I 

108TH CONGRESS 

1ST SESSION H. R. 2597

To amend the Native Hawaiian Health Care Improvement Act to revise 

and extend that Act. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 25, 2003

Mr. ABERCROMBIE (for himself and Mr. CASE) introduced the following bill; 

which was referred to the Committee on Energy and Commerce 

A BILL

To amend the Native Hawaiian Health Care Improvement 

Act to revise and extend that Act.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Native Hawaiian 

5 Health Care Improvement Reauthorization Act of 2003’’. 

6 SEC. 2. AMENDMENT TO THE NATIVE HAWAIIAN HEALTH 

7 CARE IMPROVEMENT ACT. 

8 The Native Hawaiian Health Care Improvement Act 

9 (42 U.S.C. 11701 et seq.) is amended to read as follows: 
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1 ‘‘SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

2 ‘‘(a) SHORT TITLE.—This Act may be cited as the 

3 ‘Native Hawaiian Health Care Improvement Act’. 

4 ‘‘(b) TABLE OF CONTENTS.—The table of contents 

5 of this Act is as follows:

‘‘Sec. 1. Short title; table of contents. 

‘‘Sec. 2. Findings. 

‘‘Sec. 3. Definitions. 

‘‘Sec. 4. Declaration of national Native Hawaiian health policy. 

‘‘Sec. 5. Comprehensive health care master plan for Native Hawaiians. 

‘‘Sec. 6. Functions of Papa Ola Lokahi and Office of Hawaiian Affairs. 

‘‘Sec. 7. Native Hawaiian health care. 

‘‘Sec. 8. Administrative grant for Papa Ola Lokahi. 

‘‘Sec. 9. Administration of grants and contracts. 

‘‘Sec. 10. Assignment of personnel. 

‘‘Sec. 11. Native Hawaiian health scholarships and fellowships. 

‘‘Sec. 12. Report. 

‘‘Sec. 13. Use of Federal Government facilities and sources of supply. 

‘‘Sec. 14. Demonstration projects of national significance. 

‘‘Sec. 15. Rule of construction. 

‘‘Sec. 16. Compliance with Budget Act. 

‘‘Sec. 17. Severability.

6 ‘‘SEC. 2. FINDINGS. 

7 ‘‘(a) GENERAL FINDINGS.—Congress finds that—

8 ‘‘(1) Native Hawaiians begin their story with 

9 the Kumulipo, which details the creation and inter10 relationship of all things, including the evolvement of 

11 Native Hawaiians as healthy and well people; 

12 ‘‘(2) Native Hawaiians—

13 ‘‘(A) are a distinct and unique indigenous 

14 people with a historical continuity to the origi15 nal inhabitants of the Hawaiian archipelago 

16 within Ke Moananui, the Pacific Ocean; and 
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1 ‘‘(B) have a distinct society that was first 

2 organized almost 2,000 years ago; 

3 ‘‘(3) the health and well-being of Native Hawai4 ians are intrinsically tied to the deep feelings and at5 tachment of Native Hawaiians to their lands and 

6 seas; 

7 ‘‘(4) the long-range economic and social 

8 changes in Hawaii over the 19th and early 20th cen9 turies have been devastating to the health and well10 being of Native Hawaiians; 

11 ‘‘(5) Native Hawaiians have never directly relin12 quished to the United States their claims to their in13 herent sovereignty as a people or over their national 

14 territory, either through their monarchy or through 

15 a plebiscite or referendum; 

16 ‘‘(6) the Native Hawaiian people are deter17 mined to preserve, develop, and transmit to future 

18 generations, in accordance with their own spiritual 

19 and traditional beliefs, their customs, practices, lan20 guage, social institutions, ancestral territory, and 

21 cultural identity; 

22 ‘‘(7) in referring to themselves, Native Hawai23 ians use the term ‘Kanaka Maoli’, a term frequently 

24 used in the 19th century to describe the native peo25 ple of Hawaii; 
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1 ‘‘(8) the constitution and statutes of the State 

2 of Hawaii—

3 ‘‘(A) acknowledge the distinct land rights 

4 of Native Hawaiian people as beneficiaries of 

5 the public lands trust; and 

6 ‘‘(B) reaffirm and protect the unique right 

7 of the Native Hawaiian people to practice and 

8 perpetuate their cultural and religious customs, 

9 beliefs, practices, and language; 

10 ‘‘(9) at the time of the arrival of the first non11 indigenous people in Hawaii in 1778, the Native Ha12 waiian people lived in a highly organized, self-suffi13 cient, subsistence social system based on communal 

14 land tenure with a sophisticated language, culture, 

15 and religion; 

16 ‘‘(10) a unified monarchical government of the 

17 Hawaiian Islands was established in 1810 under Ka18 mehameha I, the first King of Hawaii; 

19 ‘‘(11) throughout the 19th century until 1893, 

20 the United States—

21 ‘‘(A) recognized the independence of the 

22 Hawaiian Nation; 

23 ‘‘(B) extended full and complete diplomatic 

24 recognition to the Hawaiian Government; and 
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1 ‘‘(C) entered into treaties and conventions 

2 with the Hawaiian monarchs to govern com3 merce and navigation in 1826, 1842, 1849, 

4 1875, and 1887; 

5 ‘‘(12) in 1893, John L. Stevens, the United 

6 States Minister assigned to the sovereign and inde7 pendent Kingdom of Hawaii, conspired with a small 

8 group of non-Hawaiian residents of the Kingdom, 

9 including citizens of the United States, to overthrow 

10 the indigenous and lawful government of Hawaii; 

11 ‘‘(13) in pursuance of that conspiracy—

12 ‘‘(A) the United States Minister and the 

13 naval representative of the United States 

14 caused armed forces of the United States Navy 

15 to invade the sovereign Hawaiian Nation in 

16 support of the overthrow of the indigenous and 

17 lawful Government of Hawaii; and 

18 ‘‘(B) after that overthrow, the United 

19 States Minister extended diplomatic recognition 

20 of a provisional government formed by the con21 spirators without the consent of the native peo22 ple of Hawaii or the lawful Government of Ha23 waii, in violation of—

24 ‘‘(i) treaties between the Government 

25 of Hawaii and the United States; and
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1 ‘‘(ii) international law; 

2 ‘‘(14) in a message to Congress on December 

3 18, 1893, President Grover Cleveland—

4 ‘‘(A) reported fully and accurately on those 

5 illegal actions; 

6 ‘‘(B) acknowledged that by those acts, de7 scribed by the President as acts of war, the 

8 government of a peaceful and friendly people 

9 was overthrown; and 

10 ‘‘(C) concluded that a ‘substantial wrong 

11 has thus been done which a due regard for our 

12 national character as well as the rights of the 

13 injured people required that we should endeavor 

14 to repair’; 

15 ‘‘(15) Queen Lili‘uokalani, the lawful monarch 

16 of Hawaii, and the Hawaiian Patriotic League, rep17 resenting the aboriginal citizens of Hawaii, promptly 

18 petitioned the United States for redress of those 

19 wrongs and restoration of the indigenous govern20 ment of the Hawaiian nation, but no action was 

21 taken on that petition; 

22 ‘‘(16) in 1993, Congress enacted Public Law 

23 103–150 (107 Stat. 1510), in which Congress—

24 ‘‘(A) acknowledged the significance of 

25 those events; and 
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1 ‘‘(B) apologized to Native Hawaiians on 

2 behalf of the people of the United States for the 

3 overthrow of the Kingdom of Hawaii with the 

4 participation of agents and citizens of the 

5 United States, and the resulting deprivation of 

6 the rights of Native Hawaiians to self-deter7 mination; 

8 ‘‘(17) in 1898, the United States—

9 ‘‘(A) annexed Hawaii through Resolution 

10 No. 55 (commonly known as the ‘Newlands 

11 Resolution’) (30 Stat. 750), without the consent 

12 of, or compensation to, the indigenous people of 

13 Hawaii or the sovereign government of those 

14 people; and 

15 ‘‘(B) denied those people the mechanism 

16 for expression of their inherent sovereignty 

17 through self-government and self-determination 

18 of their lands and ocean resources; 

19 ‘‘(18) through the Newlands Resolution and the 

20 Act of April 30, 1900 (commonly known as the 

21 ‘1900 Organic Act’) (31 Stat. 141, chapter 339), 

22 Congress—

23 ‘‘(A) received 1,750,000 acres of land for24 merly owned by the Crown and Government of 

25 the Hawaiian Kingdom; and 
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1 ‘‘(B) exempted the land from then-existing 

2 public land laws of the United States by man3 dating that the revenue and proceeds from that 

4 land be ‘used solely for the benefit of the inhab5 itants of the Hawaiian Islands for education 

6 and other public purposes’, thereby establishing 

7 a special trust relationship between the United 

8 States and the inhabitants of Hawaii; 

9 ‘‘(19) in 1921, Congress enacted the Hawaiian 

10 Homes Commission Act, 1920 (42 Stat. 108, chap11 ter 42), which—

12 ‘‘(A) designated 200,000 acres of the 

13 ceded public land for exclusive homesteading by 

14 Native Hawaiians; and 

15 ‘‘(B) affirmed the trust relationship be16 tween the United States and Native Hawaiians, 

17 as expressed by Secretary of the Interior 

18 Franklin K. Lane, who was cited in the Com19 mittee Report of the Committee on Territories 

20 of the House of Representatives as stating, 

21 ‘One thing that impressed me . . . was the fact 

22 that the natives of the islands . . . for whom in 

23 a sense we are trustees, are falling off rapidly 

24 in numbers and many of them are in poverty.’; 
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1 ‘‘(20) in 1938, Congress again acknowledged 

2 the unique status of the Native Hawaiian people by 

3 including in the Act of June 20, 1938 (52 Stat. 

4 781), a provision—

5 ‘‘(A) to lease land within the extension to 

6 Native Hawaiians; and 

7 ‘‘(B) to permit fishing in the area ‘only by 

8 native Hawaiian residents of said area or of ad9 jacent villages and by visitors under their guid10 ance’; 

11 ‘‘(21) under the Act of March 18, 1959 (48 

12 U.S.C. prec. 491 note; 73 Stat. 4), the United 

13 States—

14 ‘‘(A) transferred responsibility for the ad15 ministration of the Hawaiian home lands to the 

16 State; but 

17 ‘‘(B) reaffirmed the trust relationship that 

18 existed between the United States and the Na19 tive Hawaiian people by retaining the exclusive 

20 power to enforce the trust, including the power 

21 to approve land exchanges and legislative 

22 amendments affecting the rights of beneficiaries 

23 under that Act; 

24 ‘‘(22) under the Act referred to in paragraph 

25 (21), the United States—
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1 ‘‘(A) transferred responsibility for adminis2 tration over portions of the ceded public lands 

3 trust not retained by the United States to the 

4 State; but 

5 ‘‘(B) reaffirmed the trust relationship that 

6 existed between the United States and the Na7 tive Hawaiian people by retaining the legal re8 sponsibility of the State for the betterment of 

9 the conditions of Native Hawaiians under sec10 tion 5(f) of that Act (73 Stat. 6); 

11 ‘‘(23) in 1978, the people of Hawaii—

12 ‘‘(A) amended the constitution of Hawaii 

13 to establish the Office of Hawaiian Affairs; and 

14 ‘‘(B) assigned to that Office the author15 ity—

16 ‘‘(i) to accept and hold in trust for the 

17 Native Hawaiian people real and personal 

18 property transferred from any source; 

19 ‘‘(ii) to receive payments from the 

20 State owed to the Native Hawaiian people 

21 in satisfaction of the pro rata share of the 

22 proceeds of the public land trust estab23 lished by section 5(f) of the Act of March 

24 18, 1959 (48 U.S.C. prec. 491 note; 73 

25 Stat. 6);
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1 ‘‘(iii) to act as the lead State agency 

2 for matters affecting the Native Hawaiian 

3 people; and 

4 ‘‘(iv) to formulate policy on affairs re5 lating to the Native Hawaiian people; 

6 ‘‘(24) the authority of Congress under the Con7 stitution to legislate in matters affecting the aborigi8 nal or indigenous people of the United States in9 cludes the authority to legislate in matters affecting 

10 the native people of Alaska and Hawaii; 

11 ‘‘(25) the United States has recognized the au12 thority of the Native Hawaiian people to continue to 

13 work toward an appropriate form of sovereignty, as 

14 defined by the Native Hawaiian people in provisions 

15 set forth in legislation returning the Hawaiian Is16 land of Kaho‘olawe to custodial management by the 

17 State in 1994; 

18 ‘‘(26) in furtherance of the trust responsibility 

19 for the betterment of the conditions of Native Ha20 waiians, the United States has established a pro21 gram for the provision of comprehensive health pro22 motion and disease prevention services to maintain 

23 and improve the health status of the Hawaiian peo24 ple; 
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1 ‘‘(27) that program is conducted by the Native 

2 Hawaiian Health Care Systems and Papa Ola 

3 Lokahi; 

4 ‘‘(28) health initiatives implemented by those 

5 and other health institutions and agencies using 

6 Federal assistance have been responsible for reduc7 ing the century-old morbidity and mortality rates of 

8 Native Hawaiian people by—

9 ‘‘(A) providing comprehensive disease pre10 vention; 

11 ‘‘(B) providing health promotion activities; 

12 and 

13 ‘‘(C) increasing the number of Native Ha14 waiians in the health and allied health profes15 sions; 

16 ‘‘(29) those accomplishments have been 

17 achieved through implementation of—

18 ‘‘(A) the Native Hawaiian Health Care Act 

19 of 1988 (Public Law 100–579); and 

20 ‘‘(B) the reauthorization of that Act under 

21 section 9168 of the Department of Defense Ap22 propriations Act, 1993 (Public Law 102–396; 

23 106 Stat. 1948); 

24 ‘‘(30) the historical and unique legal relation25 ship between the United States and Native Hawai-
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1 ians has been consistently recognized and affirmed 

2 by Congress through the enactment of more than 

3 160 Federal laws that extend to the Native Hawai4 ian people the same rights and privileges accorded to 

5 American Indian, Alaska Native, Eskimo, and Aleut 

6 communities, including—

7 ‘‘(A) the Native American Programs Act of 

8 1974 (42 U.S.C. 2991 et seq.); 

9 ‘‘(B) the American Indian Religious Free10 dom Act (42 U.S.C. 1996); 

11 ‘‘(C) the National Museum of the Amer12 ican Indian Act (20 U.S.C. 80q et seq.); and 

13 ‘‘(D) the Native American Graves Protec14 tion and Repatriation Act (25 U.S.C. 3001 et 

15 seq.); 

16 ‘‘(31) the United States has recognized and re17 affirmed the trust relationship to the Native Hawai18 ian people through legislation that authorizes the 

19 provision of services to Native Hawaiians, specifi20 cally—

21 ‘‘(A) the Older Americans Act of 1965 (42 

22 U.S.C. 3001 et seq.); 

23 ‘‘(B) the Developmental Disabilities Assist24 ance and Bill of Rights Act Amendments of 

25 1987 (42 U.S.C. 6000 et seq.); 
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1 ‘‘(C) the Veterans’ Benefits and Services 

2 Act of 1988 (Public Law 100–322); 

3 ‘‘(D) the Rehabilitation Act of 1973 (29 

4 U.S.C. 701 et seq.); 

5 ‘‘(E) the Native Hawaiian Health Care Act 

6 of 1988 (42 U.S.C. 11701 et seq.); 

7 ‘‘(F) the Health Professions Reauthoriza8 tion Act of 1988 (Public Law 100–607; 102 

9 Stat. 3122); 

10 ‘‘(G) the Nursing Shortage Reduction and 

11 Education Extension Act of 1988 (Public Law 

12 100–607; 102 Stat. 3153); 

13 ‘‘(H) the Handicapped Programs Technical 

14 Amendments Act of 1988 (Public Law 100–

15 630); 

16 ‘‘(I) the Indian Health Care Amendments 

17 of 1988 (Public Law 100–713); and 

18 ‘‘(J) the Disadvantaged Minority Health 

19 Improvement Act of 1990 (Public Law 101–

20 527); 

21 ‘‘(32) the United States has affirmed that his22 torical and unique legal relationship to the Hawaiian 

23 people by authorizing the provision of services to 

24 Native Hawaiians to address problems of alcohol 
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1 and drug abuse under the Anti-Drug Abuse Act of 

2 1986 (21 U.S.C. 801 note; Public Law 99–570); 

3 ‘‘(33) in addition, the United States—

4 ‘‘(A) has recognized that Native Hawai5 ians, as aboriginal, indigenous, native people of 

6 Hawaii, are a unique population group in Ha7 waii and in the continental United States; and 

8 ‘‘(B) has so declared in Office of Manage9 ment and Budget Circular 15 in 1997 and 

10 Presidential Executive Order No. 13125, dated 

11 June 7, 1999; and 

12 ‘‘(34) despite the United States having ex13 pressed in Public Law 103–150 (107 Stat. 1510) its 

14 commitment to a policy of reconciliation with the 

15 Native Hawaiian people for past grievances—

16 ‘‘(A) the unmet health needs of the Native 

17 Hawaiian people remain severe; and 

18 ‘‘(B) the health status of the Native Ha19 waiian people continues to be far below that of 

20 the general population of the United States. 

21 ‘‘(b) FINDING OF UNMET NEEDS AND HEALTH DIS22 PARITIES.—Congress finds that the unmet needs and seri23 ous health disparities that adversely affect the Native Ha24 waiian people include the following: 

25 ‘‘(1) CHRONIC DISEASE AND ILLNESS.—
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1 ‘‘(A) CANCER.—

2 ‘‘(i) IN GENERAL.—With respect to all 

3 cancer—

4 ‘‘(I) Native Hawaiians have the 

5 highest cancer mortality rates in the 

6 State (216.8 out of every 100,000 

7 male residents and 191.6 out of every 

8 100,000 female residents), rates that 

9 are 21 percent higher than the rate 

10 for the total State male population 

11 (179.0 out of every 100,000 residents) 

12 and 64 percent higher than the rate 

13 for the total State female population 

14 (117.0 per 100,000); 

15 ‘‘(II) Native Hawaiian males 

16 have the highest cancer mortality 

17 rates in the State for cancers of the 

18 lung, colon, rectum, and colorectum, 

19 and for all cancers combined; 

20 ‘‘(III) Native Hawaiian females 

21 have the highest cancer mortality 

22 rates in the State for cancers of the 

23 lung, liver, pancreas, breast, corpus 

24 uteri, stomach, colon, and rectum, and 

25 for all cancers combined; 
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1 ‘‘(IV) Native Hawaiian males 

2 have 8.7 years of productive life lost 

3 as a result of cancer in the State, the 

4 highest years of productive life lost in 

5 that State, as compared with 6.4 

6 years for all males; and 

7 ‘‘(V) Native Hawaiian females 

8 have 8.2 years of productive life lost 

9 as a result of cancer in the State as 

10 compared with 6.4 years for all fe11 males in the State. 

12 ‘‘(ii) BREAST CANCER.—With respect 

13 to breast cancer—

14 ‘‘(I) Native Hawaiians have the 

15 highest mortality rate in the State 

16 from breast cancer (30.79 out of 

17 every 100,000 residents), a rate that 

18 is 33 percent higher than that for 

19 Caucasian Americans (23.07 out of 

20 every 100,000 residents) and 106 per21 cent higher than that for Chinese 

22 Americans (14.96 out of every 

23 100,000 residents); and 

24 ‘‘(II) nationally, Native Hawai25 ians have the third highest mortality 
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1 rate as a result of breast cancer (25.0 

2 out of every 100,000 residents), be3 hind African Americans (31.4 out of 

4 every 100,000 residents) and Cauca5 sian Americans (27.0 out of every 

6 100,000 residents). 

7 ‘‘(iii) CANCER OF THE CERVIX.—Na8 tive Hawaiians have the highest mortality 

9 rate as a result of cancer of the cervix in 

10 the State (3.65 out of every 100,000 resi11 dents), followed by Filipino Americans 

12 (2.69 out of every 100,000 residents) and 

13 Caucasian Americans (2.61 out of every 

14 100,000 residents). 

15 ‘‘(iv) LUNG CANCER.—Native Hawai16 ian males and females have the highest 

17 mortality rates as a result of lung cancer 

18 in the State, at 74.79 per 100,000 for 

19 males and 47.84 per 100,000 females, 

20 which rates are higher than the rates for 

21 the total State population by 48 percent 

22 for males and 93 percent for females. 

23 ‘‘(v) PROSTATE CANCER.—Native Ha24 waiian males have the third highest mor25 tality rate as a result of prostate cancer in 
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1 the State (21.48 out of every 100,000 resi2 dents), with Caucasian Americans having 

3 the highest mortality rate as a result of 

4 prostate cancer (23.96 out of every 

5 100,000 residents). 

6 ‘‘(B) DIABETES.—With respect to diabe7 tes, in 2000—

8 ‘‘(i) Native Hawaiians had the highest 

9 mortality rate as a result of diabetes 

10 mellitis (38.8 out of every 100,000 resi11 dents) in the State, which rate is 138 per12 cent higher than the statewide rate for all 

13 racial groups (16.3 out of every 100,000 

14 residents); and 

15 ‘‘(ii) full-blood Hawaiians had a mor16 tality as a result of diabetes mellitis of 

17 93.3 out of every 100,000 residents, which 

18 is 518 percent higher than the rate for the 

19 statewide population of all other racial 

20 groups. 

21 ‘‘(C) ASTHMA.—With respect to asthma—

22 ‘‘(i) in 1990, Native Hawaiians com23 prised 44 percent of all asthma cases in 

24 the State for those 18 years of age and 
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1 younger, and 35 percent of all asthma 

2 cases reported; and 

3 ‘‘(ii) in 1999, the Native Hawaiian 

4 prevalence rate for asthma was 129.6 out 

5 of every 1,000 residents, which was 69 per6 cent higher than the rate for all others 

7 combined in the State (76.7 out of every 

8 1,000 residents). 

9 ‘‘(D) CIRCULATORY DISEASES.—

10 ‘‘(i) HEART DISEASE.—With respect 

11 to heart disease—

12 ‘‘(I) the mortality rate for Native 

13 Hawaiians as a result of heart disease 

14 (372.3 out of every 100,000 residents) 

15 is 68 percent higher than the rate for 

16 the entire State (221.9 out of every 

17 100,000 residents); and 

18 ‘‘(II) Native Hawaiian males 

19 have the greatest years of productive 

20 life lost in the State, because Native 

21 Hawaiian males lose an average of 

22 15.5 years and Native Hawaiian fe23 males lose an average of 8.2 years as 

24 a result of heart disease, as compared
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1 with 7.5 years for all males, and 6.4 

2 years for all females, in the State. 

3 ‘‘(ii) HYPERTENSION.—With respect 

4 to hypertension—

5 ‘‘(I) the mortality rate for Native 

6 Hawaiians as a result of hypertension 

7 (3.5 out of every 100,000 residents) is 

8 84 percent higher than that for the 

9 entire State (1.9 out of every 100,000 

10 residents); 

11 ‘‘(II) Native Hawaiians have sub12 stantially higher prevalence rates of 

13 hypertension than—

14 ‘‘(aa) those observed state15 wide; and 

16 ‘‘(bb) those of any other eth17 nic group in Hawaii; and 

18 ‘‘(III) the prevalence rate of hy19 pertension for Native Hawaiians is 

20 37.9 percent, 11 percent higher than 

21 that for all others in the State (34.1 

22 percent). 

23 ‘‘(iii) STROKE.—The mortality rate 

24 for Native Hawaiians as a result of stroke 

25 (72.0 out of every 100,000 residents) is 20 
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1 percent higher than that for the entire 

2 State (60 out of every 100,000 residents). 

3 ‘‘(2) INFECTIOUS DISEASE AND ILLNESS.—

4 With respect to infectious disease and illness—

5 ‘‘(A) in 1998, Native Hawaiians comprised 

6 20 percent of all deaths resulting from infec7 tious diseases in the State for all ages; and 

8 ‘‘(B) the incidence of acquired immune de9 ficiency syndrome for Native Hawaiians is at 

10 least twice as high per 100,000 residents (10.5 

11 percent) than that for any other non-Caucasian 

12 group in the State. 

13 ‘‘(3) INJURIES.—With respect to injuries—

14 ‘‘(A) the mortality rate for Native Hawai15 ians as a result of injuries (32.0 out of every 

16 100,000 residents) is 16 percent higher than 

17 that for the entire State (27.5 out of every 

18 100,000 residents); 

19 ‘‘(B) 32 percent of all deaths of individuals 

20 between the ages of 18 and 24 years of age re21 sulting from injuries were Native Hawaiian; 

22 and 

23 ‘‘(C) the 2 primary causes of Native Ha24 waiian deaths in that age group were motor ve-
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1 hicle accidents (30 percent) and intentional self2 harm (39 percent). 

3 ‘‘(4) DENTAL HEALTH.—With respect to dental 

4 health—

5 ‘‘(A) Native Hawaiian children exhibit 

6 among the highest rates of dental caries in the 

7 United States, and the highest in the State as 

8 compared with the 5 other major ethnic groups 

9 in the State; 

10 ‘‘(B) the average number of decayed or 

11 filled primary teeth for Native Hawaiian chil12 dren aged 5 through 9 years was 4.3, as com13 pared with 3.7 for all children in the State and 

14 1.9 for all children in the United States; and 

15 ‘‘(C) the proportion of Native Hawaiian 

16 children aged 5 through 12 years with unmet 

17 dental treatment needs (defined as having ac18 tive dental caries requiring treatment) is 40 

19 percent, as compared with 33 percent for all 

20 other racial groups in the State. 

21 ‘‘(5) LIFE EXPECTANCY.—With respect to life 

22 expectancy—

23 ‘‘(A) Native Hawaiians have the lowest life 

24 expectancy of all population groups in the 

25 State; 
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1 ‘‘(B) between 1910 and 1980, the life ex2 pectancy of Native Hawaiians from birth has 

3 ranged from 5 to 10 years less than that of the 

4 overall State population average; and 

5 ‘‘(C) the most recent tables for 1990 show 

6 Native Hawaiian life expectancy at birth (74.27 

7 years) to be approximately 5 years less than 

8 that of the total State population (78.85 years). 

9 ‘‘(6) MATERNAL AND CHILD HEALTH.—

10 ‘‘(A) IN GENERAL.—With respect to ma11 ternal and child health, for 2000—

12 ‘‘(i) 39 percent of all deaths of chil13 dren under the age of 18 years in the 

14 State were Native Hawaiian; and 

15 ‘‘(ii) perinatal conditions accounted 

16 for 38 percent of all Native Hawaiian 

17 deaths in that age group. 

18 ‘‘(B) PRENATAL CARE.—With respect to 

19 prenatal care—

20 ‘‘(i) as of 1998, Native Hawaiian 

21 women have the highest prevalence (24 

22 percent) of having had no prenatal care 

23 during the first trimester of pregnancy, as 

24 compared with the 5 largest ethnic groups 

25 in the State; 
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1 ‘‘(ii) of the mothers in the State who 

2 received no prenatal care throughout their 

3 pregnancies in 1996, 44 percent were Na4 tive Hawaiian; 

5 ‘‘(iii) more than 65 percent of the re6 ferrals to Healthy Start in fiscal years 

7 1996 and 1997 were Native Hawaiian 

8 newborns; and 

9 ‘‘(iv) in every region of the State, 

10 many Native Hawaiian newborns begin life 

11 in a potentially hazardous circumstance, 

12 far higher than any other racial group. 

13 ‘‘(C) BIRTHS.—With respect to births—

14 ‘‘(i) in 1996, 45 percent of the live 

15 births to Native Hawaiian mothers were 

16 infants born to single mothers, a cir17 cumstance which statistics indicate puts in18 fants at higher risk of low birth weight and 

19 infant mortality; 

20 ‘‘(ii) in 1996, of the births to Native 

21 Hawaiian single mothers, 8 percent were 

22 low birth weight (defined as a weight of 

23 less than 2,500 grams); and
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1 ‘‘(iii) of all low birth weight infants 

2 born to single mothers in the State, 44 

3 percent were Native Hawaiian. 

4 ‘‘(D) TEEN PREGNANCIES.—With respect 

5 to births—

6 ‘‘(i) in 1993 and 1994, Native Hawai7 ians had the highest percentage of teen 

8 (individuals who were less than 18 years of 

9 age) births (8.1 percent), as compared with 

10 the rate for all other racial groups in the 

11 State (3.6 percent); 

12 ‘‘(ii) in 1998, nearly 49 percent of all 

13 mothers in the State under 19 years of age 

14 were Native Hawaiian; 

15 ‘‘(iii) in 1998, Native Hawaiians com16 prised 31 percent (1,425) of all live births 

17 to mothers with medical risk factors in the 

18 State (4,559); and 

19 ‘‘(iv) lower rates of abortion (approxi20 mately 33 percent lower than for the state21 wide population) among Hawaiian women 

22 may account, in part, for that higher per23 centage of live births. 

24 ‘‘(E) FETAL MORTALITY.—With respect to 

25 fetal mortality—
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1 ‘‘(i) in 2000, Native Hawaiians had 

2 the highest number of fetal deaths in the 

3 State; and 

4 ‘‘(ii)(I) 21 percent all fetal deaths in 

5 the State were associated with expectant 

6 Native Hawaiian mothers; and 

7 ‘‘(II) 37 percent of those Native Ha8 waiian mothers were under the age of 25 

9 years. 

10 ‘‘(7) MENTAL HEALTH.—

11 ‘‘(A) ALCOHOL AND DRUG ABUSE.—With 

12 respect to alcohol and drug abuse—

13 ‘‘(i) Native Hawaiians represent 38 

14 percent of the total admissions to sub15 stance abuse treatment programs funded 

16 by the Department of Health, Alcohol, 

17 Drugs and Other Drugs of the State; 

18 ‘‘(ii) in 2000, the prevalence of ciga19 rette smoking by Native Hawaiians was 

20 31.0 percent, a rate that is 57 percent 

21 higher than that for the total population in 

22 the State, which is 19.7 percent; 

23 ‘‘(iii) Native Hawaiians have the high24 est prevalence rate of acute alcohol drink25 ing (19.6 percent), a rate that is 40 per-
28

•HR 2597 IH 

1 cent higher than that for the total popu2 lation in the State; 

3 ‘‘(iv) the chronic alcohol drinking rate 

4 among Native Hawaiians is 54 percent 

5 higher than that for all other racial groups 

6 in the State; 

7 ‘‘(v) in 1991, 40 percent of Native 

8 Hawaiian adults surveyed reported having 

9 used marijuana, as compared with 30 per10 cent for all other racial groups in the 

11 State; and 

12 ‘‘(vi) 9 percent of the Native Hawai13 ian adults surveyed reported that they use 

14 or have used marijuana within the year 

15 preceding the survey, as compared with 6 

16 percent for all other racial groups in the 

17 State. 

18 ‘‘(B) CRIME.—With respect to crime—

19 ‘‘(i) in 1998, of the 7,789 arrests that 

20 were made for property crimes in the 

21 State, arrests of Native Hawaiians com22 prised 23 percent; 

23 ‘‘(ii) Native Hawaiians comprised 40 

24 percent of juvenile arrests in 1998, the 
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•HR 2597 IH 

1 largest percentage of all juvenile arrests in 

2 that year; 

3 ‘‘(iii) in the period of 1996 through 

4 1998, the overrepresentation of Native Ha5 waiian juvenile arrests for index crimes 

6 and Part II offenses increased by 6 per7 cent and 2 percent, respectively; 

8 ‘‘(iv) in 1998, Native Hawaiians rep9 resented 22 percent of the 2,423 adults ar10 rested for drug-related offenses in the 

11 State; 

12 ‘‘(v) Native Hawaiians are overrepre13 sented in the prison population in the 

14 State; 

15 ‘‘(vi) of the 2,260 incarcerated Native 

16 Hawaiians, 70 percent are between 20 and 

17 40 years of age; 

18 ‘‘(vii) in 1995 and 1996, Native Ha19 waiians comprised 36.5 percent of the sen20 tenced felon prison population in Hawaii, 

21 as compared with 20.5 percent for Cauca22 sian Americans, 3.7 percent for Japanese 

23 Americans, and 6 percent for Chinese 

24 Americans; 
30

•HR 2597 IH 

1 ‘‘(viii) in 2002, Native Hawaiians 

2 comprised 40 percent of the total sen3 tenced felon population in the State, as 

4 compared with 25 percent for Caucasian 

5 Americans, 12 percent for Filipino Ameri6 cans, 6 percent for Japanese Americans, 

7 and 5 percent for Samoans; and 

8 ‘‘(ix) based on anecdotal information 

9 from inmates at the Halawa Correction 

10 Facilities, Native Hawaiians are estimated 

11 to comprise between 60 and 70 percent of 

12 all inmates in the State. 

13 ‘‘(8) OBESITY.—Native Hawaiians have the 

14 highest prevalence rate of overweightness and obe15 sity (69.4 percent), a rate that is 38 percent higher 

16 than that for the total State population (50.2 per17 cent). 

18 ‘‘(9) HEALTH PROFESSIONS EDUCATION AND

19 TRAINING.—With respect to health professions edu20 cation and training—

21 ‘‘(A)(i) Native Hawaiians who are at least 

22 25 years of age have a comparable rate of high 

23 school completion as compared with all people 

24 in the State who are at least 25 years of age; 

25 but
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•HR 2597 IH 

1 ‘‘(ii) the rate of baccalaureate degree 

2 achievement among Native Hawaiians is 6.9 

3 percent, which is less than the average in the 

4 State (15.76 percent); 

5 ‘‘(B) Native Hawaiian physicians make up 

6 4 percent of the total physician workforce in the 

7 State; and 

8 ‘‘(C)(i) in fiscal year 1999, Native Hawai9 ians comprised—

10 ‘‘(I) 9 percent of those individuals 

11 who earned Bachelor’s degrees; 

12 ‘‘(II) 15 percent of those individuals 

13 who earned 2-year diplomas; and 

14 ‘‘(III) 6 percent of those individuals 

15 who earned Master’s degrees; and 

16 ‘‘(ii) in 1997, Native Hawaiians comprised 

17 less than 1 percent of individuals who earned 

18 doctoral degrees at the University of Hawaii. 

19 ‘‘SEC. 3. DEFINITIONS. 

20 ‘‘In this Act: 

21 ‘‘(1) DEPARTMENT.—The term ‘Department’ 

22 means the Department of Health and Human Serv23 ices. 

24 ‘‘(2) DISEASE PREVENTION.—The term ‘disease 

25 prevention’ includes—
32

•HR 2597 IH 

1 ‘‘(A) immunizations; 

2 ‘‘(B) control of high blood pressure; 

3 ‘‘(C) control of sexually transmittable dis4 eases; 

5 ‘‘(D) prevention and control of chronic dis6 eases; 

7 ‘‘(E) control of toxic agents; 

8 ‘‘(F) occupational safety and health; 

9 ‘‘(G) injury prevention; 

10 ‘‘(H) fluoridation of water; 

11 ‘‘(I) control of infectious agents; and 

12 ‘‘(J) provision of mental health care. 

13 ‘‘(3) HEALTH PROMOTION.—The term ‘health 

14 promotion’ includes—

15 ‘‘(A) pregnancy and infant care, including 

16 prevention of fetal alcohol syndrome; 

17 ‘‘(B) cessation of tobacco smoking; 

18 ‘‘(C) reduction in the misuse of alcohol and 

19 harmful illicit drugs; 

20 ‘‘(D) improvement of nutrition; 

21 ‘‘(E) improvement in physical fitness; 

22 ‘‘(F) family planning; 

23 ‘‘(G) control of stress; 
33

•HR 2597 IH 

1 ‘‘(H) reduction of major behavioral risk 

2 factors and promotion of healthy lifestyle prac3 tices; and 

4 ‘‘(I) integration of cultural approaches to 

5 health and well-being (including traditional 

6 practices relating to the atmosphere (lewa lani), 

7 land (‘aina), water (wai), and ocean (kai)). 

8 ‘‘(4) HEALTH SERVICE.—The term ‘health serv9 ice’ means—

10 ‘‘(A) service provided by a physician, phy11 sician’s assistant, nurse practitioner, nurse, 

12 dentist, or other health professional; 

13 ‘‘(B) a diagnostic laboratory or radiologic 

14 service; 

15 ‘‘(C) a preventive health service (including 

16 a perinatal service, well child service, family 

17 planning service, nutrition service, home health 

18 service, sports medicine and athletic training 

19 service, and, generally, any service associated 

20 with enhanced health and wellness); 

21 ‘‘(D) emergency medical service, including 

22 a service provided by a first responder, emer23 gency medical technician, or mobile intensive 

24 care technician; 
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•HR 2597 IH 

1 ‘‘(E) a transportation service required for 

2 adequate patient care; 

3 ‘‘(F) a preventive dental service; 

4 ‘‘(G) a pharmaceutical and medical service; 

5 ‘‘(H) a mental health service, including a 

6 service provided by a psychologist or social 

7 worker; 

8 ‘‘(I) a genetic counseling service; 

9 ‘‘(J) a health administration service, in10 cluding a service provided by a health program 

11 administrator; 

12 ‘‘(K) a health research service, including a 

13 service provided by an individual with an ad14 vanced degree in medicine, nursing, psychology, 

15 social work, or any other related health pro16 gram; 

17 ‘‘(L) an environmental health service, in18 cluding a service provided by an epidemiologist, 

19 public health official, medical geographer, or 

20 medical anthropologist, or an individual special21 izing in biological, chemical, or environmental 

22 health determinants; 

23 ‘‘(M) a primary care service that may lead 

24 to specialty or tertiary care; and 
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•HR 2597 IH 

1 ‘‘(N) a complimentary healing practice, in2 cluding a practice performed by a traditional 

3 Native Hawaiian healer. 

4 ‘‘(5) NATIVE HAWAIIAN.—The term ‘Native 

5 Hawaiian’ means any individual who is Kanaka 

6 Maoli (a descendant of the aboriginal people who, 

7 prior to 1778, occupied and exercised sovereignty in 

8 the area that now constitutes the State), as evi9 denced by—

10 ‘‘(A) genealogical records; 

11 ‘‘(B) kama‘aina witness verification from 

12 Native Hawaiian Kupuna (elders); or 

13 ‘‘(C) birth records of the State or any 

14 other State or territory of the United States. 

15 ‘‘(6) NATIVE HAWAIIAN HEALTH CARE SYS16 TEM.—The term ‘Native Hawaiian health care sys17 tem’ means any of up to 8 entities in the State 

18 that—

19 ‘‘(A) is organized under the laws of the 

20 State; 

21 ‘‘(B) provides or arranges for the provision 

22 of health services for Native Hawaiians in the 

23 State; 

24 ‘‘(C) is a public or nonprofit private entity;
36

•HR 2597 IH 

1 ‘‘(D) has Native Hawaiians significantly 

2 participating in the planning, management, pro3 vision, monitoring, and evaluation of health 

4 services; 

5 ‘‘(E) addresses the health care needs of an 

6 island’s Native Hawaiian population; and 

7 ‘‘(F) is recognized by Papa Ola Lokahi—

8 ‘‘(i) for the purpose of planning, con9 ducting, or administering programs, or 

10 portions of programs, authorized by this 

11 Act for the benefit of Native Hawaiians; 

12 and 

13 ‘‘(ii) as having the qualifications and 

14 the capacity to provide the services and 

15 meet the requirements under—

16 ‘‘(I) the contract that each Na17 tive Hawaiian health care system en18 ters into with the Secretary under this 

19 Act; and 

20 ‘‘(II) the grant each Native Ha21 waiian health care system receives 

22 from the Secretary under this Act. 

23 ‘‘(7) NATIVE HAWAIIAN HEALTH CENTER.—The 

24 term ‘Native Hawaiian Health Center’ means any 
37

•HR 2597 IH 

1 organization that is a primary health care provider 

2 that—

3 ‘‘(A) has a governing board composed of 

4 individuals, at least 50 percent of whom are 

5 Native Hawaiians; 

6 ‘‘(B) has demonstrated cultural com7 petency in a predominantly Native Hawaiian 

8 community; 

9 ‘‘(C) serves a patient population that—

10 ‘‘(i) is made up of individuals at least 

11 50 percent of whom are Native Hawaiian; 

12 or 

13 ‘‘(ii) has not less than 2,500 Native 

14 Hawaiians as annual users of services; and 

15 ‘‘(D) is recognized by Papa Ola Lokahi as 

16 having met each of the criteria described in 

17 subparagraphs (A) through (C). 

18 ‘‘(8) NATIVE HAWAIIAN HEALTH TASK

19 FORCE.—The term ‘Native Hawaiian Health Task 

20 Force’ means a task force established by the State 

21 Council of Hawaiian Homestead Associations to im22 plement health and wellness strategies in Native Ha23 waiian communities. 
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•HR 2597 IH 

1 ‘‘(9) NATIVE HAWAIIAN ORGANIZATION.—The 

2 term ‘Native Hawaiian organization’ means any or3 ganization that—

4 ‘‘(A) serves the interests of Native Hawai5 ians; and 

6 ‘‘(B)(i) is recognized by Papa Ola Lokahi 

7 for planning, conducting, or administering pro8 grams authorized under this Act for the benefit 

9 of Native Hawaiians; and 

10 ‘‘(ii) is a public or nonprofit private entity. 

11 ‘‘(10) OFFICE OF HAWAIIAN AFFAIRS.—The 

12 term ‘Office of Hawaiian Affairs’ means the govern13 mental entity that—

14 ‘‘(A) is established under article XII, sec15 tions 5 and 6, of the Hawaii State Constitution; 

16 and 

17 ‘‘(B) charged with the responsibility to for18 mulate policy relating to the affairs of Native 

19 Hawaiians. 

20 ‘‘(11) PAPA OLA LOKAHI.—

21 ‘‘(A) IN GENERAL.—The term ‘Papa Ola 

22 Lokahi’ means an organization that—

23 ‘‘(i) is composed of public agencies 

24 and private organizations focusing on im-
39

•HR 2597 IH 

1 proving the health status of Native Hawai2 ians; and 

3 ‘‘(ii) governed by a board the mem4 bers of which may include representation 

5 from—

6 ‘‘(I) E Ola Mau; 

7 ‘‘(II) the Office of Hawaiian Af8 fairs; 

9 ‘‘(III) Alu Like, Inc.; 

10 ‘‘(IV) the University of Hawaii; 

11 ‘‘(V) the Hawaii State Depart12 ment of Health; 

13 ‘‘(VI) the Native Hawaiian 

14 Health Task Force; 

15 ‘‘(VII) the Hawaii State Primary 

16 Care Association; 

17 ‘‘(VIII) Ahahui O Na Kauka, the 

18 Native Hawaiian Physicians Associa19 tion; 

20 ‘‘(IX) Ho‘ola Lahui Hawaii, or a 

21 health care system serving the islands 

22 of Kaua‘i or Ni‘ihau (which may be 

23 composed of as many health care cen24 ters as are necessary to meet the 
40

•HR 2597 IH 

1 health care needs of the Native Ha2 waiians of those islands); 

3 ‘‘(X) Ke Ola Mamo, or a health 

4 care system serving the island of 

5 O‘ahu (which may be composed of as 

6 many health care centers as are nec7 essary to meet the health care needs 

8 of the Native Hawaiians of that is9 land); 

10 ‘‘(XI) Na Pu‘uwai or a health 

11 care system serving the islands of 

12 Moloka‘i or Lana‘i (which may be 

13 composed of as many health care cen14 ters as are necessary to meet the 

15 health care needs of the Native Ha16 waiians of those islands); 

17 ‘‘(XII) Hui No Ke Ola Pono, or 

18 a health care system serving the is19 land of Maui (which may be composed 

20 of as many health care centers as are 

21 necessary to meet the health care 

22 needs of the Native Hawaiians of that 

23 island); 

24 ‘‘(XIII) Hui Malama Ola Na 

25 ‘Oiwi, or a health care system serving
41

•HR 2597 IH 

1 the island of Hawaii (which may be 

2 composed of as many health care cen3 ters as are necessary to meet the 

4 health care needs of the Native Ha5 waiians of that island); 

6 ‘‘(XIV) such other Native Hawai7 ian health care systems as are cer8 tified and recognized by Papa Ola 

9 Lokahi in accordance with this Act; 

10 and 

11 ‘‘(XV) such other member orga12 nizations as the Board of Papa Ola 

13 Lokahi shall admit from time to time, 

14 based on satisfactory demonstration of 

15 a record of contribution to the health 

16 and well-being of Native Hawaiians. 

17 ‘‘(B) EXCLUSION.—The term ‘Papa Ola 

18 Lokahi’ does not include any organization de19 scribed in subparagraph (A) for which the Sec20 retary has made a determination that the orga21 nization has not developed a mission statement 

22 that includes—

23 ‘‘(i) clearly-defined goals and objec24 tives for the contributions the organization 

25 will make to—
42

•HR 2597 IH 

1 ‘‘(I) Native Hawaiian health care 

2 systems; and 

3 ‘‘(II) the national policy de4 scribed in section 4; and 

5 ‘‘(ii) an action plan for carrying out 

6 those goals and objectives. 

7 ‘‘(12) SECRETARY.—The term ‘Secretary’ 

8 means the Secretary of Health and Human Services. 

9 ‘‘(13) STATE.—The term ‘State’ means the 

10 State of Hawaii. 

11 ‘‘(14) TRADITIONAL NATIVE HAWAIIAN HEAL12 ER.—The term ‘traditional Native Hawaiian healer’ 

13 means a practitioner—

14 ‘‘(A) who—

15 ‘‘(i) is of Native Hawaiian ancestry; 

16 and 

17 ‘‘(ii) has the knowledge, skills, and ex18 perience in direct personal health care of 

19 individuals; and 

20 ‘‘(B) the knowledge, skills, and experience 

21 of whom are based on demonstrated learning of 

22 Native Hawaiian healing practices acquired 

23 by—

24 ‘‘(i) direct practical association with 

25 Native Hawaiian elders; and 
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•HR 2597 IH 

1 ‘‘(ii) oral traditions transmitted from 

2 generation to generation. 

3 ‘‘SEC. 4. DECLARATION OF NATIONAL NATIVE HAWAIIAN 

4 HEALTH POLICY. 

5 ‘‘(a) DECLARATION.—Congress declares that it is the 

6 policy of the United States, in fulfillment of special re7 sponsibilities and legal obligations of the United States to 

8 the indigenous people of Hawaii resulting from the unique 

9 and historical relationship between the United States and 

10 the indigenous people of Hawaii—

11 ‘‘(1) to raise the health status of Native Hawai12 ians to the highest practicable health level; and 

13 ‘‘(2) to provide Native Hawaiian health care 

14 programs with all resources necessary to effectuate 

15 that policy. 

16 ‘‘(b) INTENT OF CONGRESS.—It is the intent of Con17 gress that—

18 ‘‘(1) health care programs having a dem19 onstrated effect of substantially reducing or elimi20 nating the overrepresentation of Native Hawaiians 

21 among those suffering from chronic and acute dis22 ease and illness, and addressing the health needs of 

23 Native Hawaiians (including perinatal, early child 

24 development, and family-based health education 

25 needs), shall be established and implemented; and 
44

•HR 2597 IH 

1 ‘‘(2) the United States—

2 ‘‘(A) raise the health status of Native Ha3 waiians by the year 2010 to at least the levels 

4 described in the goals contained within Healthy 

5 People 2010 (or successor standards); and 

6 ‘‘(B) incorporate within health programs in 

7 the United States activities defined and identi8 fied by Kanaka Maoli, such as—

9 ‘‘(i) incorporating and supporting the 

10 integration of cultural approaches to health 

11 and well-being, including programs using 

12 traditional practices relating to the atmos13 phere (lewa lani), land (’aina), water (wai), 

14 or ocean (kai); 

15 ‘‘(ii) increasing the number of Native 

16 Hawaiian health and allied-health pro17 viders who provide care to or have an im18 pact on the health status of Native Hawai19 ians; 

20 ‘‘(iii) increasing the use of traditional 

21 Native Hawaiian foods in—

22 ‘‘(I) the diets and dietary pref23 erences of people, including those of 

24 students; and 

25 ‘‘(II) school feeding programs; 
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•HR 2597 IH 

1 ‘‘(iv) identifying and instituting Na2 tive Hawaiian cultural values and practices 

3 within the corporate cultures of organiza4 tions and agencies providing health serv5 ices to Native Hawaiians; 

6 ‘‘(v) facilitating the provision of Na7 tive Hawaiian healing practices by Native 

8 Hawaiian healers for individuals desiring 

9 that assistance; 

10 ‘‘(vi) supporting training and edu11 cation activities and programs in tradi12 tional Native Hawaiian healing practices 

13 by Native Hawaiian healers; and 

14 ‘‘(vii) demonstrating the integration of 

15 health services for Native Hawaiians, par16 ticularly those that integrate mental, phys17 ical, and dental services in health care. 

18 ‘‘(c) REPORT.—The Secretary shall submit to the 

19 President, for inclusion in each report required to be sub20 mitted to Congress under section 12, a report on the 

21 progress made toward meeting the national policy de22 scribed in this section. 

23 ‘‘SEC. 5. COMPREHENSIVE HEALTH CARE MASTER PLAN 

24 FOR NATIVE HAWAIIANS. 

25 ‘‘(a) DEVELOPMENT.—
46

•HR 2597 IH 

1 ‘‘(1) IN GENERAL.—The Secretary may make a 

2 grant to, or enter into a contract with, Papa Ola 

3 Lokahi for the purpose of coordinating, imple4 menting, and updating a Native Hawaiian com5 prehensive health care master plan that is de6 signed—

7 ‘‘(A) to promote comprehensive health pro8 motion and disease prevention services; 

9 ‘‘(B) to maintain and improve the health 

10 status of Native Hawaiians; and 

11 ‘‘(C) to support community-based initia12 tives that are reflective of holistic approaches to 

13 health. 

14 ‘‘(2) CONSULTATION.—

15 ‘‘(A) IN GENERAL.—In carrying out this 

16 section, Papa Ola Lokahi and the Office of Ha17 waiian Affairs shall consult with representatives 

18 of—

19 ‘‘(i) the Native Hawaiian health care 

20 systems; 

21 ‘‘(ii) the Native Hawaiian health cen22 ters; and 

23 ‘‘(iii) the Native Hawaiian commu24 nity. 
47

•HR 2597 IH 

1 ‘‘(B) MEMORANDA OF UNDERSTANDING.—

2 Papa Ola Lokahi and the Office of Hawaiian 

3 Affairs may enter into memoranda of under4 standing or agreement for the purpose of ac5 quiring joint funding, or for such other pur6 poses as are necessary, to accomplish the objec7 tives of this section. 

8 ‘‘(3) HEALTH CARE FINANCING STUDY RE9 PORT.—

10 ‘‘(A) IN GENERAL.—Not later than 18 

11 months after the date of enactment of the Na12 tive Hawaiian Health Care Improvement Reau13 thorization Act of 2003, Papa Ola Lokahi, in 

14 cooperation with the Office of Hawaiian Affairs 

15 and other appropriate agencies and organiza16 tions in the State (including the Department of 

17 Health and the Department of Human Services 

18 of the State) and appropriate Federal agencies 

19 (including the Centers for Medicare and Med20 icaid Services), shall submit to Congress a re21 port that describes the impact of Federal and 

22 State health care financing mechanisms and 

23 policies on the health and well-being of Native 

24 Hawaiians. 
48

•HR 2597 IH 

1 ‘‘(B) COMPONENTS.—The report shall in2 clude—

3 ‘‘(i) information concerning the im4 pact on Native Hawaiian health and well5 being of—

6 ‘‘(I) cultural competency; 

7 ‘‘(II) risk assessment data; 

8 ‘‘(III) eligibility requirements 

9 and exemptions; and 

10 ‘‘(IV) reimbursement policies and 

11 capitation rates in effect as of the 

12 date of the report for service pro13 viders; 

14 ‘‘(ii) such other similar information as 

15 may be important to improving the health 

16 status of Native Hawaiians, as that infor17 mation relates to health care financing (in18 cluding barriers to health care); and 

19 ‘‘(iii) recommendations for submission 

20 to the Secretary, for review in consultation 

21 with the Native Hawaiian community. 

22 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There 

23 are authorized to be appropriated such sums as are nec24 essary to carry out subsection (a). 
49

•HR 2597 IH 

1 ‘‘SEC. 6. FUNCTIONS OF PAPA OLA LOKAHI AND OFFICE OF 

2 HAWAIIAN AFFAIRS. 

3 ‘‘(a) IN GENERAL.—Papa Ola Lokahi—

4 ‘‘(1) shall be responsible for—

5 ‘‘(A) the coordination, implementation, and 

6 updating, as appropriate, of the comprehensive 

7 health care master plan under section 5; 

8 ‘‘(B) the training and education of individ9 uals providing health services; 

10 ‘‘(C) the identification of and research (in11 cluding behavioral, biomedical, epidemiological, 

12 and health service research) into the diseases 

13 that are most prevalent among Native Hawai14 ians; and 

15 ‘‘(D) the development and maintenance of 

16 an institutional review board for all research 

17 projects involving all aspects of Native Hawai18 ian health, including behavioral, biomedical, epi19 demiological, and health service research; 

20 ‘‘(2) may receive special project funds (includ21 ing research endowments under section 736 of the 

22 Public Health Service Act (42 U.S.C. 293)) made 

23 available for the purpose of—

24 ‘‘(A) research on the health status of Na25 tive Hawaiians; or 
50

•HR 2597 IH 

1 ‘‘(B) addressing the health care needs of 

2 Native Hawaiians; and 

3 ‘‘(3) shall serve as a clearinghouse for—

4 ‘‘(A) the collection and maintenance of 

5 data associated with the health status of Native 

6 Hawaiians; 

7 ‘‘(B) the identification and research into 

8 diseases affecting Native Hawaiians; 

9 ‘‘(C) the availability of Native Hawaiian 

10 project funds, research projects, and publica11 tions; 

12 ‘‘(D) the collaboration of research in the 

13 area of Native Hawaiian health; and 

14 ‘‘(E) the timely dissemination of informa15 tion pertinent to the Native Hawaiian health 

16 care systems. 

17 ‘‘(b) CONSULTATION.—

18 ‘‘(1) IN GENERAL.—The Secretary and the Sec19 retary of each other Federal agency shall—

20 ‘‘(A) consult with Papa Ola Lokahi; and 

21 ‘‘(B) provide Papa Ola Lokahi and the Of22 fice of Hawaiian Affairs, at least once annually, 

23 an accounting of funds and services provided by 

24 the Secretary to assist in accomplishing the 

25 purposes described in section 4.
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•HR 2597 IH 

1 ‘‘(2) COMPONENTS OF ACCOUNTING.—The ac2 counting under paragraph (1)(B) shall include an 

3 identification of—

4 ‘‘(A) the amount of funds expended explic5 itly for and benefiting Native Hawaiians; 

6 ‘‘(B) the number of Native Hawaiians af7 fected by those funds; 

8 ‘‘(C) the collaborations between the appli9 cable Federal agency and Native Hawaiian 

10 groups and organizations in the expenditure of 

11 those funds; and 

12 ‘‘(D) the amount of funds used for—

13 ‘‘(i) Federal administrative purposes; 

14 and 

15 ‘‘(ii) the provision of direct services to 

16 Native Hawaiians. 

17 ‘‘(c) FISCAL ALLOCATION AND COORDINATION OF

18 PROGRAMS AND SERVICES.—

19 ‘‘(1) RECOMMENDATIONS.—Papa Ola Lokahi 

20 shall provide annual recommendations to the Sec21 retary with respect to the allocation of all amounts 

22 made available under this Act. 

23 ‘‘(2) COORDINATION.—Papa Ola Lokahi shall, 

24 to the maximum extent practicable, coordinate and 

25 assist the health care programs and services pro-
52

•HR 2597 IH 

1 vided to Native Hawaiians under this Act and other 

2 Federal laws. 

3 ‘‘(3) REPRESENTATION ON COMMISSION.—The 

4 Secretary, in consultation with Papa Ola Lokahi, 

5 shall make recommendations for Native Hawaiian 

6 representation on the President’s Advisory Commis7 sion on Asian Americans and Pacific Islanders. 

8 ‘‘(d) TECHNICAL SUPPORT.—Papa Ola Lokahi pro9 vide statewide infrastructure to provide technical support 

10 and coordination of training and technical assistance to—

11 ‘‘(1) the Native Hawaiian health care systems; 

12 and 

13 ‘‘(2) the Native Hawaiian health centers. 

14 ‘‘(e) RELATIONSHIPS WITH OTHER AGENCIES.—

15 ‘‘(1) AUTHORITY.—Papa Ola Lokahi may enter 

16 into agreements or memoranda of understanding 

17 with relevant institutions, agencies, or organizations 

18 that are capable of providing—

19 ‘‘(A) health-related resources or services to 

20 Native Hawaiians and the Native Hawaiian 

21 health care systems; or 

22 ‘‘(B) resources or services for the imple23 mentation of the national policy described in 

24 section 4. 

25 ‘‘(2) HEALTH CARE FINANCING.—
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•HR 2597 IH 

1 ‘‘(A) FEDERAL CONSULTATION.—

2 ‘‘(i) IN GENERAL.—Before adopting 

3 any policy, rule, or regulation that may af4 fect the provision of services or health in5 surance coverage for Native Hawaiians, a 

6 Federal agency that provides health care 

7 financing and carries out health care pro8 grams (including the Centers for Medicare 

9 and Medicaid Services) shall consult with 

10 representatives of—

11 ‘‘(I) the Native Hawaiian com12 munity; 

13 ‘‘(II) Papa Ola Lokahi; and 

14 ‘‘(III) organizations providing 

15 health care services to Native Hawai16 ians in the State. 

17 ‘‘(ii) IDENTIFICATION OF EFFECTS.—

18 Any consultation by a Federal agency 

19 under clause (i) shall include an identifica20 tion of the effect of any policy, rule, or 

21 regulation proposed by the Federal agency. 

22 ‘‘(B) STATE CONSULTATION.—Before mak23 ing any change in an existing program or im24 plementing any new program relating to Native 

25 Hawaiian health, the State shall engage in 
54

•HR 2597 IH 

1 meaningful consultation with representatives 

2 of—

3 ‘‘(i) the Native Hawaiian community; 

4 ‘‘(ii) Papa Ola Lokahi; and 

5 ‘‘(iii) organizations providing health 

6 care services to Native Hawaiians in the 

7 State. 

8 ‘‘(C) CONSULTATION ON FEDERAL

9 HEALTH INSURANCE PROGRAMS.—

10 ‘‘(i) IN GENERAL.—The Office of Ha11 waiian Affairs, in collaboration with Papa 

12 Ola Lokahi, may develop consultative, con13 tractual, or other arrangements, including 

14 memoranda of understanding or agree15 ment, with—

16 ‘‘(I) the Centers for Medicare 

17 and Medicaid Services; 

18 ‘‘(II) the agency of the State that 

19 administers or supervises the adminis20 tration of the State plan or waiver ap21 proved under title XVIII, XIX, or 

22 XXI of the Social Security Act (42 

23 U.S.C. 1395 et seq.) for the payment 

24 of all or a part of the health care 

25 services provided to Native Hawaiians 
55

•HR 2597 IH 

1 who are eligible for medical assistance 

2 under the State plan or waiver; or 

3 ‘‘(III) any other Federal agency 

4 providing full or partial health insur5 ance to Native Hawaiians. 

6 ‘‘(ii) CONTENTS OF ARRANGE7 MENTS.—An arrangement under clause (i) 

8 may address—

9 ‘‘(I) appropriate reimbursement 

10 for health care services, including 

11 capitation rates and fee-for-service 

12 rates for Native Hawaiians who are 

13 entitled to or eligible for insurance; 

14 ‘‘(II) the scope of services; or 

15 ‘‘(III) other matters that would 

16 enable Native Hawaiians to maximize 

17 health insurance benefits provided by 

18 Federal and State health insurance 

19 programs. 

20 ‘‘(3) TRADITIONAL HEALERS.—

21 ‘‘(A) IN GENERAL.—The provision of 

22 health services under any program operated by 

23 the Department or another Federal agency (in24 cluding the Department of Veterans Affairs) 

25 may include the services of—
56

•HR 2597 IH 

1 ‘‘(i) traditional Native Hawaiian heal2 ers; or 

3 ‘‘(ii) traditional healers providing tra4 ditional health care practices (as those 

5 terms are defined in section 4 of the In6 dian Health Care Improvement Act (25 

7 U.S.C. 1603). 

8 ‘‘(B) EXEMPTION.—Services described in 

9 subparagraph (A) shall be exempt from national 

10 accreditation reviews, including reviews con11 ducted by—

12 ‘‘(i) the Joint Accreditation Commis13 sion on Health Organizations; and 

14 ‘‘(ii) the Rehabilitation Accreditation 

15 Commission. 

16 ‘‘SEC. 7. NATIVE HAWAIIAN HEALTH CARE. 

17 ‘‘(a) COMPREHENSIVE HEALTH PROMOTION, DIS18 EASE PREVENTION, AND OTHER HEALTH SERVICES.—

19 ‘‘(1) GRANTS AND CONTRACTS.—The Secretary, 

20 in consultation with Papa Ola Lokahi, may make 

21 grants to, or enter into contracts with 1 or more Na22 tive Hawaiian health care systems for the purpose of 

23 providing comprehensive health promotion and dis24 ease prevention services, as well as other health serv-
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1 ices, to Native Hawaiians who desire and are com2 mitted to bettering their own health. 

3 ‘‘(2) LIMITATION ON NUMBER OF ENTITIES.—

4 The Secretary may make a grant to, or enter into 

5 a contract with, not more than 8 Native Hawaiian 

6 health care systems under this subsection for any 

7 fiscal year. 

8 ‘‘(b) PLANNING GRANT OR CONTRACT.—In addition 

9 to grants and contracts under subsection (a), the Sec10 retary may make a grant to, or enter into a contract with, 

11 Papa Ola Lokahi for the purpose of planning Native Ha12 waiian health care systems to serve the health needs of 

13 Native Hawaiian communities on each of the islands of 

14 O‘ahu, Moloka‘i, Maui, Hawai‘i, Lana‘i, Kaua‘i, 

15 Kaho‘lawe, and Ni‘ihau in the State. 

16 ‘‘(c) HEALTH SERVICES TO BE PROVIDED.—

17 ‘‘(1) IN GENERAL.—Each recipient of funds 

18 under subsection (a) may provide or arrange for—

19 ‘‘(A) outreach services to inform and assist 

20 Native Hawaiians in accessing health services; 

21 ‘‘(B) education in health promotion and 

22 disease prevention for Native Hawaiians that, 

23 wherever practicable, is provided by—

24 ‘‘(i) Native Hawaiian health care 

25 practitioners; 
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1 ‘‘(ii) community outreach workers; 

2 ‘‘(iii) counselors; 

3 ‘‘(iv) cultural educators; and 

4 ‘‘(v) other disease prevention pro5 viders; 

6 ‘‘(C) services of individuals providing 

7 health services; 

8 ‘‘(D) collection of data relating to the pre9 vention of diseases and illnesses among Native 

10 Hawaiians; and 

11 ‘‘(E) support of culturally appropriate ac12 tivities that enhance health and wellness, in13 cluding land-based, water-based, ocean-based, 

14 and spiritually-based projects and programs. 

15 ‘‘(2) TRADITIONAL HEALERS.—The health care 

16 services referred to in paragraph (1) that are pro17 vided under grants or contracts under subsection (a) 

18 may be provided by traditional Native Hawaiian 

19 healers, as appropriate. 

20 ‘‘(d) FEDERAL TORT CLAIMS ACT.—An individual 

21 who provides a medical, dental, or other service referred 

22 to in subsection (a)(1) for a Native Hawaiian health care 

23 system, including a provider of a traditional Native Ha24 waiian healing service, shall be—
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1 ‘‘(1) treated as if the individual were a member 

2 of the Public Health Service; and 

3 ‘‘(2) subject to section 224 of the Public Health 

4 Service Act (42 U.S.C. 233). 

5 ‘‘(e) SITE FOR OTHER FEDERAL PAYMENTS.—

6 ‘‘(1) IN GENERAL.—A Native Hawaiian health 

7 care system that receives funds under subsection (a) 

8 may serve as a Federal loan repayment facility. 

9 ‘‘(2) REMISSION OF PAYMENTS.—A facility de10 scribed in paragraph (1) shall be designed to enable 

11 health and allied-health professionals to remit pay12 ments with respect to loans provided to the profes13 sionals under any Federal loan program. 

14 ‘‘(f) RESTRICTION ON USE OF GRANT AND CON15 TRACT FUNDS.—The Secretary shall not make a grant to, 

16 or enter into a contract with, an entity under subsection 

17 (a) unless the entity agrees that amounts received under 

18 the grant or contract will not, directly or through contract, 

19 be expended—

20 ‘‘(1) for any service other than a service de21 scribed in subsection (c)(1); 

22 ‘‘(2) to purchase or improve real property 

23 (other than minor remodeling of existing improve24 ments to real property); or 

25 ‘‘(3) to purchase major medical equipment. 
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1 ‘‘(g) LIMITATION ON CHARGES FOR SERVICES.—The 

2 Secretary shall not make a grant to, or enter into a con3 tract with, an entity under subsection (a) unless the entity 

4 agrees that, whether health services are provided directly 

5 or under a contract—

6 ‘‘(1) any health service under the grant or con7 tract will be provided without regard to the ability 

8 of an individual receiving the health service to pay 

9 for the health service; and 

10 ‘‘(2) the entity will impose for the delivery of 

11 such a health service a charge that is—

12 ‘‘(A) made according to a schedule of 

13 charges that is made available to the public; 

14 and 

15 ‘‘(B) adjusted to reflect the income of the 

16 individual involved. 

17 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—

18 ‘‘(1) GENERAL GRANTS.—There are authorized 

19 to be appropriated such sums as are necessary to 

20 carry out subsection (a) for each of fiscal years 2004 

21 through 2009. 

22 ‘‘(2) PLANNING GRANTS.—There are authorized 

23 to be appropriated such sums as are necessary to 

24 carry out subsection (b) for each of fiscal years 2004 

25 through 2009.
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1 ‘‘(3) HEALTH SERVICES.—There are authorized 

2 to be appropriated such sums as are necessary to 

3 carry out subsection (c) for each of fiscal years 2004 

4 through 2009. 

5 ‘‘SEC. 8. ADMINISTRATIVE GRANT FOR PAPA OLA LOKAHI. 

6 ‘‘(a) IN GENERAL.—In addition to any other grant 

7 or contract under this Act, the Secretary may make grants 

8 to, or enter into contracts with, Papa Ola Lokahi for—

9 ‘‘(1) coordination, implementation, and updat10 ing (as appropriate) of the comprehensive health 

11 care master plan developed under section 5; 

12 ‘‘(2) training and education for providers of 

13 health services; 

14 ‘‘(3) identification of and research (including 

15 behavioral, biomedical, epidemiologic, and health 

16 service research) into the diseases that are most 

17 prevalent among Native Hawaiians; 

18 ‘‘(4) a clearinghouse function for—

19 ‘‘(A) the collection and maintenance of 

20 data associated with the health status of Native 

21 Hawaiians; 

22 ‘‘(B) the identification and research into 

23 diseases affecting Native Hawaiians; and 
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1 ‘‘(C) the availability of Native Hawaiian 

2 project funds, research projects, and publica3 tions; 

4 ‘‘(5) the establishment and maintenance of an 

5 institutional review board for all health-related re6 search involving Native Hawaiians; 

7 ‘‘(6) the coordination of the health care pro8 grams and services provided to Native Hawaiians; 

9 and 

10 ‘‘(7) the administration of special project funds. 

11 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There 

12 are authorized to be appropriated such sums as are nec13 essary to carry out subsection (a) for each of fiscal years 

14 2004 through 2009. 

15 ‘‘SEC. 9. ADMINISTRATION OF GRANTS AND CONTRACTS. 

16 ‘‘(a) TERMS AND CONDITIONS.—The Secretary shall 

17 include in any grant made or contract entered into under 

18 this Act such terms and conditions as the Secretary con19 siders necessary or appropriate to ensure that the objec20 tives of the grant or contract are achieved. 

21 ‘‘(b) PERIODIC REVIEW.—The Secretary shall peri22 odically evaluate the performance of, and compliance with, 

23 grants and contracts under this Act. 
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1 ‘‘(c) ADMINISTRATIVE REQUIREMENTS.—The Sec2 retary shall not make a grant or enter into a contract 

3 under this Act with an entity unless the entity—

4 ‘‘(1) agrees to establish such procedures for fis5 cal control and fund accounting as the Secretary de6 termines are necessary to ensure proper disburse7 ment and accounting with respect to the grant or 

8 contract; 

9 ‘‘(2) agrees to ensure the confidentiality of 

10 records maintained on individuals receiving health 

11 services under the grant or contract; 

12 ‘‘(3) with respect to providing health services to 

13 any population of Native Hawaiians, a substantial 

14 portion of which has a limited ability to speak the 

15 English language—

16 ‘‘(A) has developed and has the ability to 

17 carry out a reasonable plan to provide health 

18 services under the grant or contract through in19 dividuals who are able to communicate with the 

20 population involved in the language and cultural 

21 context that is most appropriate; and 

22 ‘‘(B) has designated at least 1 individual 

23 who is fluent in English and the appropriate 

24 language to assist in carrying out the plan; 
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1 ‘‘(4) with respect to health services that are 

2 covered under a program under title XVIII, XIX, or 

3 XXI of the Social Security Act (42 U.S.C. 1395 et 

4 seq.) (including any State plan), or under any other 

5 Federal health insurance plan—

6 ‘‘(A) if the entity will provide under the 

7 grant or contract any of those health services 

8 directly—

9 ‘‘(i) has entered into a participation 

10 agreement under each such plan; and 

11 ‘‘(ii) is qualified to receive payments 

12 under the plan; and 

13 ‘‘(B) if the entity will provide under the 

14 grant or contract any of those health services 

15 through a contract with an organization—

16 ‘‘(i) ensures that the organization has 

17 entered into a participation agreement 

18 under each such plan; and 

19 ‘‘(ii) ensures that the organization is 

20 qualified to receive payments under the 

21 plan; and 

22 ‘‘(5) agrees to submit to the Secretary and 

23 Papa Ola Lokahi an annual report that—

24 ‘‘(A) describes the use and costs of health 

25 services provided under the grant or contract 
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1 (including the average cost of health services 

2 per user); and 

3 ‘‘(B) provides such other information as 

4 the Secretary determines to be appropriate. 

5 ‘‘(d) CONTRACT EVALUATION.—

6 ‘‘(1) DETERMINATION OF NONCOMPLIANCE.—

7 If, as a result of evaluations conducted by the Sec8 retary, the Secretary determines that an entity has 

9 not complied with or satisfactorily performed a con10 tract entered into under section 7, the Secretary 

11 shall, before renewing the contract—

12 ‘‘(A) attempt to resolve the areas of non13 compliance or unsatisfactory performance; and 

14 ‘‘(B) modify the contract to prevent future 

15 occurrences of the noncompliance or unsatisfac16 tory performance. 

17 ‘‘(2) NONRENEWAL.—If the Secretary deter18 mines that the noncompliance or unsatisfactory per19 formance described in paragraph (1) with respect to 

20 an entity cannot be resolved and prevented in the fu21 ture, the Secretary—

22 ‘‘(A) shall not renew the contract with the 

23 entity; and 

24 ‘‘(B) may enter into a contract under sec25 tion 7 with another entity referred to in section
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•HR 2597 IH 

1 7(a)(3) that provides services to the same popu2 lation of Native Hawaiians served by the entity 

3 the contract with which was not renewed by 

4 reason of this paragraph. 

5 ‘‘(3) CONSIDERATION OF RESULTS.—In deter6 mining whether to renew a contract entered into 

7 with an entity under this Act, the Secretary shall 

8 consider the results of the evaluations conducted 

9 under this section. 

10 ‘‘(4) APPLICATION OF FEDERAL LAWS.—Each 

11 contract entered into by the Secretary under this 

12 Act shall be in accordance with all Federal con13 tracting laws (including regulations), except that, in 

14 the discretion of the Secretary, such a contract 

15 may—

16 ‘‘(A) be negotiated without advertising; 

17 and 

18 ‘‘(B) be exempted from subchapter III of 

19 chapter 31, United States Code. 

20 ‘‘(5) PAYMENTS.—A payment made under any 

21 contract entered into under this Act—

22 ‘‘(A) may be made—

23 ‘‘(i) in advance; 

24 ‘‘(ii) by means of reimbursement; or 

25 ‘‘(iii) in installments; and 
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1 ‘‘(B) shall be made on such conditions as 

2 the Secretary determines to be necessary to 

3 carry out this Act. 

4 ‘‘(e) REPORT.—

5 ‘‘(1) IN GENERAL.—For each fiscal year during 

6 which an entity receives or expends funds under a 

7 grant or contract under this Act, the entity shall 

8 submit to the Secretary and to Papa Ola Lokahi an 

9 annual report that describes—

10 ‘‘(A) the activities conducted by the entity 

11 under the grant or contract; 

12 ‘‘(B) the amounts and purposes for which 

13 Federal funds were expended; and 

14 ‘‘(C) such other information as the Sec15 retary may request. 

16 ‘‘(2) AUDITS.—The reports and records of any 

17 entity concerning any grant or contract under this 

18 Act shall be subject to audit by—

19 ‘‘(A) the Secretary; 

20 ‘‘(B) the Inspector General of the Depart21 ment of Health and Human Services; and 

22 ‘‘(C) the Comptroller General of the 

23 United States. 

24 ‘‘(f) ANNUAL PRIVATE AUDIT.—The Secretary shall 

25 allow as a cost of any grant made or contract entered into 
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1 under this Act the cost of an annual private audit con2 ducted by a certified public accountant to carry out this 

3 section. 

4 ‘‘SEC. 10. ASSIGNMENT OF PERSONNEL. 

5 ‘‘(a) IN GENERAL.—The Secretary may enter into an 

6 agreement with Papa Ola Lokahi or any of the Native Ha7 waiian health care systems for the assignment of personnel 

8 of the Department of Health and Human Services with 

9 relevant expertise for the purpose of—

10 ‘‘(1) conducting research; or 

11 ‘‘(2) providing comprehensive health promotion 

12 and disease prevention services and health services 

13 to Native Hawaiians. 

14 ‘‘(b) APPLICABLE FEDERAL PERSONNEL PROVI15 SIONS.—Any assignment of personnel made by the Sec16 retary under any agreement entered into under subsection 

17 (a) shall be treated as an assignment of Federal personnel 

18 to a local government that is made in accordance with sub19 chapter VI of chapter 33 of title 5, United States Code. 

20 ‘‘SEC. 11. NATIVE HAWAIIAN HEALTH SCHOLARSHIPS AND 

21 FELLOWSHIPS. 

22 ‘‘(a) ELIGIBILITY.—Subject to the availability of 

23 amounts appropriated under subsection (c), the Secretary 

24 shall provide to Papa Ola Lokahi, through a direct grant 

25 or a cooperative agreement, funds for the purpose of pro-
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•HR 2597 IH 

1 viding scholarship assistance to students who are Native 

2 Hawaiians. 

3 ‘‘(b) PRIORITY.—A priority for scholarships under 

4 subsection (a) may be provided to employees of—

5 ‘‘(1) the Native Hawaiian Health Care Systems; 

6 and 

7 ‘‘(2) the Native Hawaiian Health Centers. 

8 ‘‘(c) TERMS AND CONDITIONS.—

9 ‘‘(1) SCHOLARSHIP ASSISTANCE.—

10 ‘‘(A) IN GENERAL.—The scholarship as11 sistance under subsection (a) shall be provided 

12 in accordance with subparagraphs (B) through 

13 (G). 

14 ‘‘(B) NEED.—The provision of scholar15 ships in each type of health profession training 

16 shall correspond to the need for each type of 

17 health professional to serve the Native Hawai18 ian community in providing health services, as 

19 identified by Papa Ola Lokahi. 

20 ‘‘(C) ELIGIBLE APPLICANTS.—To the max21 imum extent practicable, the Secretary shall se22 lect scholarship recipients from a list of eligible 

23 applicants submitted by Papa Ola Lokahi. 

24 ‘‘(D) OBLIGATED SERVICE REQUIRE25 MENT.—
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1 ‘‘(i) IN GENERAL.—An obligated serv2 ice requirement for each scholarship recipi3 ent (except for a recipient receiving assist4 ance under paragraph (2)) shall be fulfilled 

5 through service, in order of priority, in—

6 ‘‘(I) any of the Native Hawaiian 

7 health care systems; 

8 ‘‘(II) any of the Native Hawaiian 

9 health centers; 

10 ‘‘(III) 1 or more health profes11 sions shortage areas, medically under12 served areas, or geographic areas or 

13 facilities similarly designated by the 

14 Public Health Service in the State; 

15 ‘‘(IV) a Native Hawaiian organi16 zation that serves a geographical area, 

17 facility, or organization that serves a 

18 significant Native Hawaiian popu19 lation; 

20 ‘‘(V) any public agency or non21 profit organization providing services 

22 to Native Hawaiians; or 

23 ‘‘(VI) any of the uniformed serv24 ices of the United States.
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1 ‘‘(ii) ASSIGNMENT.—The placement 

2 service for a scholarship shall assign each 

3 Native Hawaiian scholarship recipient to 1 

4 or more appropriate sites for service in ac5 cordance with clause (i). 

6 ‘‘(E) COUNSELING, RETENTION, AND SUP7 PORT SERVICES.—The provision of academic 

8 and personal counseling, retention and other 

9 support services—

10 ‘‘(i) shall not be limited to scholarship 

11 recipients under this section; and 

12 ‘‘(ii) shall be made available to recipi13 ents of other scholarship and financial aid 

14 programs enrolled in appropriate health 

15 professions training programs. 

16 ‘‘(F) FINANCIAL ASSISTANCE.—After con17 sultation with Papa Ola Lokahi, financial as18 sistance may be provided to a scholarship re19 cipient during the period that the recipient is 

20 fulfilling the service requirement of the recipi21 ent in any of—

22 ‘‘(i) the Native Hawaiian health care 

23 systems; or 

24 ‘‘(ii) the Native Hawaiians health cen25 ters. 
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1 ‘‘(G) DISTANCE LEARNING RECIPIENTS.—

2 A scholarship may be provided to a Native Ha3 waiian who is enrolled in an appropriate dis4 tance learning program offered by an accredited 

5 educational institution. 

6 ‘‘(2) FELLOWSHIPS.—

7 ‘‘(A) IN GENERAL.—Papa Ola Lokahi may 

8 provide financial assistance in the form of a fel9 lowship to a Native Hawaiian health profes10 sional who is—

11 ‘‘(i) a Native Hawaiian community 

12 health representative, outreach worker, or 

13 health program administrator in a profes14 sional training program; 

15 ‘‘(ii) a Native Hawaiian providing 

16 health services; or 

17 ‘‘(iii) a Native Hawaiian enrolled in a 

18 certificated program provided by tradi19 tional Native Hawaiian healers in any of 

20 the traditional Native Hawaiian healing 

21 practices (including lomi-lomi, la‘au 

22 lapa‘au, and ho‘oponopono). 

23 ‘‘(B) TYPES OF ASSISTANCE.—Assistance 

24 under subparagraph (A) may include a stipend 

25 for, or reimbursement for costs associated with, 
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1 participation in a program described in that 

2 paragraph. 

3 ‘‘(3) RIGHTS AND BENEFITS.—An individual 

4 who is a health profession designated in section 

5 338A of the Public Health Service Act (42 U.S.C. 

6 254l) who receives a scholarship under this sub7 section while fulfilling a service requirement under 

8 that Act shall retain the same rights and benefits as 

9 members of the National Health Service Corps dur10 ing the period of service. 

11 ‘‘(4) NO INCLUSION OF ASSISTANCE IN GROSS

12 INCOME.—Financial assistance provided under this 

13 section shall be considered to be qualified scholar14 ships for the purpose of section 117 of the Internal 

15 Revenue Code of 1986. 

16 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

17 are authorized to be appropriated such sums as are nec18 essary to carry out subsections (a) and (c)(2) for each of 

19 fiscal years 2004 through 2009. 

20 ‘‘SEC. 12. REPORT. 

21 ‘‘For each fiscal year, the President shall, at the time 

22 at which the budget of the United States is submitted 

23 under section 1105 of title 31, United States Code, submit 

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

25 purposes of this Act, including—
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1 ‘‘(1) a review of programs established or as2 sisted in accordance with this Act; and 

3 ‘‘(2) an assessment of and recommendations for 

4 additional programs or additional assistance nec5 essary to provide, at a minimum, health services to 

6 Native Hawaiians, and ensure a health status for 

7 Native Hawaiians, that are at a parity with the 

8 health services available to, and the health status of, 

9 the general population. 

10 ‘‘SEC. 13. USE OF FEDERAL GOVERNMENT FACILITIES AND 

11 SOURCES OF SUPPLY. 

12 ‘‘(a) IN GENERAL.—The Secretary shall permit an 

13 organization that enters into a contract or receives grant 

14 under this Act to use in carrying out projects or activities 

15 under the contract or grant all existing facilities under the 

16 jurisdiction of the Secretary (including all equipment of 

17 the facilities), in accordance with such terms and condi18 tions as may be agreed on for the use and maintenance 

19 of the facilities or equipment. 

20 ‘‘(b) DONATION OF PROPERTY.—The Secretary may 

21 donate to an organization that enters into a contract or 

22 receives grant under this Act, for use in carrying out a 

23 project or activity under the contract or grant, any per24 sonal or real property determined to be in excess of the 
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1 needs of the Department or the General Services Adminis2 tration. 

3 ‘‘(c) ACQUISITION OF SURPLUS PROPERTY.—The 

4 Secretary may acquire excess or surplus Federal Govern5 ment personal or real property for donation to an organi6 zation under subsection (b) if the Secretary determines 

7 that the property is appropriate for use by the organiza8 tion for the purpose for which a contract entered into or 

9 grant received by the organization is authorized under this 

10 Act. 

11 ‘‘SEC. 14. DEMONSTRATION PROJECTS OF NATIONAL SIG12 NIFICANCE. 

13 ‘‘(a) AUTHORITY AND AREAS OF INTEREST.—

14 ‘‘(1) IN GENERAL.—The Secretary, in consulta15 tion with Papa Ola Lokahi, may allocate amounts 

16 made available under this Act, or any other Act, to 

17 carry out Native Hawaiian demonstration projects of 

18 national significance. 

19 ‘‘(2) AREAS OF INTEREST.—A demonstration 

20 project described in paragraph (1) may relate to 

21 such areas of interest as—

22 ‘‘(A) the development of a centralized 

23 database and information system relating to the 

24 health care status, health care needs, and 

25 wellness of Native Hawaiians;
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1 ‘‘(B) the education of health professionals, 

2 and other individuals in institutions of higher 

3 learning, in health and allied health programs 

4 in healing practices, including Native Hawaiian 

5 healing practices; 

6 ‘‘(C) the integration of Western medicine 

7 with complementary healing practices, including 

8 traditional Native Hawaiian healing practices; 

9 ‘‘(D) the use of telewellness and tele10 communications in—

11 ‘‘(i) chronic and infectious disease 

12 management; and 

13 ‘‘(ii) health promotion and disease 

14 prevention; 

15 ‘‘(E) the development of appropriate mod16 els of health care for Native Hawaiians and 

17 other indigenous people, including—

18 ‘‘(i) the provision of culturally com19 petent health services; 

20 ‘‘(ii) related activities focusing on 

21 wellness concepts; 

22 ‘‘(iii) the development of appropriate 

23 kupuna care programs; and 

24 ‘‘(iv) the development of financial 

25 mechanisms and collaborative relationships 
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1 leading to universal access to health care; 

2 and 

3 ‘‘(F) the establishment of—

4 ‘‘(i) a Native Hawaiian Center of Ex5 cellence for Nursing at the University of 

6 Hawaii at Hilo; 

7 ‘‘(ii) a Native Hawaiian Center of Ex8 cellence for Mental Health at the Univer9 sity of Hawaii at Manoa; 

10 ‘‘(iii) a Native Hawaiian Center of 

11 Excellence for Maternal Health and Nutri12 tion at the Waimanalo Health Center; 

13 ‘‘(iv) a Native Hawaiian Center of Ex14 cellence for Research, Training, Integrated 

15 Medicine at Molokai General Hospital; and 

16 ‘‘(v) a Native Hawaiian Center of Ex17 cellence for Complementary Health and 

18 Health Education and Training at the 

19 Waianae Coast Comprehensive Health 

20 Center. 

21 ‘‘(3) CENTERS OF EXCELLENCE.—Papa Ola 

22 Lokahi, and any centers established under para23 graph (2)(F), shall be considered to be qualified as 

24 Centers of Excellence under sections 485F and 
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1 903(b)(2)(A) of the Public Health Service Act (42 

2 U.S.C. 287c–32, 299a–1). 

3 ‘‘(b) NONREDUCTION IN OTHER FUNDING.—The al4 location of funds for demonstration projects under sub5 section (a) shall not result in any reduction in funds re6 quired by the Native Hawaiian health care systems, the 

7 Native Hawaiian Health Centers, the Native Hawaiian 

8 Health Scholarship Program, or Papa Ola Lokahi to carry 

9 out the respective responsibilities of those entities under 

10 this Act. 

11 ‘‘SEC. 15. RULE OF CONSTRUCTION. 

12 ‘‘Nothing in this Act restricts the authority of the 

13 State to require licensing of, and issue licenses to, health 

14 practitioners. 

15 ‘‘SEC. 16. COMPLIANCE WITH BUDGET ACT. 

16 ‘‘Any new spending authority described in subpara17 graph (A) or (B) of section 401(c)(2) of the Congressional 

18 Budget Act of 1974 (2 U.S.C. 651(c)(2)) that is provided 

19 under this Act shall be effective for any fiscal year only 

20 to such extent or in such amounts as are provided for in 

21 Acts of appropriation. 

22 ‘‘SEC. 17. SEVERABILITY. 

23 ‘‘If any provision of this Act, or the application of 

24 any such provision to any person or circumstance, is deter25 mined by a court of competent jurisdiction to be invalid, 
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1 the remainder of this Act, and the application of the provi2 sion to a person or circumstance other than that to which 

3 the provision is held invalid, shall not be affected by that 

4 holding.’’.

Æ