II

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.

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

3 SECTION 1. SHORT TITLE.

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

5 Health Care Improvement Act Reauthorization of 1999’’.

6 SEC. 2. AMENDMENT TO THE NATIVE HAWAIIAN HEALTH

7 CARE IMPROVEMENT ACT.

8 The Native Hawaiian Health Care Improvement Act

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

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

3 ‘Native Hawaiian Health Care Improvement Act’.

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

5 of this Act is as follows:

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

‘‘Sec. 2. Findings.

‘‘Sec. 3. Definitions.

‘‘Sec. 4. Declaration of 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.

6 ‘‘SEC. 2. FINDINGS.

7 ‘‘(a) GENERAL FINDINGS.—Congress makes the fol8 lowing findings:

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

10 the Kumulipo which details the creation and inter11 relationship of all things, including their evolvement

12 as healthy and well people.

13 ‘‘(2) Native Hawaiians are a distinct and

14 unique indigenous people with a historical continuity

15 to the original inhabitants of the Hawaiian archi16 pelago and have a distinct society organized almost

17 2,000 years ago.
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1 ‘‘(3) Native Hawaiians have never directly relin2 quished to the United States their claims to their in3 herent sovereignty as a people or over their national

4 lands, either through their monarchy or through a

5 plebiscite or referendum.

6 ‘‘(4) The health and well-being of Native Ha7 waiians are intrinsically tied to their deep feelings

8 and attachment to their lands and seas.

9 ‘‘(5) The long-range economic and social

10 changes in Hawaii over the 19th and early 20th cen11 turies have been devastating to the health and well12 being of Native Hawaiians.

13 ‘‘(6) The Native Hawaiian people are deter14 mined to preserve, develop and transmit to future

15 generations their ancestral territory, and their cul16 tural identity in accordance with their own spiritual

17 and traditional beliefs, customs, practices, language,

18 and social institutions. In referring to themselves,

19 Native Hawaiians use the term ‘‘Kanaka Maoli’’, a

20 term frequently used in the 19th century to describe

21 the native people of Hawaii.

22 ‘‘(7) The constitution and statutes of the State

23 of Hawaii—
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1 ‘‘(A) acknowledge the distinct land rights

2 of Native Hawaiian people as beneficiaries of

3 the public lands trust; and

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

5 of the Native Hawaiian people to practice and

6 perpetuate their cultural and religious customs,

7 beliefs, practices, and language.

8 ‘‘(8) At the time of the arrival of the first non9 indigenous people in Hawaii in 1778, the Native Ha10 waiian people lived in a highly organized, self-suffi11 cient, subsistence social system based on communal

12 land tenure with a sophisticated language, culture,

13 and religion.

14 ‘‘(9) A unified monarchical government of the

15 Hawaiian Islands was established in 1810 under Ka16 mehameha I, the first King of Hawaii.

17 ‘‘(10) Throughout the 19th century and until

18 1893, the United States—

19 ‘‘(A) recognized the independence of the

20 Hawaiian Nation;

21 ‘‘(B) extended full and complete diplomatic

22 recognition to the Hawaiian Government; and

23 ‘‘(C) entered into treaties and conventions

24 with the Hawaiian monarchs to govern com-
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1 merce and navigation in 1826, 1842, 1849,

2 1875 and 1887.

3 ‘‘(11) In 1893, John L. Stevens, the United

4 States Minister assigned to the sovereign and inde5 pendent Kingdom of Hawaii, conspired with a small

6 group of non-Hawaiian residents of the Kingdom,

7 including citizens of the United States, to overthrow

8 the indigenous and lawful government of Hawaii.

9 ‘‘(12) In pursuance of that conspiracy, the

10 United States Minister and the naval representative

11 of the United States caused armed naval forces of

12 the United States to invade the sovereign Hawaiian

13 Nation in support of the overthrow of the indigenous

14 and lawful Government of Hawaii and the United

15 States Minister thereupon extended diplomatic rec16 ognition of a provisional government formed by the

17 conspirators without the consent of the native people

18 of Hawaii or the lawful Government of Hawaii in

19 violation of treaties between the 2 nations and of

20 international law.

21 ‘‘(13) In a message to Congress on December

22 18, 1893, then President Grover Cleveland reported

23 fully and accurately on these illegal actions, and ac24 knowledged that by these acts, described by the

25 President as acts of war, the government of a peace-
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1 ful and friendly people was overthrown, and the

2 President concluded that a ‘‘substantial wrong has

3 thus been done which a due regard for our national

4 character as well as the rights of the injured people

5 required that we should endeavor to repair’’.

6 ‘‘(14) Queen Lili‘uokalani, the lawful monarch

7 of Hawaii, and the Hawaiian Patriotic League, rep8 resenting the aboriginal citizens of Hawaii, promptly

9 petitioned the United States for redress of these

10 wrongs and for restoration of the indigenous govern11 ment of the Hawaiian nation, but this petition was

12 not acted upon.

13 ‘‘(15) Further, the United States has acknowl14 edged the significance of these events and has apolo15 gized to Native Hawaiians on behalf of the people of

16 the United States for the overthrow of the Kingdom

17 of Hawaii with the participation of agents and citi18 zens of the United States, and the resulting depriva19 tion of the rights of Native Hawaiians to self-deter20 mination in legislation in 1993 (Public Law 103–

21 150; 107 Stat. 1510).

22 ‘‘(16) In 1898, the United States annexed Ha23 waii through the Newlands Resolution without the

24 consent of or compensation to the indigenous people

25 of Hawaii or their sovereign government who were
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1 thereby denied the mechanism for expression of their

2 inherent sovereignty through self-government and

3 self-determination, their lands and ocean resources.

4 ‘‘(17) Through the Newlands Resolution and

5 the 1900 Organic Act, the Congress received

6 1,750,000 acres of lands formerly owned by the

7 Crown and Government of the Hawaiian Kingdom

8 and exempted the lands from then existing public

9 land laws of the United States by mandating that

10 the revenue and proceeds from these lands be ‘‘used

11 solely for the benefit of the inhabitants of the Ha12 waiian Islands for education and other public pur13 poses’’, thereby establishing a special trust relation14 ship between the United States and the inhabitants

15 of Hawaii.

16 ‘‘(18) In 1921, Congress enacted the Hawaiian

17 Homes Commission Act, 1920, which designated

18 200,000 acres of the ceded public lands for exclusive

19 homesteading by Native Hawaiians, thereby affirm20 ing the trust relationship between the United States

21 and the Native Hawaiians, as expressed by then Sec22 retary of the Interior Franklin K. Lane who was

23 cited in the Committee Report of the Committee on

24 Territories of the House of Representatives as stat25 ing, ‘‘One thing that impressed me . . . was the fact
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1 that the natives of the islands . . . for whom in a

2 sense we are trustees, are falling off rapidly in num3 bers and many of them are in poverty.’’.

4 ‘‘(19) In 1938, Congress again acknowledged

5 the unique status of the Native Hawaiian people by

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

7 et seq.), a provision to lease lands within the exten8 sion to Native Hawaiians and to permit fishing in

9 the area ‘‘only by native Hawaiian residents of said

10 area or of adjacent villages and by visitors under

11 their guidance’’.

12 ‘‘(20) Under the Act entitled ‘‘An Act to pro13 vide for the admission of the State of Hawaii into

14 the Union’’, approved March 18, 1959 (73 Stat. 4),

15 the United States transferred responsibility for the

16 administration of the Hawaiian Home Lands to the

17 State of Hawaii but reaffirmed the trust relationship

18 which existed between the United States and the

19 Native Hawaiian people by retaining the exclusive

20 power to enforce the trust, including the power to

21 approve land exchanges, and legislative amendments

22 affecting the rights of beneficiaries under such Act.

23 ‘‘(21) Under the Act entitled ‘‘An Act to pro24 vide for the admission of the State of Hawaii into

25 the Union’’, approved March 18, 1959 (73 Stat. 4),
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1 the United States transferred responsibility for ad2 ministration over portions of the ceded public lands

3 trust not retained by the United States to the State

4 of Hawaii but reaffirmed the trust relationship

5 which existed between the United States and the

6 Native Hawaiian people by retaining the legal re7 sponsibility of the State for the betterment of the

8 conditions of Native Hawaiians under section 5(f) of

9 such Act.

10 ‘‘(22) The authority of the Congress under the

11 Constitution to legislate in matters affecting the ab12 original or indigenous peoples of the United States

13 includes the authority to legislate in matters affect14 ing the native peoples of Alaska and Hawaii.

15 ‘‘(23) Further, the United States has recog16 nized the authority of the Native Hawaiian people to

17 continue to work towards an appropriate form of

18 sovereignty as defined by the Native Hawaiian peo19 ple themselves in provisions set forth in legislation

20 returning the Hawaiian Island of Kaho‘olawe to cus21 todial management by the State of Hawaii in 1994.

22 ‘‘(24) In furtherance of the trust responsibility

23 for the betterment of the conditions of Native Ha24 waiians, the United States has established a pro25 gram for the provision of comprehensive health pro-
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1 motion and disease prevention services to maintain

2 and improve the health status of the Hawaiian peo3 ple. This program is conducted by the Native Ha4 waiian Health Care Systems, the Native Hawaiian

5 Health Scholarship Program and Papa Ola Lokahi.

6 Health initiatives from these and other health insti7 tutions and agencies using Federal assistance have

8 begun to lower the century-old morbidity and mor9 tality rates of Native Hawaiian people by providing

10 comprehensive disease prevention, health promotion

11 activities and increasing the number of Native Ha12 waiians in the health and allied health professions.

13 This has been accomplished through the Native Ha14 waiian Health Care Act of 1988 (Public Law 100–

15 579) and its reauthorization in section 9168 of Pub16 lic Law 102–396 (106 Stat. 1948).

17 ‘‘(25) This historical and unique legal relation18 ship has been consistently recognized and affirmed

19 by Congress through the enactment of Federal laws

20 which extend to the Native Hawaiian people the

21 same rights and privileges accorded to American In22 dian, Alaska Native, Eskimo, and Aleut commu23 nities, including the Native American Programs Act

24 of 1974 (42 U.S.C. 2991 et seq.), the American In25 dian Religious Freedom Act (42 U.S.C. 1996), the
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1 National Museum of the American Indian Act (20

2 U.S.C. 80q et seq.), and the Native American

3 Graves Protection and Repatriation Act (25 U.S.C.

4 3001 et seq.).

5 ‘‘(26) The United States has also recognized

6 and reaffirmed the trust relationship to the Native

7 Hawaiian people through legislation which author8 izes the provision of services to Native Hawaiians,

9 specifically, the Older Americans Act of 1965 (42

10 U.S.C. 3001 et seq.), the Developmental Disabilities

11 Assistance and Bill of Rights Act Amendments of

12 1987, the Veterans’ Benefits and Services Act of

13 1988, the Rehabilitation Act of 1973 (29 U.S.C. 701

14 et seq.), the Native Hawaiian Health Care Act of

15 1988 (Public Law 100–579), the Health Professions

16 Reauthorization Act of 1988, the Nursing Shortage

17 Reduction and Education Extension Act of 1988,

18 the Handicapped Programs Technical Amendments

19 Act of 1988, the Indian Health Care Amendments

20 of 1988, and the Disadvantaged Minority Health

21 Improvement Act of 1990.

22 ‘‘(27) The United States has also affirmed the

23 historical and unique legal relationship to the Ha24 waiian people by authorizing the provision of serv25 ices to Native Hawaiians to address problems of al-
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1 cohol and drug abuse under the Anti-Drug Abuse

2 Act of 1986 (Public Law 99–570).

3 ‘‘(28) Further, the United States has recog4 nized that Native Hawaiians, as aboriginal, indige5 nous, native peoples of Hawaii, are a unique popu6 lation group in Hawaii and in the continental United

7 States and has so declared in Office of Management

8 and Budget Circular 15 in 1997 and Presidential

9 Executive Order No. 13125, dated June 7, 1999.

10 ‘‘(29) Despite the United States having ex11 pressed its commitment to a policy of reconciliation

12 with the Native Hawaiian people for past grievances

13 in Public Law 103–150 (107 Stat. 1510) the unmet

14 health needs of the Native Hawaiian people remain

15 severe and their health status continues to be far

16 below that of the general population of the United

17 States.

18 ‘‘(b) UNMET NEEDS AND HEALTH DISPARITIES.—

19 Congress finds that the unmet needs and serious health

20 disparities that adversely affect the Native Hawaiian peo21 ple include the following:

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

23 ‘‘(A) CANCER.—

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

25 cancer—
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1 ‘‘(I) Native Hawaiians have the

2 highest cancer mortality rates in the

3 State of Hawaii (231.0 out of every

4 100,000 residents), 45 percent higher

5 than that for the total State popu6 lation (159.7 out of every 100,000

7 residents);

8 ‘‘(II) Native Hawaiian males

9 have the highest cancer mortality

10 rates in the State of Hawaii for can11 cers of the lung, liver and pancreas

12 and for all cancers combined;

13 ‘‘(III) Native Hawaiian females

14 ranked highest in the State of Hawaii

15 for cancers of the lung, liver, pan16 creas, breast, cervix uteri, corpus

17 uteri, stomach, and rectum, and for

18 all cancers combined;

19 ‘‘(IV) Native Hawaiian males

20 have the highest years of productive

21 life lost from cancer in the State of

22 Hawaii with 8.7 years compared to

23 6.4 years for other males; and

24 ‘‘(V) Native Hawaiian females

25 have 8.2 years of productive life lost
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1 from cancer in the State of Hawaii as

2 compared to 6.4 years for other fe3 males in the State of Hawaii;

4 ‘‘(ii) BREAST CANCER.—With respect

5 to breast cancer—

6 ‘‘(I) Native Hawaiians have the

7 highest mortality rates in the State of

8 Hawaii from breast cancer (37.96 out

9 of every 100,000 residents), which is

10 25 percent higher than that for Cau11 casian Americans (30.25 out of every

12 100,000 residents) and 106 percent

13 higher than that for Chinese Ameri14 cans (18.39 out of every 100,000 resi15 dents); and

16 ‘‘(II) nationally, Native Hawai17 ians have the third highest mortality

18 rates due to breast cancer (25.0 out

19 of every 100,000 residents) following

20 African Americans (31.4 out of every

21 100,000 residents) and Caucasian

22 Americans (27.0 out of every 100,000

23 residents).

24 ‘‘(iii) CANCER OF THE CERVIX.—Na25 tive Hawaiians have the highest mortality
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1 rates from cancer of the cervix in the State

2 of Hawaii (3.82 out of every 100,000 resi3 dents) followed by Filipino Americans

4 (3.33 out of every 100,000 residents) and

5 Caucasian Americans (2.61 out of every

6 100,000 residents).

7 ‘‘(iv) LUNG CANCER.—Native Hawai8 ians have the highest mortality rates from

9 lung cancer in the State of Hawaii (90.70

10 out of every 100,000 residents), which is

11 61 percent higher than Caucasian Ameri12 cans, who rank second and 161 percent

13 higher than Japanese Americans, who rank

14 third.

15 ‘‘(v) PROSTATE CANCER.—Native Ha16 waiian males have the second highest mor17 tality rates due to prostate cancer in the

18 State of Hawaii (25.86 out of every

19 100,000 residents) with Caucasian Ameri20 cans having the highest mortality rate

21 from prostate cancer (30.55 out of every

22 100,000 residents).

23 ‘‘(B) DIABETES.—With respect to diabe24 tes, for the years 1989 through 1991—
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1 ‘‘(i) Native Hawaiians had the highest

2 mortality rate due to diabetes mellitis

3 (34.7 out of every 100,000 residents) in

4 the State of Hawaii which is 130 percent

5 higher than the statewide rate for all other

6 races (15.1 out of every 100,000 resi7 dents);

8 ‘‘(ii) full-blood Hawaiians had a mor9 tality rate of 93.3 out of every 100,000

10 residents, which is 518 percent higher than

11 the rate for the statewide population of all

12 other races; and

13 ‘‘(iii) Native Hawaiians who are less

14 than full-blood had a mortality rate of 27.1

15 out of every 100,000 residents, which is 79

16 percent higher than the rate for the state17 wide population of all other races.

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

19 ‘‘(i) in 1990, Native Hawaiians com20 prised 44 percent of all asthma cases in

21 the State of Hawaii for those 18 years of

22 age and younger, and 35 percent of all

23 asthma cases reported; and

24 ‘‘(ii) in 1992, the Native Hawaiian

25 rate for asthma was 81.7 out of every
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1 1000 residents, which was 73 percent high2 er than the rate for the total statewide

3 population of 47.3 out of every 1000 resi4 dents.

5 ‘‘(D) CIRCULATORY DISEASES.—

6 ‘‘(i) HEART DISEASE.—With respect

7 to heart disease—

8 ‘‘(I) the death rate for Native

9 Hawaiians from heart disease (333.4

10 out of every 100,000 residents) is 66

11 percent higher than for the entire

12 State of Hawaii (201.1 out of every

13 100,000 residents); and

14 ‘‘(II) Native Hawaiian males

15 have the greatest years of productive

16 life lost in the State of Hawaii where

17 Native Hawaiian males lose an aver18 age of 15.5 years and Native Hawai19 ian females lose an average of 8.2

20 years due to heart disease, as com21 pared to 7.5 years for all males in the

22 State of Hawaii and 6.4 years for all

23 females.

24 ‘‘(ii) HYPERTENSION.—The death

25 rate for Native Hawaiians from hyper-
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1 tension (3.5 out of every 100,000 resi2 dents) is 84 percent higher than that for

3 the entire State (1.9 out of every 100,000

4 residents).

5 ‘‘(iii) STROKE.—The death rate for

6 Native Hawaiians from stroke (58.3 out of

7 every 100,000 residents) is 13 percent

8 higher than that for the entire State (51.8

9 out of every 100,000 residents).

10 ‘‘(2) INFECTIOUS DISEASE AND ILLNESS.—The

11 incidence of AIDS for Native Hawaiians is at least

12 twice as high per 100,000 residents (10.5 percent)

13 than that for any other non-Caucasian group in the

14 State of Hawaii.

15 ‘‘(3) ACCIDENTS.—With respect to accidents—

16 ‘‘(A) the death rate for Native Hawaiians

17 from accidents (38.8 out of every 100,000 resi18 dents) is 45 percent higher than that for the

19 entire State (26.8 out of every 100,000 resi20 dents);

21 ‘‘(B) Native Hawaiian males lose an aver22 age of 14 years of productive life lost from acci23 dents as compared to 9.8 years for all other

24 males in Hawaii; and
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1 ‘‘(C) Native Hawaiian females lose and av2 erage of 4 years of productive life lost from ac3 cidents but this rate is the highest rate among

4 all females in the State of Hawaii.

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

6 health—

7 ‘‘(A) Native Hawaiian children exhibit

8 among the highest rates of dental caries in the

9 nation, and the highest in the State of Hawaii

10 as compared to the 5 other major ethnic groups

11 in the State;

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

13 filled primary teeth for Native Hawaiian chil14 dren ages 5 through 9 years was 4.3 as com15 pared with 3.7 for the entire State of Hawaii

16 and 1.9 for the United States; and

17 ‘‘(C) the proportion of Native Hawaiian

18 children ages 5 through 12 years with unmet

19 treatment needs (defined as having active den20 tal caries requiring treatment) is 40 percent as

21 compared with 33 percent for all other races in

22 the State of Hawaii.

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

24 expectancy—
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1 ‘‘(A) Native Hawaiians have the lowest life

2 expectancy of all population groups in the State

3 of Hawaii;

4 ‘‘(B) between 1910 and 1980, the life ex5 pectancy of Native Hawaiians from birth has

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

7 overall State population average; and

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

9 Native Hawaiian life expectancy at birth (74.27

10 years) to be about 5 years less than that of the

11 total State population (78.85 years).

12 ‘‘(6) MATERNAL AND CHILD HEALTH.—

13 ‘‘(A) PRENATAL CARE.—With respect to

14 prenatal care—

15 ‘‘(i) as of 1996, Native Hawaiian

16 women have the highest prevalence (21

17 percent) of having had no prenatal care

18 during their first trimester of pregnancy

19 when compared to the 5 largest ethnic

20 groups in the State of Hawaii;

21 ‘‘(ii) of the mothers in the State of

22 Hawaii who received no prenatal care

23 throughout their pregnancy in 1996, 44

24 percent were Native Hawaiian;
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1 ‘‘(iii) over 65 percent of the referrals

2 to Healthy Start in fiscal years 1996 and

3 1997 were Native Hawaiian newborns; and

4 ‘‘(iv) in every region of the State of

5 Hawaii, many Native Hawaiian newborns

6 begin life in a potentially hazardous cir7 cumstance, far higher than any other ra8 cial group.

9 ‘‘(B) BIRTHS.—With respect to births—

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

11 births to Native Hawaiian mothers were

12 infants born to single mothers which sta13 tistics indicate put infants at higher risk of

14 low birth weight and infant mortality;

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

16 Hawaiian single mothers, 8 percent were

17 low birth weight (under 2500 grams); and

18 ‘‘(iii) of all low birth weight babies

19 born to single mothers in the State of Ha20 waii, 44 percent were Native Hawaiian.

21 ‘‘(C) TEEN PREGNANCIES.—With respect

22 to births—

23 ‘‘(i) in 1993 and 1994, Native Hawai24 ians had the highest percentage of teen

25 (individuals who were less than 18 years of
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1 age) births (8.1 percent) compared to the

2 rate for all other races in the State of Ha3 waii (3.6 percent);

4 ‘‘(ii) in 1996, nearly 53 percent of all

5 mothers in Hawaii under 18 years of age

6 were Native Hawaiian;

7 ‘‘(iii) lower rates of abortion (a third

8 lower than for the statewide population)

9 among Hawaiian women may account in

10 part, for the higher percentage of live

11 births;

12 ‘‘(iv) in 1995, of the births to mothers

13 age 14 years and younger in Hawaii, 66

14 percent were Native Hawaiian; and

15 ‘‘(v) in 1996, of the births in this

16 same group, 48 percent were Native Ha17 waiian.

18 ‘‘(D) FETAL MORTALITY.—In 1996, Na19 tive Hawaiian fetal mortality rates comprised

20 15 percent of all fetal deaths for the State of

21 Hawaii. However, for fetal deaths occurring in

22 mothers under the age of 18 years, 32 percent

23 were Native Hawaiian, and for mothers 18

24 through 24 years of age, 28 percent were Na25 tive Hawaiians.
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1 ‘‘(7) MENTAL HEALTH.—

2 ‘‘(A) ALCOHOL AND DRUG ABUSE.—With

3 respect to alcohol and drug abuse—

4 ‘‘(i) Native Hawaiians represent 38

5 percent of the total admissions to Depart6 ment of Health, Alcohol, Drugs and Other

7 Drugs, funded substance abuse treatment

8 programs;

9 ‘‘(ii) in 1997, the prevalence of smok10 ing by Native Hawaiians was 28.5 percent,

11 a rate that is 53 percent higher than that

12 for all other races in the State of Hawaii

13 which is 18.6 percent;

14 ‘‘(iii) Native Hawaiians have the high15 est prevalence rates of acute drinking (31

16 percent), a rate that is 79 percent higher

17 than that for all other races in the State

18 of Hawaii;

19 ‘‘(iv) the chronic drinking rate among

20 Native Hawaiians is 54 percent higher

21 than that for all other races in the State

22 of Hawaii;

23 ‘‘(v) in 1991, 40 percent of the Native

24 Hawaiian adults surveyed reported having

25 used marijuana compared with 30 percent
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1 for all other races in the State of Hawaii;

2 and

3 ‘‘(vi) nine percent of the Native Ha4 waiian adults surveyed reported that they

5 are current users (within the past year) of

6 marijuana, compared with 6 percent for all

7 other races in the State of Hawaii.

8 ‘‘(B) CRIME.—With respect to crime—

9 ‘‘(i) in 1996, of the 5,944 arrests that

10 were made for property crimes in the State

11 of Hawaii, arrests of Native Hawaiians

12 comprised 20 percent of that total;

13 ‘‘(ii) Native Hawaiian juveniles com14 prised a third of all juvenile arrests in

15 1996;

16 ‘‘(iii) In 1996, Native Hawaiians rep17 resented 21 percent of the 8,000 adults ar18 rested for violent crimes in the State of

19 Hawaii, and 38 percent of the 4,066 juve20 nile arrests;

21 ‘‘(iv) Native Hawaiians are over-rep22 resented in the prison population in Ha23 waii;

24 ‘‘(v) in 1995 and 1996 Native Hawai25 ians comprised 36.5 percent of the sen-
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1 tenced felon prison population in Hawaii,

2 as compared to 20.5 percent for Caucasian

3 Americans, 3.7 percent for Japanese

4 Americans, and 6 percent for Chinese

5 Americans;

6 ‘‘(vi) in 1995 and 1996 Native Ha7 waiians made up 45.4 percent of the tech8 nical violator population, and at the Ha9 waii Youth Correctional Facility, Native

10 Hawaiians constituted 51.6 percent of all

11 detainees in fiscal year 1997; and

12 ‘‘(vii) based on anecdotal information

13 from inmates at the Halawa Correction

14 Facilities, Native Hawaiians are estimated

15 to comprise between 60 and 70 percent of

16 all inmates.

17 ‘‘(8) HEALTH PROFESSIONS EDUCATION AND

18 TRAINING.—With respect to health professions edu19 cation and training—

20 ‘‘(A) Native Hawaiians age 25 years and

21 older have a comparable rate of high school

22 completion, however, the rates of baccalaureate

23 degree achievement amongst Native Hawaiians

24 are less than the norm in the State of Hawaii

25 (6.9 percent and 15.76 percent respectively);
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1 ‘‘(B) Native Hawaiian physicians make up

2 4 percent of the total physician workforce in the

3 State of Hawaii; and

4 ‘‘(C) in fiscal year 1997, Native Hawaiians

5 comprised 8 percent of those individuals who

6 earned Bachelor’s Degrees, 14 percent of those

7 individuals who earned professional diplomas, 6

8 percent of those individuals who earned Mas9 ter’s Degrees, and less than 1 percent of indi10 viduals who earned doctoral degrees at the Uni11 versity of Hawaii.

12 ‘‘SEC. 3. DEFINITIONS.

13 ‘‘In this Act:

14 ‘‘(1) DISEASE PREVENTION.—The term ‘disease

15 prevention’ includes—

16 ‘‘(A) immunizations;

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

18 ‘‘(C) control of sexually transmittable dis19 eases;

20 ‘‘(D) prevention and control of diabetes;

21 ‘‘(E) control of toxic agents;

22 ‘‘(F) occupational safety and health;

23 ‘‘(G) accident prevention;

24 ‘‘(H) fluoridation of water;

25 ‘‘(I) control of infectious agents; and
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1 ‘‘(J) provision of mental health care.

2 ‘‘(2) HEALTH PROMOTION.—The term ‘health

3 promotion’ includes—

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

5 prevention of fetal alcohol syndrome;

6 ‘‘(B) cessation of tobacco smoking;

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

8 drugs;

9 ‘‘(D) improvement of nutrition;

10 ‘‘(E) improvement in physical fitness;

11 ‘‘(F) family planning;

12 ‘‘(G) control of stress;

13 ‘‘(H) reduction of major behavioral risk

14 factors and promotion of healthy lifestyle prac15 tices; and

16 ‘‘(I) integration of cultural approaches to

17 health and well-being, including traditional

18 practices relating to the land (‘aina), water

19 (wai), and ocean (kai).

20 ‘‘(3) NATIVE HAWAIIAN.—The term ‘Native

21 Hawaiian’ means any individual who is Kanaka

22 Maoli (a descendant of the aboriginal people who,

23 prior to 1778, occupied and exercised sovereignty in

24 the area that now constitutes the State of Hawaii)

25 as evidenced by—
28

•S 1929 IS

1 ‘‘(A) genealogical records,

2 ‘‘(B) Kupuna (elders) or Kama‘aina (long3 term community residents) verification; or

4 ‘‘(C) birth records of the State of Hawaii.

5 ‘‘(4) NATIVE HAWAIIAN HEALTH CARE SYS6 TEM.—The term ‘Native Hawaiian health care sys7 tem’ means an entity—

8 ‘‘(A) which is organized under the laws of

9 the State of Hawaii;

10 ‘‘(B) which provides or arranges for health

11 care services through practitioners licensed by

12 the State of Hawaii, where licensure require13 ments are applicable;

14 ‘‘(C) which is a public or nonprofit private

15 entity;

16 ‘‘(D) in which Native Hawaiian health

17 practitioners significantly participate in the

18 planning, management, monitoring, and evalua19 tion of health care services;

20 ‘‘(E) which may be composed of as many

21 as 8 Native Hawaiian health care systems as

22 necessary to meet the health care needs of each

23 island’s Native Hawaiians; and

24 ‘‘(F) which is—
29

•S 1929 IS

1 ‘‘(i) recognized by Papa Ola Lokahi

2 for the purpose of planning, conducting, or

3 administering programs, or portions of

4 programs, authorized by this chapter for

5 the benefit of Native Hawaiians; and

6 ‘‘(ii) certified by Papa Ola Lokahi as

7 having the qualifications and the capacity

8 to provide the services and meet the re9 quirements under the contract the Native

10 Hawaiian health care system enters into

11 with the Secretary or the grant the Native

12 Hawaiian health care system receives from

13 the Secretary pursuant to this Act.

14 ‘‘(5) NATIVE HAWAIIAN ORGANIZATION.—The

15 term ‘Native Hawaiian organization’ means any

16 organization—

17 ‘‘(A) which serves the interests of Native

18 Hawaiians; and

19 ‘‘(B) which is—

20 ‘‘(i) recognized by Papa Ola Lokahi

21 for the purpose of planning, conducting, or

22 administering programs (or portions of

23 programs) authorized under this Act for

24 the benefit of Native Hawaiians; and
30

•S 1929 IS

1 ‘‘(ii) a public or nonprofit private enti2 ty.

3 ‘‘(6) PAPA OLA LOKAHI.—

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

5 Lokahi’ means an organization that is com6 posed of public agencies and private organiza7 tions focusing on improving the health status of

8 Native Hawaiians. Board members of such or9 ganization may include representation from—

10 ‘‘(i) E Ola Mau;

11 ‘‘(ii) the Office of Hawaiian Affairs of

12 the State of Hawaii;

13 ‘‘(iii) Alu Like Inc.;

14 ‘‘(iv) the University of Hawaii;

15 ‘‘(v) the Hawaii State Department of

16 Health;

17 ‘‘(vi) the Kamehameha Schools

18 Bishop Estate, or other Native Hawaiian

19 organization responsible for the adminis20 tration of the Native Hawaiian Health

21 Scholarship Program;

22 ‘‘(vii) the Hawaii State Primary Care

23 Association, or other organizations respon24 sible for the placement of scholars from
31

•S 1929 IS

1 the Native Hawaiian Health Scholarship

2 Program;

3 ‘‘(viii) Ahahui O Na Kauka, the Na4 tive Hawaiian Physicians Association;

5 ‘‘(ix) Ho‘ola Lahui Hawaii, or a

6 health care system serving Kaua‘i or

7 Ni‘ihau, and which may be composed of as

8 many health care centers as are necessary

9 to meet the health care needs of the Native

10 Hawaiians of those islands;

11 ‘‘(x) Ke Ola Mamo, or a health care

12 system serving the island of O‘ahu and

13 which may be composed of as many health

14 care centers as are necessary to meet the

15 health care needs of the Native Hawaiians

16 of that island;

17 ‘‘(xi) Na Pu‘uwai or a health care sys18 tem serving Moloka‘i or Lana‘i, and which

19 may be composed of as many health care

20 centers as are necessary to meet the health

21 care needs of the Native Hawaiians of

22 those islands;

23 ‘‘(xii) Hui No Ke Ola Pono, or a

24 health care system serving the island of

25 Maui, and which may be composed of as
32

•S 1929 IS

1 many health care centers as are necessary

2 to meet the health care needs of the Native

3 Hawaiians of that island;

4 ‘‘(xiii) Hui Malama Ola Ha ‘Oiwi, or

5 a health care system serving the island of

6 Hawaii, and which may be composed of as

7 many health care centers as are necessary

8 to meet the health care needs of the Native

9 Hawaiians of that island;

10 ‘‘(xiv) other Native Hawaiian health

11 care systems as certified and recognized by

12 Papa Ola Lokahi in accordance with this

13 Act; and

14 ‘‘(xv) such other member organiza15 tions as the Board of Papa Ola Lokahi

16 may admit from time to time, based upon

17 satisfactory demonstration of a record of

18 contribution to the health and well-being of

19 Native Hawaiians.

20 ‘‘(B) LIMITATION.—Such term does not in21 clude any organization described in subpara22 graph (A) if the Secretary determines that such

23 organization has not developed a mission state24 ment with clearly defined goals and objectives

25 for the contributions the organization will make
33

•S 1929 IS

1 to the Native Hawaiian health care systems,

2 and an action plan for carrying out those goals

3 and objectives.

4 ‘‘(7) PRIMARY HEALTH SERVICES.—The term

5 ‘primary health services’ means—

6 ‘‘(A) services of physicians, physicians’ as7 sistants, nurse practitioners, and other health

8 professionals;

9 ‘‘(B) diagnostic laboratory and radiologic

10 services;

11 ‘‘(C) preventive health services including

12 perinatal services, well child services, family

13 planning services, nutrition services, home

14 health services, and, generally, all those services

15 associated with enhanced health and wellness.

16 ‘‘(D) emergency medical services;

17 ‘‘(E) transportation services as required

18 for adequate patient care;

19 ‘‘(F) preventive dental services; and

20 ‘‘(G) pharmaceutical and nutraceutical

21 services.

22 ‘‘(8) SECRETARY.—The term ‘Secretary’ means

23 the Secretary of Health and Human Services.
34

•S 1929 IS

1 ‘‘(9) TRADITIONAL NATIVE HAWAIIAN HEAL2 ER.—The term ‘traditional Native Hawaiian healer’

3 means a practitioner—

4 ‘‘(A) who—

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

6 and

7 ‘‘(ii) has the knowledge, skills, and ex8 perience in direct personal health care of

9 individuals; and

10 ‘‘(B) whose knowledge, skills, and experi11 ence are based on demonstrated learning of Na12 tive Hawaiian healing practices acquired by—

13 ‘‘(i) direct practical association with

14 Native Hawaiian elders; and

15 ‘‘(ii) oral traditions transmitted from

16 generation to generation.

17 ‘‘SEC. 4. DECLARATION OF POLICY.

18 ‘‘(a) CONGRESS.—Congress hereby declares that it is

19 the policy of the United States in fulfillment of its special

20 responsibilities and legal obligations to the indigenous peo21 ple of Hawaii resulting from the unique and historical re22 lationship between the United States and the indigenous

23 people of Hawaii—

24 ‘‘(1) to raise the health status of Native Hawai25 ians to the highest possible health level; and
35

•S 1929 IS

1 ‘‘(2) to provide existing Native Hawaiian health

2 care programs with all resources necessary to effec3 tuate this policy.

4 ‘‘(b) INTENT OF CONGRESS.—

5 ‘‘(1) IN GENERAL.—It is the intent of the Con6 gress that—

7 ‘‘(A) health care programs having a dem8 onstrated effect of substantially reducing or

9 eliminating the over-representation of Native

10 Hawaiians among those suffering from chronic

11 and acute disease and illness and addressing

12 the health needs of Native Hawaiians shall be

13 established and implemented; and

14 ‘‘(B) the Nation meet the Healthy People

15 2010 and Kanaka Maoli health objectives de16 scribed in paragraph (2) by the year 2010.

17 ‘‘(2) HEALTHY PEOPLE AND KANAKA MAOLI

18 HEALTH OBJECTIVES.—The Healthy People 2010

19 and Kanaka Maoli health objectives described in this

20 paragraph are the following:

21 ‘‘(A) CHRONIC DISEASE AND ILLNESS.—

22 ‘‘(i) CARDIOVASCULAR DISEASE.—

23 With respect to cardiovascular disease—

24 ‘‘(I) to increase to 75 percent the

25 proportion of females who are aware
36

•S 1929 IS

1 that cardiovascular disease (heart dis2 ease and stroke) is the leading cause

3 of death for all females.

4 ‘‘(II) to increase to at least 95

5 percent the proportion of adults who

6 have had their blood pressure meas7 ured within the preceding 2 years and

8 can state whether their blood pressure

9 was normal or high; and

10 ‘‘(III) to increase to at least 75

11 percent the proportion of adults who

12 have had their blood cholesterol

13 checked within the preceding 5 years.

14 ‘‘(ii) DIABETES.—With respect to

15 diabetes—

16 ‘‘(I) to increase to 80 percent the

17 proportion of persons with diabetes

18 whose condition has been diagnosed;

19 ‘‘(II) to increase to at least 20

20 percent the proportion of patients

21 with diabetes who annually obtain

22 lipid assessment (total cholesterol,

23 LDL cholesterol, HDL cholesterol,

24 triglyceride); and
37

•S 1929 IS

1 ‘‘(III) to increase to 52 percent

2 the proportion of persons with diabe3 tes who have received formal diabetes

4 education.

5 ‘‘(iii) CANCER.—With respect to

6 cancer—

7 ‘‘(I) to increase to at least 95

8 percent the proportion of women age

9 18 and older who have ever received a

10 Pap test and to at least 85 percent

11 those who have received a Pap test

12 within the preceding 3 years; and

13 ‘‘(II) to increase to at least 40

14 percent the proportion of women age

15 40 and older who have received a

16 breast examination and a mammo17 gram within the preceding 2 years.

18 ‘‘(iv) DENTAL HEALTH.—With respect

19 to dental health—

20 ‘‘(I) to reduce untreated cavities

21 in the primary and permanent teeth

22 (mixed dentition) so that the propor23 tion of children with decayed teeth not

24 filled is not more than 12 percent

25 among children ages 2 through 4, 22
38

•S 1929 IS

1 percent among children ages 6

2 through 8, and 15 percent among

3 adolescents ages 8 through 15;

4 ‘‘(II) to increase to at least 70

5 percent the proportion of children

6 ages 8 through 14 who have received

7 protective sealants in permanent

8 molar teeth; and

9 ‘‘(III) to increase to at least 70

10 percent the proportion of adults age

11 18 and older using the oral health

12 care system each year.

13 ‘‘(v) MENTAL HEALTH.—With respect

14 to mental health—

15 ‘‘(I) to incorporate or support

16 land(‘aina)-based, water(wai)-based,

17 or the ocean(kai)-based programs

18 within the context of mental health

19 activities; and

20 ‘‘(II) to reduce the anger and

21 frustration levels within ‘ohana’ focus22 ing on building positive relationships

23 and striving for balance in living

24 (lokahi) and achieving a sense of con25 tentment (pono).
39

•S 1929 IS

1 ‘‘(vi) ASTHMA.—With respect to

2 asthma—

3 ‘‘(I) to increase to at least 40

4 percent the proportion of people with

5 asthma who receive formal patient

6 education, including information

7 about community and self-help re8 sources, as an integral part of the

9 management of their condition;

10 ‘‘(II) to increase to at least 75

11 percent the proportion of patients who

12 receive counseling from health care

13 providers on how to recognize early

14 signs of worsening asthma and how to

15 respond appropriately; and

16 ‘‘(III) to increase to at least 75

17 percent the proportion of primary care

18 providers who are trained to provide

19 culturally competent care to ethnic

20 minorities (Native Hawaiians) seeking

21 health care for chronic obstructive

22 pulmonary disease.

23 ‘‘(B) INFECTIOUS DISEASE AND ILL24 NESS.—
40

•S 1929 IS

1 ‘‘(i) IMMUNIZATIONS.—With respect

2 to immunizations—

3 ‘‘(I) to reduce indigenous cases of

4 vaccine-preventable disease;

5 ‘‘(II) to achieve immunization

6 coverage of at least 90 percent among

7 children between 19 and 35 months of

8 age; and

9 ‘‘(III) to increase to 90 percent

10 the rate of immunization coverage

11 among adults 65 years of age or

12 older, and 60 percent for high-risk

13 adults between 18 and 64 years of

14 age.

15 ‘‘(ii) SEXUALLY TRANSMITTED DIS16 EASES, HIV; AIDS.—To increase the num17 ber of HIV-infected adolescents and adults

18 in care who receive treatment consistent

19 with current public health treatment guide20 lines.

21 ‘‘(C) WELLNESS.—

22 ‘‘(i) EXERCISE.—With respect to

23 exercise—

24 ‘‘(I) to increase to 85 percent the

25 proportion of people ages 18 and older
41

•S 1929 IS

1 who engage in any leisure time phys2 ical activity; and

3 ‘‘(II) to increase to at least 30

4 percent the proportion of people ages

5 18 and older who engage regularly,

6 preferably daily, in sustained physical

7 activity for at least 30 minutes per

8 day.

9 ‘‘(ii) NUTRITION.—With respect to

10 nutrition—

11 ‘‘(I) to increase to at least 60

12 percent the prevalence of healthy

13 weight (defined as body mass index

14 equal to or greater than 19.0 and less

15 than 25.0) among all people age 20

16 and older;

17 ‘‘(II) to increase to at least 75

18 percent the proportion of people age 2

19 and older who meet the dietary guide20 lines’ minimum average daily goal of

21 at least 5 servings of vegetables and

22 fruits; and

23 ‘‘(III) to increase the use of tra24 ditional Native Hawaiian foods in all

25 peoples’ diets and dietary preferences.
42

•S 1929 IS

1 ‘‘(iii) LIFESTYLE.—With respect to

2 lifestyle—

3 ‘‘(I) to reduce cigarette smoking

4 among pregnant women to a preva5 lence of not more than 2 percent;

6 ‘‘(II) to reduce the prevalence of

7 respiratory disease, cardiovascular dis8 ease, and cancer resulting from expo9 sure to tobacco smoke;

10 ‘‘(III) to increase to at least 70

11 percent the proportion of all preg12 nancies among women between the

13 ages of 15 and 44 that are planned

14 (intended); and

15 ‘‘(IV) to reduce deaths caused by

16 unintentional injuries to not more

17 than 25.9 per 100,000.

18 ‘‘(iv) CULTURE.—With respect to

19 culture—

20 ‘‘(I) to develop and implement

21 cultural values within the context of

22 the corporate cultures of the Native

23 Hawaiian health care systems, the

24 Native Hawaiian Health Scholarship

25 Program, and Papa Ola Lokahi; and
43

•S 1929 IS

1 ‘‘(II) to facilitate the provision of

2 Native Hawaiian healing practices by

3 Native Hawaiian healers for those cli4 ents desiring such assistance.

5 ‘‘(D) ACCESS.—With respect to access—

6 ‘‘(i) to increase the proportion of pa7 tients who have coverage for clinical pre8 ventive services as part of their health in9 surance; and

10 ‘‘(ii) to reduce to not more than 7

11 percent the proportion of individuals and

12 families who report that they did not ob13 tain all the health care that they needed.

14 ‘‘(E) HEALTH PROFESSIONS TRAINING

15 AND EDUCATION.—With respect to health pro16 fessions training and education—

17 ‘‘(i) to increase the proportion of all

18 degrees in the health professions and allied

19 and associated health professions fields

20 awarded to members of underrepresented

21 racial and ethnic minority groups; and

22 ‘‘(ii) to support training activities and

23 programs in traditional Native Hawaiian

24 healing practices by Native Hawaiian heal25 ers.
44

•S 1929 IS

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

2 President, for inclusion in each report required to be

3 transmitted to Congress under section 11, a report on the

4 progress made in each toward meeting each of the objec5 tives described in subsection (b)(2).

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

7 FOR NATIVE HAWAIIANS.

8 ‘‘(a) DEVELOPMENT.—

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

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

11 Lokahi for the purpose of coordinating, imple12 menting and updating a Native Hawaiian com13 prehensive health care master plan designed to pro14 mote comprehensive health promotion and disease

15 prevention services and to maintain and improve the

16 health status of Native Hawaiians, and to support

17 community-based initiatives that are reflective of ho18 listic approaches to health.

19 ‘‘(2) COLLABORATION.—The Papa Ola Lokahi

20 shall collaborate with the Office of Hawaiian Affairs

21 in carrying out this section.

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

23 are authorized to be appropriated such sums as may be

24 necessary to carry out subsection (a).
45

•S 1929 IS

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

2 ‘‘(a) RESPONSIBILITY.—Papa Ola Lokahi shall be re3 sponsible for the—

4 ‘‘(1) coordination, implementation, and updat5 ing, as appropriate, of the comprehensive health care

6 master plan developed pursuant to section 5;

7 ‘‘(2) training for the persons described in sub8 paragraphs (B) and (C) of section 7(c)(1);

9 ‘‘(3) identification of and research into the dis10 eases that are most prevalent among Native Hawai11 ians, including behavioral, biomedical, epidemiolog12 ical, and health services; and

13 ‘‘(4) the development of an action plan out14 lining the contributions that each member organiza15 tion of Papa Ola Lokahi will make in carrying out

16 the policy of this Act.

17 ‘‘(b) SPECIAL PROJECT FUNDS.—Papa Ola Lokahi

18 may receive special project funds that may be appro19 priated for the purpose of research on the health status

20 of Native Hawaiians or for the purpose of addressing the

21 health care needs of Native Hawaiians.

22 ‘‘(c) CLEARINGHOUSE.—

23 ‘‘(1) IN GENERAL.—Papa Ola Lokahi shall

24 serve as a clearinghouse for—
46

•S 1929 IS

1 ‘‘(A) the collection and maintenance of

2 data associated with the health status of Native

3 Hawaiians;

4 ‘‘(B) the identification and research into

5 diseases affecting Native Hawaiians;

6 ‘‘(C) the availability of Native Hawaiian

7 project funds, research projects and publica8 tions;

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

10 area of Native Hawaiian health; and

11 ‘‘(E) the timely dissemination of informa12 tion pertinent to the Native Hawaiian health

13 care systems.

14 ‘‘(2) CONSULTATION.—The Secretary shall con15 sult periodically with Papa Ola Lokahi for the pur16 poses of maintaining the clearinghouse under para17 graph (1) and providing information about programs

18 in the Department that specifically address Native

19 Hawaiian issues and concerns.

20 ‘‘(d) FISCAL ALLOCATION AND COORDINATION OF

21 PROGRAMS AND SERVICES.—

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

23 shall provide annual recommendations to the Sec24 retary with respect to the allocation of all amounts

25 appropriated under this Act.
47

•S 1929 IS

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

2 to the maximum extent possible, coordinate and as3 sist the health care programs and services provided

4 to Native Hawaiians.

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

6 Secretary, in consultation with Papa Ola Lokahi,

7 shall make recommendations for Native Hawaiian

8 representation on the President’s Advisory Commis9 sion on Asian Americans and Pacific Islanders.

10 ‘‘(e) TECHNICAL SUPPORT.—Papa Ola Lokahi shall

11 act as a statewide infrastructure to provide technical sup12 port and coordination of training and technical assistance

13 to the Native Hawaiian health care systems.

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

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

16 into agreements or memoranda of understanding

17 with relevant agencies or organizations that are ca18 pable of providing resources or services to the Native

19 Hawaiian health care systems.

20 ‘‘(2) MEDICARE, MEDICAID, SCHIP.—Papa Ola

21 Lokahi shall develop or make every reasonable effort

22 to—

23 ‘‘(A) develop a contractual or other ar24 rangement, through memoranda of under25 standing or agreement, with the Health Care
48

•S 1929 IS

1 Financing Administration or the agency of the

2 State which administers or supervises the ad3 ministration of a State plan or waiver approved

4 under title XVIII, XIX or title XXI of the So5 cial Security Act for payment of all or a part

6 of the health care services to persons who are

7 eligible for medical assistance under such a

8 State plan or waiver; and

9 ‘‘(B) assist in the collection of appropriate

10 reimbursement for health care services to per11 sons who are entitled to insurance under title

12 XVIII of the Social Security Act.

13 ‘‘SEC. 7. NATIVE HAWAIIAN HEALTH CARE SYSTEMS.

14 ‘‘(a) COMPREHENSIVE HEALTH PROMOTION, DIS15 EASE PREVENTION, AND PRIMARY HEALTH SERVICES.—

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

17 in consultation with Papa Ola Lokahi, may make

18 grants to, or enter into contracts with, any qualified

19 entity for the purpose of providing comprehensive

20 health promotion and disease prevention services, as

21 well as primary health services, to Native Hawaiians

22 who desire and are committed to bettering their own

23 health.

24 ‘‘(2) PREFERENCE.—In making grants and en25 tering into contracts under this subsection, the Sec-
49

•S 1929 IS

1 retary shall give preference to Native Hawaiian

2 health care systems and Native Hawaiian organiza3 tions and, to the extent feasible, health promotion

4 and disease prevention services shall be performed

5 through Native Hawaiian health care systems.

6 ‘‘(3) QUALIFIED ENTITY.—An entity is a quali7 fied entity for purposes of paragraph (1) if the enti8 ty is a Native Hawaiian health care system.

9 ‘‘(4) LIMITATION ON NUMBER OF ENTITIES.—

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

11 a contract with, not more than 8 Native Hawaiian

12 health care systems under this subsection during

13 any fiscal year.

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

15 to grants and contracts under subsection (a), the Sec16 retary may make a grant to, or enter into a contract with,

17 Papa Ola Lokahi for the purpose of planning Native Ha18 waiian health care systems to serve the health needs of

19 Native Hawaiian communities on each of the islands of

20 O‘ahu, Moloka‘i, Maui, Hawai‘i, Lana‘i, Kaua‘i, and

21 Ni‘ihau in the State of Hawaii.

22 ‘‘(c) SERVICES TO BE PROVIDED.—

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

24 under subsection (a) shall ensure that the following

25 services either are provided or arranged for:
50

•S 1929 IS

1 ‘‘(A) Outreach services to inform Native

2 Hawaiians of the availability of health services.

3 ‘‘(B) Education in health promotion and

4 disease prevention of the Native Hawaiian pop5 ulation by, wherever possible, Native Hawaiian

6 health care practitioners, community outreach

7 workers, counselors, and cultural educators.

8 ‘‘(C) Services of physicians, physicians’ as9 sistants, nurse practitioners or other health and

10 allied-health professionals.

11 ‘‘(D) Immunizations.

12 ‘‘(E) Prevention and control of diabetes,

13 high blood pressure, and otitis media.

14 ‘‘(F) Pregnancy and infant care.

15 ‘‘(G) Improvement of nutrition.

16 ‘‘(H) Identification, treatment, control,

17 and reduction of the incidence of preventable

18 illnesses and conditions endemic to Native Ha19 waiians.

20 ‘‘(I) Collection of data related to the pre21 vention of diseases and illnesses among Native

22 Hawaiians.

23 ‘‘(J) Services within the meaning of the

24 terms ‘health promotion’, ‘disease prevention’,

25 and ‘primary health services’, as such terms are
51

•S 1929 IS

1 defined in section 3, which are not specifically

2 referred to in subsection (a).

3 ‘‘(K) Support of culturally appropriate ac4 tivities enhancing health and wellness including

5 land-based, water-based, ocean-based, and spir6 itually-based projects and programs.

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

8 services referred to in paragraph (1) which are pro9 vided under grants or contracts under subsection (a)

10 may be provided by traditional Native Hawaiian

11 healers.

12 ‘‘(d) FEDERAL TORT CLAIMS ACT.—Individuals that

13 provide medical, dental, or other services referred to in

14 subsection (a)(1) for Native Hawaiian health care sys15 tems, including providers of traditional Native Hawaiian

16 healing services, shall be treated as if such individuals

17 were members of the Public Health Service and shall be

18 covered under the provisions of section 224 of the Public

19 Health Service Act.

20 ‘‘(e) SITE FOR OTHER FEDERAL PAYMENTS.—A Na21 tive Hawaiian health care system that receives funds

22 under subsection (a) shall provide a designated area and

23 appropriate staff to serve as a Federal loan repayment fa24 cility. Such facility shall be designed to enable health and

25 allied-health professionals to remit payments with respect
52

•S 1929 IS

1 to loans provided to such professionals under any Federal

2 loan program.

3 ‘‘(f) RESTRICTION ON USE OF GRANT AND CON4 TRACT FUNDS.—The Secretary may not make a grant to,

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

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

7 such grant or contract will not, directly or through con8 tract, be expended—

9 ‘‘(1) for any services other than the services de10 scribed in subsection (c)(1);

11 ‘‘(2) to provide inpatient services;

12 ‘‘(3) to make cash payments to intended recipi13 ents of health services; or

14 ‘‘(4) to purchase or improve real property

15 (other than minor remodeling of existing improve16 ments to real property) or to purchase major med17 ical equipment.

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

19 Secretary may not make a grant to, or enter into a con20 tract with, an entity under subsection (a) unless the entity

21 agrees that, whether health services are provided directly

22 or through contract—

23 ‘‘(1) health services under the grant or contract

24 will be provided without regard to ability to pay for

25 the health services; and
53

•S 1929 IS

1 ‘‘(2) the entity will impose a charge for the de2 livery of health services, and such charge—

3 ‘‘(A) will be made according to a schedule

4 of charges that is made available to the public;

5 and

6 ‘‘(B) will be adjusted to reflect the income

7 of the individual involved.

8 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—

9 ‘‘(1) GENERAL GRANTS.—There is authorized

10 to be appropriated such sums as may be necessary

11 for each of fiscal years 2000 through 2010 to carry

12 out subsection (a).

13 ‘‘(2) PLANNING GRANTS.—There is authorized

14 to be appropriated such sums as may be necessary

15 for each of fiscal years 2000 through 2010 to carry

16 out subsection (b).

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

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

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

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

21 ‘‘(1) coordination, implementation, and updat22 ing (as appropriate) of the comprehensive health

23 care master plan developed pursuant to section 5;

24 ‘‘(2) training for the persons described in sub25 paragraphs (B) and (C) of section 7(c)(1);
54

•S 1929 IS

1 ‘‘(3) identification of and research into the dis2 eases that are most prevalent among Native Hawai3 ians, including behavioral, biomedical, epidemiolog4 ical, and health services;

5 ‘‘(4) the development of an action plan out6 lining the contributions that each member organiza7 tion of Papa Ola Lokahi will make in carrying out

8 the policy of this Act;

9 ‘‘(5) a clearinghouse function for—

10 ‘‘(A) the collection and maintenance of

11 data associated with the health status of Native

12 Hawaiians;

13 ‘‘(B) the identification and research into

14 diseases affecting Native Hawaiians; and

15 ‘‘(C) the availability of Native Hawaiian

16 project funds, research projects and publica17 tions;

18 ‘‘(6) the coordination of the health care pro19 grams and services provided to Native Hawaiians;

20 and

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

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

23 is authorized to be appropriated such sums as may be nec24 essary for each of fiscal years 2000 through 2010 to carry

25 out subsection (a).
55

•S 1929 IS

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

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

3 include in any grant made or contract entered into under

4 this Act such terms and conditions as the Secretary con5 siders necessary or appropriate to ensure that the objec6 tives of such grant or contract are achieved.

7 ‘‘(b) PERIODIC REVIEW.—The Secretary shall peri8 odically evaluate the performance of, and compliance with,

9 grants and contracts under this Act.

10 ‘‘(c) ADMINISTRATIVE REQUIREMENTS.—The Sec11 retary may not make a grant or enter into a contract

12 under this Act with an entity unless the entity—

13 ‘‘(1) agrees to establish such procedures for fis14 cal control and fund accounting as may be necessary

15 to ensure proper disbursement and accounting with

16 respect to the grant or contract;

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

18 records maintained on individuals receiving health

19 services under the grant or contract;

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

21 any population of Native Hawaiians, a substantial

22 portion of which has a limited ability to speak the

23 English language—

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

25 carry out a reasonable plan to provide health

26 services under the grant or contract through in-
56

•S 1929 IS

1 dividuals who are able to communicate with the

2 population involved in the language and cultural

3 context that is most appropriate; and

4 ‘‘(B) has designated at least 1 individual,

5 fluent in both English and the appropriate lan6 guage, to assist in carrying out the plan;

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

8 covered in the plan of the State of Hawaii approved

9 under title XIX of the Social Security Act—

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

11 grant or contract any such health services

12 directly—

13 ‘‘(i) the entity has entered into a par14 ticipation agreement under such plans; and

15 ‘‘(ii) the entity is qualified to receive

16 payments under such plan; and

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

18 grant or contract any such health services

19 through a contract with an organization—

20 ‘‘(i) the organization has entered into

21 a participation agreement under such plan;

22 and

23 ‘‘(ii) the organization is qualified to

24 receive payments under such plan; and
57

•S 1929 IS

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

2 Papa Ola Lokahi an annual report that describes

3 the use and costs of health services provided under

4 the grant or contract (including the average cost of

5 health services per user) and that provides such

6 other information as the Secretary determines to be

7 appropriate.

8 ‘‘(d) CONTRACT EVALUATION.—

9 ‘‘(1) DETERMINATION OF NONCOMPLIANCE.—

10 If, as a result of evaluations conducted by the Sec11 retary, the Secretary determines that an entity has

12 not complied with or satisfactorily performed a con13 tract entered into under section 7, the Secretary

14 shall, prior to renewing such contract, attempt to re15 solve the areas of noncompliance or unsatisfactory

16 performance and modify such contract to prevent fu17 ture occurrences of such noncompliance or unsatis18 factory performance.

19 ‘‘(2) NONRENEWAL.—If the Secretary deter20 mines that the noncompliance or unsatisfactory per21 formance described in paragraph (1) with respect to

22 an entity cannot be resolved and prevented in the fu23 ture, the Secretary shall not renew the contract with

24 such entity and may enter into a contract under sec25 tion 7 with another entity referred to in subsection
58

•S 1929 IS

1 (a)(3) of such section that provides services to the

2 same population of Native Hawaiians which is

3 served by the entity whose contract is not renewed

4 by reason of this paragraph.

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

7 with an entity under this Act, the Secretary shall

8 consider the results of the evaluations conducted

9 under this section.

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

11 contracts entered into by the Secretary under this

12 Act shall be in accordance with all Federal con13 tracting laws and regulations, except that, in the

14 discretion of the Secretary, such contracts may be

15 negotiated without advertising and may be exempted

16 from the provisions of the Act of August 24, 1935

17 (40 U.S.C. 270a et seq.).

18 ‘‘(5) PAYMENTS.—Payments made under any

19 contract entered into under this Act may be made

20 in advance, by means of reimbursement, or in in21 stallments and shall be made on such conditions as

22 the Secretary deems necessary to carry out the pur23 poses of this Act.

24 ‘‘(e) LIMITATION ON USE OF FUNDS FOR ADMINIS25 TRATIVE EXPENSES.—Except with respect to grants and
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•S 1929 IS

1 contracts under section 8, the Secretary may not make

2 a grant to, or enter into a contract with, an entity under

3 this Act unless the entity agrees that the entity will not

4 expend more than 15 percent of the amounts received pur5 suant to this Act for the purpose of administering the

6 grant or contract.

7 ‘‘(f) REPORT.—

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

9 which an entity receives or expends funds pursuant

10 to a grant or contract under this Act, such entity

11 shall submit to the Secretary and to Papa Ola

12 Lokahi an annual report—

13 ‘‘(A) on the activities conducted by the en14 tity under the grant or contract;

15 ‘‘(B) on the amounts and purposes for

16 which Federal funds were expended; and

17 ‘‘(C) containing such other information as

18 the Secretary may request.

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

20 entity concerning any grant or contract under this

21 Act shall be subject to audit by the Secretary, the

22 Inspector General of the Department of Health and

23 Human Services, and the Comptroller General of the

24 United States.
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•S 1929 IS

1 ‘‘(g) ANNUAL PRIVATE AUDIT.—The Secretary shall

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

3 under this Act the cost of an annual private audit con4 ducted by a certified public accountant.

5 ‘‘SEC. 10. ASSIGNMENT OF PERSONNEL.

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

7 agreement with any entity under which the Secretary may

8 assign personnel of the Department of Health and Human

9 Services with expertise identified by such entity to such

10 entity on detail for the purposes of providing comprehen11 sive health promotion and disease prevention services to

12 Native Hawaiians.

13 ‘‘(b) APPLICABLE FEDERAL PERSONNEL PROVI14 SIONS.—Any assignment of personnel made by the Sec15 retary under any agreement entered into under subsection

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

17 to a local government that is made in accordance with sub18 chapter VI of chapter 33 of title 5, United States Code.

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

20 FELLOWSHIPS.

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

22 amounts appropriated under subsection (c), the Secretary

23 shall provide funds through a direct grant or a cooperative

24 agreement to Kamehameha Schools Bishop Estate or an25 other Native Hawaiian organization or health care organi-
61

•S 1929 IS

1 zation with experience in the administration of educational

2 scholarships or placement services for the purpose of pro3 viding scholarship assistance to students who—

4 ‘‘(1) meet the requirements of section 338A of

5 the Public Health Service Act, except for assistance

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

7 ‘‘(2) are Native Hawaiians.

8 ‘‘(b) TERMS AND CONDITIONS.—

9 ‘‘(1) IN GENERAL.—The scholarship assistance

10 under subsection (a) shall be provided under the

11 same terms and subject to the same conditions, reg12 ulations, and rules as apply to scholarship assistance

13 provided under section 338A of the Public Health

14 Service Act (except as provided for in paragraph

15 (2)), except that—

16 ‘‘(A) the provision of scholarships in each

17 type of health care profession training shall cor18 respond to the need for each type of health care

19 professional to serve the Native Hawaiian

20 health care systems identified by Papa Ola

21 Lokahi;

22 ‘‘(B) to the maximum extent practicable,

23 the Secretary shall select scholarship recipients

24 from a list of eligible applicants submitted by

25 the Kamehameha Schools Bishop Estate or the
62

•S 1929 IS

1 Native Hawaiian organization administering the

2 program;

3 ‘‘(C) the obligated service requirement for

4 each scholarship recipient (except for those re5 ceiving assistance under paragraph (2)) shall be

6 fulfilled through service, in order of priority,

7 in—

8 ‘‘(i) any one of the Native Hawaiian

9 health care systems; or

10 ‘‘(ii) health professions shortage

11 areas, medically underserved areas, or geo12 graphic areas or facilities similarly des13 ignated by the United States Public Health

14 Service in the State of Hawaii;

15 ‘‘(D) the provision of counseling, retention

16 and other support services shall not be limited

17 to scholarship recipients, but shall also include

18 recipients of other scholarship and financial aid

19 programs enrolled in appropriate health profes20 sions training programs.

21 ‘‘(E) financial assistance may be provided

22 to scholarship recipients in those health profes23 sions designated in such section 338A while

24 they are fulfilling their service requirement in
63

•S 1929 IS

1 any one of the Native Hawaiian health care sys2 tems or community health centers.

3 ‘‘(2) FELLOWSHIPS.—Financial assistance

4 through fellowships may be provided to Native Ha5 waiian applicants accepted and participating in a

6 certificated program provided by a traditional Native

7 Hawaiian healer in traditional Native Hawaiian

8 healing practices including lomi-lomi, la‘au lapa‘au,

9 and ho‘oponopono. Such assistance may include a

10 stipend or reimbursement for costs associated with

11 participation in the program.

12 ‘‘(3) RIGHTS AND BENEFITS.—Scholarship re13 cipients in health professions designated in section

14 338A of the Public Health Service Act while ful15 filling their service requirements shall have all the

16 same rights and benefits of members of the National

17 Health Service Corps during their period of service.

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

19 INCOME.—Financial assistance provided to scholar20 ship recipients for tuition, books and other school-re21 lated expenditures under this section shall not be in22 cluded in gross income for purposes of the Internal

23 Revenue Code of 1986.

24 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There

25 is authorized to be appropriated such sums as may be nec-
64

•S 1929 IS

1 essary for each of fiscal years 2000 through 2010 for the

2 purpose of funding the scholarship assistance program

3 under subsection (a).

4 ‘‘SEC. 12. REPORT.

5 ‘‘The President shall, at the time the budget is sub6 mitted under section 1105 of title 31, United States Code,

7 for each fiscal year transmit to Congress a report on the

8 progress made in meeting the objectives of this Act, in9 cluding a review of programs established or assisted pur10 suant to this Act and an assessment and recommendations

11 of additional programs or additional assistance necessary

12 to, at a minimum, provide health services to Native Ha13 waiians, and ensure a health status for Native Hawaiians,

14 which are at a parity with the health services available

15 to, and the health status of, the general population.

16 ‘‘SEC. 13. DEMONSTRATION PROJECTS OF NATIONAL SIG17 NIFICANCE.

18 ‘‘(a) AUTHORITY AND AREAS OF INTEREST.—The

19 Secretary, in consultation with Papa Ola Lokahi, may allo20 cate amounts appropriated under this Act, or any other

21 Act, to carry out Native Hawaiian demonstration projects

22 of national significance. The areas of interest of such

23 projects may include—

24 ‘‘(1) the education of health professionals, and

25 other individuals in institutions of higher learning,
65

•S 1929 IS

1 in health and allied health programs in complemen2 tary healing practices, including Native Hawaiian

3 healing practices;

4 ‘‘(2) the integration of Western medicine with

5 complementary healing practices including tradi6 tional Native Hawaiian healing practices;

7 ‘‘(3) the use of tele-wellness and telecommuni8 cations in chronic disease management and health

9 promotion and disease prevention;

10 ‘‘(4) the development of appropriate models of

11 health care for Native Hawaiians and other indige12 nous people including the provision of culturally

13 competent health services, related activities focusing

14 on wellness concepts, the development of appropriate

15 kupuna care programs, and the development of fi16 nancial mechanisms and collaborative relationships

17 leading to universal access to health care;

18 ‘‘(5) the development of a centralized database

19 and information system relating to the health care

20 status, health care needs, and wellness of Native

21 Hawaiians; and

22 ‘‘(6) the establishment of a Native Hawaiian

23 Center of Excellence for Nursing at the University

24 of Hawaii at Hilo, a Native Hawaiian Center of Ex25 cellence for Mental Health at the University of Ha-
66

•S 1929 IS

1 waii at Manoa, a Native Hawaiian Center of Excel2 lence for Maternal Health and Nutrition at the

3 Waimanalo Health Center, and a Native Hawaiian

4 Center of Excellence for Research, Training, and In5 tegrated Medicine at Molokai General Hospital.

6 ‘‘(b) NONREDUCTION IN OTHER FUNDING.—The al7 location of funds for demonstration projects under sub8 section (a) shall not result in a reduction in funds required

9 by the Native Hawaiian health care systems, the Native

10 Hawaiian Health Scholarship Program, or Papa Ola

11 Lokahi to carry out their respective responsibilities under

12 this Act.

13 ‘‘SEC. 14. NATIONAL BIPARTISAN COMMISSION ON NATIVE

14 HAWAIIAN HEALTH CARE ENTITLEMENT.

15 ‘‘(a) ESTABLISHMENT.—There is hereby established

16 a National Bipartisan Native Hawaiian Health Care Enti17 tlement Commission (referred to in this Act as the ‘Com18 mission’).

19 ‘‘(b) MEMBERSHIP.—The Commission shall be com20 posed of 21 members to be appointed as follows:

21 ‘‘(1) CONGRESSIONAL MEMBERS.—

22 ‘‘(A) APPOINTMENT.—Eight members of

23 the Commission shall be members of Congress,

24 of which—
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•S 1929 IS

1 ‘‘(i) two members shall be from the

2 House of Representatives and shall be ap3 pointed by the Majority Leader;

4 ‘‘(ii) two members shall be from the

5 House of Representatives and shall be ap6 pointed by the Minority Leader;

7 ‘‘(iii) two members shall be from the

8 Senate and shall be appointed by the Ma9 jority Leader; and

10 ‘‘(iv) two members shall be from the

11 Senate and shall be appointed by the Mi12 nority Leader.

13 ‘‘(B) RELEVANT COMMITTEE MEMBER14 SHIP.—The members of the Commission ap15 pointed under subparagraph (A) shall each be

16 members of the committees of Congress that

17 consider legislation affecting the provision of

18 health care to Native Hawaiians and other Na19 tive American.

20 ‘‘(C) CHAIRPERSON.—The members of the

21 Commission appointed under subparagraph (A)

22 shall elect the chairperson and vice-chairperson

23 of the Commission.
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•S 1929 IS

1 ‘‘(2) HAWAIIAN HEALTH MEMBERS.—Eleven

2 members of the Commission shall be appointed by

3 Hawaiian health entities, of which—

4 ‘‘(A) five members shall be appointed by

5 the Native Hawaiian Health Care Systems;

6 ‘‘(B) one member shall be appointed by the

7 Hawaii State Primary Care Association;

8 ‘‘(C) one member shall be appointed by

9 Papa Ola Lokahi;

10 ‘‘(D) one member shall be appointed by the

11 State Council of Hawaiian Homestead Associa12 tions;

13 ‘‘(E) one member shall be appointed by the

14 Office of Hawaiian Affairs; and

15 ‘‘(F) two members shall be appointed by

16 the Association of Hawaiian Civic Clubs and

17 shall represent Native Hawaiian populations on

18 the United States continent.

19 ‘‘(3) SECRETARIAL MEMBERS.—Two members

20 of the Commission shall be appointed by the Sec21 retary and shall possess knowledge of the health

22 concerns and wellness issues facing Native Hawai23 ians.

24 ‘‘(c) TERMS.—
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•S 1929 IS

1 ‘‘(1) IN GENERAL.—The members of the Com2 mission shall serve for the life of the Commission.

3 ‘‘(2) INITIAL APPOINTMENT OF MEMBERS.—

4 The members of the Commission shall be appointed

5 under subsection (b)(1) not later than 90 days after

6 the date of enactment of this Act, and the remaining

7 members of the Commission shall be appointed not

8 later than 60 days after the date on which the mem9 bers are appointed under such subsection (b)(1).

10 ‘‘(3) VACANCIES.—A vacancy in the member11 ship of the Commission shall be filled in the manner

12 in which the original appointment was made.

13 ‘‘(d) DUTIES OF THE COMMISSION.—The Commis14 sion shall carry out the following duties and functions:

15 ‘‘(1) Review and analyze the recommendations

16 of the report of the study committee established

17 under paragraph (3).

18 ‘‘(2) Make recommendations to Congress for

19 the provision of health services to Native Hawaiian

20 individuals as an entitlement, giving due regard to

21 the effects of a program on existing health care de22 livery systems for Native Hawaiians and the effect

23 of such programs on self-determination and their

24 reconciliation.
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•S 1929 IS

1 ‘‘(3) Establish a study committee to be com2 posed of at least 10 members from the Commission,

3 including 4 members of the members appointed

4 under subsection (b)(1), 5 of the members appointed

5 under subsection (b)(2), and 1 of the members ap6 pointed by the Secretary under subsection (b)(3),

7 which shall—

8 ‘‘(A) to the extent necessary to carry out

9 its duties, collect and compile data necessary to

10 understand the extent of Native Hawaiian

11 needs with regards to the provision of health

12 services, including holding hearings and solic13 iting the views of Native Hawaiians and Native

14 Hawaiian organizations, and which may include

15 authorizing and funding feasibility studies of

16 various models for all Native Hawaiian bene17 ficiaries and their families, including those that

18 live on the United States continent;

19 ‘‘(B) make recommendations to the Com20 mission for legislation that will provide for the

21 culturally-competent and appropriate provision

22 of health services for Native Hawaiians as an

23 entitlement, which shall, at a minimum, address

24 issues of eligibility and benefits to be provided,

25 including recommendations regarding from
71

•S 1929 IS

1 whom such health services are to be provided

2 and the cost and mechanisms for funding of the

3 health services to be provided;

4 ‘‘(C) determine the effect of the enactment

5 of such recommendations on the existing system

6 of delivery of health services for Native Hawai7 ians;

8 ‘‘(D) determine the effect of a health serv9 ice entitlement program for Native Hawaiian

10 individuals on their self-determination and the

11 reconciliation of their relationship with the

12 United States;

13 ‘‘(E) not later than 12 months after the

14 date of the appointment of all members of the

15 Commission, make a written report of its find16 ings and recommendations to the Commission,

17 which report shall include a statement of the

18 minority and majority position of the committee

19 and which shall be disseminated, at a minimum,

20 to Native Hawaiian organizations and agencies

21 and health organizations referred to in sub22 section (b)(2) for comment to the Commission;

23 and

24 ‘‘(F) report regularly to the full Commis25 sion regarding the findings and recommenda-
72

•S 1929 IS

1 tions developed by the committee in the course

2 of carrying out its duties under this section.

3 ‘‘(4) Not later than 18 months after the date

4 of the appointment of all members of the Commis5 sion, submit a written report to Congress containing

6 a recommendation of policies and legislation to im7 plement a policy that would establish a health care

8 system for Native Hawaiians, grounded in their cul9 ture, and based on the delivery of health services as

10 an entitlement, together with a determination of the

11 implications of such an entitlement system on exist12 ing health care delivery systems for Native Hawai13 ians and their self-determination and the reconcili14 ation of their relationship with the United States.

15 ‘‘(e) ADMINISTRATIVE PROVISIONS.—

16 ‘‘(1) COMPENSATION AND EXPENSES.—

17 ‘‘(A) CONGRESSIONAL MEMBERS.—Each

18 member of the Commission appointed under

19 subsection (b)(1) shall not receive any addi20 tional compensation, allowances, or benefits by

21 reason of their service on the Commission. Such

22 members shall receive travel expenses and per

23 diem in lieu of subsistence in accordance with

24 sections 5702 and 5703 of title 5, United

25 States Code.
73

•S 1929 IS

1 ‘‘(B) OTHER MEMBERS.—The members of

2 the Commission appointed under paragraphs

3 (2) and (3) of subsection (b) shall, while serv4 ing on the business of the Commission (includ5 ing travel time), receive compensation at the

6 per diem equivalent of the rate provided for in7 dividuals under level IV of the Executive Sched8 ule under section 5315 of title 5, United States

9 Code, and while serving away from their home

10 or regular place of business, be allowed travel

11 expenses, as authorized by the chairperson of

12 the Commission.

13 ‘‘(C) OTHER PERSONNEL.—For purposes

14 of compensation (other than compensation of

15 the members of the Commission) and employ16 ment benefits, rights, and privileges, all per17 sonnel of the Commission shall be treated as if

18 they were employees of the Senate.

19 ‘‘(2) MEETINGS AND QUORUM.—

20 ‘‘(A) MEETINGS.—The Commission shall

21 meet at the call of the chairperson.

22 ‘‘(B) QUORUM.—A quorum of the Commis23 sion shall consist of not less than 12 members,

24 of which—
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•S 1929 IS

1 ‘‘(i) not less than 4 of such members

2 shall be appointees under subsection

3 (b)(1)l;

4 ‘‘(ii) not less than 7 of such members

5 shall be appointees under subsection

6 (b)(2); and

7 ‘‘(iii) not less than 1 of such members

8 shall be an appointee under subsection

9 (b)(3).

10 ‘‘(3) DIRECTOR AND STAFF.—

11 ‘‘(A) EXECUTIVE DIRECTOR.—The mem12 bers of the Commission shall appoint an execu13 tive director of the Commission. The executive

14 director shall be paid the rate of basic pay

15 equal to that under level V of the Executive

16 Schedule under section 5316 of title 5, United

17 States Code.

18 ‘‘(B) STAFF.—With the approval of the

19 Commission, the executive director may appoint

20 such personnel as the executive director deems

21 appropriate.

22 ‘‘(C) APPLICABILITY OF CIVIL SERVICE

23 LAWS.—The staff of the Commission shall be

24 appointed without regard to the provisions of

25 title 5, United States Code, governing appoint-
75

•S 1929 IS

1 ments in the competitive service, and shall be

2 paid without regard to the provisions of chapter

3 51 and subchapter III of chapter 53 of such

4 title (relating to classification and General

5 Schedule pay rates).

6 ‘‘(D) EXPERTS AND CONSULTANTS.—With

7 the approval of the Commission, the executive

8 director may procure temporary and intermit9 tent services under section 3109(b) of title 5,

10 United States Code.

11 ‘‘(E) FACILITIES.—The Administrator of

12 the General Services Administration shall locate

13 suitable office space for the operations of the

14 Commission in the State of Hawaii. The facili15 ties shall serve as the headquarters of the Com16 mission and shall include all necessary equip17 ment and incidentals required for the proper

18 functioning of the Commission.

19 ‘‘(f) POWERS.—

20 ‘‘(1) HEARINGS AND OTHER ACTIVITIES.—For

21 purposes of carrying out its duties, the Commission

22 may hold such hearings and undertake such other

23 activities as the Commission determines to be nec24 essary to carry out its duties, except that at least 8

25 hearings shall be held on each of the Hawaiian Is-
76

•S 1929 IS

1 lands and 3 hearings in the continental United

2 States in areas where large numbers of Native Ha3 waiians are present. Such hearings shall be held to

4 solicit the views of Native Hawaiians regarding the

5 delivery of health care services to such individuals.

6 To constitute a hearing under this paragraph, at

7 least 4 members of the Commission, including at

8 least 1 member of Congress, must be present. Hear9 ings held by the study committee established under

10 subsection (d)(3) may be counted towards the num11 ber of hearings required under this paragraph.

12 ‘‘(2) STUDIES BY THE GENERAL ACCOUNTING

13 OFFICE.—Upon the request of the Commission, the

14 Comptroller General shall conduct such studies or

15 investigations as the Commission determines to be

16 necessary to carry out its duties.

17 ‘‘(3) COST ESTIMATES.—

18 ‘‘(A) IN GENERAL.—The Director of the

19 Congressional Budget Office or the Chief Actu20 ary of the Health Care Financing Administra21 tion, or both, shall provide to the Commission,

22 upon the request of the Commission, such cost

23 estimates as the Commission determines to be

24 necessary to carry out its duties.
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•S 1929 IS

1 ‘‘(B) REIMBURSEMENTS.—The Commis2 sion shall reimburse the Director of the Con3 gressional Budget Office for expenses relating

4 to the employment in the office of the Director

5 of such additional staff as may be necessary for

6 the Director to comply with requests by the

7 Commission under subparagraph (A).

8 ‘‘(4) DETAIL OF FEDERAL EMPLOYEES.—Upon

9 the request of the Commission, the head of any Fed10 eral agency is authorized to detail, without reim11 bursement, any of the personnel of such agency to

12 the Commission to assist the Commission in car13 rying out its duties. Any such detail shall not inter14 rupt or otherwise affect the civil service status or

15 privileges of the Federal employees.

16 ‘‘(5) TECHNICAL ASSISTANCE.—Upon the re17 quest of the Commission, the head of any Federal

18 agency shall provide such technical assistance to the

19 Commission as the Commission determines to be

20 necessary to carry out its duties.

21 ‘‘(6) USE OF MAILS.—The Commission may use

22 the United States mails in the same manner and

23 under the same conditions as Federal agencies and

24 shall, for purposes of the frank, be considered a
78

•S 1929 IS

1 commission of Congress as described in section 3215

2 of title 39, United States Code.

3 ‘‘(7) OBTAINING INFORMATION.—The Commis4 sion may secure directly from any Federal agency

5 information necessary to enable the Commission to

6 carry out its duties, if the information may be dis7 closed under section 552 of title 5, United States

8 Code. Upon request of the chairperson of the Com9 mission, the head of such agency shall furnish such

10 information to the Commission.

11 ‘‘(8) SUPPORT SERVICES.—Upon the request of

12 the Commission, the Administrator of General Serv13 ices shall provide to the Commission on a reimburs14 able basis such administrative support services as

15 the Commission may request.

16 ‘‘(9) PRINTING.—For purposes of costs relating

17 to printing and binding, including the cost of per18 sonnel detailed from the Government Printing Of19 fice, the Commission shall be deemed to be a com20 mittee of Congress.

21 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There

22 is authorized to be appropriated $1,500,000 to carry out

23 this section. The amount appropriated under this sub24 section shall not result in a reduction in any other appro-
79

•S 1929 IS

1 priation for health care or health services for Native Ha2 waiians.

3 ‘‘SEC. 15. RULE OF CONSTRUCTION.

4 ‘‘Nothing in this Act shall be construed to restrict

5 the authority of the State of Hawaii to license health prac6 titioners.

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

8 ‘‘Any new spending authority (described in subpara9 graph (A) of (B) of section 401(c)(2) of the Congressional

10 Budget Act of 1974 (2 U.S.C. 651(c)(2) (A) or (B)))

11 which is provided under this Act shall be effective for any

12 fiscal year only to such extent or in such amounts as are

13 provided for in appropriation Acts.

14 ‘‘SEC. 17. SEVERABILITY.

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

16 any such provision to any person or circumstances is held

17 to be invalid, the remainder of this Act, and the applica18 tion of such provision or amendment to persons or cir19 cumstances other than those to which it is held invalid,

20 shall not be affected thereby.’’.

Æ