II 

112TH CONGRESS 

1ST SESSION S. 66 

To amend the Native Hawaiian Health Care Improvement Act to revise 

and extend that Act. 

IN THE SENATE OF THE UNITED STATES 

JANUARY 25 (legislative day, JANUARY 5), 2011 

Mr. INOUYE introduced the following bill; which was read twice and referred 

to the Committee on Indian Affairs 

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 2011’’. 

6 SEC. 2. AMENDMENT TO THE NATIVE HAWAIIAN HEALTH 

7 CARE IMPROVEMENT ACT. 

8 The Native Hawaiian Health Care Improvement Act 

9 (42 U.S.C. 11701 et seq.) is amended to read as follows: 


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1 ‘‘SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

3 ‘Native Hawaiian Health Care Improvement Act’. 

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

5 of this Act is as follows: 

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

‘‘Sec. 2. Findings. 

‘‘Sec. 3. Definitions. 

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

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

‘‘Sec. 6. Functions of Papa Ola Lokahi. 

‘‘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 land and 

6 seas; 

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

8 changes in Hawai‘i during 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 Kingdom of Hawai‘i; 

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 Kingdom 

11 of Hawai‘i; 

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

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

14 naval representative of the United States 

15 caused armed forces of the United States Navy 

16 to invade the sovereign Kingdom of Hawai‘i in 

17 support of the overthrow of the indigenous and 

18 lawful Government of Hawai‘i; and 

19 ‘‘(B) after the overthrow, the United 

20 States Minister extended diplomatic recognition 

21 of a provisional government formed by the con22 spirators without the consent of the native peo23 ple of Hawai‘i or the lawful Government of 

24 Hawai‘i, in violation of— 


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1 ‘‘(i) treaties between the Kingdom of 

2 Hawai‘i and the United States; and 

3 ‘‘(ii) international law; 

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

5 18, 1893, President Grover Cleveland— 

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

7 illegal actions; 

8 ‘‘(B) acknowledged that by those acts, de9 scribed by the President as acts of war, the 

10 government of a peaceful and friendly people 

11 was overthrown; and 

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

13 has thus been done which a due regard for our 

14 national character as well as the rights of the 

15 injured people required that we should endeavor 

16 to repair’; 

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

18 of the Kingdom of Hawai‘i, and the Hawaiian Patri19 otic League, representing the aboriginal citizens of 

20 Hawai‘i, promptly petitioned the United States for 

21 redress of those wrongs and restoration of the indig22 enous government of the Kingdom of Hawai‘i, but 

23 no action was taken on that petition; 

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

25 103–150 (107 Stat. 1510), in which Congress— 


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1 ‘‘(A) acknowledged the significance of 

2 those events; and 

3 ‘‘(B) apologized to Native Hawaiians on 

4 behalf of the people of the United States for the 

5 overthrow of the Kingdom of Hawai‘i with the 

6 participation of agents and citizens of the 

7 United States, and the resulting deprivation of 

8 the rights of Native Hawaiians to self-deter9 mination; 

10 ‘‘(17) between 1897 and 1898, when the total 

11 Native Hawaiian population in Hawai‘i was less 

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

13 signed petitions (commonly known as ‘Ku‘e Peti14 tions’) protesting annexation by the United States 

15 and requesting restoration of the monarchy; 

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

17 1898, the United States— 

18 ‘‘(A) annexed Hawai‘i through Resolution 

19 55 (commonly known as the ‘Newlands Resolu20 tion’) (30 Stat. 750), without the consent of, or 

21 compensation to, the indigenous people of 

22 Hawai‘i or the sovereign government of those 

23 people; and 

24 ‘‘(B) denied those people the mechanism 

25 for expression of their inherent sovereignty 


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1 through self-government and self-determination 

2 of their land and ocean resources; 

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

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

5 ‘1900 Organic Act’) (31 Stat. 141, chapter 339), the 

6 United States— 

7 ‘‘(A) received 1,750,000 acres of land for8 merly owned by the Crown and Government of 

9 the Hawaiian Kingdom; and 

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

11 public land laws of the United States by man12 dating that the revenue and proceeds from that 

13 land be ‘used solely for the benefit of the inhab14 itants of the Hawaiian Islands for education 

15 and other public purposes’, thereby establishing 

16 a special trust relationship between the United 

17 States and the inhabitants of Hawai‘i; 

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

19 Homes Commission Act, 1920 (42 Stat. 108, chap20 ter 42), which— 

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

22 ceded public land for exclusive homesteading by 

23 Native Hawaiians; and 

24 ‘‘(B) affirmed the trust relationship be25 tween the United States and Native Hawaiians, 


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1 as expressed by Secretary of the Interior 

2 Franklin K. Lane, who was cited in the Com3 mittee Report of the Committee on Territories 

4 of the House of Representatives as stating, 

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

6 that the natives of the islands . . . for whom 

7 in a sense we are trustees, are falling off rap8 idly in numbers and many of them are in pov9 erty.’; 

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

11 the unique status of the Native Hawaiian people by 

12 including in the Act of June 20, 1938 (52 Stat. 781, 

13 chapter 530), a provision— 

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

15 Native Hawaiians; and 

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

17 native Hawaiian residents of said area or of ad18 jacent villages and by visitors under their guid19 ance’; 

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

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

22 States— 

23 ‘‘(A) transferred responsibility for the ad24 ministration of the Hawaiian home lands to the 

25 State; but 


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1 ‘‘(B) reaffirmed the trust relationship that 

2 existed between the United States and the Na3 tive Hawaiian people by retaining the exclusive 

4 power to enforce the trust, including the power 

5 to approve land exchanges and legislative 

6 amendments affecting the rights of beneficiaries 

7 under that Act; 

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

9 (22), the United States— 

10 ‘‘(A) transferred responsibility for adminis11 tration over portions of the ceded public lands 

12 trust not retained by the United States to the 

13 State; but 

14 ‘‘(B) reaffirmed the trust relationship that 

15 existed between the United States and the Na16 tive Hawaiian people by retaining the legal re17 sponsibility of the State for the betterment of 

18 the conditions of Native Hawaiians under sec19 tion 5(f) of that Act (73 Stat. 6); 

20 ‘‘(24) in 1978, the people of the State of 

21 Hawai‘i— 

22 ‘‘(A) amended the constitution of the State 

23 of Hawai‘i to establish the Office of Hawaiian 

24 Affairs; and 


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1 ‘‘(B) assigned to that Office the author2 ity— 

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

4 Native Hawaiian people real and personal 

5 property transferred from any source; 

6 ‘‘(ii) to receive payments from the 

7 State owed to the Native Hawaiian people 

8 in satisfaction of the pro rata share of the 

9 proceeds of the public land trust estab10 lished by section 5(f) of the Act of March 

11 18, 1959 (48 U.S.C. prec. 491 note; 73 

12 Stat. 6); 

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

14 for matters affecting the Native Hawaiian 

15 people; and 

16 ‘‘(iv) to formulate policy on affairs re17 lating to the Native Hawaiian people; 

18 ‘‘(25) the authority of Congress under the Con19 stitution to legislate in matters affecting the aborigi20 nal or indigenous people of the United States in21 cludes the authority to legislate in matters affecting 

22 the native people of the States of Alaska and 

23 Hawai‘i; 

24 ‘‘(26) the United States has recognized the au25 thority of the Native Hawaiian people to continue to 


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1 work toward an appropriate form of sovereignty, as 

2 defined by the Native Hawaiian people in provisions 

3 set forth in legislation returning the Hawaiian Is4 land of Kaho‘olawe to custodial management by the 

5 State in 1994; 

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

7 for the betterment of the conditions of Native Ha8 waiians, the United States has established a pro9 gram for the provision of comprehensive health pro10 motion and disease prevention services to maintain 

11 and improve the health status of the Hawaiian peo12 ple; 

13 ‘‘(28) the program described in paragraph (27) 

14 is conducted by the Native Hawaiian Health Care 

15 Systems and Papa Ola Lokahi; 

16 ‘‘(29) health initiatives implemented by the Na17 tive Hawaiian Health Care Systems, Papa Ola 

18 Lokahi, and other health institutions and agencies 

19 using Federal assistance have been responsible for 

20 reducing the century-old morbidity and mortality 

21 rates of Native Hawaiian people by— 

22 ‘‘(A) providing comprehensive disease pre23 vention; 

24 ‘‘(B) providing health promotion activities; 

25 and 


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1 ‘‘(C) increasing the number of Native Ha2 waiians in the health and allied health profes3 sions; 

4 ‘‘(30) the accomplishments described in para5 graph (29) have been achieved through implementa6 tion of— 

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

8 of 1988 (Public Law 100–579; 102 Stat. 

9 2916); and 

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

11 section 9168 of the Department of Defense Ap12 propriations Act, 1993 (Public Law 102–396; 

13 106 Stat. 1948); 

14 ‘‘(31) the historical and unique legal relation15 ship between the United States and Native Hawai16 ians has been consistently recognized and affirmed 

17 by Congress through the enactment of more than 

18 160 Federal laws that extend to the Native Hawai19 ian people the same rights and privileges accorded to 

20 American Indian, Alaska Native, Eskimo, and Aleut 

21 communities, including— 

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

23 1974 (42 U.S.C. 2991 et seq.); 

24 ‘‘(B) the American Indian Religious Free25 dom Act (42 U.S.C. 1996); 


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1 ‘‘(C) the National Museum of the Amer2 ican Indian Act (20 U.S.C. 80q et seq.); and 

3 ‘‘(D) the Native American Graves Protec4 tion and Repatriation Act (25 U.S.C. 3001 et 

5 seq.); 

6 ‘‘(32) the United States has recognized and re7 affirmed the trust relationship to the Native Hawai8 ian people through Federal laws that authorize the 

9 provision of services to Native Hawaiians, specifi10 cally— 

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

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

13 ‘‘(B) the Developmental Disabilities Assist14 ance and Bill of Rights Act Amendments of 

15 1987 (Public Law 100–146; 101 Stat. 840); 

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

17 Act of 1988 (Public Law 100–322; 102 Stat. 

18 487); 

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

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

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

22 of 1988 (Public Law 100–579; 102 Stat. 

23 2916); 


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1 ‘‘(F) the Health Professions Reauthoriza2 tion Act of 1988 (Public Law 100–607; 102 

3 Stat. 3122); 

4 ‘‘(G) the Nursing Shortage Reduction and 

5 Education Extension Act of 1988 (Public Law 

6 100–607; 102 Stat. 3153); 

7 ‘‘(H) the Handicapped Programs Technical 

8 Amendments Act of 1988 (Public Law 100– 

9 630; 102 Stat. 3289); 

10 ‘‘(I) the Indian Health Care Amendments 

11 of 1988 (Public Law 100–713; 102 Stat. 

12 4784); and 

13 ‘‘(J) the Disadvantaged Minority Health 

14 Improvement Act of 1990 (Public Law 101– 

15 527; 104 Stat. 2311); 

16 ‘‘(33) the United States has affirmed the his17 torical and unique legal relationship to the Hawaiian 

18 people by authorizing the provision of services to 

19 Native Hawaiians to address problems of alcohol 

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

21 1986 (Public Law 99–570); 

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

23 ‘‘(A) has recognized that Native Hawai24 ians, as aboriginal, indigenous, native people of 

25 the State of Hawai‘i, are a unique population 


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1 group in the State and in the continental 

2 United States; and 

3 ‘‘(B) has so declared in— 

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

5 Management and Budget entitled— 

6 ‘‘(I) ‘Standards for Maintaining, 

7 Collecting, and Presenting Federal 

8 Data on Race and Ethnicity’ and 

9 dated October 30, 1997; and 

10 ‘‘(II) ‘Provisional Guidance on 

11 the Implementation of the 1997 

12 Standards for Federal Data on Race 

13 and Ethnicity’ and dated December 

14 15, 2000; 

15 ‘‘(ii) the document entitled ‘Guidance 

16 on Aggregation and Allocation of Data on 

17 Race for Use in Civil Rights Monitoring 

18 and Enforcement’ (Bulletin 00–02 to the 

19 Heads of Executive Departments and Es20 tablishments) and dated March 9, 2000; 

21 ‘‘(iii) the document entitled ‘Questions 

22 and Answers when Designing Surveys for 

23 Information Collections’ (Memorandum for 

24 the President’s Management Council) and 

25 dated January 20, 2006; 


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1 ‘‘(iv) Executive Order 13125 (64 Fed. 

2 Reg. 31105; relating to increasing partici3 pation of Asian Americans and Pacific Is4 landers in Federal programs) (June 7, 

5 1999); 

6 ‘‘(v) the document entitled ‘HHS 

7 Tribal Consultation Policy’ and dated Jan8 uary 2005; and 

9 ‘‘(vi) the Department of Health and 

10 Human Services Intradepartment Council 

11 on Native American Affairs, Revised Char12 ter, dated March 7, 2005; and 

13 ‘‘(35) despite the United States having ex14 pressed in Public Law 103–150 (107 Stat. 1510) 

15 the commitment of the United States to a policy of 

16 reconciliation with the Native Hawaiian people for 

17 past grievances— 

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

19 Hawaiian people remain severe; and 

20 ‘‘(B) the health status of the Native Ha21 waiian people continues to be far below that of 

22 the general population of the United States. 

23 ‘‘(b) FINDING OF UNMET NEEDS AND HEALTH DIS24 PARITIES.—Congress finds that the unmet needs and seriVerDate Mar 15 2010 00:23 Feb 03, 2011 Jkt 099200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\S66.IS S66

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1 ous health disparities that adversely affect the Native Ha2 waiian people include the following: 

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

4 ‘‘(A) CANCER.— 

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

6 cancer— 

7 ‘‘(I) as an underlying cause of 

8 death in the State, the cancer mor9 tality rate of Native Hawaiians (218.3 

10 deaths per 100,000 residents) is 50 

11 percent higher than the rate for the 

12 total population of the State (145.4 

13 deaths per 100,000 residents); 

14 ‘‘(II) Native Hawaiian males 

15 have the highest cancer mortality 

16 rates in the State for cancers of the 

17 lung, colon, and rectum, and for all 

18 cancers combined; 

19 ‘‘(III) Native Hawaiian females 

20 have the highest cancer mortality 

21 rates in the State for cancers of the 

22 lung, breast, colon, rectum, pancreas, 

23 stomach, ovary, liver, cervix, kidney, 

24 and uterus, and for all cancers com25 bined; and 


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1 ‘‘(IV) for the period of 1995 

2 through 2000— 

3 ‘‘(aa) the cancer mortality 

4 rate for all cancers for Native 

5 Hawaiian males (217 deaths per 

6 100,000 residents) was 22 per7 cent higher than the rate for all 

8 males in the State (179 deaths 

9 per 100,000 residents); and 

10 ‘‘(bb) the cancer mortality 

11 rate for all cancers for Native 

12 Hawaiian females (192 deaths 

13 per 100,000 residents) was 64 

14 percent higher than the rate for 

15 all females in the State (117 

16 deaths per 100,000 residents). 

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

18 to breast cancer— 

19 ‘‘(I) Native Hawaiians have the 

20 highest mortality rate in the State 

21 from breast cancer (30.79 deaths per 

22 100,000 residents), which is 33 per23 cent higher than the rate for Cauca24 sian Americans (23.07 deaths per 

25 100,000 residents) and 106 percent 


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1 higher than the rate for Chinese 

2 Americans (14.96 deaths per 100,000 

3 residents); and 

4 ‘‘(II) nationally, Native Hawai5 ians have the third-highest mortality 

6 rate as a result of breast cancer (25.0 

7 deaths per 100,000 residents), behind 

8 African-Americans (31.4 deaths per 

9 100,000 residents) and Caucasian 

10 Americans (27.0 deaths per 100,000 

11 residents). 

12 ‘‘(iii) CANCER OF THE CERVIX.—Na13 tive Hawaiians have the highest mortality 

14 rate as a result of cancer of the cervix in 

15 the State (3.65 deaths per 100,000 resi16 dents), followed by Filipino Americans 

17 (2.69 deaths per 100,000 residents) and 

18 Caucasian Americans (2.61 deaths per 

19 100,000 residents). 

20 ‘‘(iv) LUNG CANCER.—Native Hawai21 ian males and females have the highest 

22 mortality rates as a result of lung cancer 

23 in the State (74.79 deaths per 100,000 

24 and 47.84 deaths per 100,000, respec25 tively) which are higher than the rates for 


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1 the total population of the State by 48 per2 cent for males and 93 percent for females. 

3 ‘‘(v) PROSTATE CANCER.—Native Ha4 waiian males have the third-highest mor5 tality rate as a result of prostate cancer in 

6 the State (21.48 deaths per 100,000 resi7 dents), with Caucasian Americans having 

8 the highest mortality rate as a result of 

9 prostate cancer (23.96 deaths per 100,000 

10 residents). 

11 ‘‘(B) DIABETES.—With respect to diabe12 tes, in 2004— 

13 ‘‘(i) Native Hawaiians had the highest 

14 mortality rate as a result of diabetes 

15 mellitis (28.9 deaths per 100,000 resi16 dents) in the State, which is 119 percent 

17 higher than the rate for all racial groups 

18 in the State (13.2 deaths per 100,000 resi19 dents); 

20 ‘‘(ii) the prevalence of diabetes for 

21 Native Hawaiians was 12.7 percent, which 

22 is 87 percent higher than the total preva23 lence for all residents of the State of 6.8 

24 percent; and 


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1 ‘‘(iii) a higher percentage of Native 

2 Hawaiians with diabetes experienced dia3 betic retinopathy, as compared to other 

4 population groups in the State. 

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

6 and lower respiratory disease— 

7 ‘‘(i) in 2004, mortality rates for Na8 tive Hawaiians (31.6 deaths per 100,000 

9 residents) from chronic lower respiratory 

10 disease were 52 percent higher than rates 

11 for the total population of the State (20.8 

12 deaths per 100,000 residents); and 

13 ‘‘(ii) in 2005, the prevalence of cur14 rent asthma in Native Hawaiian adults 

15 (12.8 percent) was 71 percent higher than 

16 the prevalence of asthma in the total popu17 lation of the State (7.5 percent). 

18 ‘‘(D) CIRCULATORY DISEASES.— 

19 ‘‘(i) HEART DISEASE.—With respect 

20 to heart disease— 

21 ‘‘(I) in 2004, the mortality rate 

22 for Native Hawaiians as a result of 

23 heart disease (305.5 deaths per 

24 100,000 residents) was 86 percent 

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1 ulation of the State (164.3 deaths per 

2 100,000 residents); and 

3 ‘‘(II) in 2005, the prevalence of a 

4 heart attack for Native Hawaiians 

5 (4.4 percent) was 22 percent higher 

6 than the prevalence of a heart attack 

7 for the total population of the State 

8 (3.6 percent). 

9 ‘‘(ii) CEREBROVASCULAR DISEASES.— 

10 With respect to cerebrovascular diseases— 

11 ‘‘(I) the mortality rate from cere12 brovascular diseases for Native Ha13 waiians (75.6 percent) was 64 percent 

14 higher than the rate for the total pop15 ulation of the State (46 percent); and 

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

17 stroke for Native Hawaiians (4.9 per18 cent) was 69 percent higher than the 

19 prevalence for the total population of 

20 the State (2.9 percent). 

21 ‘‘(iii) OTHER CIRCULATORY DIS22 EASES.—With respect to other circulatory 

23 diseases (including high blood pressure and 

24 atherosclerosis)— 


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1 ‘‘(I) in 2004, the mortality rate 

2 for Native Hawaiians (20.6 deaths per 

3 100,000 residents) was 46 percent 

4 higher than the rate for the total pop5 ulation of the State (14.1 deaths per 

6 100,000 residents); and 

7 ‘‘(II) in 2005, the prevalence of 

8 high blood pressure for Native Hawai9 ians (26.7 percent) was 10 percent 

10 higher than the prevalence for the 

11 total population of the State (24.2 

12 percent). 

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

14 With respect to infectious disease and illness— 

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

16 20 percent of all deaths resulting from infec17 tious diseases in the State for all ages; and 

18 ‘‘(B) the incidence of acquired immune de19 ficiency syndrome for Native Hawaiians is at 

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

21 percent) than the incidence for any other non22 Caucasian group in the State. 

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

24 ‘‘(A) the mortality rate for Native Hawai25 ians as a result of injuries (32 deaths per 


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1 100,000 residents) is 16 percent higher than 

2 the rate for the total population of the State 

3 (27.5 deaths per 100,000 residents); 

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

5 between the ages of 18 and 24 years resulting 

6 from injuries were Native Hawaiian; and 

7 ‘‘(C) the 2 primary causes of Native Ha8 waiian deaths in that age group were motor ve9 hicle accidents (30 percent) and intentional self10 harm (39 percent). 

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

12 health— 

13 ‘‘(A) Native Hawaiian children experience 

14 significantly higher rates of dental caries and 

15 unmet treatment needs as compared to other 

16 children in the continental United States and 

17 other ethnic groups in the State; 

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

19 the primary (baby) teeth of Native Hawaiian 

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

21 more than twice the national average rate of 

22 1.9 per child in that age range; 

23 ‘‘(C) 81.9 percent of Native Hawaiian chil24 dren aged 6 to 8 have 1 or more decayed teeth, 

25 as compared to— 


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

2 age range in the continental United States; 

3 and 

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

5 that age range in the State; and 

6 ‘‘(D) 21 percent of Native Hawaiian chil7 dren aged 5 demonstrate signs of baby bottle 

8 tooth decay, which is generally characterized as 

9 severe, progressive dental disease in early child10 hood and associated with high rates of dental 

11 disorders, as compared to 5 percent for children 

12 of that age in the continental United States. 

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

14 expectancy— 

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

16 expectancy of all population groups in the 

17 State; 

18 ‘‘(B) between 1910 and 1980, the life ex19 pectancy of Native Hawaiians from birth has 

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

21 overall State population average; 

22 ‘‘(C) the life expectancy calculation for 

23 1990 shows Native Hawaiian life expectancy at 

24 birth (74.27 years) to be approximately 5 years 


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1 less than that of the total State population 

2 (78.85 years); and 

3 ‘‘(D) except as provided in the life expect4 ancy calculation for 1920, Native Hawaiians 

5 have had the shortest life expectancy of all 

6 major ethnic groups in the United States since 

7 1910. 

8 ‘‘(6) MATERNAL AND CHILD HEALTH.— 

9 ‘‘(A) IN GENERAL.—With respect to ma10 ternal and child health, in 2000— 

11 ‘‘(i) 39 percent of all deaths of chil12 dren under the age of 18 years in the 

13 State were Native Hawaiian; 

14 ‘‘(ii) perinatal conditions accounted 

15 for 38 percent of all Native Hawaiian 

16 deaths in that age group; 

17 ‘‘(iii) Native Hawaiian infant mor18 tality rates (9.8 deaths per 1,000 live 

19 births) are— 

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

21 ‘‘(II) 151 percent higher than the 

22 rate for Caucasian infants (3.9 deaths 

23 per 1,000 live births); and 

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

25 highest infant mortality rates in the 


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1 United States, second only to the rate for 

2 African-Americans of 13.6 deaths per 

3 1,000 live births. 

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

5 prenatal care— 

6 ‘‘(i) as of 2005, Native Hawaiian 

7 women have the highest prevalence (20.9 

8 percent) of having had no prenatal care 

9 during the first trimester of pregnancy, as 

10 compared to the 5 largest ethnic groups in 

11 the State; 

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

13 received no prenatal care in the first tri14 mester, 33 percent were Native Hawaiian; 

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

16 with live births who had not completed 

17 high school were Native Hawaiian; and 

18 ‘‘(iv) in every region of the State, Na19 tive Hawaiian newborns begin life in a po20 tentially hazardous circumstance at a far 

21 higher rate than any other racial group. 

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

23 2005— 

24 ‘‘(i) 45.2 percent of live births to Na25 tive Hawaiian women were to single mothVerDate Mar 15 2010 00:23 Feb 03, 2011 Jkt 099200 PO 00000 Frm 00028 Fmt 6652 Sfmt 6201 E:\BILLS\S66.IS S66

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1 ers, putting the affected infants at higher 

2 risk of low birth weight and infant mor3 tality; 

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

5 Hawaiian single mothers, 9 percent of the 

6 children had low birth weight (defined as a 

7 weight of less than 2,500 grams); and 

8 ‘‘(iii) 43.7 percent of all low birth9 weight infants born to single mothers in 

10 the State were Native Hawaiian. 

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

12 to births, in 2005— 

13 ‘‘(i) Native Hawaiians had the highest 

14 rate of births to mothers under the age of 

15 18 years (5.8 percent), as compared to the 

16 rate of 2.7 percent for the total population 

17 of the State; and 

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

19 in the State under the age of 19 years 

20 were Native Hawaiian. 

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

22 fetal mortality, in 2005— 

23 ‘‘(i) Native Hawaiians had the highest 

24 number of fetal deaths in the State, as 


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1 compared to Caucasian, Japanese, and Fil2 ipino residents; and 

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

4 in the State were associated with expectant 

5 Native Hawaiian mothers; and 

6 ‘‘(II) 43.5 percent of those Native 

7 Hawaiian mothers were under the age of 

8 25 years. 

9 ‘‘(7) BEHAVIORAL HEALTH.— 

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

11 respect to alcohol and drug abuse— 

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

13 the highest prevalence of smoking (27.9 

14 percent), which is 64 percent higher than 

15 the rate for the total population of the 

16 State (17 percent); and 

17 ‘‘(II) 53 percent of Native Hawaiians 

18 reported having smoked at least 100 ciga19 rettes in their lifetime, as compared to 

20 43.3 percent for the total population of the 

21 State; 

22 ‘‘(ii) 33 percent of Native Hawaiians 

23 in grade 8 have smoked cigarettes at least 

24 once in their lifetimes, as compared to— 


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

2 the State; and 

3 ‘‘(II) 28.4 percent of residents of 

4 the United States in grade 8; 

5 ‘‘(iii) Native Hawaiians have the high6 est prevalence of binge drinking (19.9 per7 cent), which is 21 percent higher than the 

8 prevalence for the total population of the 

9 State (16.5 percent); 

10 ‘‘(iv) the prevalence of heavy drinking 

11 among Native Hawaiians (10.1 percent) is 

12 36 percent higher than the prevalence for 

13 the total population of the State (7.4 per14 cent); 

15 ‘‘(v)(I) in 2003, 17.2 percent of Na16 tive Hawaiians in grade 6, 45.1 percent of 

17 Native Hawaiians in grade 8, 68.9 percent 

18 of Native Hawaiians in grade 10, and 78.1 

19 percent of Native Hawaiians in grade 12 

20 reported using alcohol at least once in 

21 their lifetimes, as compared to 13.2, 36.8, 

22 59.1, and 72.5 percent, respectively, of all 

23 adolescents in the State; and 

24 ‘‘(II) 62.1 percent Native Hawaiians 

25 in grade 12 reported being drunk at least 


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1 once, which is 20 percent higher than the 

2 percentage for all adolescents in the State 

3 (51.6 percent); 

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

5 of Native Hawaiian adolescents reported 

6 having used illicit drugs, including 

7 inhalants, at least once in their lifetime, as 

8 compared to— 

9 ‘‘(I) 46.9 percent of all adoles10 cents in the State; and 

11 ‘‘(II) 52.8 of adolescents in the 

12 United States; 

13 ‘‘(vii) on entering grade 12, 58.2 per14 cent of Native Hawaiian adolescents re15 ported having used marijuana at least 

16 once, which is 31 percent higher than the 

17 rate of other adolescents in the State (44.4 

18 percent); 

19 ‘‘(viii) in 2006, Native Hawaiians rep20 resented 40 percent of the total admissions 

21 to substance abuse treatment programs 

22 funded by the State Department of Health; 

23 and 

24 ‘‘(ix) in 2003, Native Hawaiian ado25 lescents reported the highest prevalence for 


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1 methamphetamine use in the State, fol2 lowed by Caucasian and Filipino adoles3 cents. 

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

5 ‘‘(i) during the period of 1992 to 

6 2002, Native Hawaiian arrests for violent 

7 crimes decreased, but the rate of arrest re8 mained 38.3 percent higher than the rate 

9 of the total population of the State; 

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

11 among Native Hawaiian juveniles and 

12 adults was 59 percent higher (6.2 arrests 

13 per 100,000 residents) than the rate for 

14 the total population of the State (3.9 ar15 rests per 100,000 residents); 

16 ‘‘(iii) in 2002— 

17 ‘‘(I) Native Hawaiian men com18 prised between 35 percent and 43 per19 cent of each security class in the State 

20 prison system; 

21 ‘‘(II) Native Hawaiian women 

22 comprised between 38.1 percent to 

23 50.3 percent of each class of female 

24 prison inmates in the State; 


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1 ‘‘(III) Native Hawaiians com2 prised 39.5 percent of the total incar3 cerated population of the State; and 

4 ‘‘(IV) Native Hawaiians com5 prised 40 percent of the total sen6 tenced felon population in the State, 

7 as compared to 25 percent for Cauca8 sians, 12 percent for Filipinos, and 5 

9 percent for Samoans; 

10 ‘‘(iv) Native Hawaiians are overrepre11 sented in the State prison population; 

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

13 Hawaiians, 70 percent are between 20 and 

14 40 years of age; and 

15 ‘‘(vi) based on anecdotal information, 

16 Native Hawaiians are estimated to com17 prise between 60 percent and 70 percent of 

18 all jail and prison inmates in the State. 

19 ‘‘(C) DEPRESSION AND SUICIDE.—With re20 spect to depression and suicide— 

21 ‘‘(i)(I) in 1999, the prevalence of de22 pression among Native Hawaiians was 15 

23 percent, as compared to the national aver24 age of approximately 10 percent; and 


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1 ‘‘(II) Native Hawaiian females had a 

2 higher prevalence of depression (16.9 per3 cent) than Native Hawaiian males (11.9 

4 percent); 

5 ‘‘(ii) in 2000— 

6 ‘‘(I) Native Hawaiian adolescents 

7 had a significantly higher suicide at8 tempt rate (12.9 percent) than the 

9 rate for other adolescents in the State 

10 (9.6 percent); and 

11 ‘‘(II) 39 percent of all Native 

12 Hawaiian adult deaths were due to 

13 suicide; and 

14 ‘‘(iii) in 2006, the prevalence of obses15 sive compulsive disorder among Native Ha16 waiian adolescent girls was 17.7 percent, 

17 as compared to a rate of— 

18 ‘‘(I) 9.2 percent for Native Ha19 waiian boys and non-Hawaiian girls; 

20 and 

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

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

23 respect to overweightness and obesity— 

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

25 2003, Native Hawaiian males and females had 


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1 the highest age-adjusted prevalence rates for 

2 obesity in the State (40.5 and 32.5 percent, re3 spectively), which was— 

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

5 Native Hawaiian ancestry, 145 percent 

6 higher than the rate for the total popu7 lation of the State (16.5 per 100,000); and 

8 ‘‘(ii) with respect to individuals with 

9 less than 100 percent Native Hawaiian an10 cestry, 97 percent higher than the total 

11 population of the State; and 

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

13 among Native Hawaiians (43.1 percent) was 

14 119 percent higher than the prevalence for the 

15 total population of the State (19.7 percent). 

16 ‘‘(9) FAMILY AND CHILD HEALTH.—With re17 spect to family and child health— 

18 ‘‘(A) in 2000, the prevalence of single-par19 ent families with minor children was highest 

20 among Native Hawaiian households, as com21 pared to all households in the State (15.8 per22 cent and 8.1 percent, respectively); 

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

24 for 56.8 percent of all live births among Native 


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1 Hawaiians, as compared to 34 percent of all 

2 live births in the State; 

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

4 neglect among Native Hawaiians has consist5 ently been 3 to 4 times the rates of other major 

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

7 cases, as compared to 12.8 cases for the total 

8 population of the State; 

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

10 partner was highest for Native Hawaiians, as 

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

12 percent and 2.2 percent, respectively); and 

‘‘(E)(i) 1 13 ⁄2 of uninsured adults in the State 

14 have family incomes below 200 percent of the 

15 Federal poverty level; and 

16 ‘‘(ii) Native Hawaiians residing in the 

17 State and the continental United States have a 

18 higher rate of uninsurance than other ethnic 

19 groups in the State and continental United 

20 States (14.5 percent and 9.5 percent, respec21 tively). 

22 ‘‘(10) HEALTH PROFESSIONS EDUCATION AND

23 TRAINING.—With respect to health professions edu24 cation and training— 


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

2 a higher rate of high school completion, as com3 pared to the total adult population of the State 

4 (49.4 percent and 34.4 percent, respectively); 

5 ‘‘(B) Native Hawaiian physicians make up 

6 4 percent of the total physician workforce in the 

7 State; and 

8 ‘‘(C) in 2004, Native Hawaiians com9 prised— 

10 ‘‘(i) 11.25 percent of individuals who 

11 earned bachelor’s degrees; 

12 ‘‘(ii) 6 percent of individuals who 

13 earned master’s degrees; 

14 ‘‘(iii) 3 percent of individuals who 

15 earned doctorate degrees; 

16 ‘‘(iv) 7.9 percent of the credited stu17 dent body at the University of Hawai‘i; 

18 ‘‘(v) 0.4 percent of the instructional 

19 faculty at the University of Hawai‘i at 

20 Manoa; and 

21 ‘‘(vi) 8.4 percent of the instructional 

22 faculty at the University of Hawai‘i Com23 munity Colleges. 

24 ‘‘SEC. 3. DEFINITIONS. 

25 ‘‘In this Act: 


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

2 means the Department of Health and Human Serv3 ices. 

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

5 prevention’ includes— 

6 ‘‘(A) immunizations; 

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

8 ‘‘(C) control of sexually transmittable dis9 eases; 

10 ‘‘(D) prevention and control of chronic dis11 eases; 

12 ‘‘(E) control of toxic agents; 

13 ‘‘(F) occupational safety and health; 

14 ‘‘(G) injury prevention; 

15 ‘‘(H) fluoridation of water; 

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

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

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

19 promotion’ includes— 

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

21 prevention of fetal alcohol syndrome; 

22 ‘‘(B) cessation of tobacco smoking; 

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

24 harmful illicit drugs; 

25 ‘‘(D) improvement of nutrition; 


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1 ‘‘(E) improvement in physical fitness; 

2 ‘‘(F) family planning; 

3 ‘‘(G) control of stress; 

4 ‘‘(H) reduction of major behavioral risk 

5 factors and promotion of healthy lifestyle prac6 tices; and 

7 ‘‘(I) integration of cultural approaches to 

8 health and well-being (including traditional 

9 practices relating to the atmosphere (lewa lani), 

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

11 ‘‘(4) HEALTH SERVICE.—The term ‘health serv12 ice’ means— 

13 ‘‘(A) a service provided by a physician, 

14 physician’s assistant, nurse practitioner, nurse, 

15 dentist, or other health professional; 

16 ‘‘(B) a diagnostic laboratory or radiologic 

17 service; 

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

19 a perinatal service, well child service, family 

20 planning service, nutrition service, home health 

21 service, sports medicine and athletic training 

22 service, and, generally, any service associated 

23 with enhanced health and wellness); 

24 ‘‘(D) an emergency medical service, includ25 ing a service provided by a first responder, 


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1 emergency medical technician, or mobile inten2 sive care technician; 

3 ‘‘(E) a transportation service required for 

4 adequate patient care; 

5 ‘‘(F) a preventive dental service; 

6 ‘‘(G) a pharmaceutical and medicament 

7 service; 

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

9 service provided by a psychologist or social 

10 worker; 

11 ‘‘(I) a genetic counseling service; 

12 ‘‘(J) a health administration service, in13 cluding a service provided by a health program 

14 administrator; 

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

16 service provided by an individual with an ad17 vanced degree in medicine, nursing, psychology, 

18 social work, or any other related health pro19 gram; 

20 ‘‘(L) an environmental health service, in21 cluding a service provided by an epidemiologist, 

22 public health official, medical geographer, or 

23 medical anthropologist, or an individual special24 izing in biological, chemical, or environmental 

25 health determinants; 


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

2 to specialty or tertiary care; and 

3 ‘‘(N) a complementary healing practice, in4 cluding a practice performed by a traditional 

5 Native Hawaiian healer. 

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

7 Hawaiian’ means any individual who is Kanaka 

8 Maoli (a descendant of the aboriginal people who, 

9 prior to 1778, occupied and exercised sovereignty in 

10 the area that now constitutes the State), as evi11 denced by— 

12 ‘‘(A) genealogical records; 

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

14 Native Hawaiian Kupuna (elders); or 

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

16 other State or territory of the United States. 

17 ‘‘(6) NATIVE HAWAIIAN HEALTH CARE SYS18 TEM.—The term ‘Native Hawaiian health care sys19 tem’ means each of up to 8 entities in the State 

20 that— 

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

22 State; 

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

24 of health services for Native Hawaiians in the 

25 State; 


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

2 ‘‘(D) has Native Hawaiians significantly 

3 participating in the planning, management, pro4 vision, monitoring, and evaluation of health 

5 services; 

6 ‘‘(E) addresses the health care needs of 

7 the Native Hawaiian population of an island in 

8 the State; and 

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

10 ‘‘(i) for the purpose of planning, con11 ducting, or administering programs, or 

12 portions of programs, authorized by this 

13 Act for the benefit of Native Hawaiians; 

14 and 

15 ‘‘(ii) as having the qualifications and 

16 the capacity to provide the services and 

17 meet the requirements under— 

18 ‘‘(I) the contract that each Na19 tive Hawaiian health care system en20 ters into with the Secretary under this 

21 Act; or 

22 ‘‘(II) the grant each Native Ha23 waiian health care system receives 

24 from the Secretary under this Act. 


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

2 term ‘Native Hawaiian Health Center’ means any 

3 organization that is a primary health care provider 

4 that— 

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

6 individuals, at least 50 percent of whom are 

7 Native Hawaiians; 

8 ‘‘(B) has demonstrated cultural com9 petency in a predominantly Native Hawaiian 

10 community; 

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

12 ‘‘(i) is made up of individuals, at least 

13 50 percent of whom are Native Hawaiian; 

14 or 

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

16 Hawaiians as annual users of services; and 

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

18 having met each of the criteria described in 

19 subparagraphs (A) through (C). 

20 ‘‘(8) NATIVE HAWAIIAN HEALTH TASK

21 FORCE.—The term ‘Native Hawaiian Health Task 

22 Force’ means a task force established by the State 

23 Council of Hawaiian Homestead Associations to im24 plement health and wellness strategies in Native Ha25 waiian communities. 


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

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

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

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

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

9 of Native Hawaiians; and 

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

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

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

14 ‘‘(A) is established under article XII, sec15 tions 5 and 6, of the Hawai‘i State Constitu16 tion; and 

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

19 Hawaiians. 

20 ‘‘(11) PAPA OLA LOKAHI.— 

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

22 Lokahi’ means an organization that— 

23 ‘‘(i) is composed of public agencies 

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1 proving the health status of Native Hawai2 ians; and 

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

5 from— 

6 ‘‘(I) E Ola Mau; 

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

9 ‘‘(III) Alu Like, Inc.; 

10 ‘‘(IV) the University of Hawai‘i; 

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

13 ‘‘(VI) the Native Hawaiian 

14 Health Task Force; 

15 ‘‘(VII) the Hawai‘i State Primary 

16 Care Association; 

17 ‘‘(VIII) Ahahui O Na Kauka, the 

18 Native Hawaiian Physicians Associa19 tion; 

20 ‘‘(IX) Ho‘ola Lahui Hawai‘i, or a 

21 health care system serving the islands 

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

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


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

3 ‘‘(X) Ke Ola Mamo, or a health 

4 care system serving the island of 

5 O‘ahu (which may be composed of as 

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

8 of the Native Hawaiians of that is9 land); 

10 ‘‘(XI) Na Pu‘uwai or a health 

11 care system serving the islands of 

12 Moloka‘i or Lana‘i (which may be 

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

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

17 ‘‘(XII) Hui No Ke Ola Pono, or 

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

20 of as many health care centers as are 

21 necessary to meet the health care 

22 needs of the Native Hawaiians of that 

23 island); 

24 ‘‘(XIII) Hui Malama Ola Na 

25 ‘Oiwi, or a health care system serving 


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1 the island of Hawai‘i (which may be 

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

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

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

9 Lokahi in accordance with this Act; 

10 and 

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

13 Lokahi shall admit from time to time, 

14 based on satisfactory demonstration of 

15 a record of contribution to the health 

16 and well-being of Native Hawaiians. 

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

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

22 that includes— 

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

25 will make to— 


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1 ‘‘(I) Native Hawaiian health care 

2 systems; and 

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

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

6 those goals and objectives. 

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

8 means the Secretary of Health and Human Services. 

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

10 State of Hawai‘i. 

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

13 means a practitioner— 

14 ‘‘(A) who— 

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

16 and 

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

19 individuals; and 

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

21 of whom are based on demonstrated learning of 

22 Native Hawaiian healing practices acquired 

23 by— 

24 ‘‘(i) direct practical association with 

25 Native Hawaiian elders; and 


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1 ‘‘(ii) oral traditions transmitted from 

2 generation to generation. 

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

4 HEALTH POLICY. 

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

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

8 the indigenous people of Hawai‘i resulting from the unique 

9 and historical relationship between the United States and 

10 the indigenous people of Hawai‘i— 

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

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

14 programs with all resources necessary to effectuate 

15 that policy. 

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

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

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

23 Native Hawaiians (including perinatal, early child 

24 development, and family-based health education 

25 needs), shall be established and implemented; and 


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1 ‘‘(2) the United States— 

2 ‘‘(A) raise the health status of Native Ha3 waiians by the year 2020 to at least the levels 

4 described in the goals contained within Healthy 

5 People 2020 (or successor standards); and 

6 ‘‘(B) incorporate within health programs in 

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

9 ‘‘(i) incorporating and supporting the 

10 integration of cultural approaches to health 

11 and well-being, including programs using 

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

14 or ocean (kai); 

15 ‘‘(ii) increasing the number of Native 

16 Hawaiian health and allied-health pro17 viders who provide care to, or have an im18 pact on the health status of, Native Ha19 waiians; 

20 ‘‘(iii) increasing the use of traditional 

21 Native Hawaiian foods in— 

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

24 students; and 

25 ‘‘(II) school feeding programs; 


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

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

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

8 Hawaiian healers for individuals desiring 

9 that assistance; 

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

13 by Native Hawaiian healers; and 

14 ‘‘(vii) demonstrating the integration of 

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

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

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

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

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

24 FOR NATIVE HAWAIIANS. 

25 ‘‘(a) DEVELOPMENT.— 


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

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

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

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

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

10 status of Native Hawaiians; and 

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

13 health. 

14 ‘‘(2) CONSULTATION.— 

15 ‘‘(A) IN GENERAL.—As a condition of re16 ceiving a grant under this section, in carrying 

17 out paragraph (1), Papa Ola Lokahi and the 

18 Office of Hawaiian Affairs shall consult with 

19 representatives of— 

20 ‘‘(i) the Native Hawaiian health care 

21 systems; 

22 ‘‘(ii) the Native Hawaiian health cen23 ters; and 

24 ‘‘(iii) the Native Hawaiian commu25 nity. 


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1 ‘‘(B) MEMORANDA OF UNDERSTANDING.— 

2 Papa Ola Lokahi and the Office of Hawaiian 

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

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

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

11 months after the date of enactment of the Na12 tive Hawaiian Health Care Improvement Reau13 thorization Act of 2011, Papa Ola Lokahi, in 

14 cooperation with the Office of Hawaiian Affairs 

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

17 Health and the Department of Human Services 

18 of the State) and appropriate Federal agencies 

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

22 State health care financing mechanisms and 

23 policies on the health and well-being of Native 

24 Hawaiians. 


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

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

6 ‘‘(I) cultural competency; 

7 ‘‘(II) risk assessment data; 

8 ‘‘(III) eligibility requirements 

9 and exemptions; and 

10 ‘‘(IV) reimbursement policies and 

11 capitation rates in effect as of the 

12 date of the report for service pro13 viders; 

14 ‘‘(ii) such other similar information as 

15 may be important to improving the health 

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

19 ‘‘(iii) recommendations for submission 

20 to the Secretary, for review and consulta21 tion with the Native Hawaiian community. 

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

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


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

2 ‘‘(a) IN GENERAL.—Papa Ola Lokahi— 

3 ‘‘(1) shall be responsible for— 

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

5 updating, as appropriate, of the comprehensive 

6 health care master plan under section 5; 

7 ‘‘(B) the training and education of individ8 uals providing health services; 

9 ‘‘(C) the identification of and research (in10 cluding behavioral, biomedical, epidemiological, 

11 and health service research) into the diseases 

12 that are most prevalent among Native Hawai13 ians; and 

14 ‘‘(D) the development and maintenance of 

15 an institutional review board for all research 

16 projects involving all aspects of Native Hawai17 ian health, including behavioral, biomedical, epi18 demiological, and health service research; 

19 ‘‘(2) may receive special project funds (includ20 ing research endowments under section 736 of the 

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

22 available for the purpose of— 

23 ‘‘(A) research on the health status of Na24 tive Hawaiians; or 

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

26 Native Hawaiians; and 


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

2 ‘‘(A) the collection and maintenance of 

3 data associated with the health status of Native 

4 Hawaiians; 

5 ‘‘(B) the identification and research into 

6 diseases affecting Native Hawaiians; 

7 ‘‘(C) the availability of Native Hawaiian 

8 project funds, research projects, and publica9 tions; 

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

11 area of Native Hawaiian health; and 

12 ‘‘(E) the timely dissemination of informa13 tion pertinent to the Native Hawaiian health 

14 care systems. 

15 ‘‘(b) CONSULTATION.— 

16 ‘‘(1) IN GENERAL.—The Secretary and the Sec17 retary of each other applicable Federal agency 

18 shall— 

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

20 ‘‘(B) provide Papa Ola Lokahi and the Of21 fice of Hawaiian Affairs, at least once annually, 

22 an accounting of funds and services provided by 

23 the Secretary to assist in accomplishing the 

24 purposes described in section 4. 


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

3 identification of— 

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

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

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

10 groups and organizations in the expenditure of 

11 those funds; and 

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

13 ‘‘(i) Federal administrative purposes; 

14 and 

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

16 Native Hawaiians. 

17 ‘‘(c) FISCAL ALLOCATION AND COORDINATION OF

18 PROGRAMS AND SERVICES.— 

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

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

22 made available under this Act. 

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

24 to the maximum extent practicable, coordinate and 

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1 vided to Native Hawaiians under this Act and other 

2 Federal laws. 

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

4 Secretary, in consultation with Papa Ola Lokahi, 

5 shall make recommendations for Native Hawaiian 

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

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

9 provide statewide infrastructure for technical support and 

10 coordination of training and technical assistance to— 

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

12 and 

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

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

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

16 into agreements or memoranda of understanding 

17 with relevant institutions, agencies, or organizations 

18 that are capable of providing— 

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

20 Native Hawaiians and the Native Hawaiian 

21 health care systems; or 

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

24 section 4. 

25 ‘‘(2) HEALTH CARE FINANCING.— 


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1 ‘‘(A) FEDERAL CONSULTATION.— 

2 ‘‘(i) IN GENERAL.—Before adopting 

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

6 Federal agency that provides health care 

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

9 and Medicaid Services) shall consult with 

10 representatives of— 

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

13 ‘‘(II) Papa Ola Lokahi; and 

14 ‘‘(III) organizations providing 

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

17 ‘‘(ii) IDENTIFICATION OF EFFECTS.— 

18 Any consultation by a Federal agency 

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

21 regulation proposed by the Federal agency. 

22 ‘‘(B) STATE CONSULTATION.—Before mak23 ing any change in an existing federally funded 

24 program or implementing any new federally 

25 funded program relating to Native Hawaiian 


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1 health, the State shall engage in meaningful 

2 consultation with representatives of— 

3 ‘‘(i) the Native Hawaiian community; 

4 ‘‘(ii) Papa Ola Lokahi; and 

5 ‘‘(iii) organizations providing health 

6 care services to Native Hawaiians in the 

7 State. 

8 ‘‘(C) CONSULTATION ON FEDERAL

9 HEALTH INSURANCE PROGRAMS.— 

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

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

14 memoranda of understanding or agree15 ment, with— 

16 ‘‘(I) the Centers for Medicare 

17 and Medicaid Services; 

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

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

22 XXI of the Social Security Act (42 

23 U.S.C. 1395 et seq.; 1396 et seq.; 

24 1397aa et seq.) for the payment of all 

25 or a part of the health care services 


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1 provided to Native Hawaiians who are 

2 eligible for medical assistance under 

3 the State plan or waiver; or 

4 ‘‘(III) any other Federal agency 

5 providing full or partial health insur6 ance to Native Hawaiians. 

7 ‘‘(ii) CONTENTS OF ARRANGE8 MENTS.—An arrangement under clause (i) 

9 may address— 

10 ‘‘(I) appropriate reimbursement 

11 for health care services, including 

12 capitation rates and fee-for-service 

13 rates for Native Hawaiians who are 

14 entitled to or eligible for insurance; 

15 ‘‘(II) the scope of services; or 

16 ‘‘(III) other matters that would 

17 enable Native Hawaiians to maximize 

18 health insurance benefits provided by 

19 Federal and State health insurance 

20 programs. 

21 ‘‘(3) TRADITIONAL HEALERS.— 

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

23 health services under any program operated by 

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1 cluding the Department of Veterans Affairs) 

2 may include the services of— 

3 ‘‘(i) traditional Native Hawaiian heal4 ers; or 

5 ‘‘(ii) traditional healers providing tra6 ditional health care practices. 

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

8 subparagraph (A) shall be exempt from national 

9 accreditation reviews, including reviews con10 ducted by— 

11 ‘‘(i) the Joint Commission on Accredi12 tation of Healthcare Organizations; and 

13 ‘‘(ii) the Commission on Accreditation 

14 of Rehabilitation Facilities. 

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

16 ‘‘(a) COMPREHENSIVE HEALTH PROMOTION, DIS17 EASE PREVENTION, AND OTHER HEALTH SERVICES.— 

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

19 in consultation with Papa Ola Lokahi, may make 

20 grants to, or enter into contracts with 1 or more Na21 tive Hawaiian health care systems for the purpose of 

22 providing comprehensive health promotion and dis23 ease prevention services, as well as other health serv24 ices, to Native Hawaiians who desire and are com25 mitted to bettering their own health. 


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

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

3 a contract with, not more than 8 Native Hawaiian 

4 health care systems under this subsection for any 

5 fiscal year. 

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

7 to grants and contracts under subsection (a), the Sec8 retary may make a grant to, or enter into a contract with, 

9 Papa Ola Lokahi for the purpose of planning Native Ha10 waiian health care systems to serve the health needs of 

11 Native Hawaiian communities on each of the islands of 

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

13 Kaho‘olawe, and Ni‘ihau in the State. 

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

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

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

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

18 Native Hawaiians in accessing health services; 

19 ‘‘(B) education in health promotion and 

20 disease prevention for Native Hawaiians that, 

21 wherever practicable, is provided by— 

22 ‘‘(i) Native Hawaiian health care 

23 practitioners; 

24 ‘‘(ii) community outreach workers; 

25 ‘‘(iii) counselors; 


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1 ‘‘(iv) cultural educators; and 

2 ‘‘(v) other disease prevention pro3 viders; 

4 ‘‘(C) services of individuals providing 

5 health services; 

6 ‘‘(D) collection of data relating to the pre7 vention of diseases and illnesses among Native 

8 Hawaiians; and 

9 ‘‘(E) support of culturally appropriate ac10 tivities that enhance health and wellness, in11 cluding land-based, water-based, ocean-based, 

12 and spiritually based projects and programs. 

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

14 services referred to in paragraph (1) that are pro15 vided under grants or contracts under subsection (a) 

16 may be provided by traditional Native Hawaiian 

17 healers, as appropriate. 

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

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

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

21 system, including a provider of a traditional Native Ha22 waiian healing service, shall be— 

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

24 of the Public Health Service; and 


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

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

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

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

5 care system that receives funds under subsection (a) 

6 may serve as a Federal loan repayment facility. 

7 ‘‘(2) REMISSION OF PAYMENTS.—A facility de8 scribed in paragraph (1) shall be designed to enable 

9 health and allied-health professionals to remit pay10 ments with respect to loans provided to the profes11 sionals under any Federal loan program. 

12 ‘‘(f) RESTRICTION ON USE OF GRANT AND CON13 TRACT FUNDS.—The Secretary shall not make a grant to, 

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

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

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

17 be expended— 

18 ‘‘(1) for any service other than a service de19 scribed in subsection (c)(1); 

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

21 (other than minor remodeling of existing improve22 ments to real property); or 

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

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

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1 tract with, an entity under subsection (a) unless the entity 

2 agrees that, whether health services are provided directly 

3 or under a contract— 

4 ‘‘(1) any health service under the grant or con5 tract will be provided without regard to the ability 

6 of an individual receiving the health service to pay 

7 for the health service; and 

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

9 such a health service a charge that is— 

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

11 charges that is made available to the public; 

12 and 

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

14 individual involved. 

15 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.— 

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

17 to be appropriated such sums as are necessary to 

18 carry out subsection (a) for each of fiscal years 2011 

19 through 2016. 

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

21 to be appropriated such sums as are necessary to 

22 carry out subsection (b) for each of fiscal years 2011 

23 through 2016. 

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

25 to be appropriated such sums as are necessary to 


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1 carry out subsection (c) for each of fiscal years 2011 

2 through 2016. 

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

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

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

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

7 ‘‘(1) coordination, implementation, and updat8 ing (as appropriate) of the comprehensive health 

9 care master plan developed under section 5; 

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

11 health services; 

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

13 behavioral, biomedical, epidemiologic, and health 

14 service research) into the diseases that are most 

15 prevalent among Native Hawaiians; 

16 ‘‘(4) a clearinghouse function for— 

17 ‘‘(A) the collection and maintenance of 

18 data associated with the health status of Native 

19 Hawaiians; 

20 ‘‘(B) the identification and research into 

21 diseases affecting Native Hawaiians; and 

22 ‘‘(C) the availability of Native Hawaiian 

23 project funds, research projects, and publica24 tions; 


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

2 institutional review board for all health-related re3 search involving Native Hawaiians; 

4 ‘‘(6) the coordination of the health care pro5 grams and services provided to Native Hawaiians; 

6 and 

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

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

9 are authorized to be appropriated such sums as are nec10 essary to carry out subsection (a) for each of fiscal years 

11 2011 through 2016. 

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

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

14 include in any grant made or contract entered into under 

15 this Act such terms and conditions as the Secretary con16 siders necessary to ensure that the objectives of the grant 

17 or contract are achieved. 

18 ‘‘(b) PERIODIC REVIEW.—The Secretary shall peri19 odically evaluate the performance of, and compliance with, 

20 grants and contracts under this Act. 

21 ‘‘(c) ADMINISTRATIVE REQUIREMENTS.—The Sec22 retary shall not make a grant or enter into a contract 

23 under this Act with an entity unless the entity— 

24 ‘‘(1) agrees to establish such procedures for fis25 cal control and fund accounting as the Secretary deVerDate Mar 15 2010 00:23 Feb 03, 2011 Jkt 099200 PO 00000 Frm 00069 Fmt 6652 Sfmt 6201 E:\BILLS\S66.IS S66

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1 termines are necessary to ensure proper disburse2 ment and accounting with respect to the grant or 

3 contract; 

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

5 records maintained on individuals receiving health 

6 services under the grant or contract; 

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

8 any population of Native Hawaiians, a substantial 

9 portion of which has a limited ability to speak the 

10 English language— 

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

12 carry out a reasonable plan to provide health 

13 services under the grant or contract through in14 dividuals who are able to communicate with the 

15 population involved in the language and cultural 

16 context that is most appropriate; and 

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

18 who is fluent in English and the appropriate 

19 language to assist in carrying out the plan; 

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

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

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

23 seq.; 1396 et seq.; 1397aa et seq.) (including any 

24 State plan), or under any other Federal health in25 surance plan— 


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

2 grant or contract any of those health services 

3 directly— 

4 ‘‘(i) has entered into a participation 

5 agreement under each such plan; and 

6 ‘‘(ii) is qualified to receive payments 

7 under the plan; and 

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

9 grant or contract any of those health services 

10 through a contract with an organization— 

11 ‘‘(i) ensures that the organization has 

12 entered into a participation agreement 

13 under each such plan; and 

14 ‘‘(ii) ensures that the organization is 

15 qualified to receive payments under the 

16 plan; and 

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

18 Papa Ola Lokahi an annual report that— 

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

20 services provided under the grant or contract 

21 (including the average cost of health services 

22 per user); and 

23 ‘‘(B) provides such other information as 

24 the Secretary determines to be appropriate. 

25 ‘‘(d) CONTRACT EVALUATION.— 


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1 ‘‘(1) DETERMINATION OF NONCOMPLIANCE.— 

2 If, as a result of evaluations conducted by the Sec3 retary, the Secretary determines that an entity has 

4 not complied with or satisfactorily performed a con5 tract entered into under section 7, the Secretary 

6 shall, before renewing the contract— 

7 ‘‘(A) attempt to resolve the areas of non8 compliance or unsatisfactory performance; and 

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

10 occurrences of the noncompliance or unsatisfac11 tory performance. 

12 ‘‘(2) NONRENEWAL.—If the Secretary deter13 mines that the noncompliance or unsatisfactory per14 formance described in paragraph (1) with respect to 

15 an entity cannot be resolved and prevented in the fu16 ture, the Secretary— 

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

18 entity; and 

19 ‘‘(B) may enter into a contract under sec20 tion 7 with another entity referred to in section 

21 7(a)(2) that provides services to the same popu22 lation of Native Hawaiians served by the entity 

23 the contract with which was not renewed by 

24 reason of this paragraph. 


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1 ‘‘(3) CONSIDERATION OF RESULTS.—In deter2 mining whether to renew a contract entered into 

3 with an entity under this Act, the Secretary shall 

4 consider the results of the evaluations conducted 

5 under this section. 

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

7 contract entered into by the Secretary under this 

8 Act shall be in accordance with all Federal con9 tracting laws (including regulations), except that, in 

10 the discretion of the Secretary, such a contract 

11 may— 

12 ‘‘(A) be negotiated without advertising; 

13 and 

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

15 chapter 31, United States Code. 

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

17 contract entered into under this Act— 

18 ‘‘(A) may be made— 

19 ‘‘(i) in advance; 

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

21 ‘‘(iii) in installments; and 

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

23 the Secretary determines to be necessary to 

24 carry out this Act. 

25 ‘‘(e) REPORT.— 


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

2 which an entity receives or expends funds under a 

3 grant or contract under this Act, the entity shall 

4 submit to the Secretary and to Papa Ola Lokahi an 

5 annual report that describes— 

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

7 under the grant or contract; 

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

9 Federal funds were expended; and 

10 ‘‘(C) such other information as the Sec11 retary may request. 

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

13 entity concerning any grant or contract under this 

14 Act shall be subject to audit by— 

15 ‘‘(A) the Secretary; 

16 ‘‘(B) the Inspector General of the Depart17 ment of Health and Human Services; and 

18 ‘‘(C) the Comptroller General of the 

19 United States. 

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

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

22 under this Act the cost of an annual private audit con23 ducted by a certified public accountant to carry out this 

24 section. 


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1 ‘‘SEC. 10. ASSIGNMENT OF PERSONNEL. 

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

3 agreement with Papa Ola Lokahi or any of the Native Ha4 waiian health care systems for the assignment of personnel 

5 of the Department of Health and Human Services with 

6 relevant expertise for the purpose of— 

7 ‘‘(1) conducting research; or 

8 ‘‘(2) providing comprehensive health promotion 

9 and disease prevention services and health services 

10 to Native Hawaiians. 

11 ‘‘(b) APPLICABLE FEDERAL PERSONNEL PROVI12 SIONS.—Any assignment of personnel made by the Sec13 retary under any agreement entered into under subsection 

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

15 to a local government that is made in accordance with sub16 chapter VI of chapter 33 of title 5, United States Code. 

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

18 FELLOWSHIPS. 

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

20 amounts appropriated under subsection (c), the Secretary 

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

22 or a cooperative agreement, funds for the purpose of pro23 viding scholarship and fellowship assistance, counseling, 

24 and placement service assistance to students who are Na25 tive Hawaiians. 


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

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

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

4 and 

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

6 ‘‘(c) TERMS AND CONDITIONS.— 

7 ‘‘(1) SCHOLARSHIP ASSISTANCE.— 

8 ‘‘(A) IN GENERAL.—The scholarship as9 sistance under subsection (a) shall be provided 

10 in accordance with subparagraphs (B) through 

11 (G). 

12 ‘‘(B) NEED.—The provision of scholar13 ships in each type of health profession training 

14 shall correspond to the need for each type of 

15 health professional to serve the Native Hawai16 ian community in providing health services, as 

17 identified by Papa Ola Lokahi. 

18 ‘‘(C) ELIGIBLE APPLICANTS.—To the max19 imum extent practicable, the Secretary shall se20 lect scholarship recipients from a list of eligible 

21 applicants submitted by Papa Ola Lokahi. 

22 ‘‘(D) OBLIGATED SERVICE REQUIRE23 MENT.— 

24 ‘‘(i) IN GENERAL.—An obligated serv25 ice requirement for each scholarship recipiVerDate Mar 15 2010 00:23 Feb 03, 2011 Jkt 099200 PO 00000 Frm 00076 Fmt 6652 Sfmt 6201 E:\BILLS\S66.IS S66

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1 ent (except for a recipient receiving assist2 ance under paragraph (2)) shall be fulfilled 

3 through service, in order of priority, in— 

4 ‘‘(I) any of the Native Hawaiian 

5 health care systems; 

6 ‘‘(II) any of the Native Hawaiian 

7 health centers; 

8 ‘‘(III) 1 or more health profes9 sions shortage areas, medically under10 served areas, or geographic areas or 

11 facilities similarly designated by the 

12 Public Health Service in the State; 

13 ‘‘(IV) a Native Hawaiian organi14 zation that serves a geographical area, 

15 facility, or organization that serves a 

16 significant Native Hawaiian popu17 lation; 

18 ‘‘(V) any public agency or non19 profit organization providing services 

20 to Native Hawaiians; or 

21 ‘‘(VI) any of the uniformed serv22 ices of the United States. 

23 ‘‘(ii) ASSIGNMENT.—The placement 

24 service for a scholarship shall assign each 

25 Native Hawaiian scholarship recipient to 1 


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1 or more appropriate sites for service in ac2 cordance with clause (i). 

3 ‘‘(E) COUNSELING, RETENTION, AND SUP4 PORT SERVICES.—The provision of academic 

5 and personal counseling, retention, and other 

6 support services— 

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

8 recipients under this section; and 

9 ‘‘(ii) shall be made available to recipi10 ents of other scholarship and financial aid 

11 programs enrolled in appropriate health 

12 professions training programs. 

13 ‘‘(F) FINANCIAL ASSISTANCE.—After con14 sultation with Papa Ola Lokahi, financial as15 sistance may be provided to a scholarship re16 cipient during the period that the recipient is 

17 fulfilling the service requirement of the recipi18 ent in any of— 

19 ‘‘(i) the Native Hawaiian health care 

20 systems; or 

21 ‘‘(ii) the Native Hawaiians health cen22 ters. 

23 ‘‘(G) DISTANCE LEARNING RECIPIENTS.— 

24 A scholarship may be provided to a Native Ha25 waiian who is enrolled in an appropriate disVerDate Mar 15 2010 00:23 Feb 03, 2011 Jkt 099200 PO 00000 Frm 00078 Fmt 6652 Sfmt 6201 E:\BILLS\S66.IS S66

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1 tance learning program offered by an accredited 

2 educational institution. 

3 ‘‘(2) FELLOWSHIPS.— 

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

5 provide financial assistance in the form of a fel6 lowship to a Native Hawaiian health profes7 sional who is— 

8 ‘‘(i) a Native Hawaiian community 

9 health representative, outreach worker, or 

10 health program administrator in a profes11 sional training program; 

12 ‘‘(ii) a Native Hawaiian providing 

13 health services; or 

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

15 certificated program provided by tradi16 tional Native Hawaiian healers in any of 

17 the traditional Native Hawaiian healing 

18 practices (including lomi-lomi, la‘au 

19 lapa‘au, and ho‘oponopono). 

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

21 under subparagraph (A) may include a stipend 

22 for, or reimbursement for costs associated with, 

23 participation in a program described in that 

24 paragraph. 


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

2 who is a health professional designated in section 

3 338A of the Public Health Service Act (42 U.S.C. 

4 254l) who receives a scholarship under this sub5 section while fulfilling a service requirement under 

6 that Act shall retain the same rights and benefits as 

7 members of the National Health Service Corps dur8 ing the period of service. 

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

10 INCOME.—Financial assistance provided under this 

11 section shall be considered to be qualified scholar12 ships for the purpose of section 117 of the Internal 

13 Revenue Code of 1986. 

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

15 are authorized to be appropriated such sums as are nec16 essary to carry out subsections (a) and (c)(2) for each of 

17 fiscal years 2011 through 2016. 

18 ‘‘SEC. 12. REPORT. 

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

20 at which the budget of the United States is submitted 

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

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

23 purposes of this Act, including— 

24 ‘‘(1) a review of programs established or as25 sisted in accordance with this Act; and 


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

2 additional programs or additional assistance nec3 essary to provide, at a minimum, health services to 

4 Native Hawaiians, and ensure a health status for 

5 Native Hawaiians, that are at a parity with the 

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

7 the general population. 

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

9 SOURCES OF SUPPLY. 

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

11 organization that enters into a contract or receives grant 

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

13 under the contract or grant all existing facilities under the 

14 jurisdiction of the Secretary (including all equipment of 

15 the facilities), in accordance with such terms and condi16 tions as may be agreed on for the use and maintenance 

17 of the facilities or equipment. 

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

19 donate to an organization that enters into a contract or 

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

21 project or activity under the contract or grant, any per22 sonal or real property determined to be in excess of the 

23 needs of the Department or the General Services Adminis24 tration. 


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

2 Secretary may acquire excess or surplus Federal Govern3 ment personal or real property for donation to an organi4 zation under subsection (b) if the Secretary determines 

5 that the property is appropriate for use by the organiza6 tion for the purpose for which a contract entered into or 

7 grant received by the organization is authorized under this 

8 Act. 

9 ‘‘SEC. 14. DEMONSTRATION PROJECTS OF NATIONAL SIG10 NIFICANCE. 

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

12 ‘‘(1) IN GENERAL.—The Secretary, in consulta13 tion with Papa Ola Lokahi, may allocate amounts 

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

15 carry out Native Hawaiian demonstration projects of 

16 national significance. 

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

18 project described in paragraph (1) may relate to 

19 such areas of interest as— 

20 ‘‘(A) the development of a centralized 

21 database and information system relating to the 

22 health care status, health care needs, and 

23 wellness of Native Hawaiians; 

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

25 and other individuals in institutions of higher 


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1 learning, in health and allied health programs 

2 in healing practices, including Native Hawaiian 

3 healing practices; 

4 ‘‘(C) the integration of Western medicine 

5 with complementary healing practices, including 

6 traditional Native Hawaiian healing practices; 

7 ‘‘(D) the use of telehealth and tele8 communications in— 

9 ‘‘(i) chronic and infectious disease 

10 management; and 

11 ‘‘(ii) health promotion and disease 

12 prevention; 

13 ‘‘(E) the development of appropriate mod14 els of health care for Native Hawaiians and 

15 other indigenous people, including— 

16 ‘‘(i) the provision of culturally com17 petent health services; 

18 ‘‘(ii) related activities focusing on 

19 wellness concepts; 

20 ‘‘(iii) the development of appropriate 

21 kupuna care programs; and 

22 ‘‘(iv) the development of financial 

23 mechanisms and collaborative relationships 

24 leading to universal access to health care; 

25 and 


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1 ‘‘(F) the establishment of— 

2 ‘‘(i) a Native Hawaiian Center of Ex3 cellence for Nursing at the University of 

4 Hawai‘i at Hilo; 

5 ‘‘(ii) a Native Hawaiian Center of Ex6 cellence for Mental Health at the Univer7 sity of Hawai‘i at Manoa; 

8 ‘‘(iii) a Native Hawaiian Center of 

9 Excellence for Maternal Health and Nutri10 tion at the Waimanalo Health Center; 

11 ‘‘(iv) a Native Hawaiian Center of Ex12 cellence for Research, Training, Integrated 

13 Medicine at Molokai General Hospital; and 

14 ‘‘(v) a Native Hawaiian Center of Ex15 cellence for Complementary Health and 

16 Health Education and Training at the 

17 Waianae Coast Comprehensive Health 

18 Center. 

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

20 Lokahi, and any centers established under para21 graph (2)(F), shall be considered to be qualified as 

22 Centers of Excellence under sections 464z–4 and 

23 903(b)(2)(A) of the Public Health Service Act (42 

24 U.S.C. 285t–1, 299a–1). 


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1 ‘‘(b) NONREDUCTION IN OTHER FUNDING.—The al2 location of funds for demonstration projects under sub3 section (a) shall not result in any reduction in funds re4 quired by the Native Hawaiian health care systems, the 

5 Native Hawaiian Health Centers, the Native Hawaiian 

6 Health Scholarship Program, or Papa Ola Lokahi to carry 

7 out the respective responsibilities of those entities under 

8 this Act. 

9 ‘‘SEC. 15. RULE OF CONSTRUCTION. 

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

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

12 practitioners. 

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

14 ‘‘Any new spending authority described in subpara15 graph (A) or (B) of section 401(c)(2) of the Congressional 

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

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

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

19 Acts of appropriation. 

20 ‘‘SEC. 17. SEVERABILITY. 

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

22 any such provision to any person or circumstance, is deter23 mined by a court of competent jurisdiction to be invalid, 

24 the remainder of this Act, and the application of the provi25 sion to a person or circumstance other than that to which 


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

2 holding.’’. 

Æ 


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