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[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 1929 Introduced in Senate (IS)]

106th CONGRESS
  1st Session
                                S. 1929

To amend the Native Hawaiian Health Care Improvement Act to revise and 
                            extend such Act.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                           November 16, 1999

 Mr. Inouye (for himself and Mr. Akaka) 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 such Act.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Native Hawaiian Health Care 
Improvement Act Reauthorization of 1999''.

SEC. 2. AMENDMENT TO THE NATIVE HAWAIIAN HEALTH CARE IMPROVEMENT ACT.

    The Native Hawaiian Health Care Improvement Act (42 U.S.C. 11701 et 
seq.) is amended to read as follows:

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

    ``(a) Short Title.--This Act may be cited as the `Native Hawaiian 
Health Care Improvement Act'.
    ``(b) Table of Contents.--The table of contents of this Act is as 
follows:

        ``Sec. 1. Short title; table of contents.
        ``Sec. 2. Findings.
        ``Sec. 3. Definitions.
        ``Sec. 4. Declaration of policy.
        ``Sec. 5. Comprehensive health care master plan for Native 
                            Hawaiians.
        ``Sec. 6. Functions of Papa Ola Lokahi.
        ``Sec. 7. Native Hawaiian Health Care Systems.
        ``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. Demonstration projects of national significance.
        ``Sec. 14. National Bipartisan Commission on Native Hawaiian 
                            Health Care Entitlement.
        ``Sec. 15. Rule of construction.
        ``Sec. 16. Compliance with Budget Act.
        ``Sec. 17. Severability.

``SEC. 2. FINDINGS.

    ``(a) General Findings.--Congress makes the following findings:
            ``(1) Native Hawaiians begin their story with the Kumulipo 
        which details the creation and inter-relationship of all 
        things, including their evolvement as healthy and well people.
            ``(2) Native Hawaiians are a distinct and unique indigenous 
        people with a historical continuity to the original inhabitants 
        of the Hawaiian archipelago and have a distinct society 
        organized almost 2,000 years ago.
            ``(3) Native Hawaiians have never directly relinquished to 
        the United States their claims to their inherent sovereignty as 
        a people or over their national lands, either through their 
        monarchy or through a plebiscite or referendum.
            ``(4) The health and well-being of Native Hawaiians are 
        intrinsically tied to their deep feelings and attachment to 
        their lands and seas.
            ``(5) The long-range economic and social changes in Hawaii 
        over the 19th and early 20th centuries have been devastating to 
        the health and well-being of Native Hawaiians.
            ``(6) The Native Hawaiian people are determined to 
        preserve, develop and transmit to future generations their 
        ancestral territory, and their cultural identity in accordance 
        with their own spiritual and traditional beliefs, customs, 
        practices, language, and social institutions. In referring to 
        themselves, Native Hawaiians use the term ``Kanaka Maoli'', a 
        term frequently used in the 19th century to describe the native 
        people of Hawaii.
            ``(7) The constitution and statutes of the State of 
        Hawaii--
                    ``(A) acknowledge the distinct land rights of 
                Native Hawaiian people as beneficiaries of the public 
                lands trust; and
                    ``(B) reaffirm and protect the unique right of the 
                Native Hawaiian people to practice and perpetuate their 
                cultural and religious customs, beliefs, practices, and 
                language.
            ``(8) At the time of the arrival of the first nonindigenous 
        people in Hawaii in 1778, the Native Hawaiian people lived in a 
        highly organized, self-sufficient, subsistence social system 
        based on communal land tenure with a sophisticated language, 
        culture, and religion.
            ``(9) A unified monarchical government of the Hawaiian 
        Islands was established in 1810 under Kamehameha I, the first 
        King of Hawaii.
            ``(10) Throughout the 19th century and until 1893, the 
        United States--
                    ``(A) recognized the independence of the Hawaiian 
                Nation;
                    ``(B) extended full and complete diplomatic 
                recognition to the Hawaiian Government; and
                    ``(C) entered into treaties and conventions with 
                the Hawaiian monarchs to govern commerce and navigation 
                in 1826, 1842, 1849, 1875 and 1887.
            ``(11) In 1893, John L. Stevens, the United States Minister 
        assigned to the sovereign and independent Kingdom of Hawaii, 
        conspired with a small group of non-Hawaiian residents of the 
        Kingdom, including citizens of the United States, to overthrow 
        the indigenous and lawful government of Hawaii.
            ``(12) In pursuance of that conspiracy, the United States 
        Minister and the naval representative of the United States 
        caused armed naval forces of the United States to invade the 
        sovereign Hawaiian Nation in support of the overthrow of the 
        indigenous and lawful Government of Hawaii and the United 
        States Minister thereupon extended diplomatic recognition of a 
        provisional government formed by the conspirators without the 
        consent of the native people of Hawaii or the lawful Government 
        of Hawaii in violation of treaties between the 2 nations and of 
        international law.
            ``(13) In a message to Congress on December 18, 1893, then 
        President Grover Cleveland reported fully and accurately on 
        these illegal actions, and acknowledged that by these acts, 
        described by the President as acts of war, the government of a 
        peaceful and friendly people was overthrown, and the President 
        concluded that a ``substantial wrong has thus been done which a 
        due regard for our national character as well as the rights of 
        the injured people required that we should endeavor to 
        repair''.
            ``(14) Queen Lili`uokalani, the lawful monarch of Hawaii, 
        and the Hawaiian Patriotic League, representing the aboriginal 
        citizens of Hawaii, promptly petitioned the United States for 
        redress of these wrongs and for restoration of the indigenous 
        government of the Hawaiian nation, but this petition was not 
        acted upon.
            ``(15) Further, the United States has acknowledged the 
        significance of these events and has apologized to Native 
        Hawaiians on behalf of the people of the United States for the 
        overthrow of the Kingdom of Hawaii with the participation of 
        agents and citizens of the United States, and the resulting 
        deprivation of the rights of Native Hawaiians to self-
        determination in legislation in 1993 (Public Law 103-150; 107 
        Stat. 1510).
            ``(16) In 1898, the United States annexed Hawaii through 
        the Newlands Resolution without the consent of or compensation 
        to the indigenous people of Hawaii or their sovereign 
        government who were thereby denied the mechanism for expression 
of their inherent sovereignty through self-government and self-
determination, their lands and ocean resources.
            ``(17) Through the Newlands Resolution and the 1900 Organic 
        Act, the Congress received 1,750,000 acres of lands formerly 
        owned by the Crown and Government of the Hawaiian Kingdom and 
        exempted the lands from then existing public land laws of the 
        United States by mandating that the revenue and proceeds from 
        these lands be ``used solely for the benefit of the inhabitants 
        of the Hawaiian Islands for education and other public 
        purposes'', thereby establishing a special trust relationship 
        between the United States and the inhabitants of Hawaii.
            ``(18) In 1921, Congress enacted the Hawaiian Homes 
        Commission Act, 1920, which designated 200,000 acres of the 
        ceded public lands for exclusive homesteading by Native 
        Hawaiians, thereby affirming the trust relationship between the 
        United States and the Native Hawaiians, as expressed by then 
        Secretary of the Interior Franklin K. Lane who was cited in the 
        Committee Report of the Committee on Territories of the House 
        of Representatives as stating, ``One thing that impressed me . 
        . . was the fact that the natives of the islands . . . for whom 
        in a sense we are trustees, are falling off rapidly in numbers 
        and many of them are in poverty.''.
            ``(19) In 1938, Congress again acknowledged the unique 
        status of the Native Hawaiian people by including in the Act of 
        June 20, 1938 (52 Stat. 781 et seq.), a provision to lease 
        lands within the extension to Native Hawaiians and to permit 
        fishing in the area ``only by native Hawaiian residents of said 
        area or of adjacent villages and by visitors under their 
        guidance''.
            ``(20) Under the Act entitled ``An Act to provide for the 
        admission of the State of Hawaii into the Union'', approved 
        March 18, 1959 (73 Stat. 4), the United States transferred 
        responsibility for the administration of the Hawaiian Home 
        Lands to the State of Hawaii but reaffirmed the trust 
        relationship which existed between the United States and the 
        Native Hawaiian people by retaining the exclusive power to 
        enforce the trust, including the power to approve land 
        exchanges, and legislative amendments affecting the rights of 
        beneficiaries under such Act.
            ``(21) Under the Act entitled ``An Act to provide for the 
        admission of the State of Hawaii into the Union'', approved 
        March 18, 1959 (73 Stat. 4), the United States transferred 
        responsibility for administration over portions of the ceded 
        public lands trust not retained by the United States to the 
        State of Hawaii but reaffirmed the trust relationship which 
        existed between the United States and the Native Hawaiian 
        people by retaining the legal responsibility of the State for 
        the betterment of the conditions of Native Hawaiians under 
        section 5(f) of such Act.
            ``(22) The authority of the Congress under the Constitution 
        to legislate in matters affecting the aboriginal or indigenous 
        peoples of the United States includes the authority to 
        legislate in matters affecting the native peoples of Alaska and 
        Hawaii.
            ``(23) Further, the United States has recognized the 
        authority of the Native Hawaiian people to continue to work 
        towards an appropriate form of sovereignty as defined by the 
        Native Hawaiian people themselves in provisions set forth in 
        legislation returning the Hawaiian Island of Kaho`olawe to 
        custodial management by the State of Hawaii in 1994.
            ``(24) In furtherance of the trust responsibility for the 
        betterment of the conditions of Native Hawaiians, the United 
        States has established a program for the provision of 
        comprehensive health promotion and disease prevention services 
        to maintain and improve the health status of the Hawaiian 
        people. This program is conducted by the Native Hawaiian Health 
        Care Systems, the Native Hawaiian Health Scholarship Program 
        and Papa Ola Lokahi. Health initiatives from these and other 
        health institutions and agencies using Federal assistance have 
        begun to lower the century-old morbidity and mortality rates of 
        Native Hawaiian people by providing comprehensive disease 
        prevention, health promotion activities and increasing the 
        number of Native Hawaiians in the health and allied health 
        professions. This has been accomplished through the Native 
        Hawaiian Health Care Act of 1988 (Public Law 100-579) and its 
        reauthorization in section 9168 of Public Law 102-396 (106 
        Stat. 1948).
            ``(25) This historical and unique legal relationship has 
        been consistently recognized and affirmed by Congress through 
        the enactment of Federal laws which extend to the Native 
        Hawaiian people the same rights and privileges accorded to 
        American Indian, Alaska Native, Eskimo, and Aleut communities, 
        including the Native American Programs Act of 1974 (42 U.S.C. 
        2991 et seq.), the American Indian Religious Freedom Act (42 
        U.S.C. 1996), the National Museum of the American Indian Act 
        (20 U.S.C. 80q et seq.), and the Native American Graves 
        Protection and Repatriation Act (25 U.S.C. 3001 et seq.).
            ``(26) The United States has also recognized and reaffirmed 
        the trust relationship to the Native Hawaiian people through 
        legislation which authorizes the provision of services to 
        Native Hawaiians, specifically, the Older Americans Act of 1965 
        (42 U.S.C. 3001 et seq.), the Developmental Disabilities 
        Assistance and Bill of Rights Act Amendments of 1987, the 
        Veterans' Benefits and Services Act of 1988, the Rehabilitation 
        Act of 1973 (29 U.S.C. 701 et seq.), the Native Hawaiian Health 
        Care Act of 1988 (Public Law 100-579), the Health Professions 
        Reauthorization Act of 1988, the Nursing Shortage Reduction and 
        Education Extension Act of 1988, the Handicapped Programs 
        Technical Amendments Act of 1988, the Indian Health Care 
        Amendments of 1988, and the Disadvantaged Minority Health 
        Improvement Act of 1990.
            ``(27) The United States has also affirmed the historical 
        and unique legal relationship to the Hawaiian people by 
        authorizing the provision of services to Native Hawaiians to 
        address problems of alcohol and drug abuse under the Anti-Drug 
        Abuse Act of 1986 (Public Law 99-570).
            ``(28) Further, the United States has recognized that 
        Native Hawaiians, as aboriginal, indigenous, native peoples of 
        Hawaii, are a unique population group in Hawaii and in the 
        continental United States and has so declared in Office of 
        Management and Budget Circular 15 in 1997 and Presidential 
        Executive Order No. 13125, dated June 7, 1999.
            ``(29) Despite the United States having expressed its 
        commitment to a policy of reconciliation with the Native 
        Hawaiian people for past grievances in Public Law 103-150 (107 
        Stat. 1510) the unmet health needs of the Native Hawaiian 
        people remain severe and their health status continues to be 
        far below that of the general population of the United States.
    ``(b) Unmet Needs and Health Disparities.--Congress finds that the 
unmet needs and serious health disparities that adversely affect the 
Native Hawaiian people include the following:
            ``(1) Chronic disease and illness.--
                    ``(A) Cancer.--
                            ``(i) In general.--With respect to all 
                        cancer--
                                    ``(I) Native Hawaiians have the 
                                highest cancer mortality rates in the 
                                State of Hawaii (231.0 out of every 
                                100,000 residents), 45 percent higher 
                                than that for the total State 
                                population (159.7 out of every 100,000 
                                residents);
                                    ``(II) Native Hawaiian males have 
                                the highest cancer mortality rates in 
                                the State of Hawaii for cancers of the 
                                lung, liver and pancreas and for all 
                                cancers combined;
                                    ``(III) Native Hawaiian females 
                                ranked highest in the State of Hawaii 
                                for cancers of the lung, liver, 
                                pancreas, breast, cervix uteri, corpus 
                                uteri, stomach, and rectum, and for all 
                                cancers combined;
                                    ``(IV) Native Hawaiian males have 
                                the highest years of productive life 
                                lost from cancer in the State of Hawaii 
                                with 8.7 years compared to 6.4 years 
                                for other males; and
                                    ``(V) Native Hawaiian females have 
                                8.2 years of productive life lost from 
                                cancer in the State of Hawaii as 
                                compared to 6.4 years for other females 
                                in the State of Hawaii;
                            ``(ii) Breast cancer.--With respect to 
                        breast cancer--
                                    ``(I) Native Hawaiians have the 
                                highest mortality rates in the State of 
                                Hawaii from breast cancer (37.96 out of 
                                every 100,000 residents), which is 25 
                                percent higher than that for Caucasian 
                                Americans (30.25 out of every 100,000 
                                residents) and 106 percent higher than 
                                that for Chinese Americans (18.39 out 
                                of every 100,000 residents); and
                                    ``(II) nationally, Native Hawaiians 
                                have the third highest mortality rates 
                                due to breast cancer (25.0 out of every 
                                100,000 residents) following African 
                                Americans (31.4 out of every 100,000 
                                residents) and Caucasian Americans 
                                (27.0 out of every 100,000 residents).
                            ``(iii) Cancer of the cervix.--Native 
                        Hawaiians have the highest mortality rates from 
                        cancer of the cervix in the State of Hawaii 
                        (3.82 out of every 100,000 residents) followed 
                        by Filipino Americans (3.33 out of every 
                        100,000 residents) and Caucasian Americans 
                        (2.61 out of every 100,000 residents).
                            ``(iv) Lung cancer.--Native Hawaiians have 
                        the highest mortality rates from lung cancer in 
                        the State of Hawaii (90.70 out of every 100,000 
                        residents), which is 61 percent higher than 
                        Caucasian Americans, who rank second and 161 
                        percent higher than Japanese Americans, who 
                        rank third.
                            ``(v) Prostate cancer.--Native Hawaiian 
                        males have the second highest mortality rates 
                        due to prostate cancer in the State of Hawaii 
                        (25.86 out of every 100,000 residents) with 
                        Caucasian Americans having the highest 
                        mortality rate from prostate cancer (30.55 out 
                        of every 100,000 residents).
                    ``(B) Diabetes.--With respect to diabetes, for the 
                years 1989 through 1991--
                            ``(i) Native Hawaiians had the highest 
                        mortality rate due to diabetes mellitis (34.7 
                        out of every 100,000 residents) in the State of 
                        Hawaii which is 130 percent higher than the 
                        statewide rate for all other races (15.1 out of 
                        every 100,000 residents);
                            ``(ii) full-blood Hawaiians had a mortality 
                        rate of 93.3 out of every 100,000 residents, 
                        which is 518 percent higher than the rate for 
                        the statewide population of all other races; 
                        and
                            ``(iii) Native Hawaiians who are less than 
                        full-blood had a mortality rate of 27.1 out of 
                        every 100,000 residents, which is 79 percent 
                        higher than the rate for the statewide 
                        population of all other races.
                    ``(C) Asthma.--With respect to asthma--
                            ``(i) in 1990, Native Hawaiians comprised 
                        44 percent of all asthma cases in the State of 
                        Hawaii for those 18 years of age and younger, 
                        and 35 percent of all asthma cases reported; 
                        and
                            ``(ii) in 1992, the Native Hawaiian rate 
                        for asthma was 81.7 out of every 1000 
                        residents, which was 73 percent higher than the 
                        rate for the total statewide population of 47.3 
                        out of every 1000 residents.
                    ``(D) Circulatory diseases.--
                            ``(i) Heart Disease.--With respect to heart 
                        disease--
                                    ``(I) the death rate for Native 
                                Hawaiians from heart disease (333.4 out 
                                of every 100,000 residents) is 66 
                                percent higher than for the entire 
                                State of Hawaii (201.1 out of every 
                                100,000 residents); and
                                    ``(II) Native Hawaiian males have 
                                the greatest years of productive life 
                                lost in the State of Hawaii where 
                                Native Hawaiian males lose an average 
                                of 15.5 years and Native Hawaiian 
                                females lose an average of 8.2 years 
                                due to heart disease, as compared to 
                                7.5 years for all males in the State of 
                                Hawaii and 6.4 years for all females.
                            ``(ii) Hypertension.--The death rate for 
                        Native Hawaiians from hypertension (3.5 out of 
                        every 100,000 residents) is 84 percent higher 
                        than that for the entire State (1.9 out of 
                        every 100,000 residents).
                            ``(iii) Stroke.--The death rate for Native 
                        Hawaiians from stroke (58.3 out of every 
                        100,000 residents) is 13 percent higher than 
                        that for the entire State (51.8 out of every 
                        100,000 residents).
            ``(2) Infectious disease and illness.--The incidence of 
        AIDS for Native Hawaiians is at least twice as high per 100,000 
        residents (10.5 percent) than that for any other non-Caucasian 
        group in the State of Hawaii.
            ``(3) Accidents.--With respect to accidents--
                    ``(A) the death rate for Native Hawaiians from 
                accidents (38.8 out of every 100,000 residents) is 45 
                percent higher than that for the entire State (26.8 out 
                of every 100,000 residents);
                    ``(B) Native Hawaiian males lose an average of 14 
                years of productive life lost from accidents as 
                compared to 9.8 years for all other males in Hawaii; 
                and
                    ``(C) Native Hawaiian females lose and average of 4 
                years of productive life lost from accidents but this 
                rate is the highest rate among all females in the State 
                of Hawaii.
            ``(4) Dental health.--With respect to dental health--
                    ``(A) Native Hawaiian children exhibit among the 
                highest rates of dental caries in the nation, and the 
                highest in the State of Hawaii as compared to the 5 
                other major ethnic groups in the State;
                    ``(B) the average number of decayed or filled 
                primary teeth for Native Hawaiian children ages 5 
                through 9 years was 4.3 as compared with 3.7 for the 
                entire State of Hawaii and 1.9 for the United States; 
                and
                    ``(C) the proportion of Native Hawaiian children 
                ages 5 through 12 years with unmet treatment needs 
                (defined as having active dental caries requiring 
                treatment) is 40 percent as compared with 33 percent 
                for all other races in the State of Hawaii.
            ``(5) Life expectancy.--With respect to life expectancy--
                    ``(A) Native Hawaiians have the lowest life 
                expectancy of all population groups in the State of 
                Hawaii;
                    ``(B) between 1910 and 1980, the life expectancy of 
                Native Hawaiians from birth has ranged from 5 to 10 
                years less than that of the overall State population 
                average; and
                    ``(C) the most recent tables for 1990 show Native 
                Hawaiian life expectancy at birth (74.27 years) to be 
                about 5 years less than that of the total State 
                population (78.85 years).
            ``(6) Maternal and child health.--
                    ``(A) Prenatal care.--With respect to prenatal 
                care--
                            ``(i) as of 1996, Native Hawaiian women 
                        have the highest prevalence (21 percent) of 
                        having had no prenatal care during their first 
                        trimester of pregnancy when compared to the 5 
                        largest ethnic groups in the State of Hawaii;
                            ``(ii) of the mothers in the State of 
                        Hawaii who received no prenatal care throughout 
                        their pregnancy in 1996, 44 percent were Native 
                        Hawaiian;
                            ``(iii) over 65 percent of the referrals to 
                        Healthy Start in fiscal years 1996 and 1997 
                        were Native Hawaiian newborns; and
                            ``(iv) in every region of the State of 
                        Hawaii, many Native Hawaiian newborns begin 
                        life in a potentially hazardous circumstance, 
                        far higher than any other racial group.
                    ``(B) Births.--With respect to births--
                            ``(i) in 1996, 45 percent of the live 
                        births to Native Hawaiian mothers were infants 
                        born to single mothers which statistics 
                        indicate put infants at higher risk of low 
                        birth weight and infant mortality;
                            ``(ii) in 1996, of the births to Native 
                        Hawaiian single mothers, 8 percent were low 
                        birth weight (under 2500 grams); and
                            ``(iii) of all low birth weight babies born 
                        to single mothers in the State of Hawaii, 44 
                        percent were Native Hawaiian.
                    ``(C) Teen pregnancies.--With respect to births--
                            ``(i) in 1993 and 1994, Native Hawaiians 
                        had the highest percentage of teen (individuals 
                        who were less than 18 years of age) births (8.1 
                        percent) compared to the rate for all other 
                        races in the State of Hawaii (3.6 percent);
                            ``(ii) in 1996, nearly 53 percent of all 
                        mothers in Hawaii under 18 years of age were 
                        Native Hawaiian;
                            ``(iii) lower rates of abortion (a third 
                        lower than for the statewide population) among 
                        Hawaiian women may account in part, for the 
                        higher percentage of live births;
                            ``(iv) in 1995, of the births to mothers 
                        age 14 years and younger in Hawaii, 66 percent 
                        were Native Hawaiian; and
                            ``(v) in 1996, of the births in this same 
                        group, 48 percent were Native Hawaiian.
                    ``(D) Fetal mortality.--In 1996, Native Hawaiian 
                fetal mortality rates comprised 15 percent of all fetal 
                deaths for the State of Hawaii. However, for fetal 
                deaths occurring in mothers under the age of 18 years, 
                32 percent were Native Hawaiian, and for mothers 18 
                through 24 years of age, 28 percent were Native 
                Hawaiians.
            ``(7) Mental health.--
                    ``(A) Alcohol and drug abuse.--With respect to 
                alcohol and drug abuse--
                            ``(i) Native Hawaiians represent 38 percent 
                        of the total admissions to Department of 
                        Health, Alcohol, Drugs and Other Drugs, funded 
                        substance abuse treatment programs;
                            ``(ii) in 1997, the prevalence of smoking 
                        by Native Hawaiians was 28.5 percent, a rate 
                        that is 53 percent higher than that for all 
                        other races in the State of Hawaii which is 
                        18.6 percent;
                            ``(iii) Native Hawaiians have the highest 
                        prevalence rates of acute drinking (31 
                        percent), a rate that is 79 percent higher than 
                        that for all other races in the State of 
                        Hawaii;
                            ``(iv) the chronic drinking rate among 
                        Native Hawaiians is 54 percent higher than that 
                        for all other races in the State of Hawaii;
                            ``(v) in 1991, 40 percent of the Native 
                        Hawaiian adults surveyed reported having used 
                        marijuana compared with 30 percent for all 
other races in the State of Hawaii; and
                            ``(vi) nine percent of the Native Hawaiian 
                        adults surveyed reported that they are current 
                        users (within the past year) of marijuana, 
                        compared with 6 percent for all other races in 
                        the State of Hawaii.
                    ``(B) Crime.--With respect to crime--
                            ``(i) in 1996, of the 5,944 arrests that 
                        were made for property crimes in the State of 
                        Hawaii, arrests of Native Hawaiians comprised 
                        20 percent of that total;
                            ``(ii) Native Hawaiian juveniles comprised 
                        a third of all juvenile arrests in 1996;
                            ``(iii) In 1996, Native Hawaiians 
                        represented 21 percent of the 8,000 adults 
                        arrested for violent crimes in the State of 
                        Hawaii, and 38 percent of the 4,066 juvenile 
                        arrests;
                            ``(iv) Native Hawaiians are over-
                        represented in the prison population in Hawaii;
                            ``(v) in 1995 and 1996 Native Hawaiians 
                        comprised 36.5 percent of the sentenced felon 
                        prison population in Hawaii, as compared to 
                        20.5 percent for Caucasian Americans, 3.7 
                        percent for Japanese Americans, and 6 percent 
                        for Chinese Americans;
                            ``(vi) in 1995 and 1996 Native Hawaiians 
                        made up 45.4 percent of the technical violator 
                        population, and at the Hawaii Youth 
                        Correctional Facility, Native Hawaiians 
                        constituted 51.6 percent of all detainees in 
                        fiscal year 1997; and
                            ``(vii) based on anecdotal information from 
                        inmates at the Halawa Correction Facilities, 
                        Native Hawaiians are estimated to comprise 
                        between 60 and 70 percent of all inmates.
            ``(8) Health professions education and training.--With 
        respect to health professions education and training--
                    ``(A) Native Hawaiians age 25 years and older have 
                a comparable rate of high school completion, however, 
                the rates of baccalaureate degree achievement amongst 
                Native Hawaiians are less than the norm in the State of 
                Hawaii (6.9 percent and 15.76 percent respectively);
                    ``(B) Native Hawaiian physicians make up 4 percent 
                of the total physician workforce in the State of 
                Hawaii; and
                    ``(C) in fiscal year 1997, Native Hawaiians 
                comprised 8 percent of those individuals who earned 
                Bachelor's Degrees, 14 percent of those individuals who 
                earned professional diplomas, 6 percent of those 
                individuals who earned Master's Degrees, and less than 
                1 percent of individuals who earned doctoral degrees at 
                the University of Hawaii.

``SEC. 3. DEFINITIONS.

    ``In this Act:
            ``(1) Disease prevention.--The term `disease prevention' 
        includes--
                    ``(A) immunizations;
                    ``(B) control of high blood pressure;
                    ``(C) control of sexually transmittable diseases;
                    ``(D) prevention and control of diabetes;
                    ``(E) control of toxic agents;
                    ``(F) occupational safety and health;
                    ``(G) accident prevention;
                    ``(H) fluoridation of water;
                    ``(I) control of infectious agents; and
                    ``(J) provision of mental health care.
            ``(2) Health promotion.--The term `health promotion' 
        includes--
                    ``(A) pregnancy and infant care, including 
                prevention of fetal alcohol syndrome;
                    ``(B) cessation of tobacco smoking;
                    ``(C) reduction in the misuse of alcohol and drugs;
                    ``(D) improvement of nutrition;
                    ``(E) improvement in physical fitness;
                    ``(F) family planning;
                    ``(G) control of stress;
                    ``(H) reduction of major behavioral risk factors 
                and promotion of healthy lifestyle practices; and
                    ``(I) integration of cultural approaches to health 
                and well-being, including traditional practices 
                relating to the land (`aina), water (wai), and ocean 
                (kai).
            ``(3) Native hawaiian.--The term `Native Hawaiian' means 
        any individual who is Kanaka Maoli (a descendant of the 
        aboriginal people who, prior to 1778, occupied and exercised 
        sovereignty in the area that now constitutes the State of 
        Hawaii) as evidenced by--
                    ``(A) genealogical records,
                    ``(B) Kupuna (elders) or Kama`aina (long-term 
                community residents) verification; or
                    ``(C) birth records of the State of Hawaii.
            ``(4) Native hawaiian health care system.--The term `Native 
        Hawaiian health care system' means an entity--
                    ``(A) which is organized under the laws of the 
                State of Hawaii;
                    ``(B) which provides or arranges for health care 
                services through practitioners licensed by the State of 
                Hawaii, where licensure requirements are applicable;
                    ``(C) which is a public or nonprofit private 
                entity;
                    ``(D) in which Native Hawaiian health practitioners 
                significantly participate in the planning, management, 
                monitoring, and evaluation of health care services;
                    ``(E) which may be composed of as many as 8 Native 
                Hawaiian health care systems as necessary to meet the 
health care needs of each island's Native Hawaiians; and
                    ``(F) which is--
                            ``(i) recognized by Papa Ola Lokahi for the 
                        purpose of planning, conducting, or 
                        administering programs, or portions of 
                        programs, authorized by this chapter for the 
                        benefit of Native Hawaiians; and
                            ``(ii) certified by Papa Ola Lokahi as 
                        having the qualifications and the capacity to 
                        provide the services and meet the requirements 
                        under the contract the Native Hawaiian health 
                        care system enters into with the Secretary or 
                        the grant the Native Hawaiian health care 
                        system receives from the Secretary pursuant to 
                        this Act.
            ``(5) Native hawaiian organization.--The term `Native 
        Hawaiian organization' means any organization--
                    ``(A) which serves the interests of Native 
                Hawaiians; and
                    ``(B) which is--
                            ``(i) recognized by Papa Ola Lokahi for the 
                        purpose of planning, conducting, or 
                        administering programs (or portions of 
                        programs) authorized under this Act for the 
                        benefit of Native Hawaiians; and
                            ``(ii) a public or nonprofit private 
                        entity.
            ``(6) Papa ola lokahi.--
                    ``(A) In general.--The term `Papa Ola Lokahi' means 
                an organization that is composed of public agencies and 
                private organizations focusing on improving the health 
                status of Native Hawaiians. Board members of such 
                organization may include representation from--
                            ``(i) E Ola Mau;
                            ``(ii) the Office of Hawaiian Affairs of 
                        the State of Hawaii;
                            ``(iii) Alu Like Inc.;
                            ``(iv) the University of Hawaii;
                            ``(v) the Hawaii State Department of 
                        Health;
                            ``(vi) the Kamehameha Schools Bishop 
                        Estate, or other Native Hawaiian organization 
                        responsible for the administration of the 
                        Native Hawaiian Health Scholarship Program;
                            ``(vii) the Hawaii State Primary Care 
                        Association, or other organizations responsible 
                        for the placement of scholars from the Native 
                        Hawaiian Health Scholarship Program;
                            ``(viii) Ahahui O Na Kauka, the Native 
                        Hawaiian Physicians Association;
                            ``(ix) Ho`ola Lahui Hawaii, or a health 
                        care system serving Kaua`i or Ni`ihau, and 
                        which may be composed of as many health care 
                        centers as are necessary to meet the health 
                        care needs of the Native Hawaiians of those 
                        islands;
                            ``(x) Ke Ola Mamo, or a health care system 
                        serving the island of O`ahu and which may be 
                        composed of as many health care centers as are 
                        necessary to meet the health care needs of the 
                        Native Hawaiians of that island;
                            ``(xi) Na Pu`uwai or a health care system 
                        serving Moloka`i or Lana`i, and which may be 
                        composed of as many health care centers as are 
                        necessary to meet the health care needs of the 
                        Native Hawaiians of those islands;
                            ``(xii) Hui No Ke Ola Pono, or a health 
                        care system serving the island of Maui, and 
                        which may be composed of as many health care 
                        centers as are necessary to meet the health 
                        care needs of the Native Hawaiians of that 
                        island;
                            ``(xiii) Hui Malama Ola Ha `Oiwi, or a 
                        health care system serving the island of 
                        Hawaii, and which may be composed of as many 
                        health care centers as are necessary to meet 
                        the health care needs of the Native Hawaiians 
                        of that island;
                            ``(xiv) other Native Hawaiian health care 
                        systems as certified and recognized by Papa Ola 
                        Lokahi in accordance with this Act; and
                            ``(xv) such other member organizations as 
                        the Board of Papa Ola Lokahi may admit from 
                        time to time, based upon satisfactory 
                        demonstration of a record of contribution to 
                        the health and well-being of Native Hawaiians.
                    ``(B) Limitation.--Such term does not include any 
                organization described in subparagraph (A) if the 
                Secretary determines that such organization has not 
                developed a mission statement with clearly defined 
                goals and objectives for the contributions the 
                organization will make to the Native Hawaiian health 
                care systems, and an action plan for carrying out those 
                goals and objectives.
            ``(7) Primary health services.--The term `primary health 
        services' means--
                    ``(A) services of physicians, physicians' 
                assistants, nurse practitioners, and other health 
                professionals;
                    ``(B) diagnostic laboratory and radiologic 
                services;
                    ``(C) preventive health services including 
                perinatal services, well child services, family 
                planning services, nutrition services, home health 
                services, and, generally, all those services associated 
                with enhanced health and wellness.
                    ``(D) emergency medical services;
                    ``(E) transportation services as required for 
                adequate patient care;
                    ``(F) preventive dental services; and
                    ``(G) pharmaceutical and nutraceutical services.
            ``(8) Secretary.--The term `Secretary' means the Secretary 
        of Health and Human Services.
            ``(9) Traditional native hawaiian healer.--The term 
        `traditional Native Hawaiian healer' means a practitioner--
                    ``(A) who--
                            ``(i) is of Native Hawaiian ancestry; and
                            ``(ii) has the knowledge, skills, and 
                        experience in direct personal health care of 
                        individuals; and
                    ``(B) whose knowledge, skills, and experience are 
                based on demonstrated learning of Native Hawaiian 
                healing practices acquired by--
                            ``(i) direct practical association with 
                        Native Hawaiian elders; and
                            ``(ii) oral traditions transmitted from 
                        generation to generation.

``SEC. 4. DECLARATION OF POLICY.

    ``(a) Congress.--Congress hereby declares that it is the policy of 
the United States in fulfillment of its special responsibilities and 
legal obligations to the indigenous people of Hawaii resulting from the 
unique and historical relationship between the United States and the 
indigenous people of Hawaii--
            ``(1) to raise the health status of Native Hawaiians to the 
        highest possible health level; and
            ``(2) to provide existing Native Hawaiian health care 
        programs with all resources necessary to effectuate this 
        policy.
    ``(b) Intent of Congress.--
            ``(1) In general.--It is the intent of the Congress that--
                    ``(A) health care programs having a demonstrated 
                effect of substantially reducing or eliminating the 
                over-representation of Native Hawaiians among those 
                suffering from chronic and acute disease and illness 
                and addressing the health needs of Native Hawaiians 
                shall be established and implemented; and
                    ``(B) the Nation meet the Healthy People 2010 and 
                Kanaka Maoli health objectives described in paragraph 
                (2) by the year 2010.
            ``(2) Healthy people and kanaka maoli health objectives.--
        The Healthy People 2010 and Kanaka Maoli health objectives 
        described in this paragraph are the following:
                    ``(A) Chronic disease and illness.--
                            ``(i) Cardiovascular disease.--With respect 
                        to cardiovascular disease--
                                    ``(I) to increase to 75 percent the 
                                proportion of females who are aware 
                                that cardiovascular disease (heart 
                                disease and stroke) is the leading 
                                cause of death for all females.
                                    ``(II) to increase to at least 95 
                                percent the proportion of adults who 
                                have had their blood pressure measured 
                                within the preceding 2 years and can 
                                state whether their blood pressure was 
                                normal or high; and
                                    ``(III) to increase to at least 75 
                                percent the proportion of adults who 
                                have had their blood cholesterol 
                                checked within the preceding 5 years.
                            ``(ii) Diabetes.--With respect to 
                        diabetes--
                                    ``(I) to increase to 80 percent the 
                                proportion of persons with diabetes 
                                whose condition has been diagnosed;
                                    ``(II) to increase to at least 20 
                                percent the proportion of patients with 
                                diabetes who annually obtain lipid 
                                assessment (total cholesterol, LDL 
                                cholesterol, HDL cholesterol, 
                                triglyceride); and
                                    ``(III) to increase to 52 percent 
                                the proportion of persons with diabetes 
                                who have received formal diabetes 
                                education.
                            ``(iii) Cancer.--With respect to cancer--
                                    ``(I) to increase to at least 95 
                                percent the proportion of women age 18 
                                and older who have ever received a Pap 
                                test and to at least 85 percent those 
                                who have received a Pap test within the 
                                preceding 3 years; and
                                    ``(II) to increase to at least 40 
                                percent the proportion of women age 40 
                                and older who have received a breast 
                                examination and a mammogram within the 
                                preceding 2 years.
                            ``(iv) Dental health.--With respect to 
                        dental health--
                                    ``(I) to reduce untreated cavities 
                                in the primary and permanent teeth 
                                (mixed dentition) so that the 
                                proportion of children with decayed 
                                teeth not filled is not more than 12 
                                percent among children ages 2 through 
                                4, 22 percent among children ages 6 
                                through 8, and 15 percent among 
                                adolescents ages 8 through 15;
                                    ``(II) to increase to at least 70 
                                percent the proportion of children ages 
                                8 through 14 who have received 
                                protective sealants in permanent molar 
                                teeth; and
                                    ``(III) to increase to at least 70 
                                percent the proportion of adults age 18 
                                and older using the oral health care 
                                system each year.
                            ``(v) Mental health.--With respect to 
                        mental health--
                                    ``(I) to incorporate or support 
                                land(`aina)-based, water(wai)-based, or 
                                the ocean(kai)-based programs within 
                                the context of mental health 
                                activities; and
                                    ``(II) to reduce the anger and 
                                frustration levels within `ohana' 
                                focusing on building positive 
                                relationships and striving for balance 
                                in living (lokahi) and achieving a 
                                sense of contentment (pono).
                            ``(vi) Asthma.--With respect to asthma--
                                    ``(I) to increase to at least 40 
                                percent the proportion of people with 
                                asthma who receive formal patient 
                                education, including information about 
                                community and self-help resources, as 
                                an integral part of the management of 
                                their condition;
                                    ``(II) to increase to at least 75 
                                percent the proportion of patients who 
                                receive counseling from health care 
                                providers on how to recognize early 
                                signs of worsening asthma and how to 
                                respond appropriately; and
                                    ``(III) to increase to at least 75 
                                percent the proportion of primary care 
                                providers who are trained to provide 
                                culturally competent care to ethnic 
                                minorities (Native Hawaiians) seeking 
                                health care for chronic obstructive 
                                pulmonary disease.
                    ``(B) Infectious disease and illness.--
                            ``(i) Immunizations.--With respect to 
                        immunizations--
                                    ``(I) to reduce indigenous cases of 
                                vaccine-preventable disease;
                                    ``(II) to achieve immunization 
                                coverage of at least 90 percent among 
                                children between 19 and 35 months of 
                                age; and
                                    ``(III) to increase to 90 percent 
                                the rate of immunization coverage among 
                                adults 65 years of age or older, and 60 
                                percent for high-risk adults between 18 
                                and 64 years of age.
                            ``(ii) Sexually transmitted diseases, hiv; 
                        aids.--To increase the number of HIV-infected 
                        adolescents and adults in care who receive 
                        treatment consistent with current public health 
                        treatment guidelines.
                    ``(C) Wellness.--
                            ``(i) Exercise.--With respect to exercise--
                                    ``(I) to increase to 85 percent the 
                                proportion of people ages 18 and older 
                                who engage in any leisure time physical 
                                activity; and
                                    ``(II) to increase to at least 30 
                                percent the proportion of people ages 
                                18 and older who engage regularly, 
                                preferably daily, in sustained physical 
                                activity for at least 30 minutes per 
                                day.
                            ``(ii) Nutrition.--With respect to 
                        nutrition--
                                    ``(I) to increase to at least 60 
                                percent the prevalence of healthy 
                                weight (defined as body mass index 
                                equal to or greater than 19.0 and less 
                                than 25.0) among all people age 20 and 
                                older;
                                    ``(II) to increase to at least 75 
                                percent the proportion of people age 2 
                                and older who meet the dietary 
                                guidelines' minimum average daily goal 
                                of at least 5 servings of vegetables 
                                and fruits; and
                                    ``(III) to increase the use of 
                                traditional Native Hawaiian foods in 
                                all peoples' diets and dietary 
                                preferences.
                            ``(iii) Lifestyle.--With respect to 
                        lifestyle--
                                    ``(I) to reduce cigarette smoking 
                                among pregnant women to a prevalence of 
                                not more than 2 percent;
                                    ``(II) to reduce the prevalence of 
                                respiratory disease, cardiovascular 
                                disease, and cancer resulting from 
                                exposure to tobacco smoke;
                                    ``(III) to increase to at least 70 
                                percent the proportion of all 
                                pregnancies among women between the 
                                ages of 15 and 44 that are planned 
                                (intended); and
                                    ``(IV) to reduce deaths caused by 
                                unintentional injuries to not more than 
                                25.9 per 100,000.
                            ``(iv) Culture.--With respect to culture--
                                    ``(I) to develop and implement 
                                cultural values within the context of 
                                the corporate cultures of the Native 
                                Hawaiian health care systems, the 
                                Native Hawaiian Health Scholarship 
                                Program, and Papa Ola Lokahi; and
                                    ``(II) to facilitate the provision 
                                of Native Hawaiian healing practices by 
                                Native Hawaiian healers for those 
                                clients desiring such assistance.
                    ``(D) Access.--With respect to access--
                            ``(i) to increase the proportion of 
                        patients who have coverage for clinical 
                        preventive services as part of their health 
                        insurance; and
                            ``(ii) to reduce to not more than 7 percent 
                        the proportion of individuals and families who 
                        report that they did not obtain all the health 
                        care that they needed.
                    ``(E) Health professions training and education.--
                With respect to health professions training and 
                education--
                            ``(i) to increase the proportion of all 
                        degrees in the health professions and allied 
                        and associated health professions fields 
                        awarded to members of underrepresented racial 
                        and ethnic minority groups; and
                            ``(ii) to support training activities and 
                        programs in traditional Native Hawaiian healing 
                        practices by Native Hawaiian healers.
    ``(c) Report.--The Secretary shall submit to the President, for 
inclusion in each report required to be transmitted to Congress under 
section 11, a report on the progress made in each toward meeting each 
of the objectives described in subsection (b)(2).

``SEC. 5. COMPREHENSIVE HEALTH CARE MASTER PLAN FOR NATIVE HAWAIIANS.

    ``(a) Development.--
            ``(1) In general.--The Secretary may make a grant to, or 
        enter into a contract with, Papa Ola Lokahi for the purpose of 
        coordinating, implementing and updating a Native Hawaiian 
        comprehensive health care master plan designed to promote 
        comprehensive health promotion and disease prevention services 
        and to maintain and improve the health status of Native 
        Hawaiians, and to support community-based initiatives that are 
        reflective of holistic approaches to health.
            ``(2) Collaboration.--The Papa Ola Lokahi shall collaborate 
        with the Office of Hawaiian Affairs in carrying out this 
        section.
    ``(b) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary to carry out subsection (a).

``SEC. 6. FUNCTIONS OF PAPA OLA LOKAHI.

    ``(a) Responsibility.--Papa Ola Lokahi shall be responsible for 
the--
            ``(1) coordination, implementation, and updating, as 
        appropriate, of the comprehensive health care master plan 
        developed pursuant to section 5;
            ``(2) training for the persons described in subparagraphs 
        (B) and (C) of section 7(c)(1);
            ``(3) identification of and research into the diseases that 
        are most prevalent among Native Hawaiians, including 
        behavioral, biomedical, epidemiological, and health services; 
        and
            ``(4) the development of an action plan outlining the 
        contributions that each member organization of Papa Ola Lokahi 
        will make in carrying out the policy of this Act.
    ``(b) Special Project Funds.--Papa Ola Lokahi may receive special 
project funds that may be appropriated for the purpose of research on 
the health status of Native Hawaiians or for the purpose of addressing 
the health care needs of Native Hawaiians.
    ``(c) Clearinghouse.--
            ``(1) In general.--Papa Ola Lokahi shall serve as a 
        clearinghouse for--
                    ``(A) the collection and maintenance of data 
                associated with the health status of Native Hawaiians;
                    ``(B) the identification and research into diseases 
                affecting Native Hawaiians;
                    ``(C) the availability of Native Hawaiian project 
                funds, research projects and publications;
                    ``(D) the collaboration of research in the area of 
                Native Hawaiian health; and
                    ``(E) the timely dissemination of information 
                pertinent to the Native Hawaiian health care systems.
            ``(2) Consultation.--The Secretary shall consult 
        periodically with Papa Ola Lokahi for the purposes of 
        maintaining the clearinghouse under paragraph (1) and providing 
        information about programs in the Department that specifically 
        address Native Hawaiian issues and concerns.
    ``(d) Fiscal Allocation and Coordination of Programs and 
Services.--
            ``(1) Recommendations.--Papa Ola Lokahi shall provide 
        annual recommendations to the Secretary with respect to the 
        allocation of all amounts appropriated under this Act.
            ``(2) Coordination.--Papa Ola Lokahi shall, to the maximum 
        extent possible, coordinate and assist the health care programs 
        and services provided to Native Hawaiians.
            ``(3) Representation on commission.--The Secretary, in 
        consultation with Papa Ola Lokahi, shall make recommendations 
        for Native Hawaiian representation on the President's Advisory 
        Commission on Asian Americans and Pacific Islanders.
    ``(e) Technical Support.--Papa Ola Lokahi shall act as a statewide 
infrastructure to provide technical support and coordination of 
training and technical assistance to the Native Hawaiian health care 
systems.
    ``(f) Relationships With Other Agencies.--
            ``(1) Authority.--Papa Ola Lokahi may enter into agreements 
        or memoranda of understanding with relevant agencies or 
        organizations that are capable of providing resources or 
        services to the Native Hawaiian health care systems.
            ``(2) Medicare, medicaid, schip.--Papa Ola Lokahi shall 
        develop or make every reasonable effort to--
                    ``(A) develop a contractual or other arrangement, 
                through memoranda of understanding or agreement, with 
                the Health Care Financing Administration or the agency 
                of the State which administers or supervises the 
                administration of a State plan or waiver approved under 
                title XVIII, XIX or title XXI of the Social Security 
                Act for payment of all or a part of the health care 
                services to persons who are eligible for medical 
                assistance under such a State plan or waiver; and
                    ``(B) assist in the collection of appropriate 
                reimbursement for health care services to persons who 
                are entitled to insurance under title XVIII of the 
                Social Security Act.

``SEC. 7. NATIVE HAWAIIAN HEALTH CARE SYSTEMS.

    ``(a) Comprehensive Health Promotion, Disease Prevention, and 
Primary Health Services.--
            ``(1) Grants and contracts.--The Secretary, in consultation 
        with Papa Ola Lokahi, may make grants to, or enter into 
        contracts with, any qualified entity for the purpose of 
        providing comprehensive health promotion and disease prevention 
        services, as well as primary health services, to Native 
        Hawaiians who desire and are committed to bettering their own 
        health.
            ``(2) Preference.--In making grants and entering into 
        contracts under this subsection, the Secretary shall give 
        preference to Native Hawaiian health care systems and Native 
        Hawaiian organizations and, to the extent feasible, health 
        promotion and disease prevention services shall be performed 
        through Native Hawaiian health care systems.
            ``(3) Qualified entity.--An entity is a qualified entity 
        for purposes of paragraph (1) if the entity is a Native 
        Hawaiian health care system.
            ``(4) Limitation on number of entities.--The Secretary may 
        make a grant to, or enter into a contract with, not more than 8 
        Native Hawaiian health care systems under this subsection 
        during any fiscal year.
    ``(b) Planning Grant or Contract.--In addition to grants and 
contracts under subsection (a), the Secretary may make a grant to, or 
enter into a contract with, Papa Ola Lokahi for the purpose of planning 
Native Hawaiian health care systems to serve the health needs of Native 
Hawaiian communities on each of the islands of O`ahu, Moloka`i, Maui, 
Hawai`i, Lana`i, Kaua`i, and Ni`ihau in the State of Hawaii.
    ``(c) Services To Be Provided.--
            ``(1) In general.--Each recipient of funds under subsection 
        (a) shall ensure that the following services either are 
        provided or arranged for:
                    ``(A) Outreach services to inform Native Hawaiians 
                of the availability of health services.
                    ``(B) Education in health promotion and disease 
                prevention of the Native Hawaiian population by, 
                wherever possible, Native Hawaiian health care 
                practitioners, community outreach workers, counselors, 
                and cultural educators.
                    ``(C) Services of physicians, physicians' 
                assistants, nurse practitioners or other health and 
                allied-health professionals.
                    ``(D) Immunizations.
                    ``(E) Prevention and control of diabetes, high 
                blood pressure, and otitis media.
                    ``(F) Pregnancy and infant care.
                    ``(G) Improvement of nutrition.
                    ``(H) Identification, treatment, control, and 
                reduction of the incidence of preventable illnesses and 
                conditions endemic to Native Hawaiians.
                    ``(I) Collection of data related to the prevention 
                of diseases and illnesses among Native Hawaiians.
                    ``(J) Services within the meaning of the terms 
                `health promotion', `disease prevention', and `primary 
                health services', as such terms are defined in section 
                3, which are not specifically referred to in subsection 
                (a).
                    ``(K) Support of culturally appropriate activities 
                enhancing health and wellness including land-based, 
                water-based, ocean-based, and spiritually-based 
                projects and programs.
            ``(2) Traditional healers.--The health care services 
        referred to in paragraph (1) which are provided under grants or 
        contracts under subsection (a) may be provided by traditional 
        Native Hawaiian healers.
    ``(d) Federal Tort Claims Act.--Individuals that provide medical, 
dental, or other services referred to in subsection (a)(1) for Native 
Hawaiian health care systems, including providers of traditional Native 
Hawaiian healing services, shall be treated as if such individuals were 
members of the Public Health Service and shall be covered under the 
provisions of section 224 of the Public Health Service Act.
    ``(e) Site for Other Federal Payments.--A Native Hawaiian health 
care system that receives funds under subsection (a) shall provide a 
designated area and appropriate staff to serve as a Federal loan 
repayment facility. Such facility shall be designed to enable health 
and allied-health professionals to remit payments with respect to loans 
provided to such professionals under any Federal loan program.
    ``(f) Restriction on Use of Grant and Contract Funds.--The 
Secretary may not make a grant to, or enter into a contract with, an 
entity under subsection (a) unless the entity agrees that amounts 
received under such grant or contract will not, directly or through 
contract, be expended--
            ``(1) for any services other than the services described in 
        subsection (c)(1);
            ``(2) to provide inpatient services;
            ``(3) to make cash payments to intended recipients of 
        health services; or
            ``(4) to purchase or improve real property (other than 
        minor remodeling of existing improvements to real property) or 
        to purchase major medical equipment.
    ``(g) Limitation on Charges for Services.--The Secretary may not 
make a grant to, or enter into a contract with, an entity under 
subsection (a) unless the entity agrees that, whether health services 
are provided directly or through contract--
            ``(1) health services under the grant or contract will be 
        provided without regard to ability to pay for the health 
        services; and
            ``(2) the entity will impose a charge for the delivery of 
        health services, and such charge--
                    ``(A) will be made according to a schedule of 
                charges that is made available to the public; and
                    ``(B) will be adjusted to reflect the income of the 
                individual involved.
    ``(h) Authorization of Appropriations.--
            ``(1) General grants.--There is authorized to be 
        appropriated such sums as may be necessary for each of fiscal 
        years 2000 through 2010 to carry out subsection (a).
            ``(2) Planning grants.--There is authorized to be 
        appropriated such sums as may be necessary for each of fiscal 
        years 2000 through 2010 to carry out subsection (b).

``SEC. 8. ADMINISTRATIVE GRANT FOR PAPA OLA LOKAHI.

    ``(a) In General.--In addition to any other grant or contract under 
this Act, the Secretary may make grants to, or enter into contracts 
with, Papa Ola Lokahi for--
            ``(1) coordination, implementation, and updating (as 
        appropriate) of the comprehensive health care master plan 
        developed pursuant to section 5;
            ``(2) training for the persons described in subparagraphs 
        (B) and (C) of section 7(c)(1);
            ``(3) identification of and research into the diseases that 
        are most prevalent among Native Hawaiians, including 
        behavioral, biomedical, epidemiological, and health services;
            ``(4) the development of an action plan outlining the 
        contributions that each member organization of Papa Ola Lokahi 
        will make in carrying out the policy of this Act;
            ``(5) a clearinghouse function for--
                    ``(A) the collection and maintenance of data 
                associated with the health status of Native Hawaiians;
                    ``(B) the identification and research into diseases 
                affecting Native Hawaiians; and
                    ``(C) the availability of Native Hawaiian project 
                funds, research projects and publications;
            ``(6) the coordination of the health care programs and 
        services provided to Native Hawaiians; and
            ``(7) the administration of special project funds.
    ``(b) Authorization of Appropriations.--There is authorized to be 
appropriated such sums as may be necessary for each of fiscal years 
2000 through 2010 to carry out subsection (a).

``SEC. 9. ADMINISTRATION OF GRANTS AND CONTRACTS.

    ``(a) Terms and Conditions.--The Secretary shall include in any 
grant made or contract entered into under this Act such terms and 
conditions as the Secretary considers necessary or appropriate to 
ensure that the objectives of such grant or contract are achieved.
    ``(b) Periodic Review.--The Secretary shall periodically evaluate 
the performance of, and compliance with, grants and contracts under 
this Act.
    ``(c) Administrative Requirements.--The Secretary may not make a 
grant or enter into a contract under this Act with an entity unless the 
entity--
            ``(1) agrees to establish such procedures for fiscal 
        control and fund accounting as may be necessary to ensure 
        proper disbursement and accounting with respect to the grant or 
        contract;
            ``(2) agrees to ensure the confidentiality of records 
        maintained on individuals receiving health services under the 
        grant or contract;
            ``(3) with respect to providing health services to any 
        population of Native Hawaiians, a substantial portion of which 
        has a limited ability to speak the English language--
                    ``(A) has developed and has the ability to carry 
                out a reasonable plan to provide health services under 
                the grant or contract through individuals who are able 
                to communicate with the population involved in the 
                language and cultural context that is most appropriate; 
                and
                    ``(B) has designated at least 1 individual, fluent 
                in both English and the appropriate language, to assist 
                in carrying out the plan;
            ``(4) with respect to health services that are covered in 
        the plan of the State of Hawaii approved under title XIX of the 
        Social Security Act--
                    ``(A) if the entity will provide under the grant or 
                contract any such health services directly--
                            ``(i) the entity has entered into a 
                        participation agreement under such plans; and
                            ``(ii) the entity is qualified to receive 
                        payments under such plan; and
                    ``(B) if the entity will provide under the grant or 
                contract any such health services through a contract 
                with an organization--
                            ``(i) the organization has entered into a 
                        participation agreement under such plan; and
                            ``(ii) the organization is qualified to 
                        receive payments under such plan; and
            ``(5) agrees to submit to the Secretary and to Papa Ola 
        Lokahi an annual report that describes the use and costs of 
        health services provided under the grant or contract (including 
        the average cost of health services per user) and that provides 
        such other information as the Secretary determines to be 
        appropriate.
    ``(d) Contract Evaluation.--
            ``(1) Determination of noncompliance.--If, as a result of 
        evaluations conducted by the Secretary, the Secretary 
        determines that an entity has not complied with or 
        satisfactorily performed a contract entered into under section 
        7, the Secretary shall, prior to renewing such contract, 
        attempt to resolve the areas of noncompliance or unsatisfactory 
        performance and modify such contract to prevent future 
        occurrences of such noncompliance or unsatisfactory 
        performance.
            ``(2) Nonrenewal.--If the Secretary determines that the 
        noncompliance or unsatisfactory performance described in 
        paragraph (1) with respect to an entity cannot be resolved and 
        prevented in the future, the Secretary shall not renew the 
        contract with such entity and may enter into a contract under 
        section 7 with another entity referred to in subsection (a)(3) 
        of such section that provides services to the same population 
        of Native Hawaiians which is served by the entity whose 
        contract is not renewed by reason of this paragraph.
            ``(3) Consideration of results.--In determining whether to 
        renew a contract entered into with an entity under this Act, 
        the Secretary shall consider the results of the evaluations 
        conducted under this section.
            ``(4) Application of federal laws.--All contracts entered 
        into by the Secretary under this Act shall be in accordance 
        with all Federal contracting laws and regulations, except that, 
        in the discretion of the Secretary, such contracts may be 
        negotiated without advertising and may be exempted from the 
        provisions of the Act of August 24, 1935 (40 U.S.C. 270a et 
        seq.).
            ``(5) Payments.--Payments made under any contract entered 
        into under this Act may be made in advance, by means of 
        reimbursement, or in installments and shall be made on such 
        conditions as the Secretary deems necessary to carry out the 
        purposes of this Act.
    ``(e) Limitation on Use of Funds for Administrative Expenses.--
Except with respect to grants and contracts under section 8, the 
Secretary may not make a grant to, or enter into a contract with, an 
entity under this Act unless the entity agrees that the entity will not 
expend more than 15 percent of the amounts received pursuant to this 
Act for the purpose of administering the grant or contract.
    ``(f) Report.--
            ``(1) In general.--For each fiscal year during which an 
        entity receives or expends funds pursuant to a grant or 
        contract under this Act, such entity shall submit to the 
        Secretary and to Papa Ola Lokahi an annual report--
                    ``(A) on the activities conducted by the entity 
                under the grant or contract;
                    ``(B) on the amounts and purposes for which Federal 
                funds were expended; and
                    ``(C) containing such other information as the 
                Secretary may request.
            ``(2) Audits.--The reports and records of any entity 
        concerning any grant or contract under this Act shall be 
        subject to audit by the Secretary, the Inspector General of the 
        Department of Health and Human Services, and the Comptroller 
        General of the United States.
    ``(g) Annual Private Audit.--The Secretary shall allow as a cost of 
any grant made or contract entered into under this Act the cost of an 
annual private audit conducted by a certified public accountant.

``SEC. 10. ASSIGNMENT OF PERSONNEL.

    ``(a) In General.--The Secretary may enter into an agreement with 
any entity under which the Secretary may assign personnel of the 
Department of Health and Human Services with expertise identified by 
such entity to such entity on detail for the purposes of providing 
comprehensive health promotion and disease prevention services to 
Native Hawaiians.
    ``(b) Applicable Federal Personnel Provisions.--Any assignment of 
personnel made by the Secretary under any agreement entered into under 
subsection (a) shall be treated as an assignment of Federal personnel 
to a local government that is made in accordance with subchapter VI of 
chapter 33 of title 5, United States Code.

``SEC. 11. NATIVE HAWAIIAN HEALTH SCHOLARSHIPS AND FELLOWSHIPS.

    ``(a) Eligibility.--Subject to the availability of amounts 
appropriated under subsection (c), the Secretary shall provide funds 
through a direct grant or a cooperative agreement to Kamehameha Schools 
Bishop Estate or another Native Hawaiian organization or health care 
organization with experience in the administration of educational 
scholarships or placement services for the purpose of providing 
scholarship assistance to students who--
            ``(1) meet the requirements of section 338A of the Public 
        Health Service Act, except for assistance as provided for under 
        subsection (b)(2); and
            ``(2) are Native Hawaiians.
    ``(b) Terms and Conditions.--
            ``(1) In general.--The scholarship assistance under 
        subsection (a) shall be provided under the same terms and 
        subject to the same conditions, regulations, and rules as apply 
        to scholarship assistance provided under section 338A of the 
        Public Health Service Act (except as provided for in paragraph 
        (2)), except that--
                    ``(A) the provision of scholarships in each type of 
                health care profession training shall correspond to the 
                need for each type of health care professional to serve 
                the Native Hawaiian health care systems identified by 
                Papa Ola Lokahi;
                    ``(B) to the maximum extent practicable, the 
                Secretary shall select scholarship recipients from a 
                list of eligible applicants submitted by the Kamehameha 
                Schools Bishop Estate or the Native Hawaiian 
                organization administering the program;
                    ``(C) the obligated service requirement for each 
                scholarship recipient (except for those receiving 
                assistance under paragraph (2)) shall be fulfilled 
                through service, in order of priority, in--
                            ``(i) any one of the Native Hawaiian health 
                        care systems; or
                            ``(ii) health professions shortage areas, 
                        medically underserved areas, or geographic 
                        areas or facilities similarly designated by the 
                        United States Public Health Service in the 
                        State of Hawaii;
                    ``(D) the provision of counseling, retention and 
                other support services shall not be limited to 
                scholarship recipients, but shall also include 
                recipients of other scholarship and financial aid 
                programs enrolled in appropriate health professions 
                training programs.
                    ``(E) financial assistance may be provided to 
                scholarship recipients in those health professions 
                designated in such section 338A while they are 
                fulfilling their service requirement in any one of the 
                Native Hawaiian health care systems or community health 
                centers.
            ``(2) Fellowships.--Financial assistance through 
        fellowships may be provided to Native Hawaiian applicants 
        accepted and participating in a certificated program provided 
        by a traditional Native Hawaiian healer in traditional Native 
        Hawaiian healing practices including lomi-lomi, la`au lapa`au, 
        and ho`oponopono. Such assistance may include a stipend or 
        reimbursement for costs associated with participation in the 
        program.
            ``(3) Rights and benefits.--Scholarship recipients in 
        health professions designated in section 338A of the Public 
        Health Service Act while fulfilling their service requirements 
        shall have all the same rights and benefits of members of the 
        National Health Service Corps during their period of service.
            ``(4) No inclusion of assistance in gross income.--
        Financial assistance provided to scholarship recipients for 
        tuition, books and other school-related expenditures under this 
        section shall not be included in gross income for purposes of 
        the Internal Revenue Code of 1986.
    ``(c) Authorization of Appropriations.--There is authorized to be 
appropriated such sums as may be necessary for each of fiscal years 
2000 through 2010 for the purpose of funding the scholarship assistance 
program under subsection (a).

``SEC. 12. REPORT.

    ``The President shall, at the time the budget is submitted under 
section 1105 of title 31, United States Code, for each fiscal year 
transmit to Congress a report on the progress made in meeting the 
objectives of this Act, including a review of programs established or 
assisted pursuant to this Act and an assessment and recommendations of 
additional programs or additional assistance necessary to, at a 
minimum, provide health services to Native Hawaiians, and ensure a 
health status for Native Hawaiians, which are at a parity with the 
health services available to, and the health status of, the general 
population.

``SEC. 13. DEMONSTRATION PROJECTS OF NATIONAL SIGNIFICANCE.

    ``(a) Authority and Areas of Interest.--The Secretary, in 
consultation with Papa Ola Lokahi, may allocate amounts appropriated 
under this Act, or any other Act, to carry out Native Hawaiian 
demonstration projects of national significance. The areas of interest 
of such projects may include--
            ``(1) the education of health professionals, and other 
        individuals in institutions of higher learning, in health and 
allied health programs in complementary healing practices, including 
Native Hawaiian healing practices;
            ``(2) the integration of Western medicine with 
        complementary healing practices including traditional Native 
        Hawaiian healing practices;
            ``(3) the use of tele-wellness and telecommunications in 
        chronic disease management and health promotion and disease 
        prevention;
            ``(4) the development of appropriate models of health care 
        for Native Hawaiians and other indigenous people including the 
        provision of culturally competent health services, related 
        activities focusing on wellness concepts, the development of 
        appropriate kupuna care programs, and the development of 
        financial mechanisms and collaborative relationships leading to 
        universal access to health care;
            ``(5) the development of a centralized database and 
        information system relating to the health care status, health 
        care needs, and wellness of Native Hawaiians; and
            ``(6) the establishment of a Native Hawaiian Center of 
        Excellence for Nursing at the University of Hawaii at Hilo, a 
        Native Hawaiian Center of Excellence for Mental Health at the 
        University of Hawaii at Manoa, a Native Hawaiian Center of 
        Excellence for Maternal Health and Nutrition at the Waimanalo 
        Health Center, and a Native Hawaiian Center of Excellence for 
        Research, Training, and Integrated Medicine at Molokai General 
        Hospital.
    ``(b) Nonreduction in Other Funding.--The allocation of funds for 
demonstration projects under subsection (a) shall not result in a 
reduction in funds required by the Native Hawaiian health care systems, 
the Native Hawaiian Health Scholarship Program, or Papa Ola Lokahi to 
carry out their respective responsibilities under this Act.

``SEC. 14. NATIONAL BIPARTISAN COMMISSION ON NATIVE HAWAIIAN HEALTH 
              CARE ENTITLEMENT.

    ``(a) Establishment.--There is hereby established a National 
Bipartisan Native Hawaiian Health Care Entitlement Commission (referred 
to in this Act as the `Commission').
    ``(b) Membership.--The Commission shall be composed of 21 members 
to be appointed as follows:
            ``(1) Congressional members.--
                    ``(A) Appointment.--Eight members of the Commission 
                shall be members of Congress, of which--
                            ``(i) two members shall be from the House 
                        of Representatives and shall be appointed by 
                        the Majority Leader;
                            ``(ii) two members shall be from the House 
                        of Representatives and shall be appointed by 
                        the Minority Leader;
                            ``(iii) two members shall be from the 
                        Senate and shall be appointed by the Majority 
                        Leader; and
                            ``(iv) two members shall be from the Senate 
                        and shall be appointed by the Minority Leader.
                    ``(B) Relevant committee membership.--The members 
                of the Commission appointed under subparagraph (A) 
                shall each be members of the committees of Congress 
                that consider legislation affecting the provision of 
                health care to Native Hawaiians and other Native 
                American.
                    ``(C) Chairperson.--The members of the Commission 
                appointed under subparagraph (A) shall elect the 
                chairperson and vice-chairperson of the Commission.
            ``(2) Hawaiian health members.--Eleven members of the 
        Commission shall be appointed by Hawaiian health entities, of 
        which--
                    ``(A) five members shall be appointed by the Native 
                Hawaiian Health Care Systems;
                    ``(B) one member shall be appointed by the Hawaii 
                State Primary Care Association;
                    ``(C) one member shall be appointed by Papa Ola 
                Lokahi;
                    ``(D) one member shall be appointed by the State 
                Council of Hawaiian Homestead Associations;
                    ``(E) one member shall be appointed by the Office 
                of Hawaiian Affairs; and
                    ``(F) two members shall be appointed by the 
                Association of Hawaiian Civic Clubs and shall represent 
                Native Hawaiian populations on the United States 
                continent.
            ``(3) Secretarial members.--Two members of the Commission 
        shall be appointed by the Secretary and shall possess knowledge 
        of the health concerns and wellness issues facing Native 
        Hawaiians.
    ``(c) Terms.--
            ``(1) In general.--The members of the Commission shall 
        serve for the life of the Commission.
            ``(2) Initial appointment of members.--The members of the 
        Commission shall be appointed under subsection (b)(1) not later 
        than 90 days after the date of enactment of this Act, and the 
        remaining members of the Commission shall be appointed not 
        later than 60 days after the date on which the members are 
        appointed under such subsection (b)(1).
            ``(3) Vacancies.--A vacancy in the membership of the 
        Commission shall be filled in the manner in which the original 
        appointment was made.
    ``(d) Duties of the Commission.--The Commission shall carry out the 
following duties and functions:
            ``(1) Review and analyze the recommendations of the report 
        of the study committee established under paragraph (3).
            ``(2) Make recommendations to Congress for the provision of 
        health services to Native Hawaiian individuals as an 
        entitlement, giving due regard to the effects of a program on 
        existing health care delivery systems for Native Hawaiians and 
        the effect of such programs on self-determination and their 
        reconciliation.
            ``(3) Establish a study committee to be composed of at 
        least 10 members from the Commission, including 4 members of 
        the members appointed under subsection (b)(1), 5 of the members 
        appointed under subsection (b)(2), and 1 of the members 
        appointed by the Secretary under subsection (b)(3), which 
        shall--
                    ``(A) to the extent necessary to carry out its 
                duties, collect and compile data necessary to 
                understand the extent of Native Hawaiian needs with 
                regards to the provision of health services, including 
                holding hearings and soliciting the views of Native 
                Hawaiians and Native Hawaiian organizations, and which 
                may include authorizing and funding feasibility studies 
                of various models for all Native Hawaiian beneficiaries 
                and their families, including those that live on the 
                United States continent;
                    ``(B) make recommendations to the Commission for 
                legislation that will provide for the culturally-
                competent and appropriate provision of health services 
                for Native Hawaiians as an entitlement, which shall, at 
                a minimum, address issues of eligibility and benefits 
                to be provided, including recommendations regarding 
                from whom such health services are to be provided and 
                the cost and mechanisms for funding of the health 
                services to be provided;
                    ``(C) determine the effect of the enactment of such 
                recommendations on the existing system of delivery of 
                health services for Native Hawaiians;
                    ``(D) determine the effect of a health service 
                entitlement program for Native Hawaiian individuals on 
                their self-determination and the reconciliation of 
                their relationship with the United States;
                    ``(E) not later than 12 months after the date of 
                the appointment of all members of the Commission, make 
                a written report of its findings and recommendations to 
                the Commission, which report shall include a statement 
                of the minority and majority position of the committee 
                and which shall be disseminated, at a minimum, to 
                Native Hawaiian organizations and agencies and health 
                organizations referred to in subsection (b)(2) for 
                comment to the Commission; and
                    ``(F) report regularly to the full Commission 
                regarding the findings and recommendations developed by 
                the committee in the course of carrying out its duties 
                under this section.
            ``(4) Not later than 18 months after the date of the 
        appointment of all members of the Commission, submit a written 
        report to Congress containing a recommendation of policies and 
        legislation to implement a policy that would establish a health 
        care system for Native Hawaiians, grounded in their culture, 
        and based on the delivery of health services as an entitlement, 
        together with a determination of the implications of such an 
        entitlement system on existing health care delivery systems for 
        Native Hawaiians and their self-determination and the 
        reconciliation of their relationship with the United States.
    ``(e) Administrative Provisions.--
            ``(1) Compensation and expenses.--
                    ``(A) Congressional members.--Each member of the 
                Commission appointed under subsection (b)(1) shall not 
                receive any additional compensation, allowances, or 
                benefits by reason of their service on the Commission. 
                Such members shall receive travel expenses and per diem 
                in lieu of subsistence in accordance with sections 5702 
                and 5703 of title 5, United States Code.
                    ``(B) Other members.--The members of the Commission 
                appointed under paragraphs (2) and (3) of subsection 
                (b) shall, while serving on the business of the 
                Commission (including travel time), receive 
                compensation at the per diem equivalent of the rate 
                provided for individuals under level IV of the 
                Executive Schedule under section 5315 of title 5, 
                United States Code, and while serving away from their 
                home or regular place of business, be allowed travel 
                expenses, as authorized by the chairperson of the 
                Commission.
                    ``(C) Other personnel.--For purposes of 
                compensation (other than compensation of the members of 
                the Commission) and employment benefits, rights, and 
                privileges, all personnel of the Commission shall be 
                treated as if they were employees of the Senate.
            ``(2) Meetings and quorum.--
                    ``(A) Meetings.--The Commission shall meet at the 
                call of the chairperson.
                    ``(B) Quorum.--A quorum of the Commission shall 
                consist of not less than 12 members, of which--
                            ``(i) not less than 4 of such members shall 
                        be appointees under subsection (b)(1)l;
                            ``(ii) not less than 7 of such members 
                        shall be appointees under subsection (b)(2); 
                        and
                            ``(iii) not less than 1 of such members 
                        shall be an appointee under subsection (b)(3).
            ``(3) Director and staff.--
                    ``(A) Executive director.--The members of the 
                Commission shall appoint an executive director of the 
                Commission. The executive director shall be paid the 
                rate of basic pay equal to that under level V of the 
                Executive Schedule under section 5316 of title 5, 
                United States Code.
                    ``(B) Staff.--With the approval of the Commission, 
                the executive director may appoint such personnel as 
                the executive director deems appropriate.
                    ``(C) Applicability of civil service laws.--The 
                staff of the Commission shall be appointed without 
                regard to the provisions of title 5, United States 
                Code, governing appointments in the competitive 
                service, and shall be paid without regard to the 
                provisions of chapter 51 and subchapter III of chapter 
                53 of such title (relating to classification and 
                General Schedule pay rates).
                    ``(D) Experts and consultants.--With the approval 
                of the Commission, the executive director may procure 
                temporary and intermittent services under section 
                3109(b) of title 5, United States Code.
                    ``(E) Facilities.--The Administrator of the General 
                Services Administration shall locate suitable office 
                space for the operations of the Commission in the State 
                of Hawaii. The facilities shall serve as the 
                headquarters of the Commission and shall include all 
                necessary equipment and incidentals required for the 
                proper functioning of the Commission.
    ``(f) Powers.--
            ``(1) Hearings and other activities.--For purposes of 
        carrying out its duties, the Commission may hold such hearings 
        and undertake such other activities as the Commission 
        determines to be necessary to carry out its duties, except that 
        at least 8 hearings shall be held on each of the Hawaiian 
        Islands and 3 hearings in the continental United States in 
        areas where large numbers of Native Hawaiians are present. Such 
        hearings shall be held to solicit the views of Native Hawaiians 
        regarding the delivery of health care services to such 
        individuals. To constitute a hearing under this paragraph, at 
        least 4 members of the Commission, including at least 1 member 
        of Congress, must be present. Hearings held by the study 
        committee established under subsection (d)(3) may be counted 
        towards the number of hearings required under this paragraph.
            ``(2) Studies by the general accounting office.--Upon the 
        request of the Commission, the Comptroller General shall 
        conduct such studies or investigations as the Commission 
        determines to be necessary to carry out its duties.
            ``(3) Cost estimates.--
                    ``(A) In general.--The Director of the 
                Congressional Budget Office or the Chief Actuary of the 
                Health Care Financing Administration, or both, shall 
                provide to the Commission, upon the request of the 
                Commission, such cost estimates as the Commission 
                determines to be necessary to carry out its duties.
                    ``(B) Reimbursements.--The Commission shall 
                reimburse the Director of the Congressional Budget 
                Office for expenses relating to the employment in the 
                office of the Director of such additional staff as may 
                be necessary for the Director to comply with requests 
                by the Commission under subparagraph (A).
            ``(4) Detail of federal employees.--Upon the request of the 
        Commission, the head of any Federal agency is authorized to 
        detail, without reimbursement, any of the personnel of such 
        agency to the Commission to assist the Commission in carrying 
        out its duties. Any such detail shall not interrupt or 
        otherwise affect the civil service status or privileges of the 
        Federal employees.
            ``(5) Technical assistance.--Upon the request of the 
        Commission, the head of any Federal agency shall provide such 
        technical assistance to the Commission as the Commission 
        determines to be necessary to carry out its duties.
            ``(6) Use of mails.--The Commission may use the United 
        States mails in the same manner and under the same conditions 
        as Federal agencies and shall, for purposes of the frank, be 
        considered a commission of Congress as described in section 
        3215 of title 39, United States Code.
            ``(7) Obtaining information.--The Commission may secure 
        directly from any Federal agency information necessary to 
        enable the Commission to carry out its duties, if the 
        information may be disclosed under section 552 of title 5, 
        United States Code. Upon request of the chairperson of the 
        Commission, the head of such agency shall furnish such 
        information to the Commission.
            ``(8) Support services.--Upon the request of the 
        Commission, the Administrator of General Services shall provide 
        to the Commission on a reimbursable basis such administrative 
        support services as the Commission may request.
            ``(9) Printing.--For purposes of costs relating to printing 
        and binding, including the cost of personnel detailed from the 
        Government Printing Office, the Commission shall be deemed to 
        be a committee of Congress.
    ``(g) Authorization of Appropriations.--There is authorized to be 
appropriated $1,500,000 to carry out this section. The amount 
appropriated under this subsection shall not result in a reduction in 
any other appropriation for health care or health services for Native 
Hawaiians.

``SEC. 15. RULE OF CONSTRUCTION.

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

``SEC. 16. COMPLIANCE WITH BUDGET ACT.

    ``Any new spending authority (described in subparagraph (A) of (B) 
of section 401(c)(2) of the Congressional Budget Act of 1974 (2 U.S.C. 
651(c)(2) (A) or (B))) which is provided under this Act shall be 
effective for any fiscal year only to such extent or in such amounts as 
are provided for in appropriation Acts.

``SEC. 17. SEVERABILITY.

    ``If any provision of this Act, or the application of any such 
provision to any person or circumstances is held to be invalid, the 
remainder of this Act, and the application of such provision or 
amendment to persons or circumstances other than those to which it is 
held invalid, shall not be affected thereby.''.
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