79–010

Calendar No. 765

106TH CONGRESS REPORT

2d Session " ! SENATE 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

REPORT

[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

2

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 NaVerDate 11-MAY-2000 07:39 Sep 01, 2000 Jkt 079010 PO 00000 Frm 00002 Fmt 6659 Sfmt 6602 E:\HR\OC\SR389.XXX pfrm07 PsN: SR389
3

tive 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

4

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

5

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.

6

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 was reached 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.

7

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 counVerDate 11-MAY-2000 07:39 Sep 01, 2000 Jkt 079010 PO 00000 Frm 00007 Fmt 6659 Sfmt 6602 E:\HR\OC\SR389.XXX pfrm07 PsN: SR389
8

selors, 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 effective functioning 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 necVerDate 11-MAY-2000 07:39 Sep 01, 2000 Jkt 079010 PO 00000 Frm 00008 Fmt 6659 Sfmt 6602 E:\HR\OC\SR389.XXX pfrm07 PsN: SR389
9

essary 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

10

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

11

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 and conducts 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 ocVerDate 11-MAY-2000 07:39 Sep 01, 2000 Jkt 079010 PO 00000 Frm 00011 Fmt 6659 Sfmt 6602 E:\HR\OC\SR389.XXX pfrm07 PsN: SR389
12

curring 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.

13

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 the development 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,

14

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 EnVerDate 11-MAY-2000 07:39 Sep 01, 2000 Jkt 079010 PO 00000 Frm 00014 Fmt 6659 Sfmt 6602 E:\HR\OC\SR389.XXX pfrm07 PsN: SR389
15

titlement 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 interrelationship 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

16

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

17

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

18

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 centuryold 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 the inclusion 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 canVerDate 11-MAY-2000 07:39 Sep 01, 2000 Jkt 079010 PO 00000 Frm 00018 Fmt 6659 Sfmt 6602 E:\HR\OC\SR389.XXX pfrm07 PsN: SR389
19

cer) 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 fullblood 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 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. 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.

20

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

21

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 practitioners licensed 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

22

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

23

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 and oral 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 alliedhealth 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

24

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 of Papa 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 orgaVerDate 11-MAY-2000 07:39 Sep 01, 2000 Jkt 079010 PO 00000 Frm 00024 Fmt 6659 Sfmt 6602 E:\HR\OC\SR389.XXX pfrm07 PsN: SR389
25

nizations 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 HaVerDate 11-MAY-2000 07:39 Sep 01, 2000 Jkt 079010 PO 00000 Frm 00025 Fmt 6659 Sfmt 6602 E:\HR\OC\SR389.XXX pfrm07 PsN: SR389
26

waiians 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 health care 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.

27

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 alliedhealth 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

to Native Hawaiians; and the administration of special project

funds.

28

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

29

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 an annual 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.

30

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/or reimbursement for costs

associated with participating in the program.

31

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:

32

(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 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.

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 HaVerDate 11-MAY-2000 07:39 Sep 01, 2000 Jkt 079010 PO 00000 Frm 00032 Fmt 6659 Sfmt 6602 E:\HR\OC\SR389.XXX pfrm07 PsN: SR389
33

waiian 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 findVerDate 11-MAY-2000 07:39 Sep 01, 2000 Jkt 079010 PO 00000 Frm 00033 Fmt 6659 Sfmt 6602 E:\HR\OC\SR389.XXX pfrm07 PsN: SR389
34

ings and recommendations to the Commission which shall

include statements from the minority and majority positions 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 AdVerDate 11-MAY-2000 07:39 Sep 01, 2000 Jkt 079010 PO 00000 Frm 00034 Fmt 6659 Sfmt 6602 E:\HR\OC\SR389.XXX pfrm07 PsN: SR389
35

ministration 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

36

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 authorVerDate 11-MAY-2000 07:39 Sep 01, 2000 Jkt 079010 PO 00000 Frm 00036 Fmt 6659 Sfmt 6602 E:\HR\OC\SR389.XXX pfrm07 PsN: SR389
37

ized 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-asyou-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 Authority1 ................................................................ 5 5 0 0 0 0

Estimated Outlays ............................................................... 5 5 2 (2)00

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 Level1 ........................................... 5 7 5 5 5 5

Estimated Outlays ............................................................... 5 6 5 5 5 5

1The 2000 level is the amount appropriated for that year for activities conducted under the Native Hawaiian Health Care Improvement Act. 2Less 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

38

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.

39

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

§ 11701. Findings

øThe 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.

ø(1)¿ (2) Native Hawaiians øcomprise¿ are a distinct and

unique indigenous people with a historical continuity to the

original inhabitants of the Hawaiian archipelago øwhose 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.

ø(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.

40

ø(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.

ø(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.

ø(5)¿ (9) A unified monarchical government of the Hawaiian

Islands was established in 1810 under Kamehameha I, the

first King of Hawaii.

ø(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.

ø(7)¿ (11) In øthe year¿ 1893, John L. Stevens, the United

States Minister assigned to the sovereign and independent

Kingdom of Hawaii, øJohn 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.

ø(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 and

lawful 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.

ø(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’’.

ø(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.

41

(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).

ø(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.

ø(12)¿ (17) Through the Newlands Resolution and the 1900

Organic Act, the United States Congress received ø1.75 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.

ø(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.’’.

ø(14)¿ (19) In 1938, øthe 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’’.

ø(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.

ø(16)¿ (21) Under the Act entitled ‘‘An Act to provide for the

admission of the State of Hawaii into the Union’’, approved

42

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) øof 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.

ø(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.

ø(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).

ø(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

43

(42 U.S.C.A. § 2991 et seq.); the American Indian Religious

Freedom Act (42 U.S.C.A. § 1996); the National Museum of the

American Indian Act (20 U.S.C.A. § 80q et seq.); and the Native American Graves Protection and Repatriation Act (25

U.S.C.A. § 3001 et seq.).

ø(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. § 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. § 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.

ø(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.

ø(22)¿ (30) Despite øsuch 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 øare¿ remain severe and øthe¿ their health status øof 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,

44

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 resiVerDate 11-MAY-2000 07:39 Sep 01, 2000 Jkt 079010 PO 00000 Frm 00044 Fmt 6659 Sfmt 6603 E:\HR\OC\SR389.XXX pfrm07 PsN: SR389
45

dents, 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 every 1000,000 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 nonCaucasian 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

46

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

47

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

48

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.

§ 11702. Declaration of National Native Hawaiian Health

Pøp¿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 øGovernment 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—

øthe nation meet the following health objectives with respect to Native Hawaiians by the year 2000:¿

(1) øReduce 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) øReduce 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 inVerDate 11-MAY-2000 00:35 Sep 02, 2000 Jkt 079010 PO 00000 Frm 00048 Fmt 6659 Sfmt 6602 E:\HR\OC\SR389.XXX pfrm11 PsN: SR389
49

corporate 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.

ø(3) Increase control of high blood pressure to at least 50

percent of people with high blood pressure.

ø(4) Reduce blood cholesterol to an average of no more than

200 mg/dl.

ø(5) Slow the rise in lung cancer deaths to achieve a rate of

no more than 42 per 100,000.

ø(6) Reduce breast cancer deaths to no more than 20.6 per

100,000 women.

ø(7) Increase Pap tests every 1 to 3 years to at least 85 percent of women age 18 and older.

ø(8) Increase fecal occult blood testing every 1 to 2 years to

at least 50 percent of people age 50 and older.

ø(9) Reduce diabetes-related deaths to no more than 34 per

100,000.

ø(10) Reduce the most severe complications of diabetes as

follows:

ø(A) end-stage renal disease to no more than 1.4 in

1,000;

ø(B) blindness to no more than 1.4 in 1,000;

ø(C) lower extremity amputation to no more than 4.9 in

1,000;

ø(D) perinatal mortality to no more than 2 percent; and

ø(E) major congenital malformations to no more than 4

percent.

ø(11) Reduce infant mortality to no more than 7 deaths per

1,000 live births.

ø(12) Reduce low birth weight to no more than 5 percent of

live births.

ø(13) Increase first trimester prenatal care to at least 90 percent of live births.

ø(14) Reduce teenage pregnancies to no more than 50 per

1,000 girls age 17 and younger.

50

ø(15) Reduce unintended pregnancies to no more than 30

percent of pregnancies.

ø(16) Increase to at least 60 percent the proportion of primary care providers who provide age-appropriate preconception

care and counseling.

ø(17) Increase years of healthy life to at least 65 years.

ø(18) Eliminate financial barriers to clinical preventive services.

ø(19) Increase childhood immunization levels to at least 90

percent of 2-year- olds.

ø(20) Reduce the prevalence of dental caries to no more than

35 percent of children by age 8.

ø(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.

ø(22) Reduce edentulism to no more than 20 percent in people age 65 and older.

ø(23) Increase moderate daily physical activity to at least 30

percent of the population.

ø(24) Reduce sedentary lifestyles to no more than 15 percent

of the population.

ø(25) Reduce overweight to a prevalence of no more than 20

percent of the population.

ø(26) Reduce dietary fat intake to an average of 30 percent

of calories or less.

ø(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.

ø(28) Reduce cigarette smoking prevalence to no more than

15 percent of adults.

ø(29) Reduce initiation of smoking to no more than 15 percent by age 20.

ø(30) Reduce alcohol-related motor vehicle crash deaths to no

more than 8.5 per 100,000 adjusted for age.

ø(31) Reduce alcohol use by school children age 12 to 17 to

less than 13 percent.

ø(32) Reduce marijuana use by youth age 18 to 25 to less

than 8 percent.

ø(33) Reduce cocaine use by youth aged 18 to 25 to less than

3 percent.

ø(34) Confine HIV infection to no more than 800 per 100,000.

ø(35) Reduce gonorrhea infections to no more than 225 per

100,000.

ø(36) Reduce syphilis infections to no more than 10 per

100,000.

ø(37) Reduce significant hearing impairment to a prevalance

of no more than 82 per 1,000.

ø(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.

ø(39) Reduce indigenous cases of vaccine-preventable diseases as follows:

51

ø(A) Diphtheria among individuals age 25 and younger

to 0;

ø(B) Tetanus among individuals age 25 and younger to

0;

ø(C) Polio (wild-type virus) to 0;

ø(D) Measles to 0;

ø(E) Rubella to 0;

ø(F) Congenital Rubella Syndrome to 0;

ø(G) Mumps to 500; and

ø(H) Pertussis to 1,000; and

ø40) 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 ø11710 of this title¿ 12, a report on the progress

made in each area toward meeting øeach of the objectives described

in subsection (b) of this section.¿ the National policy as set forth in

this section.

§ 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

Hawaiiansø. 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 financVerDate 11-MAY-2000 07:39 Sep 01, 2000 Jkt 079010 PO 00000 Frm 00051 Fmt 6659 Sfmt 6603 E:\HR\OC\SR389.XXX pfrm07 PsN: SR389
52

ing 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) øof this section¿.

§ 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 ø11703 of this title¿ 5;

(2) training for the persons described in øsection

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

ø(4)¿ (5) the ødevelopment¿ 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

øchapter¿ Act.

(b) SPECIAL PROJECT FUNDS.—Papa Ola Lokahi øis 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:

ø(1)¿ (A) the collection and maintenance of data associated with the health status of Native Hawaiians;

ø(2)¿ (B) the identification and research into diseases affecting Native Hawaiians;

ø(3)¿ (C) the availability of Native Hawaiian project

funds, research projects and publications;

ø(4)¿ (D) the collaboration of research in the area of Native Hawaiian health; and

ø(5)¿ (E) the timely dissemination of information pertinent to the Native Hawaiian health care systems.

ø(d) COORDINATION OF PROGRAMS AND SERVICES.¿

53

(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 of understanding 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.

54

(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.

§ 11705. Native Hawaiian health care øsystems¿

(a) COMPREHENSIVE HEALTH PROMOTION, DISEASE PREVENTION,

AND PRIMARY HEALTH SERVICES.—

(1)ø(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.

ø(B)¿ (2) PREFERENCE.—In making grants and entering into

contracts under this øparagraph¿ subsection, the Secretary

shall give preference to Native Hawaiian health care systems

and Native Hawaiian organizations and, to the extent feasible,

55

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.—ø(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.

ø(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)ø(1)¿ of this section shall øprovide 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.

ø(2) In addition to the mandatory services under paragraph

(1), the following services may be provided pursuant to subsection (a)(1) of this section:¿

ø(A)¿ (H) identification, treatment, control, and reduction of the incidence of preventable illnesses and conditions endemic to Native Hawaiians;

ø(B)¿ (I) collection of data related to the prevention of

diseases and illnesses among Native Hawaiians; øand¿

ø(C)¿ (J) services within the meaning of the terms

‘‘health promotion’’, ‘‘disease prevention’’, and ‘‘primary

health services’’, as such terms are defined in section

ø11711¿ 3 of this title, which are not specifically referred

to in øparagraph (1) of this¿ subsection (a)ø.¿; and

(K) support of culturally appropriate activities enhancing

health and wellness including land-based, water-based;

ocean-based, and spiritually-based projects and programs.

ø(3)¿ (2) TRADITIONAL HEALERS.—The health care services

referred to in paragraphs (1) and (2) which are provided under

56

grants or contracts under subsection (a)ø(1)¿ of this section

may be provided by traditional Native Hawaiian healers.

ø(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.

øDuring 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.¿

ø(e) MATCHING FUNDS.—¿

ø(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—

ø(A) in an amount exceeding 83.3 percent of the costs of

providing health services under the grant or contract; and

ø(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, nonFederal 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.

ø(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.

ø(3) The Secretary may waive the requirement established in

paragraph (1) if—

ø(A) the Native Hawaiian health care system involved is

a nonprofit private entity described in subsection (b) of

this section; and

ø(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—

57

(1) for any purpose other than the purposes described in subsection (c) øof this section¿ (1);

ø(2) to provide inpatient services;

ø(3) to make cash payments to intended recipients of health

services; or¿

ø(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)ø(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 ø1993¿

2001 through ø2001¿ 2011 to carry out subsection ø(a)(1) of

this section¿ (b).

(2) PLANNING GRANTS.—There øare¿ is authorized to be appropriate such sums as may be necessary for each of fiscal

years 2001 through 2011 to carry out subsection ø(a)(2) of this

section¿ (b).

§ 11706. Administrative grant for Papa Ola Kokahi

(a) IN GENERAL.—In addition to any other grant or contract

under this øchapter¿ 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 ø11703 of this title¿;

(2) training for the persons described in section

ø11705(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 ødevelopment¿ 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

øchapter¿ 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;

58

(6) øthe 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) øthe 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

ø1993¿ 2001 through ø2001¿ 2011 to carry out subsection (a) øof

this section¿.

§ 11707. Administration of grants and contracts

(a) TERMS AND CONDITIONS.—The Secretary shall include in any

grant made or contract entered into under this øchapter¿ 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 øchapter¿ Act.

(c) ADMINISTRATIVE REQUIREMENTS.—The Secretary may not

make a grant or enter into a contract under this øchapter¿ 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 øin 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—ø42 U.S.C.A. § 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

59

(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 øutilization 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 ø11705 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.

øIf 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.

ø(2)¿ (3) CONSIDERATION OF RESULTS.—In determining

whether to renew a contract entered into with an entity under

this øchapter¿ Act, the Secretary shall consider the results of

the evaluation under this section.

ø(3)¿ (4) APPLICATION OF FEDERAL LAWS.—All contracts entered into by the Secretary under this øchapter¿ 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.).

ø(4)¿ (5) Payments made under any contract entered into

under this øchapter¿ 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 øchapter¿ Act.

60

(e) øLIMITATIONS ON USE OF FUNDS FOR ADMINISTRATIVE EXPENSES¿ REPORT.—

øExcept 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.¿

ø(f) REPORT.—¿

(1) For each fiscal year during which an entity receives or

expends funds pursuant to a grant or contract under this

øchapter¿ Act, such entity shall submit to the Secretary and to

Papa Ola Lokahi a øquarterly¿ 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.

§ 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.

§ 11709. Native Hawaiian health scholarships and fellowships

(a) ELIGIBILITY.—Subject to the availability of øfunds¿ amounts

appropriated under the authority of subsection (c) øof this section,¿

the Secretary shall provide funds through a direct grant or a cooperative agreement to Kamehameha Schoolsø/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—

61

(1) meet the requirements of section ø254l 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.

ø(b)¿ (c) TERMS AND CONDITIONS.—

(1) IN GENERAL.—The scholarship assistance provided under

subsection (a) øof this section¿ shall be provided under the

same terms and subject to the same conditions, regulations,

and rules øthat¿ as apply to scholarship assistance provided

under section ø254l 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 øidentified in the Native Hawaiian comprehensive health care master plan implemented under section 11703 of this title¿ to serve the

øNative Hawaiian health care systems¿ Native Hawaiian

Community as identified by Papa Ola Lokahi;

ø(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;¿

ø(C)¿ (B) to the maximum extent practicable, the Secretary shall select scholarship recipients from a list of eligible applicants submitted by the Kamehameha Schoolsø/

Bishop Estate¿ or the Native Hawaiian organization administering the program;

ø(D)¿ (C) the obligated service requirement for each

scholarship recipient (except for those receiving assistance

under paragraph (2)) shall be fulfilled through øthe fulltime 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) øfirst,¿ in any one of the øfive¿ Native Hawaiian

health care systems; and

(ii) øsecond, 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

ø(I) a health professional shortage area or medically underserved area located in the State of Hawaii; or¿

ø(II)¿ (iii) a geographic area or facility øthat 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.

ø(aa) located in the State of Hawaii; and¿

62

ø(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) øthe 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.

ø(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.

ø(2) The Native Hawaiian Health Scholarship program shall

not be administered by or through the Indian Health Service.

ø(c)¿ (d) AUTHORIZATION OF APPROPRIATIONS.—There are authorized to be appropriated such sums as may be necessary for fiscal

years ø1993¿ 2001 through ø2001¿ 2011 for the purpose of funding

the scholarship assistance provided under subsection (a) øof this

section¿ and fellowship assistance under subsection (c)(2).

§ 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

63

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 receive contracts 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

64

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.

65

(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;

66

(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 of

subsistence 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

67

(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 estiVerDate 11-MAY-2000 07:39 Sep 01, 2000 Jkt 079010 PO 00000 Frm 00067 Fmt 6659 Sfmt 6603 E:\HR\OC\SR389.XXX pfrm07 PsN: SR389
68

mates 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.

69

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.

§ 11711. Definitions

For purposes of this chapter:

(1) DEPARTMENT.—The term ‘‘department’’ means the Department of Health and Human Services.

ø(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.

ø(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, øand¿

(G) control of stressø.¿,

(H) reduction of major behavioral risk factors and promotion of health lifestyle practices, and

(I) integration of cultural approaches to health and wellbeing, including traditional practices relating to the atmosphere (lewa lani), land (’aina), water (wai), and ocean (kai).

ø(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) øa citizen of the United States, and¿ genealogical

records,

(B) øa 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

ø(i) genealogical records,

ø(ii) Kupuna (elders) or Kama’aina (long-term community residents) verification, or

70

ø(iii)¿ (C) birth records of the State of Hawaii or any

State or territory of the United States.

ø(4)¿ (5) NATIVE HAWAIIAN HEALTH øCENTER¿ CARE SYSTEM.—The term ‘‘Native Hawaiian health øcenter¿ 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.

ø(5)¿ (6) øNATIVE HAWAIIAN ORGANIZATION¿ NATIVE HAWAIIAN HEALTH CENTER.—The term ‘‘Native Hawaiian øorganization’’¿ Health Center’’ means any organization that is a primary care provider and that—

(A) øwhich 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) øwhich is—¿ has demonstrated cultural competency

in a predominately Native Hawaiian community;

(C) services a patient population that—

(i) ørecognized 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) øcertified 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

ø(C) in which Native Hawaiian health practitioners significantly participate in the planning, management, monitoring, and evaluation of health services, and¿

71

(D) øwhich is a public or nonprofit private entity.¿ is recognized by Papa Ola Lokahi has having met all the criteria

of this paragraph.

ø(6)¿ (7) NATIVE HAWAIIAN HEALTH øCARE SYSTEM¿ TASK

FORCE.—The term ‘‘Native Hawaiian health øcare system¿

Task Force’’ means øan entity—¿ a task force established by

the State Council of Hawaiian Homestead Associations to implement health and wellness strategies in Native Hawaiian

communities.

ø(A) which is organized under the laws of the State of

Hawaii,

ø(B) which provides or arranges for health care services

through practitioners licensed by the State of Hawaii,

where licensure requirements are applicable,

ø(C) which is a public or nonprofit private entity,

ø(D) in which Native Hawaiian health practitioners significantly participate in the planning, management, monitoring, and evaluation of health care services,

ø(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

ø(F) which is—

ø(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

ø(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.¿

ø(7)¿ (8) øPAPA OLA LOKAHI.—¿ NATIVE HAWAIIAN ORGANIZATION.—The term ‘‘Native Hawaiian organization’’ means any

organization—

(A) øThe term ‘‘Papa Ola Lokahi’’ means an organization

composed of—¿ which serves the interests of Native Hawaiians; and

ø(i) E Ola Mau;

ø(ii) the Office of Hawaiian Affairs of the State of

Hawaii;

ø(iii) Alu Like Inc.;

ø(iv) the University of Hawaii;

ø(v) the Office of Hawaiian Health of the Hawaii

State Department of Health;

ø(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;

ø(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

72

health care needs of the Native Hawaiians of that island;

ø(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;

ø(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;

ø(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

ø(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) øSuch 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.

ø(8)¿ (9) øPRIMARY 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.

øThe term ‘‘primary health services’’ means—

ø(A) services of physicians, physicians’ assistants, nurse

practitioners, and other health professionals;

ø(B) diagnostic laboratory and radiologic services;

ø(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);

ø(D) emergency medical services;

73

ø(E) transportation services as required for adequate patient care;

ø(F) preventive dental services; and

ø(G) pharmaceutical service, as may be appropriate for

particular health centers.¿

ø(9)¿ (10) øSECRETARY¿ PAPA OLA LOKAHI.—øThe 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

74

(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.

ø(10)¿ (11) øTRADITIONAL NATIVE HAWAIIAN HEALER—¿ PRIMARY HEALTH SERVICES.—The term ‘‘primary health services’’

means—øThe term ‘‘traditional Native Hawaiian healer’’

means a practitioner—¿

(A) øwho—¿ services of physicians, physicians’ assistants,

nurse practitioners, and other health professionals;

ø(i) is of Hawaiian ancestry, and

ø(ii) has the knowledge, skills, and experience in direct personal health care of individuals, and¿

(B) øwhose knowledge, skills, and experience are based

on demonstrated learning of Native Hawaiian healing

practices acquired by—¿ diagnostic laboratory and

radiologic services;

ø(i) direct practical association with Native Hawaiian elders, and

ø(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—

75

(i) direct practical association with Native Hawaiian

elders; and

(ii) oral traditions transmitted from generation to

generation.

§ 11712. Rule of construction

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

§ 11713. Compliance with Budget Act

Any new spending authority (described in øsubsection (c)(2)¿ subparagraph (A) øor¿ of (B) of section ø651¿ 401(c)(2) of øTitle 2)¿

the Congressional Budget Act of 1974 (2 U.C. C. 651 (c)(2) (A) or

(B))) which is provided under this øchapter¿ Act shall be effective

for any fiscal year only to such extent or in such amounts as are

provided in appropriation Acts.

§ 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.

(77)

APPENDIX A.—TABLE OF FEDERAL ACTS AFFECTING

NATIVE HAWAIIANS

Federal act name Session law cite Summary

Act of June 21, 1910 .............. Pub. L. No. 61–266, 36 Stat.

703, 718 (1910).

Authorizes appropriations for the Smithsonian Institute for

ethnological research of American Indians and Native

Hawaiians.

Act of Mar. 4, 1911 ................ Pub. L. No. 62–525, 36 Stat.

1363, 1395 (1911).

Authorizes appropriations for the Smithsonian Institute for

ethnological research of American Indians and Native

Hawaiians.

Act of Aug. 24, 1912 .............. Pub. L. No. 63–302, 37 Stat.

417, 436 (1912).

Authorizes appropriations for the Smithsonian Institute for

ethnological research of American Indians and Native

Hawaiians.

Act of June 23, 1913 .............. Pub. L. No. 63–3, 38 Stat. 4,

26 (1913).

Authorizes appropriations for the Smithsonian Institute for

ethnological research of American Indians and Native

Hawaiians.

Act of Aug. 1, 1914 ................ Pub. L. No. 63–161, 38 Stat.

609, 625 (1914).

Authorizes appropriations for the Smithsonian Institute for

ethnological research of American Indians and Native

Hawaiians.

Act of Mar. 3, 1915 ................ Pub. L. No. 63–623, 38 Stat.

822, 838 (1915).

Authorizes appropriations for the Smithsonian Institute for

ethnological research of American Indians and Native

Hawaiians.

Act of July 1, 1916 ................. Pub. L. No. 64–132, 39 Stat.

262, 279 (1916).

Authorizes appropriations for the Smithsonian Institute for

ethnological research of American Indians and Native

Hawaiians.

Act of June 12, 1917 .............. Pub. L. No. 65–21, 40 Stat

105, 122 (1917).

Authorizes appropriations for the Smithsonian Institute for

ethnological research of American Indians and Native

Hawaiians.

Act of July 19, 1919 ............... Pub. L. No. 66–21, 41 Stat.

163, 181 (1919).

Authorizes appropriations for the Smithsonian Institute for

ethnological research of American Indians and Native

Hawaiians.

Act of July 1, 1918 ................. Pub. L. No. 65–181, 40 Stat.

634, 651 (1918).

Authorizes appropriations for the Smithsonian Institute for

ethnological research of American Indians and Native

Hawaiians.

Act of June 5, 1920 ................ Pub. L. No. 66–246, 41 Stat.

874, 891 (1920).

Authorizes appropriations for the Smithsonian Institute for

ethnological research of American Indians and Native

Hawaiians.

Act of Mar. 4 1921 ................. Pub. L. No. 66–388, 41 Stat.

1367, 1383 (1921).

Authorizes appropriations for the Smithsonian Institute for

ethnological research of American Indians and Native

Hawaiians.

Act of July 9, 1921 ................. Pub. L. No. 66–34, 42 Stat.

108 (1921).

Creates a homesteading program for Native Hawaiians.

Act of June 12, 1922 .............. Pub. L. No. 67–240, 42 Stat.

635, 643 (1922).

Authorizes appropriations for the Smithsonian Institute for

ethnological research of American Indians and Native

Hawaiians.

Act of Feb. 3, 1923 ................ Pub. L. No. 67–403, 42 Stat.

1221 (1923).

Amends Hawaiian Homes Commission Act by increasing

dollar limits for residential loans and other provisions.

Act of Feb. 13, 1923 .............. Pub. L. No. 67–409, 42 Stat.

1227, 1235 (1923).

Authorizes appropriations for the Smithsonian Institute for

ethnological research of American Indians and Native

Hawaiians.

Act of June 7, 1924 ................ Pub. L. No. 68–214, 43 Stat.

521, 528 (1924).

Authorizes appropriations for the Smithsonian Institute for

ethnological research of American Indians and Native

Hawaiians.

Act of Mar. 3, 1925 ................ Pub. L. No. 68–586, 43 Stat.

1198, 1206 (1925).

Authorizes appropriations for the Smithsonian Institute for

ethnological research of American Indians and Native

Hawaiians.

78

Federal act name Session law cite Summary

Act of Apr. 22, 1926 ............... Pub. L. No. 69–141, 44 Stat.

305, 315 (1926).

Authorizes appropriations for the Smithsonian Institute for

ethnological research of American Indians and Native

Hawaiians.

Act of Feb. 11, 1927 .............. Pub. L. No. 69–600, 44 Stat.

1069, 1079 91927).

Authorizes appropriations for the Smithsonian Institute for

ethnological research of American Indians and Native

Hawaiians.

Act of Mar. 7, 1928 ................ Pub. L. No. 70–105, 45 Stat.

246 (1928).

Amends the Hawaiian Homes Commission Act 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. 70–400, 45 Stat.

573, 583 (1928).

Authorizes appropriations for 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. 70–778, 45 Stat.

1230, 1241 (1929).

Authorizes appropriations for the Smithsonian Institute for

ethnological research of American Indians and Native

Hawaiians.

Act of Apr. 19, 1930 ............... Pub. L. No. 71–158, 46 Stat.

229, 241 (1930).

Authorizes appropriations for the Smithsonian Institute for

ethnological research of American Indians and Native

Hawaiians.

Act of July 26, 1935 ............... Pub. L. No. 74–223, 49 Stat.

504 (1935).

Requires three of five Hawaiian Homes Commission members to be at least one-quarter Native Hawaiian.

Act of July 10, 1937 ............... Pub. L. No. 75–200, 50 Stat.

497, 503 (1937).

Amends Hawaiian Homes Commission Act by establishing

age minimum for lessee and adding more lands under

the Act.

Act of June 20, 1938 .............. Pub. L. No. 75–680, § 3, 52

Stat. 784, 784–85 (1938).

Authorizes leasing land within the Hawai’i National Park to

Native Hawaiians and recognizes limited Native Hawaiian fishing rights in the area.

Act of Nov. 26, 1941 .............. Pub. L. No. 77–325, § 3, 55

Stat. 782, 782 (1941).

Amends Hawaiian Homes Commission Act by creating a

Home Development fund and allowing investing of loan

fund.

Act of May 31, 1944 ............... Pub. L. No. 78–320, 58 Stat.

260, 264 (1944).

Amends Hawaiian Homes Commission Act by returning

lands under the Commissions’s jurisdiction to the Territory of Hawai’i.

Act of June 14, 1948 .............. Pub. L. No. 80–638, 62 Stat.

390 (1948).

Amends Hawaiian Homes Commission Act by authorizing

churches, hospitals, schools, theaters, and the Federal

government to use the land.

Act of July 9, 1952 ................. Pub. L. No. 82–481, 66 Stat.

511, 514 (1952).

Amends Hawaiian Homes Commission Act by adding lands

to the Commission’s jurisdiction.

Act of July 9, 1952 ................. Pub. L. No. 82–482, 66 Stat.

514 (1952).

Amends Hawaiian Homes Commission Act by increasing

dollar amounts in the Hawaiian Homes Land Fund and

the Hawaiian Homes Development Fund.

Act of June 18, 1954 .............. Pub. L. No. 83–417, 68 Stat.

263 (1954).

Amends Hawaiian Homes Commission Act by authorizing

leases for irrigated pastoral lands.

Hawai’i Admission Act, Act of

Mar. 18, 1959.

Pub. L. No. 86–3, § 5(f), 73

Stat. 4, 6 (1959).

Admits Hawai’i as a State and establishes a public 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. 88–233, 77 Stat.

472 (1963).

Protects the corpus of the public lands trust, whose intended beneficiaries are Native Hawaiians, by revising

procedures under the Hawai’i Statehood Act.

Act of July 11, 1972 ............... Pub. L. No. 92–346, 86 Stat.

457 (1972).

Designates Honokohau as a National Historical Landmark

and authorizes preservation of the site, giving employment preference to and providing training for Native

Hawaiians.

Native American Programs Act

of 1074.

Pub. L. No. 93–644, § 801,

88 Stat. 2291, 2324

(1975).

Promotes Native Hawaiian, American Indian, and Alaska

Native Economic and social self-sufficiency through financial assistance to agencies serving Native Hawaiians.

Departments of Labor and

Health, Education, and

Welfare Appropriation Act,

1976.

Pub. L. No. 94–2006, 90

Stat. 3 (1975).

Appropriates funds for Native American programs (includes

Native Hawaiians).

Act of Oct. 17, 1976 ............... Pub. L. No. 94–518, § 401–

405, 90 Stat. 2447, 2447,

2449 (1976).

Preserves Kalaupapa Settlement and authorizes a preference for former patients and Native Hawaiians to

manage the site.

79

Federal act name Session law cite Summary

Act of Aug. 5, 1977 ................ Pub. L. No. 95–93, sec. 303,

§ 701(a), 91 Stat. 627,

650 (1977).

Amends the comprehensive Employment Training Act of

1973 to include employment training programs for Native Hawaiians.

Joint Resolution, American Indian Religious Freedom.Pub. L. No. 95–341, 92 Stat.

469 (1977).

Recognizes the rights of American Indians, Eskimos,

Aleuts, and Native Hawaiians to practice their traditional religions.

Act of Nov. 20, 1979 .............. Pub. L. No. 96–123, 93 Stat.

923 (1979).

Appropriates funds for Native Hawaiian 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. 96–374, § 1331,

94 Stat. 1367, 1449

(1980).

Creates Advisory Council on Native Hawaiian Education to

study the effectiveness of State and Federal education

programs for Native Hawaiians.

Act of Dec. 22, 1980 .............. Pub. L. No. 96–565, §§ 101–

110, 94 Stat. 3321, 3321–

23 (1980).

Establishes Kalaupapa National Historic Park which shall

be administered by Hansen’s Disease patients and Native Hawaiians.

Urgent Supplemental Appropriations Act, 1982.Pub. L. No. 97–216, 96 Stat.

180 (1982).

Appropriates funds for nursing research grants and encourages that priority be given to Native Hawaiians,

other Native Americans, native American Pacific Islanders, and Hispanics.

Supplemental Appropriations

Act, 1982.

Pub. L. No. 97–257, 96 Stat.

818 (1982).

Appropriates funds to promote economic and social selfsufficiency 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. 98–63, 97 Stat.

301 (1983).

Appropriates funds to address the unique 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 Commission Act.Pub. L. No. 96–565, §§ 301–

307, 94 Stat. 3321, 3324–

27 (1980).

Establishes Native Hawaiian Study Commission to study

the culture, needs, and concerns of Native Hawaiians.

Department of Health and

Human Services Appropriations Act, 1984.

Pub. L. No. 98–139, 97 Stat.

871 (1983).

Appropriates funds to the Administration 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 Appropriations Act, 1984.Pub. L. No. 98–139, 97 Stat.

871 (1983).

Appropriates funds for vocational training and other labor

services for Native Hawaiians and other Native Americans.

Department of Education Appropriation Act, 1984.Pub. L. No. 98–139, 97 Stat.

871 (1983).

Appropriates funds for Native Hawaiian education programs as allowed under authorizing legislation.

Act of Dec. 21, 1982 .............. Pub. L. No. 97–377, 96 Stat.

1830 (1982).

Appropriates funds to address alcohol abuse among Native

Hawaiians.

Act of Aug. 22, 1984 .............. Pub. L. No. 98–396, 99 Stat.

1369 (1984).

Appropriates funds for a Native Hawaiian health study and

report.

Act of Oct. 12, 1984 ............... Pub. L. No. 98–473, 99 Stat.

1837 (1984).

Appropriates funds for historic preservation of marine resources, including the Hawaiian voyaging canoe

Hokule’a.

Department of Health and

Human Services Appropriation Act, 1985.

Pub. L. No. 98–619, 99 Stat.

3305 (1984).

Appropriates funds for Native Hawaiian 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,

1985.

Pub. L. No. 98–619, 99 Stat.

3305 (1984).

Appropriates funds for Native Hawaiian education programs as allowed under authorizing legislation.

Act of Dec. 19, 1985 .............. Pub. L. No. 90–190, 99 Stat.

1185 (1985).

Appropriates funds for education assistance to health profession students who will serve geographical concentrations of Native Hawaiians and Indian reservations.

American Indian, Alaska Native and Native Hawaiian

Culture and Art Development Act.

Pub. L. No. 99–498,

§§ 1501–1503, 1521–

1522, 100 Stat. 1268,

1600, 1610–11 (1986).

Authorizes grants to support a program for Native Hawaiian culture and arts development.

80

Federal act name Session law cite Summary

Anti-Drug Abuse Act of 1986 Pub. L. No. 99–570, § 4134,

100 Stat. 3207, 3207–134

(1986).

Authorizes the Health and Human Services Secretary to

contract with organizations that provide drug abuse

prevention, education, treatment, and rehabilitation

services to Native Hawaiians.

Act of July 11, 1987 ............... Pub. L. No. 100–71, 101

Stat. 391 (1987).

Appropriates funds for the Native Hawaiian Culture and

Arts Development Program.

Native American Programs Act

Amendments of 1987.

Pub. L. No. 100–175, sec.

506, § 803A, 101 Stat.

926, 926–75 (1987).

Establishes Native Hawaiian Revolving loan fund for Native Hawaiian organizations and Native Hawaiians to

promote economic development.

Department of Health and

Human Services Appropriations Act, 1988.

Pub. L. No. 100–202, 101

Stat. 1329–263 (1987).

Appropriates funds for Native Hawaiian health programs

under authorizing legislation.

Jacob K. Javits Gifted and

Talented Students Education Act of 1988.

Pub. L. No. 100–297, sec.

1001, §§ 4101–4108, 102

Stat. 130, 237 (1988).

Authorizes grants or contracts with institutions (including

Indian 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 Communities Act of 1986.Pub. L. No. 100–297, sec.

1001, §§ 5112, 5134, 102

Stat. 130, 253, 261

(1988).

Authorizes education grants, cooperative agreements, or

contracts with organizations that primarily serve and

represent Native Hawaiians; also appropriates funds for

drug abuse education and preventive programs for Native Hawaiians.

Augustus F. Hawkins-Robert T.

Stafford Elementary and

Secondary School Improvement Amendments of 1988.

Pub. L. No. 100–297,

§§ 4001–4009, 102 Stat.

130, 358 (1988).

Recognizes the Federal government’s legal responsibility to

enforce Hawai’i’s 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 Services Act of 1988.Pub. L. No. 100–322, § 413,

102 Stat. 487, 487 (1988).

Adds Native Hawaiians to the Advisory Committee on Native American Veterans which evaluates programs for

Native American veterans.

Indian Housing Act of 1988 ... Pub. L. No. 100–358, sec. 2,

§ 204, 102 Stat. 676, 679

(1988).

Requires assessment of the housing and mortgage needs

of Native Hawaiians.

National Science Foundation

University Infrastructure Act

of 1988.

Pub. L. No. 100–418, § 6402,

102 Stat. 1107, 1543

(1988).

Reserves percentage of appropriation for institutions of

higher learning that serve Native Americans (including

Native Hawaiians) and specific ethnic groups.

Department of Health and

Human Service Appropriations Act, 1989.

Pub. L. No. 100–436, 102

Stat. 1688 (1988).

Appropriates funds for Native Hawaiian health programs

under authorizing legislation.

Native Hawaiian Health Care

Act of 1988.

Pub. L. No. 100–579, 102

Stat. 2916 (1988); Pub. L.

No. 100–690, § 2301–

2312, 102 Stat. 4181,

4223 (1988).

Authorizes programs to improve the health status of Native Hawaiians; authorizes grants or contracts with

Papa Ola Lokahi to develop comprehensive health care

mater plan to improve Native Hawaiian health.

Health Professions Reauthorization Act of 1988.Pub. L. No. 100–607, sec.

604, § 751,102 Stat.

3048, 3126 (1988).

Provides health professionals with incentives to staff

health centers serving Native Hawaiians, Indians, and

rural areas.

Nursing Shortage Reduction

and Education Extension

Act of 1888.

Pub. L. No. 100–607, sec.

714–715, § 836(h), 102

Stat. 3048, 3161 (1988).

Authorizes grants to nursing schools, loan repayment incentives to encourage work with 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 Amendments Act of

1988.

Pub. L. No. 100–630, sec.

102, § 616, 102 Stat.

3289, 3296 (1988).

Amends the Education of the Handicapped Act which provides handicapped Native Hawaiian (and other native

Pacific basin) children with a free appropriate public

education.

Business Opportunity Development Reform Act of 1988

Small Business.

Pub. L. No. 100–656, sec.

207, § 8(a), 102 Stat.

3853, 3861 (1988).

Amends the Small Business Act by including economicallydisadvantaged Native Hawaiian organizations as socially and economically disadvantaged small business

concerns.

Comprehensive Alcohol Abuse,

Drug Abuse, and Mental

Health Amendments Act of

1888.

Pub. L. No. 100–690, sec.

2022, § 1912A, 102 Stat.

4181, 4194 (1988).

Amends the Public Health Service Act by establishing the

formula to fund comprehensive substance abuse and

treatment programs for Native Hawaiians.

81

Federal act name Session law cite Summary

Indian Health Care Amendments of 1988.Pub. L. No. 100–713, sec.

106, § 338J, 102 Stat.

4784, 4787 (1988).

Amends the Public Health Service Act by creating a Native

Hawaiian Health Professions Scholarship program.

Department of Health and

Human Services Appropriations Act, 1990.

Pub. L. No. 101–166, 103

Stat. 1166 (1989).

Appropriates funds for Native Hawaiian health programs

under authorizing legislation.

Department of Education Appropriations Act, 1990.Pub. L. No. 101–166, 103

Stat. 1179 (1989).

Appropriates funds for Native Hawaiian education programs under authoring legislation.

National Museum of the

American Indian Act.

Pub. L. No. 101–185, 103

Stat. 1336 (1989).

Establishes the National Museum of 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

Urban Development Reform

Act of 1989.

Pub. L. No. 101–235,

§§ 601–605, 103 Stat.

1987, 2052 (1989).

Establishes commission to study and propose solutions to

Indian, Alaska Native, and Native Hawaiian housing

problems.

Veterans’ Benefits Amendments of 1989.Pub. L. No. 101–237, sec.

312, § 3102, 103 Stat.

2062 (1989).

Authorizes the study of Native Hawaiian veterans’ and

other Native American veterans’ participation in Veterans Affairs’ home loan guaranty program.

Dire Emergency Supplemental

Appropriation for Disaster

Assistance, Food Stamps,

Unemployment Compensation Administration, and

other urgent Needs, and

Transfers, and Reducing

Funds Budgeted for Military

Spending Act of 1990.

Pub. L. No. 101–302, 104

Stat. 213, 239 (1990).

Authorizes appropriations for the National Commission on

American Indian, Alaska Native, and Native Hawaiian

housing and provides grant money to Indian and Hawaiian Native youth for the Drug-Free Schools and

Communities Act.

Native American Languages

Act.

Pub. L. No. 101–477,

§§ 101–104, 104 Stat.

1152, 1154 (1990).

Adopts the policy to preserve, protect, and promote the

rights and freedom of Native Americans to use, practice, and develop Native American languages; Native

Americans include Native Hawaiians.

Department of Health and

Human Services Appropriations Act, 1991.

Pub. L. No. 101–517, 104

Stat. 2190 (1990).

Authorizes appropriations for the Native Hawaiian Health

Care Act of 1988.

Department of Education Appropriation Act, 1991.Pub. L. No. 101–517, 104

Stat. 2190 (1990).

Authorizes appropriations for Native Hawaiian education

programs under authorizing legislation.

Disadvantaged Minority Health

Improvement Act of 1990.

Pub. L. No. 101–527, sec. 4,

§ 782, 104 Stat. 2311,

2321 (1990).

Authorizes grants to health profession schools to assist

programs of excellence for Native Hawaiians, other Native Americans, and specified ethnic groups.

Native American Graves Protection and Repatriation

Act.

Pub. L. No. 101–601, 104

Stat. 3048 (1990).

Provides for the protection of Native American graves and

repatriation of funerary objects, human remains, and

objects of cultural patrimony; Native Americans include

Native Hawaiians.

Cranston-Gonzalez National

Affordable Housing Act.

Pub. L. No. 101–625, sec.

917, § 109, 104 Stat.

4079, 4398 (1990).

Authorizes appropriations for the Neighborhood Reinvestment Corporation which serves rural communities, Native Americans, Native Hawaiians, and other communities in need.

Act of Nov. 29, 1990 .............. Pub. L. No. 101–644, sec.

401, § 338J(a), 104 Stat.

4662, 4668 (1990).

Amends the Public Health Service Act by providing scholarship assistance to Native Hawaiian students.

Act of Nov. 29, 1990 .............. Pub. L. No. 101–644, sec.

501–502, §§ 1507, 1510,

104 Stat. 4662, 4668

(1990).

Amends the American Indian, Alaska Native, and Native

Hawaiian Culture and Art Development Act by allowing

interest and earnings to be used to carry out the Institute’s responsibilities.

National Dropout Prevention

Act of 1991.

Pub. L. No. 102–103, sec.

311, § 103(b), 105 Stat.

497, 505 (1991).

Amends the Carl D. Perkins Vocational and Applied Technology Education Act by providing stipends to Native

Hawaiian vocational students.

Departments of Veterans Affairs and Housing and

Urban Development, and

Independent Agencies Appropriations Act, 1992.

Pub. L. No. 102–139, 105

Stat. 736 (1991).

Authorizes appropriations for the National Commission on

American Indian, Alaska Native, and Native Hawaiian

Housing.

82

Federal act name Session law cite Summary

Department of Health and

Human Services Appropriations Act, 1992.

Pub. L. No. 102–170, 105

Stat. 1107 (1991).

Appropriates funds for Native Hawaiian health programs

under authorizing legislation.

Department of Education Appropriations Act, 1992.Pub. L. No. 102–170, 105

Stat. 1107 (1991).

Appropriates funds for Native Hawaiian education programs under authorizing legislation.

Department of Defense Appropriations Act 1992.Pub. L. No. 102–172, 105

Stat. 1150 (1991).

Amends the National Defense 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. 102–218, sec. 1,

§ 317, 105 Stat. 1671

(1991).

Amends title 38 (Veterans’ Benefits) to designate the

Chief Minority 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

(Alcohol, Drug Abuse, and

Mental Health Administration).

Pub. L. No. 102–321, sec.

203, § 1953, 106 Stat.

323, 409 (1992).

Amends the Public Health Services Act by requiring the

State of Hawaii to contract with organizations which

plan, conduct, and administer comprehensive substance

abuse and treatment programs for Native Hawaiians.

Higher Education Amendments

of 1992.

Pub. L. No. 102–325, sec.

305 §§ 357(b)(7), 1406,

106 Stat. 448, 479, 818

(1992).

Amends the Higher Education Amendments of 1965 by authorizing Federal repayment of loan 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 Act

of 1992.

Pub. L. No. 102–325, sec.

422, § 428J(a), 106 Stat.

448, 541 (1992).

Amends the Higher Education Act of 1965 by authorizing

grants and fellowships to promote higher education of

Indians, Alaska Natives, and Native Hawaiians, along

with specified ethnic groups.

Job Training Reform Amendments of 1992.Pub. L. No. 102–367, sec.

401, § 401, 106 Stat.

1021, 1074 (1992).

Authorizes employment and recruitment preference for Native Hawaiians, 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 of 1992.Pub. L. No. 102–375, sec.

201, § 201(c)(3), 106 Stat.

1195, 1203 (1992).

Amends the Older Americans Act Amendment of 1965 by

creating an advocate 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

Amendments of 1992.

Pub. L. No. 102–375, sec.

811, 822, §§ 803A, 811A,

106 Stat. 1195, 1295,

1296 (1992).

Amends Native American Programs Act by requiring the

filing of annual report on the social and economic 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

Related Agencies Appropriations Act, 1993.

Pub. L. No. 102–381, 106

Stat. 1374 (1993).

Authorizes appropriations for the Alaska Native Culture

and Arts Development Act which also provides funds for

Native Hawaiians.

Departments of Veterans Affairs and Housing and

Urban Development, and

Independent Agencies Appropriations Act, 1993.

Pub. L. No. 102–389, 106

Stat. 1571 (1992).

Provides for appropriations for the National Commission on

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 Services Appropriations Act, 1993.

Pub. L. No. 102–394, 106

Stat. 1792 (1992).

Specifies funding guidelines for the Native Hawaiian

Health Care Act of 1988.

Department of Education Appropriations Act, 1993.Pub. L. No. 102–394, 106

Stat. 1792 (1992).

Appropriates funds for Native Hawaiian education programs under authorizing legislation.

83

Federal act name Session law cite Summary

Department of Defense Appropriations Act, 1993.Pub. L. No. 102–396, 106

Stat. 1876 (1993).

Amends the Native Hawaiian Health Care Act of 1988 by

establishing health goals for Native Hawaiians and

scholarships for Native Hawaiian health students.

Joint Resolution to consent to

certain amendments enacted by the legislature of

the State of Hawai’i to the

Hawaiian Homes Commission Act, 1920.

Pub. L. No. 102–398, 106

Stat. 1953 (1992).

Agrees to the adoption of amendments enacted by the

State of Hawai’i to the Hawaiian Homes Commission

Act of 1920.

Veterans’ Medical Programs

Amendments of 1992.

Pub. L. No. 102–405, § 123,

106 Stat. 1972, 1982

(1992).

Requires development of a plan to treat veterans’ posttraumatic stress disorder, especially the needs of Native

Hawaiians, other Native Americans, women, and ethnic

minorities.

Health Professions Education

Extension Amendments of

1992.

Pub. L. No. 102–408, sec.

102, § 739, 106 Stat.

1992, 2055 (1992).

Amends the Public Health Services Act by authorizing

grants to health professions schools to support programs of excellence in health professions education for

Native Hawaiians, other Native Americans, and minority

individuals.

Nurse Education and Practice

Improvement Amendments

of 1992.

Pub. L. No. 102–408, sec.

102, § 846, 106 Stat.

1992, 2031 (1992).

Amends the Public Health Service Act by authorizing the

repayment of school 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

Amendments of 1992.

Pub. L. No. 102–547, sec. 8,

§§ 3761–3764, 106 Stat.

3633, 3639 (1992).

Amends Title 38 by providing direct housing loans to Native American veterans (including Native Hawaiians)

and includes the Department of Hawaiian Homelands in

the definition of ‘‘tribal organization.’’

Housing and Community Development Act of 1992.Pub. L. No. 102–550, sec.

128, § 605, 106 Stat.

3672 (1992).

Authorizes appropriations for National Commission on

American Indians, Alaska Natives, and Native Hawaiian

housing.

Hawai’i Tropical forest Recovery Act.Pub. L. No. 102–574, § 4,

106 Stat. 4593, 4597

(1992).

Establishes the Hawai’i Tropical Forest Recovery Task

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

Act Amendments of 1992.

Pub. L. No. 102–575, sec.

4002, 4006, §§ 2, 101,

106 Stat. 4600, 4753

(1992).

Amends the National Historic Preservation Act to protect

Native Hawaiian, Indian, 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

1992.

Pub. L. No. 102–585, sec.

602, § 340B, 106 Stat.

4943, 4967 (1992).

Authorizes Native Hawaiian Health centers to purchase

pharmaceuticals at the Federal government-negotiated

price.

Department of Health and

Human Services Appropriations Act, 1994.

Pub. L. No. 103–112, Stat.

1082 (1993).

Authorizes appropriations for the Native Hawaiian Health

Care Act of 1988.

Department of Education Appropriations Act, 1994.Pub. L. No. 103–112, Stat.

1082 (1993).

Authorizes appropriations for Native Hawaiian education

programs under authorizing legislation.

100th Anniversary of the

Overthrow of the Hawaiian

Kingdom.

Pub. L. No. 103–150, 107

Stat. 1510 (1993).

Acknowledges and apologizes for the United States’ role in

the overthrow of the Kingdom of Hawai’i.

Goals 2000: Educate America

Act.

Pub. L. No. 103–227, sec. 2–

3, 108 Stat. 125, 129

(1994).

Establishes National Education Goals for schools and students from diverse backgrounds, including Indians,

Alaska Natives, and Native Hawaiians, the disabled,

and limited English-speakers.

84

Federal act name Session law cite Summary

School-to-Work Opportunities

Act of 1994.

Pub. L. No. 103–239, sec. 3–

4, 108 Stat. 568, 572

(1994).

Establishes school-to-work activities to improve the 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 Development Act.

Pub. L. No. 103–239, sec.

721, § 1521, 108 Stat.

568, 572 (1994).

Amends the Higher Education Act of 1986 by authorizing

grants to organizations that primarily serve and represent Native Hawaiians or Alaska Natives to support

Native culture and art programs.

Department of Health and

Human Services Appropriations Act, 1995.

Pub. L. No. 103–333, 108

Stat. 2539 (1994).

Authorizes appropriations for Native Hawaiian health.

Department of Education Appropriations Act, 1995.Pub. L. No. 103–333, 108

Stat. 2539 (1994).

Authorizes appropriations for Native Hawaiian education.

Department of Defense Appropriations Act, 1995.Pub. L. No. 103–335, 108

Stat. 2599 (1994).

Authorizes preference to Native Hawaiian contractors restoring Kaho’olawe’s environment.

Safe and Drug-Free Schools

and Communities Act of

1994.

Pub. L. No. 103–382, sec.

101, §§ 4004, 4011, 4118,

108 Stat. 3518, 3674,

3685 (1994).

Authorizes grants for Native Hawaiian-serving institutions

to plan, conduct, and administer violence and drug prevention programs.

Native Hawaiian Education

Act.

Pub. L. No. 103–382, sec.

101, § 9201–9212, 108

Stat. 3518, 3794 (1994).

Recognizes that Native Hawaiians are indigenous people

and authorizes, among other things, grants to assist

Native Hawaiians in achieving national education goals.

Jacob K. Javits Gifted and

Talented Students Education Act of 1994.

Pub. L. No. 103–382, sec.

101, § 10201, 108 Stat.

3518, 3820 (1994).

Authorizes grants and/or contracts to Native Hawaiian organizations and Indian tribes to assist in carrying out

programs or projects for gifted/talented students.

Improving America’s Schools

Act of 1994.

Pub. L. No. 103–382, sec.

101, § 13102, 108 Stat.

3518, 3878 (1994).

Provides support, training, assistance to grant recipients

to improve the quality of education for immigrants, migrants, the poor, American Indian, Alaska Natives, and

Native Hawaiians.

Bilingual Education Act .......... Pub. L. No. 103–382, sec.

101§§ 7101, 7104, 7136,

108 Stat. 3518, 3716,

3718, 3732 (1994).

Authorizes grants to implement new comprehensive bilingual education programs for Native American and Native Hawaiian languages.

Improving America’s Schools,

Act of 1994 (Part E).

Pub. L. No. 103–382, sec.

101, § 7501, 108 Stat.

3518, 3745 (1994).

Authorizes subgrants from State and local governments to

implement a bilingual education program for the ancestral languages of American Indians, Alaska Natives,

and Native Hawaiians.

Native American Veterans’

Memorial Establishment Act

of 1994.

Pub. L. No. 103–384, § 2,

108 Stat. 4067, 4067

(1994).

Establishes memorial to recognize contributions of Native

American Veterans (American Indians, Native Alaskans,

and Native Hawaiians).

Veterans’ Benefits Improvements Act of 1994.Pub. L. No. 103–446, sec.

510, § 544, 108 stat.

4645, 4669 (1994).

Authorizes creation of a Center for Minority Veterans and

Advisory 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 Act.Pub. L. No. 104–42, §§ 201–

06, 109 Stat. 353, 357

(1995).

Settles Department of Hawaii Home Lands claims against

the Federal government for the value of the lost use of

lands by Native Hawaiians.

The Balanced Budget Down

Payment Act.

Pub. L. No. 104–99, § 115,

110 Stat. 26, 29 (1996).

Authorizes appropriations to cover termination of Native

Hawaiian and Alaska Native Cultural Arts

National Defense Authorization

Act for FY 1996.

Pub. L. No. 104–106, § 524,

110 Stat. 186 (1996).

Authorizes upgrading the Distinguished Service Cross to

the Medal of Honor for World War II Native American

Pacific Islander veterans (including Native Hawaiians).

Department of Health and

Human Services Appropriations Act, 1996.

Pub. L. No. 104–134, 110

Stat. 1321 (1996).

Authorizes appropriations for the Native Hawaiian Health

Care Act of 1988.

Department of Education Appropriations Act, 1996.Pub. L. No. 104–134, 110

Stat. 1321 (1996).

Authorizes appropriations for Native Hawaiian education

programs under authorizing legislation.

85

Federal act name Session law cite Summary

Child Care and Development

Block Grant Amendment of

1996.

Pub. L. No. 104–193, sec.

614, § 658P, 110 Stat.

2105, 2287 (1996).

Amends the Child Care and Development Block Grant Act

of 1990 by authorizing 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 Affairs and Housing and

Urban Development, and

Independent Agencies Appropriations Act, 1997.

Pub. L. No. 104–204, sec.

213 § 282, 110 Stat.

2874, 2904 (1996).

Authorizes the Housing Secretary to waive anti-discrimination 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 Services Appropriations Act, 1997.

Pub. L. No. 104–208, 110

Stat. 3009 (1996).

Authorizes appropriations for the Native Hawaiian Health

Care Act of1988 and Older Americans Act of 1965.

Department of Education Appropriations Act, 1997.Pub. L. No. 104–208, 110

Stat. 3009 (1996).

Authorizes appropriations for Native Hawaiian education

programs under authorizing legislation.

National Museum of the

American Indian Act

Amendments of 1996.

Pub. L. No. 104–278, sec. 4,

§ 11A, 110 Stat. 3355,

3356 (1996).

Amends National Museum of the American Indian Act by

authorizing reparation of Indian and Native Hawaiian

sacred or funerary objects and cultural patrimony objects.

Joint Resolution to consent to

certain amendments enacted by the legislature of

the State of Hawai’i to the

Hawaiian Homes Commission Act, 1920.

Pub. L. No. 105–21, 111

Stat. 235 (1997).

Agrees to the adoption of amendments enacted by the

State of Hawai’i to the Hawaiian Homes Commission

Act of 1920.

Department of Transportation

and Related Agencies Appropriations Act, 1998.

Pub. L. No. 105–66, 111

Stat. 1425 (1997).

Waives repayment of airport funds that were diverted for

the betterment of American Indians, Alaska Natives,

and Native Hawaiians.

Department of Health and

Human Services Appropriations Act, 1998.

Pub. L. No. 105–78, 111

Stat. 1467 (1997).

Authorizes appropriations for the Native Hawaiian Health

Care Act and Older Americans Act of 1965.

Department of Education Appropriations Act, 1998.Pub. L. No. 105–78, 111

Stat. 1467 (1997).

Authorizes appropriations for Native Hawaiian education

programs under authorizing legislation.

Museum and Library Services

Technical and Conforming

Amendments of 1997.

Pub. L. No. 105–128, sec. 6,

§ 262, 111 Stat. 2548,

2549 (1997).

Amends Museum and Library Services Act by authorizing

Hawaiian organizations eligible to receive grants (along

with American Indian tribes) to electronically link libraries with education, social, or information services.

Workforce Investment Act of

1998.

Pub. L. No. 105–220, § 166,

112 Stat. 936, 1021

(1998).

Authorizes grants to Indian Tribes, tribal organizations,

Alaska Native entities, Indian-controlled organizations,

and Native Hawaiian organizations for employment and

training activities.

Rehabilitation Act Amendments of 1998.Pub. L. No. 105–220, sec.

404, § 101, 112 Stat. 936,

1163 (1998).

Amends the Rehabilitation Act of 1973 by requiring State

agencies to consult with Indian Tribes, tribal organizations, and Native Hawaiian organizations before adopting any policies for vocational rehabilitation services.

Higher Education Amendments

of 1998.

Pub. L. No. 105–244, sec.

303, § 1001, 112 Stat.

1581, 1638 (1998).

Amends the Higher Education Act of 1965 by authorizing

grants to improve education institutions’ ability to serve

Alaska Natives and Native Hawaiians.

Act of October 14, 1998 ......... Pub. L. No. 105–256, sec.

12, § 10(b)(1), 112 Stat.

1896, 1899 (1998).

Amends the Native Hawaiian Health Care Improvement Act

by requiring recipients of the Native Hawaiian Health

Scholarship Program to work in the Native Hawaiian

Health Care System.

Department of Health and

Human Services Appropriations Act, 1999.

Pub. L. No. 105–277, 112

Stat. 2681 (1998).

Authorizes appropriations to carry out the Native Hawaiian

Health Care Act of 1988 and the Older Americans Act.

Department of Education Appropriations Act, 1999.Pub. L. No. 105–277, 112

Stat. 2681 (1998).

Authorizes appropriations for Native Hawaiian education

programs under authorizing legislation.

Head Start Amendments of

1998.

Pub. L. No. 105–285, sec.

117, § 650, 112 Stat.

2702, 2727 (1998).

Amends the Head Start Act by requiring the Secretary of

Health and Human Services 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.

86

Federal act name Session law cite Summary

Assets for Independence Act .. Pub. L. No. 105–285,

§§ 401–416, 112 Stat.

2702, 2759 (1998).

Authorizes Native Hawaiian organizations (and State, local,

and 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

Technical Education Act of

1998.

Pub. L. No. 105–332, sec. 1,

§ 116, 112 Stat. 3076,

3095 (1998).

Authorizes grants to plan, conduct, and administer vocational programs for Native Hawaiians and other Native

Americans.

Native American Programs Act

Amendments of 1997.

Pub. L. No. 105–361, sec. 3,

§ 803A, 112 Stat. 3278,

3278 (1998).

Amends the Native Hawaiian Revolving Loan fund to include a loan guarantee.

National Park Service Concessions Management Improvement Act of 1998.

Pub. L. No. 105–391, § 416,

112 Stat. 3497, 3516

(1998).

Promotes the sale of authentic American Indian, Alaska

Native, and Native Hawaiian handicrafts and makes

those revenues exempt from franchise fees.

Health Professions Education

Partnerships Act of 1998.

Pub. L. No. 105–392, sec.

101, § 736, 112 Stat.

3524, 3525 (1998).

Authorizes grants to assist schools with health professions

education programs for Native Hawaiians, American Indians, Alaska Natives, and under-represented minorities.

Æ