                                    ethnic minority
                                                    veterans.
Hawaiian Home Lands Recovery    Pub. L. No. 104-   Settles Department of
 Act.                            42, Sec. Sec.      Hawaii Home Lands
                                 201-06, 109        claims against the
                                 Stat. 353, 357     Federal government
                                 (1995).            for the value of the
                                                    lost use of lands by
                                                    Native Hawaiians.
The Balanced Budget Down        Pub. L. No. 104-   Authorizes
 Payment Act.                    99, Sec.  115,     appropriations to
                                 110 Stat. 26, 29   cover termination of
                                 (1996).            Native Hawaiian and
                                                    Alaska Native
                                                    Cultural Arts
National Defense Authorization  Pub. L. No. 104-   Authorizes upgrading
 Act for FY 1996.                106, Sec.  524,    the Distinguished
                                 110 Stat. 186      Service Cross to the
                                 (1996).            Medal of Honor for
                                                    World War II Native
                                                    American Pacific
                                                    Islander veterans
                                                    (including Native
                                                    Hawaiians).
Department of Health and Human  Pub. L. No. 104-   Authorizes
 Services Appropriations Act,    134, 110 Stat.     appropriations for
 1996.                           1321 (1996).       the Native Hawaiian
                                                    Health Care Act of
                                                    1988.
Department of Education         Pub. L. No. 104-   Authorizes
 Appropriations Act, 1996.       134, 110 Stat.     appropriations for
                                 1321 (1996).       Native Hawaiian
                                                    education programs
                                                    under authorizing
                                                    legislation.
Child Care and Development      Pub. L. No. 104-   Amends the Child Care
 Block Grant Amendment of 1996.  193, sec. 614,     and Development
                                 Sec.  658P, 110    Block Grant Act of
                                 Stat. 2105, 2287   1990 by authorizing
                                 (1996).            Native Hawaiian
                                                    organizations to
                                                    apply for grants or
                                                    enter into contracts
                                                    with the Health and
                                                    Human Services
                                                    Secretary to improve
                                                    child care, increase
                                                    the availability of
                                                    early childhood
                                                    development, and
                                                    increase before and
                                                    after school care
                                                    services.
Departments of Veterans         Pub. L. No. 104-   Authorizes the
 Affairs and Housing and Urban   204, sec. 213      Housing Secretary to
 Development, and Independent    Sec.  282, 110     waive anti-
 Agencies Appropriations Act,    Stat. 2874, 2904   discrimination
 1997.                           (1996).            provisions of the
                                                    Cranston-Gonzalez
                                                    National Affordable
                                                    Housing ACt for
                                                    lands set aside
                                                    under the Hawaiian
                                                    Homes Commission
                                                    Act, 1920.
Department of Health and Human  Pub. L. No. 104-   Authorizes
 Services Appropriations Act,    208, 110 Stat.     appropriations for
 1997.                           3009 (1996).       the Native Hawaiian
                                                    Health Care Act
                                                    of1988 and Older
                                                    Americans Act of
                                                    1965.
Department of Education         Pub. L. No. 104-   Authorizes
 Appropriations Act, 1997.       208, 110 Stat.     appropriations for
                                 3009 (1996).       Native Hawaiian
                                                    education programs
                                                    under authorizing
                                                    legislation.
National Museum of the          Pub. L. No. 104-   Amends National
 American Indian Act             278, sec. 4,       Museum of the
 Amendments of 1996.             Sec.  11A, 110     American Indian Act
                                 Stat. 3355, 3356   by authorizing
                                 (1996).            reparation of Indian
                                                    and Native Hawaiian
                                                    sacred or funerary
                                                    objects and cultural
                                                    patrimony objects.
Joint Resolution to consent to  Pub. L. No. 105-   Agrees to the
 certain amendments enacted by   21, 111 Stat.      adoption of
 the legislature of the State    235 (1997).        amendments enacted
 of Hawai'i to the Hawaiian                         by the State of
 Homes Commission Act, 1920.                        Hawai'i to the
                                                    Hawaiian Homes
                                                    Commission Act of
                                                    1920.
Department of Transportation    Pub. L. No. 105-   Waives repayment of
 and Related Agencies            66, 111 Stat.      airport funds that
 Appropriations Act, 1998.       1425 (1997).       were diverted for
                                                    the betterment of
                                                    American Indians,
                                                    Alaska Natives, and
                                                    Native Hawaiians.
Department of Health and Human  Pub. L. No. 105-   Authorizes
 Services Appropriations Act,    78, 111 Stat.      appropriations for
 1998.                           1467 (1997).       the Native Hawaiian
                                                    Health Care Act and
                                                    Older Americans Act
                                                    of 1965.
Department of Education         Pub. L. No. 105-   Authorizes
 Appropriations Act, 1998.       78, 111 Stat.      appropriations for
                                 1467 (1997).       Native Hawaiian
                                                    education programs
                                                    under authorizing
                                                    legislation.
Museum and Library Services     Pub. L. No. 105-   Amends Museum and
 Technical and Conforming        128, sec. 6,       Library Services Act
 Amendments of 1997.             Sec.  262, 111     by authorizing
                                 Stat. 2548, 2549   Hawaiian
                                 (1997).            organizations
                                                    eligible to receive
                                                    grants (along with
                                                    American Indian
                                                    tribes) to
                                                    electronically link
                                                    libraries with
                                                    education, social,
                                                    or information
                                                    services.
Workforce Investment Act of     Pub. L. No. 105-   Authorizes grants to
 1998.                           220, Sec.  166,    Indian Tribes,
                                 112 Stat. 936,     tribal
                                 1021 (1998).       organizations,
                                                    Alaska Native
                                                    entities, Indian-
                                                    controlled
                                                    organizations, and
                                                    Native Hawaiian
                                                    organizations for
                                                    employment and
                                                    training activities.
Rehabilitation Act Amendments   Pub. L. No. 105-   Amends the
 of 1998.                        220, sec. 404,     Rehabilitation Act
                                 Sec.  101, 112     of 1973 by requiring
                                 Stat. 936, 1163    State agencies to
                                 (1998).            consult with Indian
                                                    Tribes, tribal
                                                    organizations, and
                                                    Native Hawaiian
                                                    organizations before
                                                    adopting any
                                                    policies for
                                                    vocational
                                                    rehabilitation
                                                    services.
Higher Education Amendments of  Pub. L. No. 105-   Amends the Higher
 1998.                           244, sec. 303,     Education Act of
                                 Sec.  1001, 112    1965 by authorizing
                                 Stat. 1581, 1638   grants to improve
                                 (1998).            education
                                                    institutions'
                                                    ability to serve
                                                    Alaska Natives and
                                                    Native Hawaiians.
Act of October 14, 1998.......  Pub. L. No. 105-   Amends the Native
                                 256, sec. 12,      Hawaiian Health Care
                                 Sec.  10(b)(1),    Improvement Act by
                                 112 Stat. 1896,    requiring recipients
                                 1899 (1998).       of the Native
                                                    Hawaiian Health
                                                    Scholarship Program
                                                    to work in the
                                                    Native Hawaiian
                                                    Health Care System.
Department of Health and Human  Pub. L. No. 105-   Authorizes
 Services Appropriations Act,    277, 112 Stat.     appropriations to
 1999.                           2681 (1998).       carry out the Native
                                                    Hawaiian Health Care
                                                    Act of 1988 and the
                                                    Older Americans Act.
Department of Education         Pub. L. No. 105-   Authorizes
 Appropriations Act, 1999.       277, 112 Stat.     appropriations for
                                 2681 (1998).       Native Hawaiian
                                                    education programs
                                                    under authorizing
                                                    legislation.
Head Start Amendments of 1998.  Pub. L. No. 105-   Amends the Head Start
                                 285, sec. 117,     Act by requiring the
                                 Sec.  650, 112     Secretary of Health
                                 Stat. 2702, 2727   and Human Services
                                 (1998).            to prepare and
                                                    submit a report
                                                    concerning the
                                                    condition, location,
                                                    and ownership of
                                                    facilities used, or
                                                    available to be
                                                    used, by Native
                                                    Hawaiian Head Start
                                                    agencies.
Assets for Independence Act...  Pub. L. No. 105-   Authorizes Native
                                 285, Sec. Sec.     Hawaiian
                                 401-416, 112       organizations (and
                                 Stat. 2702, 2759   State, local, and
                                 (1998).            tribal governments)
                                                    to conduct
                                                    demonstration
                                                    projects to evaluate
                                                    the effects of
                                                    savings,
                                                    microenterprise, and
                                                    home ownership on
                                                    families and the
                                                    community.
Carl D. Perkins Vocational and  Pub. L. No. 105-   Authorizes grants to
 Technical Education Act of      332, sec. 1,       plan, conduct, and
 1998.                           Sec.  116, 112     administer
                                 Stat. 3076, 3095   vocational programs
                                 (1998).            for Native Hawaiians
                                                    and other Native
                                                    Americans.
Native American Programs Act    Pub. L. No. 105-   Amends the Native
 Amendments of 1997.             361, sec. 3,       Hawaiian Revolving
                                 Sec.  803A, 112    Loan fund to include
                                 Stat. 3278, 3278   a loan guarantee.
                                 (1998).
National Park Service           Pub. L. No. 105-   Promotes the sale of
 Concessions Management          391, Sec.  416,    authentic American
 Improvement Act of 1998.        112 Stat. 3497,    Indian, Alaska
                                 3516 (1998).       Native, and Native
                                                    Hawaiian handicrafts
                                                    and makes those
                                                    revenues exempt from
                                                    franchise fees.
Health Professions Education    Pub. L. No. 105-   Authorizes grants to
 Partnerships Act of 1998.       392, sec. 101,     assist schools with
                                 Sec.  736, 112     health professions
                                 Stat. 3524, 3525   education programs
                                 (1998).            for Native
                                                    Hawaiians, American
                                                    Indians, Alaska
                                                    Natives, and under-
                                                    represented
                                                    minorities.
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