89–010

Calendar No. 144

107TH CONGRESS REPORT

1st Session " ! SENATE 107–56

AMENDING THE NATIVE HAWAIIAN HEALTH CARE

IMPROVEMENT ACT TO REVISE AND EXTEND SUCH ACT

AUGUST 28, 2001.—Ordered to be printed

Filed under authority of the order of the Senate of July 30, 2001.

Mr. INOUYE, from the Committee on Indian Affairs,

submitted the following

REPORT

[To accompany S. 87]

The Committee on Indian Affairs, to which was referred the bill

(S. 87) to amend the Native Hawaiian Health Care Improvement

Act to revise and extend such Act, having considered the same, reports favorably thereon with amendments and recommends that

the bill (as amended) do pass.

PURPOSE

The purpose of S. 87, 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 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. 87 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. 87 is intended to assure the continuity of the health care programs that are provided to Native Hawaiians under the authority

of Public Law 100–579.

As enacted in 1988, the Native Hawaiian Health Care Improvement Act is premised upon the findings and recommendations of

the Native Hawaiian Health Research Consortium report to the

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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 Hawai‘i 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.) Expanded trade with the United States resulted in increased western influence in the islands, 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 Hawai‘i to the United States. The United States

minister in Hawai‘i 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,

Hawai‘i 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. In response the United States Congress in 1920 legislated directly to benefit 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.’’ Hawai‘i became a state in 1959. Under the Admissions Act, the

title of the Hawaiian home lands (that the Hawaiian Homes Commission administered) was transferred from the Federal government to the State of Hawai‘i. The Admissions Act requires the

State to hold the lands ‘‘as a public trust * * * for the betterment

of the conditions of Native Hawaiians * * * and their use for any

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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 Hawai‘i 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’s report’s findings as to the health status of Native Hawaiians was compared only to other populations

within the State of Hawai‘i, 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 Hawai‘i, the Office of

Technology Assessment report contains the following findings:

‘‘The Native Hawaiian population living in Hawai‘i 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 the 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

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cancers, with lesser contributions from cerebrovascular diseases

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 is 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 twenty 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 not at all.

In 1998, Papa Ola Lokahi updated the health care statistics from

the original E Ola Mau report. Additionally Papa Ola Lokahi extrapolates the data that the Hawai‘i State Department of Health

annually gathers on Native Hawaiians 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 Hawai‘i (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 Hawai‘i for cancers of the lung, liver, pancreas

and for all cancers combined, and the highest years of productive

life lost from cancer in the State of Hawai‘i. Native Hawaiian females ranked highest in the State of Hawai‘i for cancers of the

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lung, liver, pancreas, breast, cervix uterus, corpus uterus, stomach,

rectum, and for all cancers combined.

With respect to breast cancer, Native Hawaiians have the highest mortality rates in the State of Hawai‘i, 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 Hawai‘i 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 ate due to diabetes mellitus in the State of

Hawai‘i, 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 Hawai‘i 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 statwide population.

With respect to heart disease, the death rate for Native Hawaiians in 66 percent higher than for the entire State of Hawai‘i, and

Native Hawaiian males have the greatest years of productive life

lost in the State of Hawai‘i. 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 populations groups in the State of Hawai‘i. 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 the most recent data for 1990 indicates that Native Hawaiian

life expectancy at birth is approximatley 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 very region of the State of Hawai‘i, 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 Hawai‘i, 44 percent were Native Hawaiians.

In 1996, Native Hawaiian fetal mortality rates comprised 15 percent of all fetal deaths for the State of Hawai‘i. 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.

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These and other health status statistics contained in the findings

section of S. 87 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. 87 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)

of 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, 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 biopsycho-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

would 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 made to the Constitution of the State of Hawai‘i 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

Hawai‘i; and (5) the Office of Hawaiian Health within the State Department of Health.

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1 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 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 a po‘o (the head of the household or designated leader

of the organization).

Papa Ola Lokahi has assumed the primary responsibility of overseeing the development and maintenance of a Native Hawaiian

Comprehensive Health Care Master Plan. Papa Ola Lokahi also 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 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 programs; 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 1 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 Hawai‘i, upon the acceptance of and in consultation with the Native Hawaiian communities on those islands,

and wherever possible, using existing health care facilities and

health care providers now serving the Native Hawaiian communities on those islands. These centers were intended to lead and coordinate the development and implementation of a statewide Native Hawaiian health care system which would include: (1) a research and monitoring staff, state-certified neighborhood counselors, outreach workers and health educators, traditional Native

Hawaiian healers, and Native Hawaiian cultural educators; (2) primary health care providers; (3) primary health care facilities, using

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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 multidisciplinary 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) prevention-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

care services are not available within the Native Hawaiian Health

Center.

Following enactment of the Native Hawaiian Health Care Act,

the Papa Ola Lokahi Board became incorporated and began working with health care providers on each island toward the development of a master plan and an island-specific plan for the provision

of primary health care and health care referral services. Those involved in the planning effort ultimately determined that the health

care needs of Native Hawaiians would be better served by the establishment of five Native Hawaiian health care systems which

could be composed of as many health care centers as might be necessary to serve the health care needs of Native Hawaiians on each

island.

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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 continental 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 February

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 he 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, physician’s assistants, nurse practitioners

or, other health professionals; (4) immunizations; (5) prevention

and control of diabetes, high blood pressure, and otitis media; (6)

pregnancy and infant care; and (7) improvement of nutrition.

In the initial stages, because the five health care systems needed

to gain experience in managing health services and because of limited funds, each health care system concentrated on outreach,

health assessments, case management, and disease prevention and

health promotion activities, with the ultimate objective of providing

the full range of health and medical services that are available

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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, work with 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‘au (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-tansmitted diseases, family planning, maternal and infant care, and alcohol/substance abuse. Ho‘ola Lahui

Hawai‘i plans include establishing a health education component in

kindergarten, elementary, and high schools, tailored to the physical

and psychological needs of the particular age group.

Ke Ola Mamo is committed to improving the health status of Native Hawaiians on the island of O‘ahu through the development of

a system of culturally-competent services that use rather than duplicate the existing health care service delivery system. Through

outreach referral and case consultation, Ke Ola Mamo’s goal is the

empowerment of Native Hawaiian families and individuals to acVerDate 11-MAY-2000 08:09 Aug 30, 2001 Jkt 000000 PO 00000 Frm 00010 Fmt 6659 Sfmt 6602 C:\DISC\SR056.107 ATX007 PsN: ATX007
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cess 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 20 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 following and outreach services.

Hui No Ke Ola Pono (an association to strengthen and perpetuate life) is Maui’s Native Hawaiian Health Care System, providing services that are culturally relevant to Native Hawaiians of

Maui, including identification, treatment, control, and reduction of

the incidence of preventable illnesses and conditions frequently occurring in the Native Hawaiian population. The services provided

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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

and 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 Hawai‘i; (2) assist and promote personal responsibility

among Native Hawaiians toward making sound, informed decisions

which would decrease unhealthy behaviors and reduce mobility 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, and regular exercise.

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), use of tobacco, alcohol and other harmful drugs, sexually transmitted disease, stress, cancer, the importance of sound nutrition habits, regular exercise, and proper maternal 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.

Through the work of the five Native Hawaiian health care systems, on an annual basis 20,000 Native Hawaiians continue to benefit from the range of health care services provided by the systems.

NATIVE HAWAIIAN HEALTH CARE PROFESSIONS SCHOLARSHIPS

The Native Hawaiian Health Care Improvement Act also provides authority for the provision of scholarships to Native HawaiVerDate 11-MAY-2000 08:09 Aug 30, 2001 Jkt 000000 PO 00000 Frm 00012 Fmt 6659 Sfmt 6602 C:\DISC\SR056.107 ATX007 PsN: ATX007
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ians who are seeking higher education opportunities in the health

care professions. The Native Hawaiian Health Scholarship Program is administered by the Kamehameha Schools, and has awarded 92 scholarships since 1991. These scholarships include: 10 bachelors of science in nursing, 2 clinical psychology doctoral programs,

2 dentists, 7 dental hygienists, one osteopathic physician, 29

allopathic physicians, 6 masters in 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, 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 (the Act), from December of

1997 through January of 1998, eight island ‘aha (island-wide conferences) were held involving more than 1,200 individuals in an effort to identify the principle Native Hawaiian health and wellness

issues and concerns. In March 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

1999, a Nature Hawaiian Health Forum was convened to discuss

major health care trends and strategies for health care trends and

strategies for health care and wellness developed by the indigenous

peoples of North America and Aotearoa (New Zealand).

In March 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, 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

Senate bill 87 extends the existing program authorities of the Act

and authorizes appropriations in such sums as may be necessary

through fiscal year 2006. The bill contains extensive findings on

the current health status of Native Hawaiians including the incidence and morality rates associated with various forms of cancer,

diabetes, asthma, circulatory diseases, infectious disease and illness, and injuries, as well as statistics on life expectancy, maternal

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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‘i and Ni‘ihau. The Board of Papa Ola Lokahi has been expanded to include the five Native Hawaiian health care systems,

the Kamehameha Schools (or other organizations responsible for

placing scholars from the Native Hawaiian Health Scholarship Program), the Hawai‘i State Primary Care Association (which represents the community health centers), the Native Hawaiian Physicians Association, and such other 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. Senate bill 87 establishes new objectives the Native Hawaiian health care systems must meet based on the objectives in the

U.S. Surgeon General’s Healthy People 2010.

Senate bill 87 proposes that the providers of health care services,

including traditional Native Hawaiian healers, who provide services under the auspices of the Native Hawaiian health care systems

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 for 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 Hawai‘i at Hilo, a Native Hawaiian Center for

Excellence for Mental Health at the University of Hawai‘i at

Manoa, a Native Hawaiian Center of Maternal Health Center, a

Native Hawaiian Center of Excellence for Research, Training, and

Integrated Medicine at Moloka‘i General Hospital, and a Native

Hawaiian Center of Excellence for Complementary Health and

Health Education and Training at the Waianae Coast Comprehensive Health Center.

Senate bill 87 also authorizes the establishment of a 21-member

National Bipartisan Native Hawaiian Health Care Entitlement

Commission which would in turn be authorized to establish a 10-

member study committee to collect and compile data necessary to

understand the extent of Native Hawaiian needs with regard to the

provision of health services. This study committee would 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.

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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 exercises 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 Hawai‘i. 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 Act of 2001.

Section 2. Findings

Subsection (a) sets forth the findings of the Congress with regard

to the historical and legal basis for a Federal program designed to

address the health care needs of Native Hawaiians. Subsection (b)

sets forth the unmet needs and serious health disparities affecting

Native Hawaiians, including chronic diseases and illnesses, infectious diseases and illnesses, injuries, dental health, life expectancy,

maternal and child health, mental health, and health provisions

education and training.

Section 3. Definitions

This section sets forth the definitions of terms used in the Act.

Section 2(1) defines ‘‘Department’’ to mean the Department of

Health and Human Services.

Section 3(2) defines ‘‘disease prevention’’ to include immunizations, control of high blood pressure, control of sexually transmittable diseases, the prevention and control of chronic diseases, control of toxic agents, occupational safety and health, injury prevention, fluoridation of water, control of infectious agents, and provision of mental health care.

Section 3(3) defines ‘‘health promotion’’ to include pregnancy and

infant care, including prevention of fetal alcohol syndrome, cessation of tobacco smoking, reduction in the use 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) defines ‘‘Native Hawaiian’’ as 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 genealoglogical records, kama‘aina

(long-term community residents) witness verification from Native

Hawaiian kupuna (elders) or birth records of the State of Hawai‘i

or any state or territory of the United States.

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Section 3(5) defines ‘‘Native Hawaiian health care service’’ as an

entity which has the following characteristics: organizes under

Hawai‘i law; provides or arranges for health care services through

State-licensed practitioners (where applicable); a public or nonprofit private entity; its Native Hawaiian health practitioners significantly participate in the planning, management, monitoring,

and evaluation of health care services; may be composed of as

many as eight Native Hawaiian Health Centers; is recognized by

Papa Ola Lokahi for the purpose of planning, conducting, or administering Native Hawaiian programs, or portions of programs; and

is certified by Papa Ola Lokahi as having the qualifications and the

capacity to provide the services as specified in the contract or grant

entered between the Native Hawaiian health care system and Secretary.

Section 3(6) defines ‘‘Native Hawaiian Health Center’’ as an organization that provides primary health care services and which Papa

Ola Lokahi has certified has met the following criteria: a governing

board with a membership that has a minimum of fifty-percent

(50%) 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) defines ‘‘Native Hawaiian Health Task Force’’ as a

task force established by the State Council of Hawaiian Homestead

Associations that implements health and wellness strategies in

Hawai‘i’s Native Hawaiian communities.

Section 3(8) defines ‘‘Native Hawaiian organization’’ as a public

or nonprofit organization that serves Native Hawaiian interests

and which Papa Ola Lokahi has recognized for purposes of planning, conducting, or administering programs (or portions of programs) authorized under this Act.

Section 3(9) defines ‘‘Office of Hawaiian Affairs’’ and ‘‘OHA’’ as

the governmental entity established under the Hawai‘i’ State Constitution which is charged with the responsibility of formulating

policy relating to Native Hawaiian affairs.

Section 3(10) defines ‘‘Papa Ola Lokahi’’ as an organization composed of: 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);

Hawai‘i State Primary Care Association or Native Hawaiian; 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 Ha

‘Oiwi (or a health care system serving the island of Hawai‘i);

Ahahui O Na Kauka; 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. However, organizations will not be added to Papa Ola

Lokahi if the Secretary determines that an organization has not developed a mission statement with clearly defined goals and objecVerDate 11-MAY-2000 08:09 Aug 30, 2001 Jkt 000000 PO 00000 Frm 00016 Fmt 6659 Sfmt 6602 C:\DISC\SR056.107 ATX007 PsN: ATX007
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tives for its contributions to the Native Hawaiian health care systems and an action plan for carrying out those goals and objectives.

Section 3(11) defines ‘‘primary health services’’ as the services of

physicians, physician’s 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) defines ‘‘Secretary’’ as the Secretary of the U.S. Department of Health and Human Services.

Section 3(13) defines ‘‘traditional Native Hawaiian healer’’ as a

practitioner who is of Hawaiian ancestry and has the knowledge,

skills and experience in direct personal health care of individuals,

and whose knowledge, skills, and experience are based on demonstrated learning of Native Hawaiian healing practices acquired

by direct practical association with Native Hawaiian elders and

oral traditions 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 result from the unique and historical relationship between the United States and 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 the Surgeon General’s Healthy People 2010, and to

incorporate within health programs the following activities: integration of cultural approaches to health and well-being; increasing

the number of health and allied-health care providers who can provide culturally competent care; increasing the use of traditional

Native Hawaiian foods in peoples’ diets and dietary preferences including those of students and the use of traditional foods in school

feeding programs; identifying and instituting Native Hawaiian cultural values and practices within the ‘‘corporate cultures’’ of organizations and agencies providing health services to Native Hawaiians; facilitating the provision of Native Hawaiian healing practices

by Native Hawaiian healers for those clients desiring such assistance; and supporting training and education activities and programs in traditional Native Hawaiian healing practices by Native

Hawaiian healers. progress made toward meeting the national policy of the Act which will be included in the President’s report to

the Congress under section 12.

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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 Native Hawaiian health status.

Section 5(a)(2) requires Papa Ola Lokahi and the Office of Hawaiian Affairs to consult with the Native Hawaiian health care systems, the Native Hawaiian Health Center, 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 purposes of addressing other issues to accomplish the objectives of this

section.

Section 5(a)(3) requires that within eighteen (18) months of the

Act’s enactment that Papa Ola Lokahi, in cooperation with the Office of Hawaiian Affairs and other appropriate agencies of the State

of Hawai‘i, prepare and submit a study report to the Congress detailing the impact of current Federal and state health care financing mechanisms and policies on Native Hawaiians’ health and wellbeing. The report will 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. The report’s recommendations will 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 coordinate, implement, and update the master plan

and to prepare the health care financing study report.

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

This section sets forth the functions of Papa Ola Lokahi and

amends the previous Act to include the Office of Hawaiian Affairs.

Section 6(a) authorizes Papa Ola Lokahi to carry out the following responsibilities:

(1) coordinating, implementing, and updating the comprehensive health care master plan developed under section 5;

(2) training of Native Hawaiian health care practitioners,

community outreach workers, counselors, cultural educators,

physicians, physician’s assistants, nurse practitioners, and

other health and allied-health professionals 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

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(5) maintaining an action plan outlining the contributions

that each of Papa Ola Lokahi’s member organizations will

make in carrying out the policy of the Act.

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 provides to States and non-profit groups and organizations in carrying out the Act’s policy. This accounting will include, but not be limited to, the following: the amount of funds expended explicitly for and benefitting 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 that Papa Ola Lokahi, to the extent possible, 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 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 to providing health-related resources or services to the Native Hawaiians, the Native Hawaiian health care systems, and/or efforts towards carrying out the

national policy of this Act.

Section 6(f)(2) addresses health care financing as follows:

Subsection (A) requires that Federal agencies providing health

care financing and health care programs consult with Native Hawaiians and organizations providing Native Hawaiian health care

services prior to adopting any policy or regulation which may impact on service provision or health insurance coverage. The consultation is to include but not be limited to identifying the impact

of proposed policies, rules, or regulations.

20

Subsection (B) authorizes the State of Hawai‘i to engage in

meaningful consultation with Native Hawaiians and organizations

providing Native Hawaiian health care services prior to making

any changes or initiating new programs.

Subsection (C) authorizes the Office of Hawaiian Affairs, in concert with Papa Ola Lokahi, to develop consultative, contractual, or

other arrangements with the following: the Centers for Medicare

and Medicaid Services; the agency of the state which administers

or supervises the administration of a state plan or waiver approved

under Title XVIII, XIX, or XXI 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 with any other Federal agency or agencies providing Native Hawaiians with full or partial health insurance. Such arrangements may include but are not limited to appropriate reimbursement for health care services including capitation and fee for service rates for Native Hawaiians who are entitled to insurance, scope

of services provided, and/or any other matters which enable Native

Hawaiians to maximize health insurance benefits provided by Federal and state health insurance programs.

Section 6(f)(3) provides that the Department and other Federal

agencies that provide health care services 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 to be exempt from national accreditation reviews.

Section 7. Native Hawaiian health care systems

This section addresses the Secretary’s authority to enter into contracts and grants with Native Hawaiian health care systems for

the provision of Native Hawaiian health care and health care referral services and the responsibilities of the Native Hawaiian health

care systems.

Section 7(a) authorizes the Secretary 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 and disease prevention services as well as primary health

care services to Native Hawaiians who desire and are committed

to bettering their own health. The Secretary may enter into not

more than eight (8) grants or contracts, with preference given to

Native Hawaiian health care systems and Native Hawaiian organizations. And to the extent feasible, health promotion and disease

prevention services shall be performed through Native Hawaiian

health care systems. A ‘qualified entity’ for purposes of subsection

7(a)(1) means a Native Hawaiian health care system or a Native

Hawaiian Health Center predominantly serving Native Hawaiians.

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.

Section 7(c) specifies that each qualified entity receiving funds

under section 7(a) must ensure that the following services are provided: outreach services to inform Native Hawaiians of the availability of health services; health promotion and disease prevention

21

education of Native Hawaiians by, wherever possible, Native Hawaiian health care practitioners, community outreach workers,

counselors, and cultural educators; services of physicians, physician’s assistants, nurse practitioners, and other health professionals; immunizations; prevention and control of diabetes, hypertension, and otitis media (middle ear infection); pregnancy and infant care; improvement of nutrition, identification, treatment, control and reduction of 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 enhancing health and wellness including landbased, ocean-based, and spiritually-based projects and programs.

These services may be provided by traditional Native Hawaiian

healers.

Section 7(d) provides that individuals who provide medical, dental, or other services under subsection (7)(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

receiving funds under subsection 7(a) must provide a designated

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 authorized under subsection 7(a) unless the

qualified entity agrees that the grant or contract amount will not,

directly or through contract, be expended for the following: health

care services except as described in section 7(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 regardless of payment ability and

the entity will impose a charge for the delivery of health services

which will be made according to a public schedule of charges 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 the general grant and planning grant activities

under subsections 7(a) and 7(b) for fiscal years 2002 through 2012.

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 following: the coordination, implementation, and appropriate updating of the comprehensive health care master plan; training for persons described in secVerDate 11-MAY-2000 08:09 Aug 30, 2001 Jkt 000000 PO 00000 Frm 00021 Fmt 6659 Sfmt 6602 C:\DISC\SR056.107 ATX007 PsN: ATX007
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tion 7(c)(1); identification of and research into the diseases that are

most prevalent among Native Hawaiians, including behavioral, biomedical, epidemiologic 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.

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 2002 through 2012.

Section 9. Administration of grants and contracts

This section sets forth the terms and conditions under which the

Secretary makes grants or enters into contracts.

Section 9(a) specifies that within any grants made or contracts

entered include terms and conditions that 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) restricts the Secretary’s authority to make any grant

or enter into any contract under this 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 health services provided to any population

of Native Hawaiians, a substantial portion of whom has a limited ability to speak the English language, 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 that population in the language

of that population 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 that are covered 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, the entity has entered into a participation agreement under such plans and the entity is qualified to receive payments under such plan, or if the entity will

23

provide under the grant or contract any such health services

through a contract with an organization, the organization has

entered into a participation agreement under such plan, and

the organization is qualified to receive payments under such

plan; and

(5) agrees to submit an annual report to the Secretary and

to Papa Ola Lokahi that describes the use and costs of health

services provided under the grant or contract, including the average cost of health services per user, and that provides such

other information the Secretary determines to be appropriate.

Section 9(d) addresses the Secretary’s evaluation of contracts entered into by the Secretary.

Subsection (1) provides that when the Secretary’s evaluation reveals that an entity has not complied with or satisfactorily performed a contract entered into under section 7, that before the contract is renewed the Secretary must attempt to resolve the areas

of noncompliance or unsatisfactory performance and modify the

contract to prevent future noncompliance or unsatisfactory performance.

Subsection (2) provides that if the Secretary determines that the

noncompliance or unsatisfactory performance cannot be resolved

and prevented in the future, the Secretary shall not renew that entity’s contract and is authorized to enter into a new section 7 contract with a qualified entity, as defined in section 7(a)(3), that provides services to the same population of Native Hawaiians that was

served by the entity whose contract was not renewed.

Subsection (3) specifies that in determining whether to renew an

entity’s contract under the Act, the Secretary shall consider the results of the evaluations undertaken under the authority of section

9.

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 in installments and shall be made on such conditions as the Secretary deems necessary to carry out the purposes

of this Act.

Section 9(e) provides that for each fiscal year during which an

entity receives or expends funds pursuant to a grant or contract

under the Act, that 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.

24

Section 10. Assignment of personnel

This section addresses the assignment of personnel by the Secretary.

Section 10(a) authorizes the Secretary to enter into an agreement

with any entity under which the Secretary may assign personnel

from 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.

Section 10(b) specifies that any personnel assignment the Secretary agrees to under the authority of subsection 10(a) is to be

treated as an assignment of Federal personnel to a local government that is made in accordance with subchapter VI of chapter 33

of title 5 of the United States Code.

Section 11. Native Hawaiian health scholarships and fellowships

Section 11(a) provides 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 Kamehameha Schools or another Native Hawaiian

organization or health care organization with experience in administering education scholarships 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) provides authority for employees of the Native Hawaiian Health Care Systems and the Native Hawaiian Health Centers to have a priority for these 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 (42 U.S.C. 2541), except 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; to the maximum extent practicable,

the Secretary is to select scholarship recipients from a list of eligible applicants the Kamehameha Schools or the Native Hawaiian

organization administering the program submits; the obligated

service requirement for each scholarship recipient is to be fulfilled

through service, in 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 U.S. 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) provides that the scholarship program’s placement services will assign scholarship recipients to appropriate

sites.

Subsection (E) further specifies that counseling, retention, and

other support services will be available to scholarship recipients

and other scholarship and financial aid programs recipients enrolled in appropriate health professions training programs.

25

Subsection (F) provides 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 Native Hawaiian Health Centers.

Section 11(c)(2) provides that the financial aid provided 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.

The financial assistance may include a stipend and/or reimbursement for costs associated with participating in the program.

Section 11(c)(3) provides that scholarship recipients in health

professions designated in section 338A of the Public Health Service

Act shall have the same rights and benefits of 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 shall be deemed ‘Qualified Scholarships’ for purposes of 26 U.S.C. section 117.

Section 11(d) authorizes the appropriation of such sums as may

be necessary for the purpose of funding the scholarship assistance

under subsection 11(a) for fiscal years 2002 through 2012.

Section 12. Report

This section provides that at the time the budget is submitted,

the President is to transmit a report to Congress for each fiscal

year on the progress made in meeting the Act’s objectives. The report should include a review of programs established or assisted

pursuant to the Act and an assessment and recommendation 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 personal or real property for donation to

organizations that receive grants or contracts under this Act, provided that the Secretary determines that the property is appropriate for the organization’s use for the purpose for which the contract or grant was authorized.

26

Section 14. Demonstration projects of national significance

This section authorizes demonstration projects to improve the

health status of Native Hawaiians.

Section 14(a) authorizes the Secretary to consult with Papa Ola

Lokahi and allocate appropriated amounts under this or any other

Act to carry out Native Hawaiian demonstration projects of national significance. The project areas of interest may include the

following:

(1) the development of a centralized database and information system relating to Native Hawaiian health care status,

health care needs, and wellness;

(2) the education of health professionals, and other individuals in higher learning institutions, in health and allied health

programs in healing practices, including Native Hawaiian healing practices;

(3) the integration of Western medicine with complementary

healing practices including traditional Native Hawaiian healing practices;

(4) the use of tele-wellness and telecommunications in chronic disease management and health promotion and disease prevention;

(5) the development of appropriate models of Native Hawaiian health care and other indigenous people including the provision of culturally competent health services, related activities

focusing on wellness concepts, and 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, and Integrated Medicine at Moloka‘i General Hospital; and for Complementary Health and Health Education and Training at the Waianae Coast Comprehensive

Health Center. Papa Ola Lokahi and any centers established

under paragraph (6) shall be deemed qualified as Centers of

Excellence under the Public Health Service Act.

Section 14(b) provides that funds allocated for demonstration

projects under subsection 14(a) shall not result in a reduction of

funds, required by the Native Hawaiian health care systems, 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 (to be referred to in this Act

as the ‘‘Commission’’).

27

Section 15(b) provides that the Commission 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 section 15(b)(1) will elect the Commission’s chairperson

and vice-chairperson.

(2) the Native Hawaiian health care systems will appoint

five members, and the Hawai‘i State Primary Care Association,

Papa Ola Lokahi, Native Hawaiian Health Task Force, and the

Office of Hawaiian Affairs will each appoint one member. The

Association of Hawaiian Civic Clubs shall appoint two members who will represent Native Hawaiian populations residing

in the continental United States.

(3) the Secretary shall appoint two members who possess

knowledge of Native Hawaiian health concerns and wellness.

Section 153(c) provides that Commission members shall serve for

the life of the Commission. Initial Commission members under subsection 15(b)(1) 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) review and analyze the recommendations of the report of

the study committee establishes under subsection 15(d)(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 their reconciliation;

(3) establish a study committee composed of at least ten (10)

Commission members, with four appointed under subsection

(b)(1), five members appointed under subsection 15(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 other states;

(B) make recommendations to the Commission for legislation that will provide for culturally-competent and appropriate provision of health services to Native Hawaiians as

an entitlement which, shall at a minimum, address issues

28

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 recommendation on the existing system of delivery of health

services for Native Hawaiians;

(D) determine the effect of a health service entitlement

program for Native Hawaiian individuals on their self-determination and the reconciliation of their relationship

with the United States;

(E) within twelve months after the appointment of the

Commission members, make a written report of its findings and recommendations to the Commission which shall

include statements from the minority and 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 (18) 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.

Commission members appointed under subsection 15(b)(2) and (3)

may receive compensation while the performing Commission business, and while serving away from home or regular place of business, be allowed travel expenses as the Commission chairperson

authorizes. Commission personnel will be treated as if they were

Senate employees for purposes of compensation (except for Commission members), employment benefits, rights, and privileges.

Section 15(e)(2) specifies that the Commission chairperson shall

call Commission meetings. This subsection further specifies that a

quorum shall consist of not less than twelve (12) members, with

not less than four (4) such members appointed under subsection

15(b)(1), with not less than seven (7) such members appointed

under subsection 15(b)(2), and not less than one (1) member appointed under subsection 15(b)(3).

Section 15(e)(3) authorizes Commission members to appoint an

executive director. The executive director, with the Commission’s

approval, may appoint such personnel as the executive director

deems appropriate. This subsection also specifies that the executive

director, with the Commission’s approval, may procure temporary

29

and intermittent services. This subsection authorizes the General

Services Administration Administrator to locate suitable office

space for Commission headquarters in Washington, D.C. 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 (8) hearings

shall be held on each of the Hawaiian Islands and three (3) hearings in the continental United States in areas where large numbers

of Native Hawaiians are present. Such hearings shall be held to solicit the views of Native Hawaiians regarding the delivery of health

care services to such individuals. 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 Centers for Medicare and Medicaid Services shall

provide cost estimates the Commission determines to be necessary

to carry out 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.

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. 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

30

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 section 15. 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 Hawai‘i to license health

practitioners.

Section 17. Compliance with Budget Act

This section provides that any new spending authority described

in section 401(c)(2)(A) or (B) of the Congressional Budget Act of

1974 which is provided under the authority of the Act is to be effective only for any fiscal year to the extent or in such amounts as

are provided in appropriation acts.

Section 18. Severability

This section specifies that if any provision of the Act or application of any provision of the Act to any person or circumstances is

held to be invalid, the remainder of the Act will be unaffected.

LEGISLATIVE HISTORY

On January 22, 2001 Senator Daniel K. Inouye, for himself and

Senator Daniel K. Akaka, introduced Senate bill 87. It was referred

to the Committee on Indian Affairs. No hearings were held on S.

87, however, during the 106th Congress, the Committee did hold

a series of hearings on S. 1929 which is nearly identical to S. 87.

Those hearings were as follows: Moloka‘i and Kaua‘i (January 18,

2000); Maui (January 19, 2000); Hilo, Hawai‘i (January 20, 2000);

O‘ahu (January 21, 2000); Kona, Hawai‘i and Lana‘i (March 16,

2000).

COMMITTEE RECOMMENDATION AND TABULATION OF VOTE

The Committee on Indian Affairs, on July 24, 2001, in an open

business meeting, by a unanimous vote, recommended that the

Senate pass an amendment in the nature of a substitute to S. 87,

a bill to reauthorize and amend the Native Hawaiian Health Care

Act.

COST AND BUDGETARY CONSIDERATIONS

At the time of filing this report, the cost estimate of the Congressional Budget Office on S. 87 has not yet been received. Compliance

with Senate Rule XXVI, paragraph 11(a) is therefore impracticable

at this time.

EXECUTIVE COMMUNICATIONS

The Committee received no communications from the Executive

branch of government on S. 87.

31

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. 87 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 øcomprise¿ begin their story with the

Kumulipo which details the creation and the inter-relationship

of all things, including their evolvement as healthy and well

people.

(2) Native Hawaiians are a distinct and unique indigenous

øpeople¿ peoples 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 Hawai‘i

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 Hawai‘i.

ø(3)¿ (7) The constitution and statutes of the State of

Hawai‘i:

(A) acknowledge the distinct land rights of Native Hawaiian people as beneficiaries of the public lands trust;

and

32

(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

øpeople¿ peoples in Hawai‘i 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 Hawai‘i.

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 Hawai‘i, 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 øGovernment¿ government of Hawai‘i.

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 overthrow of the

indigenous and lawful Government of Hawai‘i 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 Hawai‘i or the lawful Government of Hawai‘i in violation of treaties between the øtwo¿ 2

nations and 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

Hawai‘i, and the Hawaiian Patriotic League, representing the

aboriginal citizens of Hawai‘i, promptly petitioned the United

States for redress of these wrongs and for restoration of the indigenous government of the Hawaiian nation, but this petition

was not acted upon.

(15) The United States has acknowledged the significance of

these events and has apologized to Native Hawaiians on behalf

of the people of the United States for the overthrow of the Kingdom of Hawai‘i 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).

33

ø(11)¿ (16) In 1898, the United States annexed Hawai‘i

through the Newlands Resolution without the consent of or

compensation to the indigenous øpeople¿ peoples 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 over their

lands and ocean resources.

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

Organic Act, the øUnited 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 Hawai‘i.

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 øUnited States¿ Committee on

Territories of the House of Representatives øCommittee on Territories¿ as stating, ‘‘One thing that impressed me * * * was

the fact that the natives of the islands øwho are our wards, I

should say, and¿ * * * for whom in a sense we are trustees,

are falling off rapidly in numbers 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 Hawai‘i 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 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.

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

admission of the State of Hawai‘i into the Union’’, approved

March 18, 1959 (73 Stat. 4), the United States transferred responsibility for administration over portions of the ceded public

lands trust not retained by the United States to the State of

Hawai‘i but reaffirmed the trust relationship which existed between the United States and the Native Hawaiian people by

retaining the legal responsibility of the State for the betterVerDate 11-MAY-2000 08:09 Aug 30, 2001 Jkt 000000 PO 00000 Frm 00033 Fmt 6659 Sfmt 6602 C:\DISC\SR056.107 ATX007 PsN: ATX007
34

ment 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 Hawai‘i into Union’’, approved March 18, 1959 (73

Stat. 4, 6).¿ of such Act.

(22) 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 transferred from any source in trust for the Native Hawaiian people, to receive payments from the State of Hawai‘i

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 86–

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 øUnited

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 Hawai‘i.

(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 Hawai‘i 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 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 øthe¿ Congress

through the enactment of Federal laws which extend to the

Native 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 ø42 U.S.C.A. § 2991 et seq.¿; the American Indian Religious Freedom Act ø42 U.S.C.A. 1996¿; the National Museum

of the American Indian Act ø20 U.S.C.A. § 80q et seq.¿; and

the Native American Graves Protection and Repatriation Act

ø25 U.S.C.A. § 3001 et seq.¿.

35

ø(20)¿ (27) The United States has also recognized and reaffirmed the trust relationship to the Native Hawaiian people

through legislation which authorizes the provision of services

to Native Hawaiians, specifically, the Older Americans Act of

1965 ø42 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 ø29 U.S.C.A. § 701 et seq.¿, the Native Hawaiian Health Care Act of 1988 (Public Law 100–579), 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 peoples of

Hawai‘i, are a unique population group in Hawai‘i 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 committment 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 disparties 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 Hawai‘i (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 Hawai‘i for

cancers of the lung, liver and pancreas and for all

cancers combined;

(III) Native Hawaiian females ranked highest in

the State of Hawai‘i for cancers of the lung, liver,

pancreas, breast, cervix uteri, corpus uteri, stomach, and rectum, and for all cancers combined;

(IV) Native Hawaiian males have the highest

years of productive life lost from cancer in the

State of Hawai‘i with 8.7 years compared to 6.4

yeas for other males; and

36

(V) Native Hawaiian females have 8.2 years of

productive life lost from cancer in the State of

Hawai‘i as compared to 6.4 years for other females

in the State of Hawai‘i;

(ii) BREAST CANCER.—With respect to breast cancer—

(I) Native Hawaiians have the highest mortality

rates in the State of Hawai‘i 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 Hawai‘i (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

Hawai‘i (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 Hawai‘i (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 Hawai‘i which is 130 percent

higher than the statewide rate for all other races (15.1

out of every 100,000 residents);

(ii) full-blood Hawaiians had a mortality rate of 93.3

out of every 100,000 residents, which is 518 percent

higher than the rate for the statewide population of all

other races; and

(iii) Native Hawaiians who are less than full-blood

had a mortality rate of 27.1 out of every 100,000 residents, which is 79 percent higher than the rate for the

statewide population of all other races.

(C) ASTHMA.—With respect to asthma—

(i) in 1990, Native Hawaiians comprised 44 percent

of all asthma cases in the State of Hawai‘i for those 18

37

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 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

Hawai‘i (201.1 out over every 100,000 residents);

and

(II) Native Hawaiian males have the greatest

years of productive life lost in the State of Hawai‘i

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

Hawai‘i and 6.4 years for all females.

(ii) HYPERTENSION.—The death rate for Native Hawaiians from hypertension (3.5 out of 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 100,000 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 Hawai‘i.

(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 Hawai‘i; 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 Hawai‘i.

(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 Hawai‘i as compared to the 5 other major ethnic

groups in the State;

(B) the average number of decayed or filled primary teeth

for Native Hawaiian children ages 5 through 9 years was

4.3 as compared with 3.7 for the entire State of Hawai‘i

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 perVerDate 11-MAY-2000 08:09 Aug 30, 2001 Jkt 000000 PO 00000 Frm 00037 Fmt 6659 Sfmt 6603 C:\DISC\SR056.107 ATX007 PsN: ATX007
38

cent as compared with 33 percent for all other races in the

State of Hawai‘i.

(5) LIFE EXPECTANCY.—With respect to life expectancy—

(A) Native Hawaiians have the lowest life expectancy of

all population groups in the State of Hawai‘i;

(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 Hawai‘i;

(ii) of the mothers in the State of Hawai‘i 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 Hawai‘i, 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 Hawai‘i, 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 Hawai‘i (3.6

percent);

(ii) in 1996, nearly 53 percent of all mothers in

Hawai‘i under 18 years of age were Native Hawaiian;

(iii) lower rates of abortion (a third lower than for

the statewide population) among Hawaiian women

may account in part, for the higher percentage of live

births;

(iv) in 1995, of the births to mothers age 14 years

and younger in Hawai‘i, 66 percent were Native Hawaiian; and

39

(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 Hawai‘i. 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 other races in the State of

Hawai‘i 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 Hawai‘i;

(iv) the chronic drinking rate among Native Hawaiians is 54 percent higher than that for all other races

in the State off Hawai‘i;

(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 Hawai‘i; 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 Hawai‘i.

(B) CRIME.—With respect to crime—

(i) in 1996, of the 5,944 arrests that were made for

property crimes in the State of Hawai‘i, 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 Hawai‘i, and 38 percent of the 4,066 juvenile arrests:

(iv) Native Hawaiians are over-represented in the

prison population in Hawai‘i;

(v) in 1995 and 1996 Native Hawaiians comprised

36.5 percent of the sentenced felon prison population in

Hawai‘i, as compared to 20.5 percent for Caucasian

Americans, 3.7 percent for Japanese Americans, and 6

percent for Chinese Americans;

(vi) in 1995 and 1996 Native Hawaiians made up

45.4 percent of the technical violator population, and at

the Hawai‘i Youth Correctional Facility, native HawaiVerDate 11-MAY-2000 08:09 Aug 30, 2001 Jkt 000000 PO 00000 Frm 00039 Fmt 6659 Sfmt 6603 C:\DISC\SR056.107 ATX007 PsN: ATX007
40

ians 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 Hawai‘i

(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 Hawai‘i; 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 Hawai‘i.

§ 11702. Declaration of øpolicy¿ National Native Hawaiian

Health Policy

(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 øpeople¿ peoples of Hawai‘i

resulting from the unique and historical relationship between the

United States and the øGovernment of the¿ indigenous øpeople¿

peoples of Hawai‘i— (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 incorporate within health programs, activities defined and identified by Kanaka Maoli which may include—

(A) incorporating and supporting the integration of cultural approaches to health and well-being, including programs using traditional practices relating to the atmosphere (lewa lani), land (‘aina), water (wai), or ocean (kai);

41

(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 with 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.

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.

42

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 physicial 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 dietitians.

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

15 percent of adults.

ø(29) Reduce initiation of smoking to 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 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 prevalence

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:

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;

43

ø(F) Congenital Rubella Syndrome to 0;

ø(G) Mumps to 500; and

ø(H) Pertussis to 1,000; and

ø(40) Reduce significant visual impairment to a prevalence of

no more than 30 per 1,000.¿

(c) REPORT.—The Secretary shall submit to the President, for inclusion in each report required to be transmitted to øthe¿ Congress

under section ø11710 of this title¿ 12, a report on the progress

ømade in each area toward meeting each of the objectives described

in subsection (b) of this section.¿ towards meeting 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

Hawaiians øThe 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 Hawai‘i, including the

Department of Health and the Department of Human Services

and the Native Hawaiian health care systems and Native Hawaiian Health Centers, shall submit to Congress a report detailing the impact of current Federal and State health care financing mechanisms and policies on the health and well-being

of Native Hawaiians. Such report shall include— (A) information concerning the impact of cultural competency, risk assessment data, eligibility requirements and

exemptions, and reimbursement policies and capitation

rates currently in effect for service providers;

(B) any other such information as may be important to

improving the health status of Native Hawaiians as such

44

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 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.¿

(2) CONSULTATION.—The Secretary shall provide Papa Ola

Lokahi and the Office of Hawaiian Affairs at least once 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 and benefiting Native Hawaiians;

45

(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 and to Native Hawaiian Health Centers.

(f) RELATIONSHIPS WITH OTHER AGENCIES.—

(1) AUTHORITY.—Papa Ola Lokahi øis authorized to¿ may

enter into agreements or memoranda of understanding with

relevant institutions, 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.—Federal agencies 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 Hawai‘i shall

engage in meaningful consultation with Native Hawaiians

and organizations providing health care services to Native

Hawaiians in the State of Hawai‘i prior to making any

changes or initiating new programs.

(C) CONSULTATION ON FEDERAL HEALTH INSURANCE PROGRAMS.—

(i) The Office of Hawaiian 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

46

(II) the agency of the State of Hawai‘i 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

(iii) other matters that would enable Native Hawaiians to maximize health insurance benefits provided by

Federal and State health insurance programs.

(3) TRADITIONAL HEALERS.—The provision of health services

under any program operated by the Department 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 Public

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.—

ø(A)¿ (1) GRANTS AND CONTRACTS.—The Secretary, in consultation with Papa Ola Lokahi, may make grants to, or enter

into contracts 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,

health promotion and disease prevention services shall be performed through Native Hawaiian health care systems.

(3) QUALIFIED ENTITY.—An entity is a qualified entity for purposes of paragraph (1) if the entity is a Native Hawaiian health

care system or a Native Hawaiian Health Center.

(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 health care systems under this subsection

during any fiscal year.

47

ø2¿ (b) PLANNING GRANT OR CONTRACT.—In addition to øparagraph (1)¿ 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 Hawai‘i.

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, counselors, and cultural educators;

(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; øand¿

(G) Improvement of nutritionø.¿;

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); 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 øparagraphs (1) and (2)¿ paragraph (1) which

are provided under 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

48

covered under the provisions of section 224 of the Public Health

Service Act.

(3) 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 an 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 Hawai‘i 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. Amount 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

Lokahi, 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 (a)(1) of this section unless the entity

agrees that, amounts received pursuant to such subsection will not,

directly or through contract, be expended—

(1) for any purpose other than the purposes described in subsection (c) 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.

49

(g) LIMITATION ON CHARGES FOR SERVICES.—The Secretary may

not make a grant, or enter into a contract with, øany¿ an entity

under subsection (a) ø(1) of this 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 APPROPRIATIONS.—

(1) GENERAL GRANTS.—There øare¿ is authorized to be appropriated such sums as may be necessary for fiscal years

ø1993¿ 2002 through ø2001¿ 2006 to carry out subsection (a)

ø(1) of this section¿.

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

years 2002 through 2006 to carry out subsection ø(a)(2) of this

section¿ (b).

§ 11706. Administrative grant for Papa Ola Lokahi

(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¿ 5;

(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, øepidemiological¿ epidemiologic, 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 data associated

with the health status of Native Hawaiians;

(B) the identification and research into diseases affecting

Native Hawaiians; and

(C) the availability of Native Hawaiian project funds, research projects and publications;

(6) the establishment and maintenance of an institutional review board for all health-related research involving Native Hawaiians;

ø6¿ (7) the coordination of the health care programs and

services provided to Native Hawaiians; and

ø7¿ (8) the administration of special project funds.

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(b) AUTHORIZATION OF APPROPRIATIONS.—There are authorized to

be appropriated such sums as may be necessary for fiscal years

ø1993¿ 2002 through ø2001¿ 2006 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 øone¿ 1 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 Hawai‘i approved¿ under programs under

titles XVII, XIX, or XXI of the Social Security Act, ø42

U.S.C.A. § 1396 et seq.¿ including any State plan, or under any

other Federal health insurance plan—

(A) if the entity will provide under the grant or contract

any such health services directly—

(i) the entity had entered into a participation agreement under such plans; and

(ii) the entity is qualified to receive payments under

such plan; and

(B) if the entity will provide under the grant or contract

any such health services through a contract with an

organization—

(i) the organization has entered into a participation

agreement under such plan; and

(ii) the organizaiton 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¿ use and costs

51

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) CONTRACT 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.

(2) NONRENEWAL.—If the Secretary determines that øsuch¿

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 øsuch¿

the contract with such entity and øis authorized to¿ may enter

into a contract under section ø11705 of this title¿ 7 with another entity referred to in øsection 11705(b)¿ subsection (a)(3)

of øthis title¿ 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 øsubsection¿

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 øevaluation¿ evaluations conducted 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.

(e) øLIMITATION 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 øa quarterly¿ an annual report øon¿—

(A) on the activities conducted by the entity under the

grant or contract;

52

(B) on the amounts and purposes for which Federal

funds were expended; and

(C) containing such other information as the Secretary

may request.

(2) AUDIT.—The reports and records of any entity øwhich

concern¿ concerning any grant or contract under this øchapter¿ 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.

ø(g)¿ (f) ANNUAL PRIVATE AUDIT.—The Secretary shall allow as

a cost of any grant made or contract entered into under this øchapter¿ Act the cost of an annual private audit conducted by a certified

public accountant.

§ 11708. Assignment of personnel

(a) IN GENERAL.—The Secretary øis authorized to¿ may 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 øthe authority of¿ subsection (a) øof 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 øthe authority of¿ subsection (c) øof this section,¿ the Secretary shall provide funds through a direct grant or

a cooperative agreement to Kamehameha Schools ø/Bishop Estate¿

or another Native Hawaiian organization or health care organization with experience in the administration of educational scholarships or placement services for the purpose of providing scholarship

assistance to students who—

(1) meet the requirements of section ø2541 of this title,¿

338A of the Public Health Service Act (42 U.S.C. 2541), except

for assistance as provided for under subsection (b)(2); and

(2) are Native Hawaiians.

(b) PRIORITY.—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 øprovided¿

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 ø2541 of this title, provided that—¿ 338A

of the Public Health Service Act (42 U.S.C. 2541) (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

53

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

Native Hawaiian øhealth care systems¿ 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 Schools ø/

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¿ service in order of priority øthat would provide for practice—¿, in—

(i) øfirst, in¿ any one of the øfive¿ Native Hawaiian

health care systems or Native Hawaiian Health Centers;

øI¿ (ii) øa¿ health øprofessional¿ professions shortage øarea or¿ areas, medically underserved øarea located¿ areas, or geographic areas or facilities similarly

designated by the United States Public Health Service

in the State of Hawai‘i; or

øII¿ (iii) a øgeographic area or facility that is—

ø(aa) located in the State of Hawai‘i; and

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;¿ geographical area, facility, 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 Hawai‘i; and

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 (42 U.S.C. 2541) while they are

fulfilling their service requirement in any one of the Native

54

Hawaiian health care systems or Native Hawaiian 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 øare¿ is authorized to be appropriated such sums as may be necessary for fiscal years ø1993¿ 2002 through ø2001¿ 2006 for the purpose of

funding the scholarship assistance øprovided¿ program 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, United States Code, for each fiscal year

transmit to the Congress a report on the progress made in meeting

the objectives of this øchapter¿ Act, including a review of programs

established or assisted pursuant to this chapter and an assessment

and recommendations of additional programs or additional assistance necessary to, at a minimum, provide health services to Native

Hawaiians, and ensure a health status for native Hawaiians, which

are at a parity with the health services available to, and the health

status of, the general population.

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

SUPPLY.

(a) IN GENERAL.—The Secretary shall permit organizations that

receive contracts or grants under this Act, in carrying out such contracts or grants, to use existing facilities and all equipment therein

or under the jurisdiction of the Secretary under such terms and conditions as may be agreed for the use and maintenance of such facilities or equipment.

55

(b) DONATION OF PROPERTY.—The Secretary may donate to organizations that receive contracts or grants 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 or 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 Excellence for Nursing at the University of Hawai‘i at Hilo, a Native

Hawaiian Center of Excellence for Mental Health at the University of Hawai‘i at Manoa, Native Hawaiian Center of Excellence

for Maternal Health and Nutrition at the Waimanalo Health

Center, and a Native Hawaiian Center of Excellence for Research, Training, and Integrated Medicine at Moloka‘i 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.

56

SEC. 15. NATIONAL BIPARTISAN COMMISSION ON NATIVE HAWAIIAN

HEALTH CARE ENTITLEMENT.

(a) ESTABLISHMENT.—There is hereby established a National Bipartisan Native Hawaiian Health 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;

(iii) two members shall be from the Senate and shall

be appointed by the Majority Leader; and

(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 Hawai‘i State

Primary Care Association;

(C) one member shall be appointed by Papa Ola Lokahi;

(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 the Association of

Hawaiian Civic Clubs and shall represent Native Hawaiian populations residing in the continental United States.

(3) SECRETARIAL MEMBERS.—Two members of the Commission shall be appointed by the Secretary and shall possess

knowledge of Native Hawaiian health concerns and wellness.

(c) TERMS.—

(1) IN GENERAL.—The members of the Commission 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).

57

(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 establishment 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

Hawaiian beneficiaries and their families, including those

that live in the continental United States;

(B) make recommendations to the Commission for legislation that will provide for the culturally-competent and appropriate provision of health services for Native Hawaiians

as an entitlement, which shall, at a minimum, address

issues of eligibility and benefits to be provided, including

recommendations regarding from whom such health services are to be provided and the cost and mechanisms for

funding of the health services to be provided;

(C) determine the effect of the enactment of such recommendations on the existing system of delivery of health

services for Native Hawaiians;

(D) determine the effect of a health service entitlement

program for Native Hawaiian individuals on their self-determination and the reconciliation of their relationship

with the United States;

(E) not later than 12 months after the date of the appointment of all members of the Commission, make a written report of its findings and recommendations to the Commission, which report shall include a statement of the minority and majority position of the committee and which

shall be disseminated, at a minimum, to Native Hawaiian

organizations and agencies and health organizations referred to in subsection (b)(2) for comment to the Commission; and

(F) report regularly to the full Commission regarding the

findings and recommendations developed by the committee

in the course of carrying out its duties under this section.

58

(4) Not later than 18 months after the date of appointment

of 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

(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.

59

(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 Hawai‘i. The Washington, D.C. facilities shall

serve as the headquarters of the Commission while the

Hawai‘i 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 Attorney of the Centers for Medicare and Medicaid Services, or both, shall provide to the

Commission, upon the request of the Commission, such cost

estimates as the Commission determines to be necessary to

carry out its duties.

(B) REIMBURSEMENTS.—The Commission shall reimburse

the Director of the Congressional Budget Office for expenses

relating to the employment in the office of the Director of

such additional staff as may be necessary for the Director

to comply with requests by the Commission under subparagraph (A).

(4) DETAIL OF FEDERAL EMPLOYEES.—Upon the request of the

Commission, the head of any Federal agency is authorized to

detail, without reimbursement, any of the personnel of such

agency to the Commission to assist the Commission in carrying

60

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 of 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 Commission 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 or

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 Hawai‘i to license health practitioners.

SEC. 17. COMPLIANCE WITH BUDGET ACT.

Any new spending authority (described in subparagraph (A) of (B)

of section 401(c)(2) of the Congressional Budget Act of 1974 (2

U.S.C. 651(c)(2)(A) or (B))) which is provided under this Act shall

be effective for any fiscal year only to such extent or in such

amounts as are provided for in appropriation Acts.

SEC. 18. SEVERABILITY.

If any provision of this Act, or the application of any such provision to any person or circumstances is held to be invalid, the remainder of this Act, and the application of such provision or

amendment to persons or circumstances other than those to which

it is held invalid, shall not be affected thereby.

§ 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—

61

(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, and

(G) control of stress.

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

(I) integration of cultural approaches to health and 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

Hawai‘i) 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 Hawai‘i, 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

ø(iii)¿ (C) birth records of the State of Hawai‘i 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

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; øand¿

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

62

(E) which are established 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

ƒenters into with, or grant≈ 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 øorganization¿ any organization that is 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¿

(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

Hawai‘i,

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

through practitioners licensed by the State of Hawai‘i,

where licensure requirements are applicable,

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

63

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

Hawai‘i;

ø(iii) Alu Like Inc.;

ø(iv) the University of Hawai‘i;

ø(v) the Office of Hawaiian Health of the Hawai‘i

State Department of Health;

ø(vi) Ho‘ola Lahui Hawai‘i, 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

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 Hawai‘i, and which may be

composed of as many health care centers as are necVerDate 11-MAY-2000 08:09 Aug 30, 2001 Jkt 000000 PO 00000 Frm 00063 Fmt 6659 Sfmt 6602 C:\DISC\SR056.107 ATX007 PsN: ATX007
64

essary 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 Hawai‘i 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;

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

Hawai‘i;

(iii) Alu Like, Inc.;

65

(iv) the University of Hawai‘i

(v) the Hawai‘i 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 Hawai‘i 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 Hawai‘i, 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 Hawai‘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 that island;

(xiv) other Native Hawaiian health care systems as

certified and recognized by Papa Ola Lokahi in according with this Act; and

(xv) such other member organizations as the Board

of Papa Ola Lokahi will admit from time to time,

based upon satisfactory demonstration of a record of

contribution to the health and well-being of Native Hawaiians.

(B) LIMITATION.—Such term does not include any organization described in subparagraph (A) if the Secretary determines that such organization has not developed a mission

statement with clearly defined goals and objectives for the

contributions the organization will make to the Native Hawaiian health care systems, the national policy as set forth

in section 4, and an action plan for carrying out those goals

and objectives.

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

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

means a practitioner—¿

66

(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 speciality or

tertiary care; and

(I) complimentary healing practices, including those performed by traditional Native Hawaiian healers.

(12) SECRETARY.—The term ‘‘Secretary’’ means the Secretary

of Health and Human Services.

(13) TRADITIONAL NATIVE HAWAIIAN HEALER.—The term ‘‘traditional Native Hawaiian healer’’ means a practitioner—

(A) who—

(i) is of Native Hawaiian ancestry; and

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

(B) whose knowledge, skills, and experience are based on

demonstrated learning of Native Hawaiian healing practices acquired by—

(i) direct practical association with Native Hawaiian

elders; and

(ii) oral traditions transmitted from generation to

generation.

§ 11712. Rule of construction

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

§ 11713. Compliance with Budget Act

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

the Congressional Budget Act of 1974 (2 U.S.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 for in appropriation Acts.

67

§ 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 øchapter¿ 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.

Æ