I 

111TH CONGRESS 

1ST SESSION H. R. 4024 

To amend the Native Hawaiian Health Care Improvement Act to revise 

and extend that Act. 

IN THE HOUSE OF REPRESENTATIVES 

NOVEMBER 4, 2009 

Ms. HIRONO (for herself and Mr. ABERCROMBIE) 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 2009’’. 

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 ‘‘SEC. 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. 

‘‘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) IN GENERAL.—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 Hawai’i over the 19th and early 20th 

9 centuries have been devastating to the health and 

10 well-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 Hawai’i; 


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1 ‘‘(8) the constitution and statutes of the State 

2 of Hawai’i— 

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 Hawai’i in 1778, the Native 

12 Hawaiian people lived in a highly organized, self-suf13 ficient, 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 Hawai’i; 

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 Hawai’i, 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 Hawai’i; 

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 

15 Navy to invade the sovereign Hawaiian Nation 

16 in support of the overthrow of the indigenous 

17 and lawful Government of Hawai’i; 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 Hawai’i or the lawful Government of Ha23 wai’i, in violation of— 

24 ‘‘(i) treaties between the Government 

25 of Hawai’i 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 Hawai’i, and the Hawaiian Patriotic League, rep17 resenting the aboriginal citizens of Hawai’i, prompt18 ly 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 Hawai’i 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) between 1897 and 1898, when the total 

9 Native Hawaiian population in Hawai’i was less 

10 than 40,000, more than 38,000 Native Hawaiians 

11 signed petitions (commonly known as ‘Ku’e Peti12 tions’) protesting annexation by the United States 

13 and requesting restoration of the monarchy; 

14 ‘‘(18) despite Native Hawaiian protests, in 

15 1898, the United States— 

16 ‘‘(A) annexed Hawai’i through Resolution 

17 No. 55 (commonly known as the ‘Newlands 

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

19 of, or compensation to, the indigenous people of 

20 Hawai’i or the sovereign government of those 

21 people; and 

22 ‘‘(B) denied those people the mechanism 

23 for expression of their inherent sovereignty 

24 through self-government and self-determination 

25 of their lands and ocean resources; 


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

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

3 ‘1900 Organic Act’) (31 Stat. 141, chapter 339), the 

4 United States— 

5 ‘‘(A) received 1,750,000 acres of land for6 merly owned by the Crown and Government of 

7 the Hawaiian Kingdom; and 

8 ‘‘(B) exempted the land from then-existing 

9 public land laws of the United States by man10 dating that the revenue and proceeds from that 

11 land be ‘used solely for the benefit of the inhab12 itants of the Hawaiian Islands for education 

13 and other public purposes’, thereby establishing 

14 a special trust relationship between the United 

15 States and the inhabitants of Hawai’i; 

16 ‘‘(20) in 1921, Congress enacted the Hawaiian 

17 Homes Commission Act, 1920 (42 Stat. 108, chap18 ter 42), which— 

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

20 ceded public land for exclusive homesteading by 

21 Native Hawaiians; and 

22 ‘‘(B) affirmed the trust relationship be23 tween the United States and Native Hawaiians, 

24 as expressed by Secretary of the Interior 

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1 mittee Report of the Committee on Territories 

2 of the House of Representatives as stating, 

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

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

5 a sense we are trustees, are falling off rapidly 

6 in numbers and many of them are in poverty.’; 

7 ‘‘(21) in 1938, Congress again acknowledged 

8 the unique status of the Native Hawaiian people by 

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

10 781), a provision— 

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

12 Native Hawaiians; and 

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

14 Native Hawaiian residents of said area or of 

15 adjacent villages and by visitors under their 

16 guidance’; 

17 ‘‘(22) under the Act of March 18, 1959 (48 

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

19 States— 

20 ‘‘(A) transferred responsibility for the ad21 ministration of the Hawaiian home lands to the 

22 State; but 

23 ‘‘(B) reaffirmed the trust relationship that 

24 existed between the United States and the Na25 tive Hawaiian people by retaining the exclusive 


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1 power to enforce the trust, including the power 

2 to approve land exchanges and legislative 

3 amendments affecting the rights of beneficiaries 

4 under that Act; 

5 ‘‘(23) under the Act referred to in paragraph 

6 (22), the United States— 

7 ‘‘(A) transferred responsibility for adminis8 tration over portions of the ceded public lands 

9 trust not retained by the United States to the 

10 State; but 

11 ‘‘(B) reaffirmed the trust relationship that 

12 existed between the United States and the Na13 tive Hawaiian people by retaining the legal re14 sponsibility of the State for the betterment of 

15 the conditions of Native Hawaiians under sec16 tion 5(f) of that Act (73 Stat. 6); 

17 ‘‘(24) in 1978, the people of Hawai’i— 

18 ‘‘(A) amended the constitution of Hawai’i 

19 to establish the Office of Hawaiian Affairs; and 

20 ‘‘(B) assigned to that Office the author21 ity— 

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

23 Native Hawaiian people real and personal 

24 property transferred from any source; 


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1 ‘‘(ii) to receive payments from the 

2 State owed to the Native Hawaiian people 

3 in satisfaction of the pro rata share of the 

4 proceeds of the public land trust estab5 lished by section 5(f) of the Act of March 

6 18, 1959 (48 U.S.C. prec. 491 note; 73 

7 Stat. 6); 

8 ‘‘(iii) to act as the lead State agency 

9 for matters affecting the Native Hawaiian 

10 people; and 

11 ‘‘(iv) to formulate policy on affairs re12 lating to the Native Hawaiian people; 

13 ‘‘(25) the authority of Congress under the Con14 stitution to legislate in matters affecting the aborigi15 nal or indigenous people of the United States in16 cludes the authority to legislate in matters affecting 

17 the native people of Alaska and Hawai’i; 

18 ‘‘(26) the United States has recognized the au19 thority of the Native Hawaiian people to continue to 

20 work toward an appropriate form of sovereignty, as 

21 defined by the Native Hawaiian people in provisions 

22 set forth in legislation returning the Hawaiian Is23 land of Kaho‘olawe to custodial management by the 

24 State in 1994; 


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1 ‘‘(27) in furtherance of the trust responsibility 

2 for the betterment of the conditions of Native Ha3 waiians, the United States has established a pro4 gram for the provision of comprehensive health pro5 motion and disease prevention services to maintain 

6 and improve the health status of the Hawaiian peo7 ple; 

8 ‘‘(28) that program is conducted by the Native 

9 Hawaiian Health Care Systems and Papa Ola 

10 Lokahi; 

11 ‘‘(29) health initiatives implemented by those 

12 and other health institutions and agencies using 

13 Federal assistance have been responsible for reduc14 ing the century-old morbidity and mortality rates of 

15 Native Hawaiian people by— 

16 ‘‘(A) providing comprehensive disease pre17 vention; 

18 ‘‘(B) providing health promotion activities; 

19 and 

20 ‘‘(C) increasing the number of Native Ha21 waiians in the health and allied health profes22 sions; 

23 ‘‘(30) those accomplishments have been 

24 achieved through implementation of— 


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

2 of 1988 (Public Law 100–579); and 

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

4 section 9168 of the Department of Defense Ap5 propriations Act, 1993 (Public Law 102–396; 

6 106 Stat. 1948); 

7 ‘‘(31) the historical and unique legal relation8 ship between the United States and Native Hawai9 ians has been consistently recognized and affirmed 

10 by Congress through the enactment of more than 

11 160 Federal laws that extend to the Native Hawai12 ian people the same rights and privileges accorded to 

13 American Indian, Alaska Native, Eskimo, and Aleut 

14 communities, including— 

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

16 1974 (42 U.S.C. 2991 et seq.); 

17 ‘‘(B) the American Indian Religious Free18 dom Act (42 U.S.C. 1996); 

19 ‘‘(C) the National Museum of the Amer20 ican Indian Act (20 U.S.C. 80q et seq.); and 

21 ‘‘(D) the Native American Graves Protec22 tion and Repatriation Act (25 U.S.C. 3001 et 

23 seq.); 

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1 ian people through legislation that authorizes the 

2 provision of services to Native Hawaiians, specifi3 cally— 

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

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

6 ‘‘(B) the Developmental Disabilities Assist7 ance and Bill of Rights Act Amendments of 

8 1987 (42 U.S.C. 6000 et seq.); 

9 ‘‘(C) the Veterans’ Benefits and Services 

10 Act of 1988 (Public Law 100–322); 

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

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

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

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

15 ‘‘(F) the Health Professions Reauthoriza16 tion Act of 1988 (Public Law 100–607; 102 

17 Stat. 3122); 

18 ‘‘(G) the Nursing Shortage Reduction and 

19 Education Extension Act of 1988 (Public Law 

20 100–607; 102 Stat. 3153); 

21 ‘‘(H) the Handicapped Programs Technical 

22 Amendments Act of 1988 (Public Law 100– 

23 630); 

24 ‘‘(I) the Indian Health Care Amendments 

25 of 1988 (Public Law 100–713); and 


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1 ‘‘(J) the Disadvantaged Minority Health 

2 Improvement Act of 1990 (Public Law 101– 

3 527); 

4 ‘‘(33) the United States has affirmed that his5 torical and unique legal relationship to the Hawaiian 

6 people by authorizing the provision of services to 

7 Native Hawaiians to address problems of alcohol 

8 and drug abuse under the Anti-Drug Abuse Act of 

9 1986 (21 U.S.C. 801 note; Public Law 99–570); 

10 ‘‘(34) in addition, the United States— 

11 ‘‘(A) has recognized that Native Hawai12 ians, as aboriginal, indigenous, native people of 

13 Hawai’i, are a unique population group in Ha14 wai’i and in the continental United States; and 

15 ‘‘(B) has so declared in— 

16 ‘‘(i) the documents of the Office of 

17 Management and Budget entitled— 

18 ‘‘(I) ‘Standards for Maintaining, 

19 Collecting, and Presenting Federal 

20 Data on Race and Ethnicity’ and 

21 dated October 30, 1997; and 

22 ‘‘(II) ‘Provisional Guidance on 

23 the Implementation of the 1997 

24 Standards for Federal Data on Race 


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1 and Ethnicity’ and dated December 

2 15, 2000; 

3 ‘‘(ii) the document entitled ‘Guidance 

4 on Aggregation and Allocation of Data on 

5 Race for Use in Civil Rights Monitoring 

6 and Enforcement’ (Bulletin 00–02 to the 

7 Heads of Executive Departments and Es8 tablishments) and dated March 9, 2000; 

9 ‘‘(iii) the document entitled ‘Questions 

10 and Answers when Designing Surveys for 

11 Information Collections’ (Memorandum for 

12 the President’s Management Council) and 

13 dated January 20, 2006; 

14 ‘‘(iv) Executive Order Number 13125 

15 (64 Fed. Reg. 31105; relating to increas16 ing participation of Asian-Americans and 

17 Pacific Islanders in Federal programs) 

18 (June 7, 1999); 

19 ‘‘(v) the document entitled ‘HHS 

20 Tribal Consultation Policy’ and dated Jan21 uary 2005; and 

22 ‘‘(vi) the Department of Health and 

23 Human Services Intradepartment Council 

24 on Native American Affairs, Revised Char25 ter, dated March 7, 2005; and 


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1 ‘‘(35) despite the United States having ex2 pressed in Public Law 103–150 (107 Stat. 1510) its 

3 commitment to a policy of reconciliation with the 

4 Native Hawaiian people for past grievances— 

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

6 Hawaiian people remain severe; and 

7 ‘‘(B) the health status of the Native Ha8 waiian people continues to be far below that of 

9 the general population of the United States. 

10 ‘‘(b) FINDING OF UNMET NEEDS AND HEALTH DIS11 PARITIES.—Congress finds that the unmet needs and seri12 ous health disparities that adversely affect the Native Ha13 waiian people include the following: 

14 ‘‘(1) CHRONIC DISEASE AND ILLNESS.— 

15 ‘‘(A) CANCER.— 

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

17 cancer— 

18 ‘‘(I) as an underlying cause of 

19 death in the State, the cancer mor20 tality rate of Native Hawaiians of 

21 218.3 per 100,000 residents is 50 per22 cent higher than the rate for the total 

23 population of the State of 145.4 per 

24 100,000 residents; 


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1 ‘‘(II) Native Hawaiian males 

2 have the highest cancer mortality 

3 rates in the State for cancers of the 

4 lung, colon, and rectum, and for all 

5 cancers combined; 

6 ‘‘(III) Native Hawaiian females 

7 have the highest cancer mortality 

8 rates in the State for cancers of the 

9 lung, breast, colon, rectum, pancreas, 

10 stomach, ovary, liver, cervix, kidney, 

11 and uterus, and for all cancers com12 bined; and 

13 ‘‘(IV) for the period of 1995 

14 through 2000— 

15 ‘‘(aa) the cancer mortality 

16 rate for all cancers for Native 

17 Hawaiian males of 217 per 

18 100,000 residents was 22 percent 

19 higher than the rate for all males 

20 in the State of 179 per 100,000 

21 residents; and 

22 ‘‘(bb) the cancer mortality 

23 rate for all cancers for Native 

24 Hawaiian females of 192 per 

25 100,000 residents was 64 percent 


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1 higher than the rate for all fe2 males in the State of 117 per 

3 100,000 residents. 

4 ‘‘(ii) BREAST CANCER.—With respect 

5 to breast cancer— 

6 ‘‘(I) Native Hawaiians have the 

7 highest mortality rate in the State 

8 from breast cancer (30.79 per 

9 100,000 residents), which is 33 per10 cent higher than the rate for Cauca11 sian-Americans (23.07 per 100,000 

12 residents) and 106 percent higher 

13 than the rate for Chinese-Americans 

14 (14.96 per 100,000 residents); and 

15 ‘‘(II) nationally, Native Hawai16 ians have the third-highest mortality 

17 rate as a result of breast cancer (25.0 

18 per 100,000 residents), behind Afri19 can-Americans (31.4 per 100,000 

20 residents) and Caucasian-Americans 

21 (27.0 per 100,000 residents). 

22 ‘‘(iii) CANCER OF THE CERVIX.—Na23 tive Hawaiians have the highest mortality 

24 rate as a result of cancer of the cervix in 

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1 lowed by Filipino-Americans (2.69 per 

2 100,000 residents) and Caucasian-Ameri3 cans (2.61 per 100,000 residents). 

4 ‘‘(iv) LUNG CANCER.—Native Hawai5 ian males and females have the highest 

6 mortality rates as a result of lung cancer 

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

8 males and 47.84 per 100,000 females, 

9 which are higher than the rates for the 

10 total population of the State by 48 percent 

11 for males and 93 percent for females. 

12 ‘‘(v) PROSTATE CANCER.—Native Ha13 waiian males have the third-highest mor14 tality rate as a result of prostate cancer in 

15 the State (21.48 per 100,000 residents), 

16 with Caucasian-Americans having the high17 est mortality rate as a result of prostate 

18 cancer (23.96 per 100,000 residents). 

19 ‘‘(B) DIABETES.—With respect to diabe20 tes, in 2004— 

21 ‘‘(i) Native Hawaiians had the highest 

22 mortality rate as a result of diabetes 

23 mellitis (28.9 per 100,000 residents) in the 

24 State, which is 119 percent higher than 


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1 the rate for all racial groups in the State 

2 (13.2 per 100,000 residents); 

3 ‘‘(ii) the prevalence of diabetes for 

4 Native Hawaiians was 12.7 percent, which 

5 is 87 percent higher than the total preva6 lence for all residents of the State of 6.8 

7 percent; and 

8 ‘‘(iii) a higher percentage of Native 

9 Hawaiians with diabetes experienced dia10 betic retinopathy, as compared to other 

11 population groups in the State. 

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

13 and lower respiratory disease— 

14 ‘‘(i) in 2004, mortality rates for Na15 tive Hawaiians (31.6 per 100,000 resi16 dents) from chronic lower respiratory dis17 ease were 52 percent higher than rates for 

18 the total population of the State (20.8 per 

19 100,000 residents); and 

20 ‘‘(ii) in 2005, the prevalence of cur21 rent asthma in Native Hawaiian adults 

22 was 12.8 percent, which is 71 percent 

23 higher than the prevalence of the total 

24 population of the State of 7.5 percent. 

25 ‘‘(D) CIRCULATORY DISEASES.— 


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1 ‘‘(i) HEART DISEASE.—With respect 

2 to heart disease— 

3 ‘‘(I) in 2004, the mortality rate 

4 for Native Hawaiians as a result of 

5 heart disease (305.5 per 100,000 resi6 dents) was 86 percent higher than the 

7 rate for the total population of the 

8 State (164.3 per 100,000 residents); 

9 and 

10 ‘‘(II) in 2005, the prevalence for 

11 heart attack was 4.4 percent for Na12 tive Hawaiians, which is 22 percent 

13 higher than the prevalence for the 

14 total population of 3.6 percent. 

15 ‘‘(ii) CEREBROVASCULAR DISEASES.— 

16 With respect to cerebrovascular diseases— 

17 ‘‘(I) the mortality rate from cere18 brovascular diseases for Native Ha19 waiians (75.6 percent) was 64 percent 

20 higher than the rate for the total pop21 ulation of the State (46 percent); and 

22 ‘‘(II) in 2005, the prevalence for 

23 stroke was 4.9 percent for Native Ha24 waiians, which is 69 percent higher 


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1 than the prevalence for the total pop2 ulation of the State (2.9 percent). 

3 ‘‘(iii) OTHER CIRCULATORY DIS4 EASES.—With respect to other circulatory 

5 diseases (including high blood pressure and 

6 atherosclerosis)— 

7 ‘‘(I) in 2004, the mortality rate 

8 for Native Hawaiians of 20.6 per 

9 100,000 residents was 46 percent 

10 higher than the rate for the total pop11 ulation of the State of 14.1 per 

12 100,000 residents; and 

13 ‘‘(II) in 2005, the prevalence of 

14 high blood pressure for Native Hawai15 ians was 26.7 percent, which is 10 

16 percent higher than the prevalence for 

17 the total population of the State of 

18 24.2 percent. 

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

20 With respect to infectious disease and illness— 

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

22 20 percent of all deaths resulting from infec23 tious diseases in the State for all ages; and 

24 ‘‘(B) the incidence of acquired immune de25 ficiency syndrome for Native Hawaiians is at 


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

2 percent) than the incidence for any other non3 Caucasian group in the State. 

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

5 ‘‘(A) the mortality rate for Native Hawai6 ians as a result of injuries (32 per 100,000 

7 residents) is 16 percent higher than the rate for 

8 the total population of the State (27.5 per 

9 100,000 residents); 

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

11 between the ages of 18 and 24 years resulting 

12 from injuries were Native Hawaiian; and 

13 ‘‘(C) the 2 primary causes of Native Ha14 waiian deaths in that age group were motor ve15 hicle accidents (30 percent) and intentional self16 harm (39 percent). 

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

18 health— 

19 ‘‘(A) Native Hawaiian children experience 

20 significantly higher rates of dental caries and 

21 unmet treatment needs as compared to other 

22 children in the continental United States and 

23 other ethnic groups in the State; 

24 ‘‘(B) the prevalence rate of dental caries in 

25 the primary (baby) teeth of Native Hawaiian 


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1 children aged 5 to 9 years of 4.2 per child is 

2 more than twice the national average rate of 

3 1.9 per child in that age range; 

4 ‘‘(C) 81.9 percent of Native Hawaiian chil5 dren aged 6 to 8 have 1 or more decayed teeth, 

6 as compared to— 

7 ‘‘(i) 53 percent for children in that 

8 age range in the continental United States; 

9 and 

10 ‘‘(ii) 72.7 percent of other children in 

11 that age range in the State; and 

12 ‘‘(D) 21 percent of Native Hawaiian chil13 dren aged 5 demonstrate signs of baby bottle 

14 tooth decay, which is generally characterized as 

15 severe, progressive dental disease in early child16 hood and associated with high rates of dental 

17 disorders, as compared to 5 percent for children 

18 of that age in the continental United States. 

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

20 expectancy— 

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

22 expectancy of all population groups in the 

23 State; 

24 ‘‘(B) between 1910 and 1980, the life ex25 pectancy of Native Hawaiians from birth has 


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

2 overall State population average; 

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

4 Native Hawaiian life expectancy at birth (74.27 

5 years) to be approximately 5 years less than 

6 that of the total State population (78.85 years); 

7 and 

8 ‘‘(D) except as provided in the life expect9 ancy calculation for 1920, Native Hawaiians 

10 have had the shortest life expectancy of all 

11 major ethnic groups in the United States since 

12 1910. 

13 ‘‘(6) MATERNAL AND CHILD HEALTH.— 

14 ‘‘(A) IN GENERAL.—With respect to ma15 ternal and child health, in 2000— 

16 ‘‘(i) 39 percent of all deaths of chil17 dren under the age of 18 years in the 

18 State were Native Hawaiian; 

19 ‘‘(ii) perinatal conditions accounted 

20 for 38 percent of all Native Hawaiian 

21 deaths in that age group; 

22 ‘‘(iii) Native Hawaiian infant mor23 tality rates (9.8 per 1,000 live births) 

24 are— 

25 ‘‘(I) the highest in the State; and 


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1 ‘‘(II) 151 percent higher than the 

2 rate for Caucasian infants (3.9 per 

3 1,000 live births); and 

4 ‘‘(iv) Native Hawaiians have 1 of the 

5 highest infant mortality rates in the 

6 United States, second only to the rate for 

7 African-Americans of 13.6 per 1,000 live 

8 births. 

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

10 prenatal care— 

11 ‘‘(i) as of 2005, Native Hawaiian 

12 women have the highest prevalence (20.9 

13 percent) of having had no prenatal care 

14 during the first trimester of pregnancy, as 

15 compared to the 5 largest ethnic groups in 

16 the State; 

17 ‘‘(ii) of the mothers in the State who 

18 received no prenatal care in the first tri19 mester, 33 percent were Native Hawaiian; 

20 ‘‘(iii) in 2005, 41 percent of mothers 

21 with live births who had not completed 

22 high school were Native Hawaiian; and 

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

24 many Native Hawaiian newborns begin life 


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1 in a potentially hazardous circumstance, 

2 far higher than any other racial group. 

3 ‘‘(C) BIRTHS.—With respect to births, in 

4 2005— 

5 ‘‘(i) 45.2 percent of live births to Na6 tive Hawaiian mothers were nonmarital, 

7 putting the affected infants at higher risk 

8 of low birth weight and infant mortality; 

9 ‘‘(ii) of the 2,934 live births to Native 

10 Hawaiian single mothers, 9 percent were 

11 low birth weight (defined as a weight of 

12 less than 2,500 grams); and 

13 ‘‘(iii) 43.7 percent of all low birth14 weight infants born to single mothers in 

15 the State were Native Hawaiian. 

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

17 to births, in 2005— 

18 ‘‘(i) Native Hawaiians had the highest 

19 rate of births to mothers under the age of 

20 18 years (5.8 percent), as compared to the 

21 rate of 2.7 percent for the total population 

22 of the State; and 

23 ‘‘(ii) nearly 62 percent of all mothers 

24 in the State under the age of 19 years 

25 were Native Hawaiian. 


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

2 fetal mortality, in 2005— 

3 ‘‘(i) Native Hawaiians had the highest 

4 number of fetal deaths in the State, as 

5 compared to Caucasian, Japanese, and Fil6 ipino residents; and 

7 ‘‘(ii)(I) 17.2 percent of all fetal deaths 

8 in the State were associated with expectant 

9 Native Hawaiian mothers; and 

10 ‘‘(II) 43.5 percent of those Native 

11 Hawaiian mothers were under the age of 

12 25 years. 

13 ‘‘(7) BEHAVIORAL HEALTH.— 

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

15 respect to alcohol and drug abuse— 

16 ‘‘(i)(I) in 2005, Native Hawaiians had 

17 the highest prevalence of smoking of 27.9 

18 percent, which is 64 percent higher than 

19 the rate for the total population of the 

20 State (17 percent); and 

21 ‘‘(II) 53 percent of Native Hawaiians 

22 reported having smoked at least 100 ciga23 rettes in their lifetime, as compared to 

24 43.3 percent for the total population of the 

25 State; 


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1 ‘‘(ii) 33 percent of Native Hawaiians 

2 in grade 8 have smoked cigarettes at least 

3 once in their lifetime, as compared to— 

4 ‘‘(I) 22.5 percent for all youth in 

5 the State; and 

6 ‘‘(II) 28.4 percent of residents of 

7 the United States in grade 8; 

8 ‘‘(iii) Native Hawaiians have the high9 est prevalence of binge drinking of 19.9 

10 percent, which is 21 percent higher than 

11 the prevalence for the total population of 

12 the State (16.5 percent); 

13 ‘‘(iv) the prevalence of heavy drinking 

14 among Native Hawaiians (10.1 percent) is 

15 36 percent higher than the prevalence for 

16 the total population of the State (7.4 per17 cent); 

18 ‘‘(v)(I) in 2003, 17.2 percent of Na19 tive Hawaiians in grade 6, 45.1 percent of 

20 Naive Hawaiians in grade 8, 68.9 percent 

21 of Native Hawaiians in grade 10, and 78.1 

22 percent of Native Hawaiians in grade 12 

23 reported using alcohol at least once in 

24 their lifetime, as compared to 13.2, 36.8, 


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1 59.1, and 72.5 percent, respectively, of all 

2 adolescents in the State; and 

3 ‘‘(II) 62.1 percent Native Hawaiians 

4 in grade 12 reported being drunk at least 

5 once, which is 20 percent higher than the 

6 percentage for all adolescents in the State 

7 (51.6 percent); 

8 ‘‘(vi) on entering grade 12, 60 percent 

9 of Native Hawaiian adolescents reported 

10 having used illicit drugs, including 

11 inhalants, at least once in their lifetime, as 

12 compared to— 

13 ‘‘(I) 46.9 percent of all adoles14 cents in the State; and 

15 ‘‘(II) 52.8 of adolescents in the 

16 United States; 

17 ‘‘(vii) on entering grade 12, 58.2 per18 cent of Native Hawaiian adolescents re19 ported having used marijuana at least 

20 once, which is 31 percent higher than the 

21 rate of other adolescents in the State (44.4 

22 percent); 

23 ‘‘(viii) in 2006, Native Hawaiians rep24 resented 40 percent of the total admissions 

25 to substance abuse treatment programs 


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1 funded by the State Department of Health; 

2 and 

3 ‘‘(ix) in 2003, Native Hawaiian ado4 lescents reported the highest prevalence for 

5 methamphetamine use in the State, fol6 lowed by Caucasian and Filipino adoles7 cents. 

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

9 ‘‘(i) during the period of 1992 to 

10 2002, Native Hawaiian arrests for violent 

11 crimes decreased, but the rate of arrest re12 mained 38.3 percent higher than the rate 

13 of the total population of the State; 

14 ‘‘(ii) the robbery arrest rate in 2002 

15 among Native Hawaiian juveniles and 

16 adults was 59 percent higher (6.2 arrests 

17 per 100,000 residents) than the rate for 

18 the total population of the State (3.9 ar19 rests per 100,000 residents); 

20 ‘‘(iii) in 2002— 

21 ‘‘(I) Native Hawaiian men com22 prised between 35 percent and 43 per23 cent of each security class in the State 

24 prison system; 


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1 ‘‘(II) Native Hawaiian women 

2 comprised between 38.1 percent to 

3 50.3 percent of each class of female 

4 prison inmates in the State; 

5 ‘‘(III) Native Hawaiians com6 prised 39.5 percent of the total incar7 cerated population of the State; and 

8 ‘‘(IV) Native Hawaiians com9 prised 40 percent of the total sen10 tenced felon population in the State, 

11 as compared to 25 percent for Cauca12 sians, 12 percent for Filipinos, and 5 

13 percent for Samoans; 

14 ‘‘(iv) Native Hawaiians are overrepre15 sented in the State prison population; 

16 ‘‘(v) of the 2,260 incarcerated Native 

17 Hawaiians, 70 percent are between 20 and 

18 40 years of age; and 

19 ‘‘(vi) based on anecdotal information, 

20 Native Hawaiians are estimated to com21 prise between 60 percent and 70 percent of 

22 all jail and prison inmates in the State. 

23 ‘‘(C) DEPRESSION AND SUICIDE.—With re24 spect to depression and suicide— 


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1 ‘‘(i)(I) in 1999, the prevalence of de2 pression among Native Hawaiians was 15 

3 percent, as compared to the national aver4 age of approximately 10 percent; and 

5 ‘‘(II) Native Hawaiian females had a 

6 higher prevalence of depression (16.9 per7 cent) than Native Hawaiian males (11.9 

8 percent); 

9 ‘‘(ii) in 2000— 

10 ‘‘(I) Native Hawaiian adolescents 

11 had a significantly higher suicide at12 tempt rate (12.9 percent) than the 

13 rate for other adolescents in the State 

14 (9.6 percent); and 

15 ‘‘(II) 39 percent of all Native 

16 Hawaiian adult deaths were due to 

17 suicide; and 

18 ‘‘(iii) in 2006, the prevalence of obses19 sive compulsive disorder among Native Ha20 waiian adolescent girls was 17.7 percent, 

21 as compared to a rate of— 

22 ‘‘(I) 9.2 percent for Native Ha23 waiian boys and non-Hawaiian girls; 

24 and 

25 ‘‘(II) a national rate of 2 percent. 


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1 ‘‘(8) OVERWEIGHTNESS AND OBESITY.—With 

2 respect to overweightness and obesity— 

3 ‘‘(A) during the period of 2000 through 

4 2003, Native Hawaiian males and females had 

5 the highest age-adjusted prevalence rates for 

6 obesity (40.5 and 32.5 percent, respectively), 

7 which was— 

8 ‘‘(i) with respect to individuals of full 

9 Native Hawaiian ancestry, 145 percent 

10 higher than the rate for the total popu11 lation of the State (16.5 per 100,000); and 

12 ‘‘(ii) with respect to individuals with 

13 less than 100 percent Native Hawaiian an14 cestry, 97 percent higher than the total 

15 population of the State; and 

16 ‘‘(B) for 2005, the prevalence of obesity 

17 among Native Hawaiians was 43.1 percent, 

18 which was 119 percent higher than the preva19 lence for the total population of the State (19.7 

20 percent). 

21 ‘‘(9) FAMILY AND CHILD HEALTH.—With re22 spect to family and child health— 

23 ‘‘(A) in 2000, the prevalence of single-par24 ent families with minor children was highest 

25 among Native Hawaiian households, as comVerDate Nov 24 2008 03:25 Nov 05, 2009 Jkt 089200 PO 00000 Frm 00035 Fmt 6652 Sfmt 6201 E:\BILLS\H4024.IH H4024

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1 pared to all households in the State (15.8 per2 cent and 8.1 percent, respectively); 

3 ‘‘(B) in 2002, nonmarital births accounted 

4 for 56.8 percent of all live births among Native 

5 Hawaiians, as compared to 34 percent of all 

6 live births in the State; 

7 ‘‘(C) the rate of confirmed child abuse and 

8 neglect among Native Hawaiians has consist9 ently been 3 to 4 times the rates of other major 

10 ethnic groups, with a 3-year average of 63.9 

11 cases in 2002, as compared to 12.8 cases for 

12 the total population of the State; 

13 ‘‘(D) spousal abuse or abuse of an intimate 

14 partner was highest for Native Hawaiians, as 

15 compared to all cases of abuse in the State (4.5 

16 percent and 2.2 percent, respectively); and 

‘‘(E)(i) 1 17 ⁄2 of uninsured adults in the State 

18 have family incomes below 200 percent of the 

19 Federal poverty level; and 

20 ‘‘(ii) Native Hawaiians residing in the 

21 State and the continental United States have a 

22 higher rate of uninsurance than other ethnic 

23 groups in the State and continental United 

24 States (14.5 percent and 9.5 percent, respec25 tively). 


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1 ‘‘(10) HEALTH PROFESSIONS EDUCATION AND

2 TRAINING.—With respect to health professions edu3 cation and training— 

4 ‘‘(A) in 2003, adult Native Hawaiians had 

5 a higher rate of high school completion, as com6 pared to the total adult population of the State 

7 (49.4 percent and 34.4 percent, respectively); 

8 ‘‘(B) Native Hawaiian physicians make up 

9 4 percent of the total physician workforce in the 

10 State; and 

11 ‘‘(C) in 2004, Native Hawaiians com12 prised— 

13 ‘‘(i) 11.25 percent of individuals who 

14 earned bachelor’s degrees; 

15 ‘‘(ii) 6 percent of individuals who 

16 earned master’s degrees; 

17 ‘‘(iii) 3 percent of individuals who 

18 earned doctorate degrees; 

19 ‘‘(iv) 7.9 percent of the credited stu20 dent body at the University of Hawai’i; 

21 ‘‘(v) 0.4 percent of the instructional 

22 faculty at the University of Hawai’i at 

23 Manoa; and 


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1 ‘‘(vi) 8.4 percent of the instructional 

2 faculty at the University of Hawai’i Com3 munity Colleges. 

4 ‘‘SEC. 3. DEFINITIONS. 

5 ‘‘In this Act: 

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

7 means the Department of Health and Human Serv8 ices. 

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

10 prevention’ includes— 

11 ‘‘(A) immunizations; 

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

13 ‘‘(C) control of sexually transmittable dis14 eases; 

15 ‘‘(D) prevention and control of chronic dis16 eases; 

17 ‘‘(E) control of toxic agents; 

18 ‘‘(F) occupational safety and health; 

19 ‘‘(G) injury prevention; 

20 ‘‘(H) fluoridation of water; 

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

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

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

24 promotion’ includes— 


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

2 prevention of fetal alcohol syndrome; 

3 ‘‘(B) cessation of tobacco smoking; 

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

5 harmful illicit drugs; 

6 ‘‘(D) improvement of nutrition; 

7 ‘‘(E) improvement in physical fitness; 

8 ‘‘(F) family planning; 

9 ‘‘(G) control of stress; 

10 ‘‘(H) reduction of major behavioral risk 

11 factors and promotion of healthy lifestyle prac12 tices; and 

13 ‘‘(I) integration of cultural approaches to 

14 health and well-being (including traditional 

15 practices relating to the atmosphere (lewa lani), 

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

17 ‘‘(4) HEALTH SERVICE.—The term ‘health serv18 ice’ means— 

19 ‘‘(A) service provided by a physician, phy20 sician’s assistant, nurse practitioner, nurse, 

21 dentist, or other health professional; 

22 ‘‘(B) a diagnostic laboratory or radiologic 

23 service; 

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

25 a perinatal service, well child service, family 


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1 planning service, nutrition service, home health 

2 service, sports medicine and athletic training 

3 service, and, generally, any service associated 

4 with enhanced health and wellness); 

5 ‘‘(D) emergency medical service, including 

6 a service provided by a first responder, emer7 gency medical technician, or mobile intensive 

8 care technician; 

9 ‘‘(E) a transportation service required for 

10 adequate patient care; 

11 ‘‘(F) a preventive dental service; 

12 ‘‘(G) a pharmaceutical and medicament 

13 service; 

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

15 service provided by a psychologist or social 

16 worker; 

17 ‘‘(I) a genetic counseling service; 

18 ‘‘(J) a health administration service, in19 cluding a service provided by a health program 

20 administrator; 

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

22 service provided by an individual with an ad23 vanced degree in medicine, nursing, psychology, 

24 social work, or any other related health pro25 gram; 


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1 ‘‘(L) an environmental health service, in2 cluding a service provided by an epidemiologist, 

3 public health official, medical geographer, or 

4 medical anthropologist, or an individual special5 izing in biological, chemical, or environmental 

6 health determinants; 

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

8 to specialty or tertiary care; and 

9 ‘‘(N) a complementary healing practice, in10 cluding a practice performed by a traditional 

11 Native Hawaiian healer. 

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

13 Hawaiian’ means any individual who is Kanaka 

14 Maoli (a descendant of the aboriginal people who, 

15 prior to 1778, occupied and exercised sovereignty in 

16 the area that now constitutes the State), as evi17 denced by— 

18 ‘‘(A) genealogical records; 

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

20 Native Hawaiian Kupuna (elders); or 

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

22 other State or territory of the United States. 

23 ‘‘(6) NATIVE HAWAIIAN HEALTH CARE SYS24 TEM.—The term ‘Native Hawaiian health care sysVerDate Nov 24 2008 03:25 Nov 05, 2009 Jkt 089200 PO 00000 Frm 00041 Fmt 6652 Sfmt 6201 E:\BILLS\H4024.IH H4024

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1 tem’ means any of up to 8 entities in the State 

2 that— 

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

4 State; 

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

6 of health services for Native Hawaiians in the 

7 State; 

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

9 ‘‘(D) has Native Hawaiians significantly 

10 participating in the planning, management, pro11 vision, monitoring, and evaluation of health 

12 services; 

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

14 island’s Native Hawaiian population; and 

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

16 ‘‘(i) for the purpose of planning, con17 ducting, or administering programs, or 

18 portions of programs, authorized by this 

19 Act for the benefit of Native Hawaiians; 

20 and 

21 ‘‘(ii) as having the qualifications and 

22 the capacity to provide the services and 

23 meet the requirements under— 

24 ‘‘(I) the contract that each Na25 tive Hawaiian health care system enVerDate Nov 24 2008 03:25 Nov 05, 2009 Jkt 089200 PO 00000 Frm 00042 Fmt 6652 Sfmt 6201 E:\BILLS\H4024.IH H4024

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1 ters into with the Secretary under this 

2 Act; or 

3 ‘‘(II) the grant each Native Ha4 waiian health care system receives 

5 from the Secretary under this Act. 

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

7 term ‘Native Hawaiian Health Center’ means any 

8 organization that is a primary health care provider 

9 that— 

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

11 individuals, at least 50 percent of whom are 

12 Native Hawaiians; 

13 ‘‘(B) has demonstrated cultural com14 petency in a predominantly Native Hawaiian 

15 community; 

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

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

18 50 percent of whom are Native Hawaiian; 

19 or 

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

21 Hawaiians as annual users of services; and 

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

23 having met each of the criteria described in 

24 subparagraphs (A) through (C). 


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1 ‘‘(8) NATIVE HAWAIIAN HEALTH TASK

2 FORCE.—The term ‘Native Hawaiian Health Task 

3 Force’ means a task force established by the State 

4 Council of Hawaiian Homestead Associations to im5 plement health and wellness strategies in Native Ha6 waiian communities. 

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

8 term ‘Native Hawaiian organization’ means any or9 ganization that— 

10 ‘‘(A) serves the interests of Native Hawai11 ians; and 

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

13 for planning, conducting, or administering pro14 grams authorized under this Act for the benefit 

15 of Native Hawaiians; and 

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

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

18 term ‘Office of Hawaiian Affairs’ means the govern19 mental entity that— 

20 ‘‘(A) is established under article XII, sec21 tions 5 and 6, of the Hawai’i State Constitu22 tion; and 

23 ‘‘(B) charged with the responsibility to for24 mulate policy relating to the affairs of Native 

25 Hawaiians. 


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1 ‘‘(11) PAPA OLA LOKAHI.— 

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

3 Lokahi’ means an organization that— 

4 ‘‘(i) is composed of public agencies 

5 and private organizations focusing on im6 proving the health status of Native Hawai7 ians; and 

8 ‘‘(ii) governed by a board the mem9 bers of which may include representation 

10 from— 

11 ‘‘(I) E Ola Mau; 

12 ‘‘(II) the Office of Hawaiian Af13 fairs; 

14 ‘‘(III) Alu Like, Inc.; 

15 ‘‘(IV) the University of Hawaii; 

16 ‘‘(V) the Hawai’i State Depart17 ment of Health; 

18 ‘‘(VI) the Native Hawaiian 

19 Health Task Force; 

20 ‘‘(VII) the Hawai’i State Primary 

21 Care Association; 

22 ‘‘(VIII) Ahahui O Na Kauka, the 

23 Native Hawaiian Physicians Associa24 tion; 


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1 ‘‘(IX) Ho‘ola Lahui Hawaii, or a 

2 health care system serving the islands 

3 of Kaua‘i or Ni‘ihau (which may be 

4 composed of as many health care cen5 ters as are necessary to meet the 

6 health care needs of the Native Ha7 waiians of those islands); 

8 ‘‘(X) Ke Ola Mamo, or a health 

9 care system serving the island of 

10 O‘ahu (which may be composed of as 

11 many health care centers as are nec12 essary to meet the health care needs 

13 of the Native Hawaiians of that is14 land); 

15 ‘‘(XI) Na Pu‘uwai or a health 

16 care system serving the islands of 

17 Moloka‘i or Lana‘i (which may be 

18 composed of as many health care cen19 ters as are necessary to meet the 

20 health care needs of the Native Ha21 waiians of those islands); 

22 ‘‘(XII) Hui No Ke Ola Pono, or 

23 a health care system serving the is24 land of Maui (which may be composed 

25 of as many health care centers as are 


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1 necessary to meet the health care 

2 needs of the Native Hawaiians of that 

3 island); 

4 ‘‘(XIII) Hui Malama Ola Na 

5 ‘Oiwi, or a health care system serving 

6 the island of Hawai’i (which may be 

7 composed of as many health care cen8 ters as are necessary to meet the 

9 health care needs of the Native Ha10 waiians of that island); 

11 ‘‘(XIV) such other Native Hawai12 ian health care systems as are cer13 tified and recognized by Papa Ola 

14 Lokahi in accordance with this Act; 

15 and 

16 ‘‘(XV) such other member orga17 nizations as the Board of Papa Ola 

18 Lokahi shall admit from time to time, 

19 based on satisfactory demonstration of 

20 a record of contribution to the health 

21 and well-being of Native Hawaiians. 

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

23 Lokahi’ does not include any organization de24 scribed in subparagraph (A) for which the Sec25 retary has made a determination that the orgaVerDate Nov 24 2008 03:25 Nov 05, 2009 Jkt 089200 PO 00000 Frm 00047 Fmt 6652 Sfmt 6201 E:\BILLS\H4024.IH H4024

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1 nization has not developed a mission statement 

2 that includes— 

3 ‘‘(i) clearly defined goals and objec4 tives for the contributions the organization 

5 will make to— 

6 ‘‘(I) Native Hawaiian health care 

7 systems; and 

8 ‘‘(II) the national policy de9 scribed in section 4; and 

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

11 those goals and objectives. 

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

13 means the Secretary of Health and Human Services. 

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

15 State of Hawaii. 

16 ‘‘(14) TRADITIONAL NATIVE HAWAIIAN HEAL17 ER.—The term ‘traditional Native Hawaiian healer’ 

18 means a practitioner— 

19 ‘‘(A) who— 

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

21 and 

22 ‘‘(ii) has the knowledge, skills, and ex23 perience in direct personal health care of 

24 individuals; and 


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

2 of whom are based on demonstrated learning of 

3 Native Hawaiian healing practices acquired 

4 by— 

5 ‘‘(i) direct practical association with 

6 Native Hawaiian elders; and 

7 ‘‘(ii) oral traditions transmitted from 

8 generation to generation. 

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

10 HEALTH POLICY. 

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

12 policy of the United States, in fulfillment of special re13 sponsibilities and legal obligations of the United States to 

14 the indigenous people of Hawai’i resulting from the unique 

15 and historical relationship between the United States and 

16 the indigenous people of Hawaii— 

17 ‘‘(1) to raise the health status of Native Hawai18 ians to the highest practicable health level; and 

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

20 programs with all resources necessary to effectuate 

21 that policy. 

22 ‘‘(b) INTENT OF CONGRESS.—It is the intent of Con23 gress that— 

24 ‘‘(1) health care programs having a dem25 onstrated effect of substantially reducing or elimiVerDate Nov 24 2008 03:25 Nov 05, 2009 Jkt 089200 PO 00000 Frm 00049 Fmt 6652 Sfmt 6201 E:\BILLS\H4024.IH H4024

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1 nating the overrepresentation of Native Hawaiians 

2 among those suffering from chronic and acute dis3 ease and illness, and addressing the health needs of 

4 Native Hawaiians (including perinatal, early child 

5 development, and family-based health education 

6 needs), shall be established and implemented; and 

7 ‘‘(2) the United States— 

8 ‘‘(A) raise the health status of Native Ha9 waiians by the year 2010 to at least the levels 

10 described in the goals contained within Healthy 

11 People 2010 (or successor standards); and 

12 ‘‘(B) incorporate within health programs in 

13 the United States activities defined and identi14 fied by Kanaka Maoli, such as— 

15 ‘‘(i) incorporating and supporting the 

16 integration of cultural approaches to health 

17 and well-being, including programs using 

18 traditional practices relating to the atmos19 phere (lewa lani), land (’aina), water (wai), 

20 or ocean (kai); 

21 ‘‘(ii) increasing the number of Native 

22 Hawaiian health and allied-health pro23 viders who provide care to or have an im24 pact on the health status of Native Hawai25 ians; 


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1 ‘‘(iii) increasing the use of traditional 

2 Native Hawaiian foods in— 

3 ‘‘(I) the diets and dietary pref4 erences of people, including those of 

5 students; and 

6 ‘‘(II) school feeding programs; 

7 ‘‘(iv) identifying and instituting Na8 tive Hawaiian cultural values and practices 

9 within the corporate cultures of organiza10 tions and agencies providing health serv11 ices to Native Hawaiians; 

12 ‘‘(v) facilitating the provision of Na13 tive Hawaiian healing practices by Native 

14 Hawaiian healers for individuals desiring 

15 that assistance; 

16 ‘‘(vi) supporting training and edu17 cation activities and programs in tradi18 tional Native Hawaiian healing practices 

19 by Native Hawaiian healers; and 

20 ‘‘(vii) demonstrating the integration of 

21 health services for Native Hawaiians, par22 ticularly those that integrate mental, phys23 ical, and dental services in health care. 

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

25 President, for inclusion in each report required to be subVerDate Nov 24 2008 03:25 Nov 05, 2009 Jkt 089200 PO 00000 Frm 00051 Fmt 6652 Sfmt 6201 E:\BILLS\H4024.IH H4024

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1 mitted to Congress under section 12, a report on the 

2 progress made toward meeting the national policy de3 scribed in this section. 

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

5 FOR NATIVE HAWAIIANS. 

6 ‘‘(a) DEVELOPMENT.— 

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

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

9 Lokahi for the purpose of coordinating, imple10 menting, and updating a Native Hawaiian com11 prehensive health care master plan that is de12 signed— 

13 ‘‘(A) to promote comprehensive health pro14 motion and disease prevention services; 

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

16 status of Native Hawaiians; and 

17 ‘‘(C) to support community-based initia18 tives that are reflective of holistic approaches to 

19 health. 

20 ‘‘(2) CONSULTATION.— 

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

22 section, Papa Ola Lokahi and the Office of Ha23 waiian Affairs shall consult with representatives 

24 of— 


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1 ‘‘(i) the Native Hawaiian health care 

2 systems; 

3 ‘‘(ii) the Native Hawaiian health cen4 ters; and 

5 ‘‘(iii) the Native Hawaiian commu6 nity. 

7 ‘‘(B) MEMORANDA OF UNDERSTANDING.— 

8 Papa Ola Lokahi and the Office of Hawaiian 

9 Affairs may enter into memoranda of under10 standing or agreement for the purpose of ac11 quiring joint funding, or for such other pur12 poses as are necessary, to accomplish the objec13 tives of this section. 

14 ‘‘(3) HEALTH CARE FINANCING STUDY RE15 PORT.— 

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

17 months after the date of enactment of the Na18 tive Hawaiian Health Care Improvement Reau19 thorization Act of 2009, Papa Ola Lokahi, in 

20 cooperation with the Office of Hawaiian Affairs 

21 and other appropriate agencies and organiza22 tions in the State (including the Department of 

23 Health and the Department of Human Services 

24 of the State) and appropriate Federal agencies 

25 (including the Centers for Medicare and MedVerDate Nov 24 2008 03:25 Nov 05, 2009 Jkt 089200 PO 00000 Frm 00053 Fmt 6652 Sfmt 6201 E:\BILLS\H4024.IH H4024

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1 icaid Services), shall submit to Congress a re2 port that describes the impact of Federal and 

3 State health care financing mechanisms and 

4 policies on the health and well-being of Native 

5 Hawaiians. 

6 ‘‘(B) COMPONENTS.—The report shall in7 clude— 

8 ‘‘(i) information concerning the im9 pact on Native Hawaiian health and well10 being of— 

11 ‘‘(I) cultural competency; 

12 ‘‘(II) risk assessment data; 

13 ‘‘(III) eligibility requirements 

14 and exemptions; and 

15 ‘‘(IV) reimbursement policies and 

16 capitation rates in effect as of the 

17 date of the report for service pro18 viders; 

19 ‘‘(ii) such other similar information as 

20 may be important to improving the health 

21 status of Native Hawaiians, as that infor22 mation relates to health care financing (in23 cluding barriers to health care); and 


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1 ‘‘(iii) recommendations for submission 

2 to the Secretary, for review and consulta3 tion with the Native Hawaiian community. 

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

5 are authorized to be appropriated such sums as are nec6 essary to carry out subsection (a). 

7 ‘‘SEC. 6. FUNCTIONS OF PAPA OLA LOKAHI. 

8 ‘‘(a) IN GENERAL.—Papa Ola Lokahi— 

9 ‘‘(1) shall be responsible for— 

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

11 updating, as appropriate, of the comprehensive 

12 health care master plan under section 5; 

13 ‘‘(B) the training and education of individ14 uals providing health services; 

15 ‘‘(C) the identification of and research (in16 cluding behavioral, biomedical, epidemiological, 

17 and health service research) into the diseases 

18 that are most prevalent among Native Hawai19 ians; and 

20 ‘‘(D) the development and maintenance of 

21 an institutional review board for all research 

22 projects involving all aspects of Native Hawai23 ian health, including behavioral, biomedical, epi24 demiological, and health service research; 


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1 ‘‘(2) may receive special project funds (includ2 ing research endowments under section 736 of the 

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

4 available for the purpose of— 

5 ‘‘(A) research on the health status of Na6 tive Hawaiians; or 

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

8 Native Hawaiians; and 

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

10 ‘‘(A) the collection and maintenance of 

11 data associated with the health status of Native 

12 Hawaiians; 

13 ‘‘(B) the identification and research into 

14 diseases affecting Native Hawaiians; 

15 ‘‘(C) the availability of Native Hawaiian 

16 project funds, research projects, and publica17 tions; 

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

19 area of Native Hawaiian health; and 

20 ‘‘(E) the timely dissemination of informa21 tion pertinent to the Native Hawaiian health 

22 care systems. 

23 ‘‘(b) CONSULTATION.— 

24 ‘‘(1) IN GENERAL.—The Secretary and the Sec25 retary of each other Federal agency shall— 


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

2 ‘‘(B) provide Papa Ola Lokahi and the Of3 fice of Hawaiian Affairs, at least once annually, 

4 an accounting of funds and services provided by 

5 the Secretary to assist in accomplishing the 

6 purposes described in section 4. 

7 ‘‘(2) COMPONENTS OF ACCOUNTING.—The ac8 counting under paragraph (1)(B) shall include an 

9 identification of— 

10 ‘‘(A) the amount of funds expended explic11 itly for and benefitting Native Hawaiians; 

12 ‘‘(B) the number of Native Hawaiians af13 fected by those funds; 

14 ‘‘(C) the collaborations between the appli15 cable Federal agency and Native Hawaiian 

16 groups and organizations in the expenditure of 

17 those funds; and 

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

19 ‘‘(i) Federal administrative purposes; 

20 and 

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

22 Native Hawaiians. 

23 ‘‘(c) FISCAL ALLOCATION AND COORDINATION OF

24 PROGRAMS AND SERVICES.— 


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

2 shall provide annual recommendations to the Sec3 retary with respect to the allocation of all amounts 

4 made available under this Act. 

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

6 to the maximum extent practicable, coordinate and 

7 assist the health care programs and services pro8 vided to Native Hawaiians under this Act and other 

9 Federal laws. 

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

11 Secretary, in consultation with Papa Ola Lokahi, 

12 shall make recommendations for Native Hawaiian 

13 representation on the President’s Advisory Commis14 sion on Asian Americans and Pacific Islanders. 

15 ‘‘(d) TECHNICAL SUPPORT.—Papa Ola Lokahi shall 

16 provide statewide infrastructure to provide technical sup17 port and coordination of training and technical assistance 

18 to— 

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

20 and 

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

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

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

24 into agreements or memoranda of understanding 


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1 with relevant institutions, agencies, or organizations 

2 that are capable of providing— 

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

4 Native Hawaiians and the Native Hawaiian 

5 health care systems; or 

6 ‘‘(B) resources or services for the imple7 mentation of the national policy described in 

8 section 4. 

9 ‘‘(2) HEALTH CARE FINANCING.— 

10 ‘‘(A) FEDERAL CONSULTATION.— 

11 ‘‘(i) IN GENERAL.—Before adopting 

12 any policy, rule, or regulation that may af13 fect the provision of services or health in14 surance coverage for Native Hawaiians, a 

15 Federal agency that provides health care 

16 financing and carries out health care pro17 grams (including the Centers for Medicare 

18 and Medicaid Services) shall consult with 

19 representatives of— 

20 ‘‘(I) the Native Hawaiian com21 munity; 

22 ‘‘(II) Papa Ola Lokahi; and 

23 ‘‘(III) organizations providing 

24 health care services to Native Hawai25 ians in the State. 


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1 ‘‘(ii) IDENTIFICATION OF EFFECTS.— 

2 Any consultation by a Federal agency 

3 under clause (i) shall include an identifica4 tion of the effect of any policy, rule, or 

5 regulation proposed by the Federal agency. 

6 ‘‘(B) STATE CONSULTATION.—Before mak7 ing any change in an existing program or im8 plementing any new program relating to Native 

9 Hawaiian health, the State shall engage in 

10 meaningful consultation with representatives 

11 of— 

12 ‘‘(i) the Native Hawaiian community; 

13 ‘‘(ii) Papa Ola Lokahi; and 

14 ‘‘(iii) organizations providing health 

15 care services to Native Hawaiians in the 

16 State. 

17 ‘‘(C) CONSULTATION ON FEDERAL

18 HEALTH INSURANCE PROGRAMS.— 

19 ‘‘(i) IN GENERAL.—The Office of Ha20 waiian Affairs, in collaboration with Papa 

21 Ola Lokahi, may develop consultative, con22 tractual, or other arrangements, including 

23 memoranda of understanding or agree24 ment, with— 


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1 ‘‘(I) the Centers for Medicare 

2 and Medicaid Services; 

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

4 administers or supervises the adminis5 tration of the State plan or waiver ap6 proved under title XVIII, XIX, or 

7 XXI of the Social Security Act (42 

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

9 of all or a part of the health care 

10 services provided to Native Hawaiians 

11 who are eligible for medical assistance 

12 under the State plan or waiver; or 

13 ‘‘(III) any other Federal agency 

14 providing full or partial health insur15 ance to Native Hawaiians. 

16 ‘‘(ii) CONTENTS OF ARRANGE17 MENTS.—An arrangement under clause (i) 

18 may address— 

19 ‘‘(I) appropriate reimbursement 

20 for health care services, including 

21 capitation rates and fee-for-service 

22 rates for Native Hawaiians who are 

23 entitled to or eligible for insurance; 

24 ‘‘(II) the scope of services; or 


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1 ‘‘(III) other matters that would 

2 enable Native Hawaiians to maximize 

3 health insurance benefits provided by 

4 Federal and State health insurance 

5 programs. 

6 ‘‘(3) TRADITIONAL HEALERS.— 

7 ‘‘(A) IN GENERAL.—The provision of 

8 health services under any program operated by 

9 the Department or another Federal agency (in10 cluding the Department of Veterans Affairs) 

11 may include the services of— 

12 ‘‘(i) traditional Native Hawaiian heal13 ers; or 

14 ‘‘(ii) traditional healers providing tra15 ditional health care practices (as those 

16 terms are defined in section 4 of the In17 dian Health Care Improvement Act (25 

18 U.S.C. 1603). 

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

20 subparagraph (A) shall be exempt from national 

21 accreditation reviews, including reviews con22 ducted by— 

23 ‘‘(i) the Joint Commission on Accredi24 tation of Healthcare Organizations; and 


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1 ‘‘(ii) the Commission on Accreditation 

2 of Rehabilitation Facilities. 

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

4 ‘‘(a) COMPREHENSIVE HEALTH PROMOTION, DIS5 EASE PREVENTION, AND OTHER HEALTH SERVICES.— 

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

7 in consultation with Papa Ola Lokahi, may make 

8 grants to, or enter into contracts with 1 or more Na9 tive Hawaiian health care systems for the purpose of 

10 providing comprehensive health promotion and dis11 ease prevention services, as well as other health serv12 ices, to Native Hawaiians who desire and are com13 mitted to bettering their own health. 

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

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

16 a contract with, not more than 8 Native Hawaiian 

17 health care systems under this subsection for any 

18 fiscal year. 

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

20 to grants and contracts under subsection (a), the Sec21 retary may make a grant to, or enter into a contract with, 

22 Papa Ola Lokahi for the purpose of planning Native Ha23 waiian health care systems to serve the health needs of 

24 Native Hawaiian communities on each of the islands of 


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

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

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

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

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

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

7 Native Hawaiians in accessing health services; 

8 ‘‘(B) education in health promotion and 

9 disease prevention for Native Hawaiians that, 

10 wherever practicable, is provided by— 

11 ‘‘(i) Native Hawaiian health care 

12 practitioners; 

13 ‘‘(ii) community outreach workers; 

14 ‘‘(iii) counselors; 

15 ‘‘(iv) cultural educators; and 

16 ‘‘(v) other disease prevention pro17 viders; 

18 ‘‘(C) services of individuals providing 

19 health services; 

20 ‘‘(D) collection of data relating to the pre21 vention of diseases and illnesses among Native 

22 Hawaiians; and 

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1 cluding land-based, water-based, ocean-based, 

2 and spiritually based projects and programs. 

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

4 services referred to in paragraph (1) that are pro5 vided under grants or contracts under subsection (a) 

6 may be provided by traditional Native Hawaiian 

7 healers, as appropriate. 

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

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

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

11 system, including a provider of a traditional Native Ha12 waiian healing service, shall be— 

13 ‘‘(1) treated as if the individual were a member 

14 of the Public Health Service; and 

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

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

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

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

19 care system that receives funds under subsection (a) 

20 may serve as a Federal loan repayment facility. 

21 ‘‘(2) REMISSION OF PAYMENTS.—A facility de22 scribed in paragraph (1) shall be designed to enable 

23 health and allied-health professionals to remit pay24 ments with respect to loans provided to the profes25 sionals under any Federal loan program. 


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1 ‘‘(f) RESTRICTION ON USE OF GRANT AND CON2 TRACT FUNDS.—The Secretary shall not make a grant to, 

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

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

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

6 be expended— 

7 ‘‘(1) for any service other than a service de8 scribed in subsection (c)(1); 

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

10 (other than minor remodeling of existing improve11 ments to real property); or 

12 ‘‘(3) to purchase major medical equipment. 

13 ‘‘(g) LIMITATION ON CHARGES FOR SERVICES.—The 

14 Secretary shall not make a grant to, or enter into a con15 tract with, an entity under subsection (a) unless the entity 

16 agrees that, whether health services are provided directly 

17 or under a contract— 

18 ‘‘(1) any health service under the grant or con19 tract will be provided without regard to the ability 

20 of an individual receiving the health service to pay 

21 for the health service; and 

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

23 such a health service a charge that is— 


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

2 charges that is made available to the public; 

3 and 

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

5 individual involved. 

6 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.— 

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

8 to be appropriated such sums as are necessary to 

9 carry out subsection (a) for each of fiscal years 2009 

10 through 2014. 

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

12 to be appropriated such sums as are necessary to 

13 carry out subsection (b) for each of fiscal years 2009 

14 through 2014. 

15 ‘‘(3) HEALTH SERVICES.—There are authorized 

16 to be appropriated such sums as are necessary to 

17 carry out subsection (c) for each of fiscal years 2009 

18 through 2014. 

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

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

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

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

23 ‘‘(1) coordination, implementation, and updat24 ing (as appropriate) of the comprehensive health 

25 care master plan developed under section 5; 


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

2 health services; 

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

4 behavioral, biomedical, epidemiologic, and health 

5 service research) into the diseases that are most 

6 prevalent among Native Hawaiians; 

7 ‘‘(4) a clearinghouse function for— 

8 ‘‘(A) the collection and maintenance of 

9 data associated with the health status of Native 

10 Hawaiians; 

11 ‘‘(B) the identification and research into 

12 diseases affecting Native Hawaiians; and 

13 ‘‘(C) the availability of Native Hawaiian 

14 project funds, research projects, and publica15 tions; 

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

17 institutional review board for all health-related re18 search involving Native Hawaiians; 

19 ‘‘(6) the coordination of the health care pro20 grams and services provided to Native Hawaiians; 

21 and 

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

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

24 are authorized to be appropriated such sums as are necVerDate Nov 24 2008 03:25 Nov 05, 2009 Jkt 089200 PO 00000 Frm 00068 Fmt 6652 Sfmt 6201 E:\BILLS\H4024.IH H4024

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1 essary to carry out subsection (a) for each of fiscal years 

2 2009 through 2014. 

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

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

5 include in any grant made or contract entered into under 

6 this Act such terms and conditions as the Secretary con7 siders necessary or appropriate to ensure that the objec8 tives of the grant or contract are achieved. 

9 ‘‘(b) PERIODIC REVIEW.—The Secretary shall peri10 odically evaluate the performance of, and compliance with, 

11 grants and contracts under this Act. 

12 ‘‘(c) ADMINISTRATIVE REQUIREMENTS.—The Sec13 retary shall not make a grant or enter into a contract 

14 under this Act with an entity unless the entity— 

15 ‘‘(1) agrees to establish such procedures for fis16 cal control and fund accounting as the Secretary de17 termines are necessary to ensure proper disburse18 ment and accounting with respect to the grant or 

19 contract; 

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

21 records maintained on individuals receiving health 

22 services under the grant or contract; 

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

24 any population of Native Hawaiians, a substantial 


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1 portion of which has a limited ability to speak the 

2 English language— 

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

4 carry out a reasonable plan to provide health 

5 services under the grant or contract through in6 dividuals who are able to communicate with the 

7 population involved in the language and cultural 

8 context that is most appropriate; and 

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

10 who is fluent in English and the appropriate 

11 language to assist in carrying out the plan; 

12 ‘‘(4) with respect to health services that are 

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

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

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

16 Federal health insurance plan— 

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

18 grant or contract any of those health services 

19 directly— 

20 ‘‘(i) has entered into a participation 

21 agreement under each such plan; and 

22 ‘‘(ii) is qualified to receive payments 

23 under the plan; and 


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

2 grant or contract any of those health services 

3 through a contract with an organization— 

4 ‘‘(i) ensures that the organization has 

5 entered into a participation agreement 

6 under each such plan; and 

7 ‘‘(ii) ensures that the organization is 

8 qualified to receive payments under the 

9 plan; and 

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

11 Papa Ola Lokahi an annual report that— 

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

13 services provided under the grant or contract 

14 (including the average cost of health services 

15 per user); and 

16 ‘‘(B) provides such other information as 

17 the Secretary determines to be appropriate. 

18 ‘‘(d) CONTRACT EVALUATION.— 

19 ‘‘(1) DETERMINATION OF NONCOMPLIANCE.— 

20 If, as a result of evaluations conducted by the Sec21 retary, the Secretary determines that an entity has 

22 not complied with or satisfactorily performed a con23 tract entered into under section 7, the Secretary 

24 shall, before renewing the contract— 


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1 ‘‘(A) attempt to resolve the areas of non2 compliance or unsatisfactory performance; and 

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

4 occurrences of the noncompliance or unsatisfac5 tory performance. 

6 ‘‘(2) NONRENEWAL.—If the Secretary deter7 mines that the noncompliance or unsatisfactory per8 formance described in paragraph (1) with respect to 

9 an entity cannot be resolved and prevented in the fu10 ture, the Secretary— 

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

12 entity; and 

13 ‘‘(B) may enter into a contract under sec14 tion 7 with another entity referred to in section 

15 7(a)(3) that provides services to the same popu16 lation of Native Hawaiians served by the entity 

17 the contract with which was not renewed by 

18 reason of this paragraph. 

19 ‘‘(3) CONSIDERATION OF RESULTS.—In deter20 mining whether to renew a contract entered into 

21 with an entity under this Act, the Secretary shall 

22 consider the results of the evaluations conducted 

23 under this section. 

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

25 contract entered into by the Secretary under this 


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1 Act shall be in accordance with all Federal con2 tracting laws (including regulations), except that, in 

3 the discretion of the Secretary, such a contract 

4 may— 

5 ‘‘(A) be negotiated without advertising; 

6 and 

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

8 chapter 31, United States Code. 

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

10 contract entered into under this Act— 

11 ‘‘(A) may be made— 

12 ‘‘(i) in advance; 

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

14 ‘‘(iii) in installments; and 

15 ‘‘(B) shall be made on such conditions as 

16 the Secretary determines to be necessary to 

17 carry out this Act. 

18 ‘‘(e) REPORT.— 

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

20 which an entity receives or expends funds under a 

21 grant or contract under this Act, the entity shall 

22 submit to the Secretary and to Papa Ola Lokahi an 

23 annual report that describes— 

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

25 under the grant or contract; 


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

2 Federal funds were expended; and 

3 ‘‘(C) such other information as the Sec4 retary may request. 

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

6 entity concerning any grant or contract under this 

7 Act shall be subject to audit by— 

8 ‘‘(A) the Secretary; 

9 ‘‘(B) the Inspector General of the Depart10 ment of Health and Human Services; and 

11 ‘‘(C) the Comptroller General of the 

12 United States. 

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

14 allow as a cost of any grant made or contract entered into 

15 under this Act the cost of an annual private audit con16 ducted by a certified public accountant to carry out this 

17 section. 

18 ‘‘SEC. 10. ASSIGNMENT OF PERSONNEL. 

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

20 agreement with Papa Ola Lokahi or any of the Native Ha21 waiian health care systems for the assignment of personnel 

22 of the Department of Health and Human Services with 

23 relevant expertise for the purpose of— 

24 ‘‘(1) conducting research; or 


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1 ‘‘(2) providing comprehensive health promotion 

2 and disease prevention services and health services 

3 to Native Hawaiians. 

4 ‘‘(b) APPLICABLE FEDERAL PERSONNEL PROVI5 SIONS.—Any assignment of personnel made by the Sec6 retary under any agreement entered into under subsection 

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

8 to a local government that is made in accordance with sub9 chapter VI of chapter 33 of title 5, United States Code. 

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

11 FELLOWSHIPS. 

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

13 amounts appropriated under subsection (c), the Secretary 

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

15 or a cooperative agreement, funds for the purpose of pro16 viding scholarship and fellowship assistance, counseling, 

17 and placement service assistance to students who are Na18 tive Hawaiians. 

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

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

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

22 and 

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

24 ‘‘(c) TERMS AND CONDITIONS.— 

25 ‘‘(1) SCHOLARSHIP ASSISTANCE.— 


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1 ‘‘(A) IN GENERAL.—The scholarship as2 sistance under subsection (a) shall be provided 

3 in accordance with subparagraphs (B) through 

4 (G). 

5 ‘‘(B) NEED.—The provision of scholar6 ships in each type of health profession training 

7 shall correspond to the need for each type of 

8 health professional to serve the Native Hawai9 ian community in providing health services, as 

10 identified by Papa Ola Lokahi. 

11 ‘‘(C) ELIGIBLE APPLICANTS.—To the max12 imum extent practicable, the Secretary shall se13 lect scholarship recipients from a list of eligible 

14 applicants submitted by Papa Ola Lokahi. 

15 ‘‘(D) OBLIGATED SERVICE REQUIRE16 MENT.— 

17 ‘‘(i) IN GENERAL.—An obligated serv18 ice requirement for each scholarship recipi19 ent (except for a recipient receiving assist20 ance under paragraph (2)) shall be fulfilled 

21 through service, in order of priority, in— 

22 ‘‘(I) any of the Native Hawaiian 

23 health care systems; 

24 ‘‘(II) any of the Native Hawaiian 

25 health centers; 


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1 ‘‘(III) 1 or more health profes2 sions shortage areas, medically under3 served areas, or geographic areas or 

4 facilities similarly designated by the 

5 Public Health Service in the State; 

6 ‘‘(IV) a Native Hawaiian organi7 zation that serves a geographical area, 

8 facility, or organization that serves a 

9 significant Native Hawaiian popu10 lation; 

11 ‘‘(V) any public agency or non12 profit organization providing services 

13 to Native Hawaiians; or 

14 ‘‘(VI) any of the uniformed serv15 ices of the United States. 

16 ‘‘(ii) ASSIGNMENT.—The placement 

17 service for a scholarship shall assign each 

18 Native Hawaiian scholarship recipient to 1 

19 or more appropriate sites for service in ac20 cordance with clause (i). 

21 ‘‘(E) COUNSELING, RETENTION, AND SUP22 PORT SERVICES.—The provision of academic 

23 and personal counseling, retention and other 

24 support services— 


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

2 recipients under this section; and 

3 ‘‘(ii) shall be made available to recipi4 ents of other scholarship and financial aid 

5 programs enrolled in appropriate health 

6 professions training programs. 

7 ‘‘(F) FINANCIAL ASSISTANCE.—After con8 sultation with Papa Ola Lokahi, financial as9 sistance may be provided to a scholarship re10 cipient during the period that the recipient is 

11 fulfilling the service requirement of the recipi12 ent in any of— 

13 ‘‘(i) the Native Hawaiian health care 

14 systems; or 

15 ‘‘(ii) the Native Hawaiians health cen16 ters. 

17 ‘‘(G) DISTANCE LEARNING RECIPIENTS.— 

18 A scholarship may be provided to a Native Ha19 waiian who is enrolled in an appropriate dis20 tance learning program offered by an accredited 

21 educational institution. 

22 ‘‘(2) FELLOWSHIPS.— 

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

24 provide financial assistance in the form of a felVerDate Nov 24 2008 03:25 Nov 05, 2009 Jkt 089200 PO 00000 Frm 00078 Fmt 6652 Sfmt 6201 E:\BILLS\H4024.IH H4024

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1 lowship to a Native Hawaiian health profes2 sional who is— 

3 ‘‘(i) a Native Hawaiian community 

4 health representative, outreach worker, or 

5 health program administrator in a profes6 sional training program; 

7 ‘‘(ii) a Native Hawaiian providing 

8 health services; or 

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

10 certificated program provided by tradi11 tional Native Hawaiian healers in any of 

12 the traditional Native Hawaiian healing 

13 practices (including lomi-lomi, la‘au 

14 lapa‘au, and ho‘oponopono). 

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

16 under subparagraph (A) may include a stipend 

17 for, or reimbursement for costs associated with, 

18 participation in a program described in that 

19 paragraph. 

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

21 who is a health professional designated in section 

22 338A of the Public Health Service Act (42 U.S.C. 

23 254l) who receives a scholarship under this sub24 section while fulfilling a service requirement under 

25 that Act shall retain the same rights and benefits as 


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1 members of the National Health Service Corps dur2 ing the period of service. 

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

4 INCOME.—Financial assistance provided under this 

5 section shall be considered to be qualified scholar6 ships for the purpose of section 117 of the Internal 

7 Revenue Code of 1986. 

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

9 are authorized to be appropriated such sums as are nec10 essary to carry out subsections (a) and (c)(2) for each of 

11 fiscal years 2009 through 2014. 

12 ‘‘SEC. 12. REPORT. 

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

14 at which the budget of the United States is submitted 

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

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

17 purposes of this Act, including— 

18 ‘‘(1) a review of programs established or as19 sisted in accordance with this Act; and 

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

21 additional programs or additional assistance nec22 essary to provide, at a minimum, health services to 

23 Native Hawaiians, and ensure a health status for 

24 Native Hawaiians, that are at a parity with the 


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

2 the general population. 

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

4 SOURCES OF SUPPLY. 

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

6 organization that enters into a contract or receives grant 

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

8 under the contract or grant all existing facilities under the 

9 jurisdiction of the Secretary (including all equipment of 

10 the facilities), in accordance with such terms and condi11 tions as may be agreed on for the use and maintenance 

12 of the facilities or equipment. 

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

14 donate to an organization that enters into a contract or 

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

16 project or activity under the contract or grant, any per17 sonal or real property determined to be in excess of the 

18 needs of the Department or the General Services Adminis19 tration. 

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

21 Secretary may acquire excess or surplus Federal Govern22 ment personal or real property for donation to an organi23 zation under subsection (b) if the Secretary determines 

24 that the property is appropriate for use by the organiza25 tion for the purpose for which a contract entered into or 


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1 grant received by the organization is authorized under this 

2 Act. 

3 ‘‘SEC. 14. DEMONSTRATION PROJECTS OF NATIONAL SIG4 NIFICANCE. 

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

6 ‘‘(1) IN GENERAL.—The Secretary, in consulta7 tion with Papa Ola Lokahi, may allocate amounts 

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

9 carry out Native Hawaiian demonstration projects of 

10 national significance. 

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

12 project described in paragraph (1) may relate to 

13 such areas of interest as— 

14 ‘‘(A) the development of a centralized 

15 database and information system relating to the 

16 health care status, health care needs, and 

17 wellness of Native Hawaiians; 

18 ‘‘(B) the education of health professionals, 

19 and other individuals in institutions of higher 

20 learning, in health and allied health programs 

21 in healing practices, including Native Hawaiian 

22 healing practices; 

23 ‘‘(C) the integration of Western medicine 

24 with complementary healing practices, including 

25 traditional Native Hawaiian healing practices; 


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1 ‘‘(D) the use of telehealth and tele2 communications in— 

3 ‘‘(i) chronic and infectious disease 

4 management; and 

5 ‘‘(ii) health promotion and disease 

6 prevention; 

7 ‘‘(E) the development of appropriate mod8 els of health care for Native Hawaiians and 

9 other indigenous people, including— 

10 ‘‘(i) the provision of culturally com11 petent health services; 

12 ‘‘(ii) related activities focusing on 

13 wellness concepts; 

14 ‘‘(iii) the development of appropriate 

15 kupuna care programs; and 

16 ‘‘(iv) the development of financial 

17 mechanisms and collaborative relationships 

18 leading to universal access to health care; 

19 and 

20 ‘‘(F) the establishment of— 

21 ‘‘(i) a Native Hawaiian Center of Ex22 cellence for Nursing at the University of 

23 Hawai’i at Hilo; 


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1 ‘‘(ii) a Native Hawaiian Center of Ex2 cellence for Mental Health at the Univer3 sity of Hawai’i at Manoa; 

4 ‘‘(iii) a Native Hawaiian Center of 

5 Excellence for Maternal Health and Nutri6 tion at the Waimanalo Health Center; 

7 ‘‘(iv) a Native Hawaiian Center of Ex8 cellence for Research, Training, Integrated 

9 Medicine at Molokai General Hospital; and 

10 ‘‘(v) a Native Hawaiian Center of Ex11 cellence for Complementary Health and 

12 Health Education and Training at the 

13 Waianae Coast Comprehensive Health 

14 Center. 

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

16 Lokahi, and any centers established under para17 graph (2)(F), shall be considered to be qualified as 

18 Centers of Excellence under sections 485F and 

19 903(b)(2)(A) of the Public Health Service Act (42 

20 U.S.C. 287c–32, 299a–1). 

21 ‘‘(b) NONREDUCTION IN OTHER FUNDING.—The al22 location of funds for demonstration projects under sub23 section (a) shall not result in any reduction in funds re24 quired by the Native Hawaiian health care systems, the 

25 Native Hawaiian Health Centers, the Native Hawaiian 


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1 Health Scholarship Program, or Papa Ola Lokahi to carry 

2 out the respective responsibilities of those entities under 

3 this Act. 

4 ‘‘SEC. 15. RULE OF CONSTRUCTION. 

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

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

7 practitioners. 

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

9 ‘‘Any new spending authority described in subpara10 graph (A) or (B) of section 401(c)(2) of the Congressional 

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

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

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

14 Acts of appropriation. 

15 ‘‘SEC. 17. SEVERABILITY. 

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

17 any such provision to any person or circumstance, is deter18 mined by a court of competent jurisdiction to be invalid, 

19 the remainder of this Act, and the application of the provi20 sion to a person or circumstance other than that to which 

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

22 holding.’’. 

Æ 


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