106TH CONGRESS

2D SESSION S. 1929

AN ACT

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 2000’’.
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1 SEC. 2. AMENDMENT TO THE NATIVE HAWAIIAN HEALTH

2 CARE IMPROVEMENT ACT.

3 The Native Hawaiian Health Care Improvement Act

4 (42 U.S.C. 11701 et seq.) is amended to read as follows:

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

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

7 ‘Native Hawaiian Health Care Improvement Act’.

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

9 of this Act is as follows:

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

‘‘Sec. 2. Findings.

‘‘Sec. 3. Definitions.

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

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

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

‘‘Sec. 7. Native Hawaiian health care.

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

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

‘‘Sec. 10. Assignment of personnel.

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

‘‘Sec. 12. Report.

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

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

‘‘Sec. 15. National Bipartisan Commission on Native Hawaiian Health

Care Entitlement.

‘‘Sec. 16. Rule of construction.

‘‘Sec. 17. Compliance with Budget Act.

‘‘Sec. 18. Severability.

10 ‘‘SEC. 2. FINDINGS.

11 ‘‘(a) GENERAL FINDINGS.—Congress makes the fol12 lowing findings:

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

14 the Kumulipo which details the creation and inter15 relationship of all things, including their evolvement

16 as healthy and well people.
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1 ‘‘(2) Native Hawaiians are a distinct and

2 unique indigenous peoples with a historical con3 tinuity to the original inhabitants of the Hawaiian

4 archipelago within Ke Moananui, the Pacific Ocean,

5 and have a distinct society organized almost 2,000

6 years ago.

7 ‘‘(3) The health and well-being of Native Ha8 waiians are intrinsically tied to their deep feelings

9 and attachment to their lands and seas.

10 ‘‘(4) The long-range economic and social

11 changes in Hawaii over the 19th and early 20th cen12 turies have been devastating to the health and well13 being of Native Hawaiians.

14 ‘‘(5) Native Hawaiians have never directly relin15 quished to the United States their claims to their in16 herent sovereignty as a people or over their national

17 territory, either through their monarchy or through

18 a plebiscite or referendum.

19 ‘‘(6) The Native Hawaiian people are deter20 mined to preserve, develop and transmit to future

21 generations their ancestral territory, and their cul22 tural identity in accordance with their own spiritual

23 and traditional beliefs, customs, practices, language,

24 and social institutions. In referring to themselves,

25 Native Hawaiians use the term ‘Kanaka Maoli’, a
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1 term frequently used in the 19th century to describe

2 the native people of Hawaii.

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

4 of Hawaii—

5 ‘‘(A) acknowledge the distinct land rights

6 of Native Hawaiian people as beneficiaries of

7 the public lands trust; and

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

9 of the Native Hawaiian people to practice and

10 perpetuate their cultural and religious customs,

11 beliefs, practices, and language.

12 ‘‘(8) At the time of the arrival of the first non13 indigenous peoples in Hawaii in 1778, the Native

14 Hawaiian people lived in a highly organized, self-suf15 ficient, subsistence social system based on communal

16 land tenure with a sophisticated language, culture,

17 and religion.

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

19 Hawaiian Islands was established in 1810 under Ka20 mehameha I, the first King of Hawaii.

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

22 1893, the United States—

23 ‘‘(A) recognized the independence of the

24 Hawaiian Nation;
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1 ‘‘(B) extended full and complete diplomatic

2 recognition to the Hawaiian Government; and

3 ‘‘(C) entered into treaties and conventions

4 with the Hawaiian monarchs to govern com5 merce and navigation in 1826, 1842, 1849,

6 1875 and 1887.

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

8 States Minister assigned to the sovereign and inde9 pendent Kingdom of Hawaii, conspired with a small

10 group of non-Hawaiian residents of the Kingdom,

11 including citizens of the United States, to overthrow

12 the indigenous and lawful government of Hawaii.

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

14 United States Minister and the naval representative

15 of the United States caused armed naval forces of

16 the United States to invade the sovereign Hawaiian

17 Nation in support of the overthrow of the indigenous

18 and lawful Government of Hawaii and the United

19 States Minister thereupon extended diplomatic rec20 ognition of a provisional government formed by the

21 conspirators without the consent of the native people

22 of Hawaii or the lawful Government of Hawaii in

23 violation of treaties between the 2 nations and of

24 international law.
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1 ‘‘(13) In a message to Congress on December

2 18, 1893, then President Grover Cleveland reported

3 fully and accurately on these illegal actions, and ac4 knowledged that by these acts, described by the

5 President as acts of war, the government of a peace6 ful and friendly people was overthrown, and the

7 President concluded that a ‘substantial wrong has

8 thus been done which a due regard for our national

9 character as well as the rights of the injured people

10 required that we should endeavor to repair’.

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

12 of Hawaii, and the Hawaiian Patriotic League, rep13 resenting the aboriginal citizens of Hawaii, promptly

14 petitioned the United States for redress of these

15 wrongs and for restoration of the indigenous govern16 ment of the Hawaiian nation, but this petition was

17 not acted upon.

18 ‘‘(15) The United States has acknowledged the

19 significance of these events and has apologized to

20 Native Hawaiians on behalf of the people of the

21 United States for the overthrow of the Kingdom of

22 Hawaii with the participation of agents and citizens

23 of the United States, and the resulting deprivation

24 of the rights of Native Hawaiians to self-determina-
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1 tion in legislation enacted into law in 1993 (Public

2 Law 103–150; 107 Stat. 1510).

3 ‘‘(16) In 1898, the United States annexed Ha4 waii through the Newlands Resolution without the

5 consent of or compensation to the indigenous peoples

6 of Hawaii or their sovereign government who were

7 thereby denied the mechanism for expression of their

8 inherent sovereignty through self-government and

9 self-determination, their lands and ocean resources.

10 ‘‘(17) Through the Newlands Resolution and

11 the 1900 Organic Act, the Congress received

12 1,750,000 acres of lands formerly owned by the

13 Crown and Government of the Hawaiian Kingdom

14 and exempted the lands from then existing public

15 land laws of the United States by mandating that

16 the revenue and proceeds from these lands be ‘used

17 solely for the benefit of the inhabitants of the Ha18 waiian Islands for education and other public pur19 poses’, thereby establishing a special trust relation20 ship between the United States and the inhabitants

21 of Hawaii.

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

23 Homes Commission Act, 1920, which designated

24 200,000 acres of the ceded public lands for exclusive

25 homesteading by Native Hawaiians, thereby affirm-
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1 ing the trust relationship between the United States

2 and the Native Hawaiians, as expressed by then Sec3 retary of the Interior Franklin K. Lane who was

4 cited in the Committee Report of the Committee on

5 Territories of the House of Representatives as stat6 ing, ‘One thing that impressed me . . . was the fact

7 that the natives of the islands . . . for whom in a

8 sense we are trustees, are falling off rapidly in num9 bers and many of them are in poverty.’.

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

11 the unique status of the Native Hawaiian people by

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

13 et seq.), a provision to lease lands within the exten14 sion to Native Hawaiians and to permit fishing in

15 the area ‘only by native Hawaiian residents of said

16 area or of adjacent villages and by visitors under

17 their guidance’.

18 ‘‘(20) Under the Act entitled ‘An Act to provide

19 for the admission of the State of Hawaii into the

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

21 United States transferred responsibility for the ad22 ministration of the Hawaiian Home Lands to the

23 State of Hawaii but reaffirmed the trust relationship

24 which existed between the United States and the

25 Native Hawaiian people by retaining the exclusive
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1 power to enforce the trust, including the power to

2 approve land exchanges, and legislative amendments

3 affecting the rights of beneficiaries under such Act.

4 ‘‘(21) Under the Act entitled ‘An Act to provide

5 for the admission of the State of Hawaii into the

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

7 United States transferred responsibility for adminis8 tration over portions of the ceded public lands trust

9 not retained by the United States to the State of

10 Hawaii but reaffirmed the trust relationship which

11 existed between the United States and the Native

12 Hawaiian people by retaining the legal responsibility

13 of the State for the betterment of the conditions of

14 Native Hawaiians under section 5(f) of such Act.

15 ‘‘(22) In 1978, the people of Hawaii amended

16 their Constitution to establish the Office of Hawai17 ian Affairs and assigned to that body the authority

18 to accept and hold real and personal property trans19 ferred from any source in trust for the Native Ha20 waiian people, to receive payments from the State of

21 Hawaii due to the Native Hawaiian people in satis22 faction of the pro rata share of the proceeds of the

23 Public Land Trust created under section 5 of the

24 Admission Act of 1959 (Public Law 83–3), to act as

25 the lead State agency for matters affecting the Na-
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1 tive Hawaiian people, and to formulate policy on af2 fairs relating to the Native Hawaiian people.

3 ‘‘(23) The authority of the Congress under the

4 Constitution to legislate in matters affecting the ab5 original or indigenous peoples of the United States

6 includes the authority to legislate in matters affect7 ing the native peoples of Alaska and Hawaii.

8 ‘‘(24) The United States has recognized the au9 thority of the Native Hawaiian people to continue to

10 work towards an appropriate form of sovereignty as

11 defined by the Native Hawaiian people themselves in

12 provisions set forth in legislation returning the Ha13 waiian Island of Kaho‘olawe to custodial manage14 ment by the State of Hawaii in 1994.

15 ‘‘(25) In furtherance of the trust responsibility

16 for the betterment of the conditions of Native Ha17 waiians, the United States has established a pro18 gram for the provision of comprehensive health pro19 motion and disease prevention services to maintain

20 and improve the health status of the Hawaiian peo21 ple. This program is conducted by the Native Ha22 waiian Health Care Systems, the Native Hawaiian

23 Health Scholarship Program and Papa Ola Lokahi.

24 Health initiatives from these and other health insti25 tutions and agencies using Federal assistance have
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1 been responsible for reducing the century-old mor2 bidity and mortality rates of Native Hawaiian people

3 by providing comprehensive disease prevention,

4 health promotion activities and increasing the num5 ber of Native Hawaiians in the health and allied

6 health professions. This has been accomplished

7 through the Native Hawaiian Health Care Act of

8 1988 (Public Law 100–579) and its reauthorization

9 in section 9168 of Public Law 102–396 (106 Stat.

10 1948).

11 ‘‘(26) This historical and unique legal relation12 ship has been consistently recognized and affirmed

13 by Congress through the enactment of Federal laws

14 which extend to the Native Hawaiian people the

15 same rights and privileges accorded to American In16 dian, Alaska Native, Eskimo, and Aleut commu17 nities, including the Native American Programs Act

18 of 1974 (42 U.S.C. 2991 et seq.), the American In19 dian Religious Freedom Act (42 U.S.C. 1996), the

20 National Museum of the American Indian Act (20

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

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

23 3001 et seq.).

24 ‘‘(27) The United States has also recognized

25 and reaffirmed the trust relationship to the Native
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1 Hawaiian people through legislation which author2 izes the provision of services to Native Hawaiians,

3 specifically, the Older Americans Act of 1965 (42

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

5 Assistance and Bill of Rights Act Amendments of

6 1987, the Veterans’ Benefits and Services Act of

7 1988, the Rehabilitation Act of 1973 (29 U.S.C. 701

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

9 1988 (Public Law 100–579), the Health Professions

10 Reauthorization Act of 1988, the Nursing Shortage

11 Reduction and Education Extension Act of 1988,

12 the Handicapped Programs Technical Amendments

13 Act of 1988, the Indian Health Care Amendments

14 of 1988, and the Disadvantaged Minority Health

15 Improvement Act of 1990.

16 ‘‘(28) The United States has also affirmed the

17 historical and unique legal relationship to the Ha18 waiian people by authorizing the provision of serv19 ices to Native Hawaiians to address problems of al20 cohol and drug abuse under the Anti-Drug Abuse

21 Act of 1986 (Public Law 99–570).

22 ‘‘(29) Further, the United States has recog23 nized that Native Hawaiians, as aboriginal, indige24 nous, native peoples of Hawaii, are a unique popu25 lation group in Hawaii and in the continental United
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1 States and has so declared in Office of Management

2 and Budget Circular 15 in 1997 and Presidential

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

4 ‘‘(30) Despite the United States having ex5 pressed its commitment to a policy of reconciliation

6 with the Native Hawaiian people for past grievances

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

8 health needs of the Native Hawaiian people remain

9 severe and their health status continues to be far

10 below that of the general population of the United

11 States.

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

13 Congress finds that the unmet needs and serious health

14 disparities that adversely affect the Native Hawaiian peo15 ple include the following:

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

17 ‘‘(A) CANCER.—

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

19 cancer—

20 ‘‘(I) Native Hawaiians have the

21 highest cancer mortality rates in the

22 State of Hawaii (231.0 out of every

23 100,000 residents), 45 percent higher

24 than that for the total State popu-
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1 lation (159.7 out of every 100,000

2 residents);

3 ‘‘(II) Native Hawaiian males

4 have the highest cancer mortality

5 rates in the State of Hawaii for can6 cers of the lung, liver and pancreas

7 and for all cancers combined;

8 ‘‘(III) Native Hawaiian females

9 ranked highest in the State of Hawaii

10 for cancers of the lung, liver, pan11 creas, breast, cervix uteri, corpus

12 uteri, stomach, and rectum, and for

13 all cancers combined;

14 ‘‘(IV) Native Hawaiian males

15 have the highest years of productive

16 life lost from cancer in the State of

17 Hawaii with 8.7 years compared to

18 6.4 years for all males; and

19 ‘‘(V) Native Hawaiian females

20 have 8.2 years of productive life lost

21 from cancer in the State of Hawaii as

22 compared to 6.4 years for all females

23 in the State of Hawaii;

24 ‘‘(ii) BREAST CANCER.—With respect

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

2 highest mortality rates in the State of

3 Hawaii from breast cancer (37.96 out

4 of every 100,000 residents), which is

5 25 percent higher than that for Cau6 casian Americans (30.25 out of every

7 100,000 residents) and 106 percent

8 higher than that for Chinese Ameri9 cans (18.39 out of every 100,000 resi10 dents); and

11 ‘‘(II) nationally, Native Hawai12 ians have the third highest mortality

13 rates due to breast cancer (25.0 out

14 of every 100,000 residents) following

15 African Americans (31.4 out of every

16 100,000 residents) and Caucasian

17 Americans (27.0 out of every 100,000

18 residents).

19 ‘‘(iii) CANCER OF THE CERVIX.—Na20 tive Hawaiians have the highest mortality

21 rates from cancer of the cervix in the State

22 of Hawaii (3.82 out of every 100,000 resi23 dents) followed by Filipino Americans

24 (3.33 out of every 100,000 residents) and
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1 Caucasian Americans (2.61 out of every

2 100,000 residents).

3 ‘‘(iv) LUNG CANCER.—Native Hawai4 ians have the highest mortality rates from

5 lung cancer in the State of Hawaii (90.70

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

7 61 percent higher than Caucasian Ameri8 cans, who rank second and 161 percent

9 higher than Japanese Americans, who rank

10 third.

11 ‘‘(v) PROSTATE CANCER.—Native Ha12 waiian males have the second highest mor13 tality rates due to prostate cancer in the

14 State of Hawaii (25.86 out of every

15 100,000 residents) with Caucasian Ameri16 cans having the highest mortality rate

17 from prostate cancer (30.55 out of every

18 100,000 residents).

19 ‘‘(B) DIABETES.—With respect to diabe20 tes, for the years 1989 through 1991—

21 ‘‘(i) Native Hawaiians had the highest

22 mortality rate due to diabetes mellitis

23 (34.7 out of every 100,000 residents) in

24 the State of Hawaii which is 130 percent

25 higher than the statewide rate for all other
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1 races (15.1 out of every 100,000 resi2 dents);

3 ‘‘(ii) full-blood Hawaiians had a mor4 tality rate of 93.3 out of every 100,000

5 residents, which is 518 percent higher than

6 the rate for the statewide population of all

7 other races; and

8 ‘‘(iii) Native Hawaiians who are less

9 than full-blood had a mortality rate of 27.1

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

11 percent higher than the rate for the state12 wide population of all other races.

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

14 ‘‘(i) in 1990, Native Hawaiians com15 prised 44 percent of all asthma cases in

16 the State of Hawaii for those 18 years of

17 age and younger, and 35 percent of all

18 asthma cases reported; and

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

20 rate for asthma was 81.7 out of every

21 1000 residents, which was 73 percent high22 er than the rate for the total statewide

23 population of 47.3 out of every 1000 resi24 dents.

25 ‘‘(D) CIRCULATORY DISEASES.—
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1 ‘‘(i) HEART DISEASE.—With respect

2 to heart disease—

3 ‘‘(I) the death rate for Native

4 Hawaiians from heart disease (333.4

5 out of every 100,000 residents) is 66

6 percent higher than for the entire

7 State of Hawaii (201.1 out of every

8 100,000 residents); and

9 ‘‘(II) Native Hawaiian males

10 have the greatest years of productive

11 life lost in the State of Hawaii where

12 Native Hawaiian males lose an aver13 age of 15.5 years and Native Hawai14 ian females lose an average of 8.2

15 years due to heart disease, as com16 pared to 7.5 years for all males in the

17 State of Hawaii and 6.4 years for all

18 females.

19 ‘‘(ii) HYPERTENSION.—The death

20 rate for Native Hawaiians from hyper21 tension (3.5 out of every 100,000 resi22 dents) is 84 percent higher than that for

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

24 residents).
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1 ‘‘(iii) STROKE.—The death rate for

2 Native Hawaiians from stroke (58.3 out of

3 every 100,000 residents) is 13 percent

4 higher than that for the entire State (51.8

5 out of every 100,000 residents).

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

7 incidence of AIDS for Native Hawaiians is at least

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

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

10 State of Hawaii.

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

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

13 from injuries (38.8 out of every 100,000 resi14 dents) is 45 percent higher than that for the

15 entire State (26.8 out of every 100,000 resi16 dents);

17 ‘‘(B) Native Hawaiian males lose an aver18 age of 14 years of productive life lost from inju19 ries as compared to 9.8 years for all other

20 males in Hawaii; and

21 ‘‘(C) Native Hawaiian females lose and av22 erage of 4 years of productive life lost from in23 juries but this rate is the highest rate among

24 all females in the State of Hawaii.
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1 ‘‘(4) DENTAL HEALTH.—With respect to dental

2 health—

3 ‘‘(A) Native Hawaiian children exhibit

4 among the highest rates of dental caries in the

5 nation, and the highest in the State of Hawaii

6 as compared to the 5 other major ethnic groups

7 in the State;

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

9 filled primary teeth for Native Hawaiian chil10 dren ages 5 through 9 years was 4.3 as com11 pared with 3.7 for the entire State of Hawaii

12 and 1.9 for the United States; and

13 ‘‘(C) the proportion of Native Hawaiian

14 children ages 5 through 12 years with unmet

15 treatment needs (defined as having active den16 tal caries requiring treatment) is 40 percent as

17 compared with 33 percent for all other races in

18 the State of Hawaii.

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

20 expectancy—

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

22 expectancy of all population groups in the State

23 of Hawaii;

24 ‘‘(B) between 1910 and 1980, the life ex25 pectancy of Native Hawaiians from birth has
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1 ranged from 5 to 10 years less than that of the

2 overall State population average; and

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

4 Native Hawaiian life expectancy at birth (74.27

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

6 total State population (78.85 years).

7 ‘‘(6) MATERNAL AND CHILD HEALTH.—

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

9 prenatal care—

10 ‘‘(i) as of 1996, Native Hawaiian

11 women have the highest prevalence (21

12 percent) of having had no prenatal care

13 during their first trimester of pregnancy

14 when compared to the 5 largest ethnic

15 groups in the State of Hawaii;

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

17 Hawaii who received no prenatal care

18 throughout their pregnancy in 1996, 44

19 percent were Native Hawaiian;

20 ‘‘(iii) over 65 percent of the referrals

21 to Healthy Start in fiscal years 1996 and

22 1997 were Native Hawaiian newborns; and

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

24 Hawaii, many Native Hawaiian newborns

25 begin life in a potentially hazardous cir-
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1 cumstance, far higher than any other ra2 cial group.

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

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

5 births to Native Hawaiian mothers were

6 infants born to single mothers which sta7 tistics indicate put infants at higher risk of

8 low birth weight and infant mortality;

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

10 Hawaiian single mothers, 8 percent were

11 low birth weight (under 2500 grams); and

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

13 born to single mothers in the State of Ha14 waii, 44 percent were Native Hawaiian.

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

16 to births—

17 ‘‘(i) in 1993 and 1994, Native Hawai18 ians had the highest percentage of teen

19 (individuals who were less than 18 years of

20 age) births (8.1 percent) compared to the

21 rate for all other races in the State of Ha22 waii (3.6 percent);

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

24 mothers in Hawaii under 18 years of age

25 were Native Hawaiian;
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1 ‘‘(iii) lower rates of abortion (a third

2 lower than for the statewide population)

3 among Hawaiian women may account in

4 part, for the higher percentage of live

5 births;

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

7 age 14 years and younger in Hawaii, 66

8 percent were Native Hawaiian; and

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

10 same group, 48 percent were Native Ha11 waiian.

12 ‘‘(D) FETAL MORTALITY.—In 1996, Na13 tive Hawaiian fetal mortality rates comprised

14 15 percent of all fetal deaths for the State of

15 Hawaii. However, for fetal deaths occurring in

16 mothers under the age of 18 years, 32 percent

17 were Native Hawaiian, and for mothers 18

18 through 24 years of age, 28 percent were Na19 tive Hawaiians.

20 ‘‘(7) MENTAL HEALTH.—

21 ‘‘(A) ALCOHOL AND DRUG ABUSE.—With

22 respect to alcohol and drug abuse—

23 ‘‘(i) Native Hawaiians represent 38

24 percent of the total admissions to Depart25 ment of Health, Alcohol, Drugs and Other
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1 Drugs, funded substance abuse treatment

2 programs;

3 ‘‘(ii) in 1997, the prevalence of ciga4 rette smoking by Native Hawaiians was

5 28.5 percent, a rate that is 53 percent

6 higher than that for all other races in the

7 State of Hawaii which is 18.6 percent;

8 ‘‘(iii) Native Hawaiians have the high9 est prevalence rates of acute alcohol drink10 ing (31 percent), a rate that is 79 percent

11 higher than that for all other races in the

12 State of Hawaii;

13 ‘‘(iv) the chronic alcohol drinking rate

14 among Native Hawaiians is 54 percent

15 higher than that for all other races in the

16 State of Hawaii;

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

18 Hawaiian adults surveyed reported having

19 used marijuana compared with 30 percent

20 for all other races in the State of Hawaii;

21 and

22 ‘‘(vi) nine percent of the Native Ha23 waiian adults surveyed reported that they

24 are current users (within the past year) of
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1 marijuana, compared with 6 percent for all

2 other races in the State of Hawaii.

3 ‘‘(B) CRIME.—With respect to crime—

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

5 were made for property crimes in the State

6 of Hawaii, arrests of Native Hawaiians

7 comprised 20 percent of that total;

8 ‘‘(ii) Native Hawaiian juveniles com9 prised a third of all juvenile arrests in

10 1996;

11 ‘‘(iii) In 1996, Native Hawaiians rep12 resented 21 percent of the 8,000 adults ar13 rested for violent crimes in the State of

14 Hawaii, and 38 percent of the 4,066 juve15 nile arrests;

16 ‘‘(iv) Native Hawaiians are over-rep17 resented in the prison population in Ha18 waii;

19 ‘‘(v) in 1995 and 1996 Native Hawai20 ians comprised 36.5 percent of the sen21 tenced felon prison population in Hawaii,

22 as compared to 20.5 percent for Caucasian

23 Americans, 3.7 percent for Japanese

24 Americans, and 6 percent for Chinese

25 Americans;
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1 ‘‘(vi) in 1995 and 1996 Native Ha2 waiians made up 45.4 percent of the tech3 nical violator population, and at the Ha4 waii Youth Correctional Facility, Native

5 Hawaiians constituted 51.6 percent of all

6 detainees in fiscal year 1997; and

7 ‘‘(vii) based on anecdotal information

8 from inmates at the Halawa Correction

9 Facilities, Native Hawaiians are estimated

10 to comprise between 60 and 70 percent of

11 all inmates.

12 ‘‘(8) HEALTH PROFESSIONS EDUCATION AND

13 TRAINING.—With respect to health professions edu14 cation and training—

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

16 older have a comparable rate of high school

17 completion, however, the rates of baccalaureate

18 degree achievement amongst Native Hawaiians

19 are less than the norm in the State of Hawaii

20 (6.9 percent and 15.76 percent respectively);

21 ‘‘(B) Native Hawaiian physicians make up

22 4 percent of the total physician workforce in the

23 State of Hawaii; and

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

25 comprised 8 percent of those individuals who
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1 earned Bachelor’s Degrees, 14 percent of those

2 individuals who earned professional diplomas, 6

3 percent of those individuals who earned Mas4 ter’s Degrees, and less than 1 percent of indi5 viduals who earned doctoral degrees at the Uni6 versity of Hawaii.

7 ‘‘SEC. 3. DEFINITIONS.

8 ‘‘In this Act:

9 ‘‘(1) DEPARTMENT.—The term ‘department’

10 means the Department of Health and Human Serv11 ices.

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

13 prevention’ includes—

14 ‘‘(A) immunizations;

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

16 ‘‘(C) control of sexually transmittable dis17 eases;

18 ‘‘(D) prevention and control of chronic dis19 eases;

20 ‘‘(E) control of toxic agents;

21 ‘‘(F) occupational safety and health;

22 ‘‘(G) injury prevention;

23 ‘‘(H) fluoridation of water;

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

25 ‘‘(J) provision of mental health care.
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1 ‘‘(3) HEALTH PROMOTION.—The term ‘health

2 promotion’ includes—

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

4 prevention of fetal alcohol syndrome;

5 ‘‘(B) cessation of tobacco smoking;

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

7 harmful illicit drugs;

8 ‘‘(D) improvement of nutrition;

9 ‘‘(E) improvement in physical fitness;

10 ‘‘(F) family planning;

11 ‘‘(G) control of stress;

12 ‘‘(H) reduction of major behavioral risk

13 factors and promotion of healthy lifestyle prac14 tices; and

15 ‘‘(I) integration of cultural approaches to

16 health and well-being, including traditional

17 practices relating to the atmosphere (lewa lani),

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

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

20 Hawaiian’ means any individual who is Kanaka

21 Maoli (a descendant of the aboriginal people who,

22 prior to 1778, occupied and exercised sovereignty in

23 the area that now constitutes the State of Hawaii)

24 as evidenced by—

25 ‘‘(A) genealogical records,
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1 ‘‘(B) kama‘aina witness verification from

2 Native Hawaiian Kupuna (elders); or

3 ‘‘(C) birth records of the State of Hawaii

4 or any State or territory of the United States.

5 ‘‘(5) 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—
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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 ‘‘(6) NATIVE HAWAIIAN HEALTH CENTER.—The

15 term ‘Native Hawaiian Health Center’ means any

16 organization that is a primary care provider and

17 that—

18 ‘‘(A) has a governing board that is com19 posed of individuals, at least 50 percent of

20 whom are Native Hawaiians;

21 ‘‘(B) has demonstrated cultural com22 petency in a predominantly Native Hawaiian

23 community;

24 ‘‘(C) serves a patient population that—
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1 ‘‘(i) is made up of individuals at least

2 50 percent of whom are Native Hawaiian;

3 or

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

5 Hawaiians as annual users of services; and

6 ‘‘(D) is recognized by Papa Ola Lokahi has

7 having met all the criteria of this paragraph.

8 ‘‘(7) NATIVE HAWAIIAN HEALTH TASK

9 FORCE.—The term ‘Native Hawaiian Health Task

10 Force’ means a task force established by the State

11 Council of Hawaiian Homestead Associations to im12 plement health and wellness strategies in Native Ha13 waiian communities.

14 ‘‘(8) 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
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1 ‘‘(ii) a public or nonprofit private enti2 ty.

3 ‘‘(9) OFFICE OF HAWAIIAN AFFAIRS.—The

4 terms ‘Office of Hawaiian Affairs’ and ‘OHA’ mean

5 the governmental entity established under Article

6 XII, sections 5 and 6 of the Hawaii State Constitu7 tion and charged with the responsibility to formulate

8 policy relating to the affairs of Native Hawaiians.

9 ‘‘(10) PAPA OLA LOKAHI.—

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

11 Lokahi’ means an organization that is com12 posed of public agencies and private organiza13 tions focusing on improving the health status of

14 Native Hawaiians. Board members of such or15 ganization may include representation from—

16 ‘‘(i) E Ola Mau;

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

18 the State of Hawaii;

19 ‘‘(iii) Alu Like, Inc.;

20 ‘‘(iv) the University of Hawaii;

21 ‘‘(v) the Hawaii State Department of

22 Health;

23 ‘‘(vi) the Kamehameha Schools, or

24 other Native Hawaiian organization re25 sponsible for the administration of the Na-
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1 tive Hawaiian Health Scholarship Pro2 gram;

3 ‘‘(vii) the Hawaii State Primary Care

4 Association, or Native Hawaiian Health

5 Centers whose patient populations are pre6 dominantly Native Hawaiian;

7 ‘‘(viii) Ahahui O Na Kauka, the Na8 tive Hawaiian Physicians Association;

9 ‘‘(ix) Ho‘ola Lahui Hawaii, or a

10 health care system serving the islands of

11 Kaua‘i or Ni‘ihau, and which may be com12 posed of as many health care centers as

13 are necessary to meet the health care

14 needs of the Native Hawaiians of those is15 lands;

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

17 system serving the island of O‘ahu and

18 which may be composed of as many health

19 care centers as are necessary to meet the

20 health care needs of the Native Hawaiians

21 of that island;

22 ‘‘(xi) Na Pu‘uwai or a health care sys23 tem serving the islands of Moloka‘i or

24 Lana‘i, and which may be composed of as

25 many health care centers as are necessary
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1 to meet the health care needs of the Native

2 Hawaiians of those islands;

3 ‘‘(xii) Hui No Ke Ola Pono, or a

4 health care system serving the island of

5 Maui, and which may be composed of as

6 many health care centers as are necessary

7 to meet the health care needs of the Native

8 Hawaiians of that island;

9 ‘‘(xiii) Hui Malama Ola Na ‘Oiwi, or

10 a health care system serving the island of

11 Hawaii, and which may be composed of as

12 many health care centers as are necessary

13 to meet the health care needs of the Native

14 Hawaiians of that island;

15 ‘‘(xiv) other Native Hawaiian health

16 care systems as certified and recognized by

17 Papa Ola Lokahi in accordance with this

18 Act; and

19 ‘‘(xv) such other member organiza20 tions as the Board of Papa Ola Lokahi will

21 admit from time to time, based upon satis22 factory demonstration of a record of con23 tribution to the health and well-being of

24 Native Hawaiians.
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1 ‘‘(B) LIMITATION.—Such term does not in2 clude any organization described in subpara3 graph (A) if the Secretary determines that such

4 organization has not developed a mission state5 ment with clearly defined goals and objectives

6 for the contributions the organization will make

7 to the Native Hawaiian health care systems, the

8 national policy as set forth in section 4, and an

9 action plan for carrying out those goals and ob10 jectives.

11 ‘‘(11) PRIMARY HEALTH SERVICES.—The term

12 ‘primary health services’ means—

13 ‘‘(A) services of physicians, physicians’ as14 sistants, nurse practitioners, and other health

15 professionals;

16 ‘‘(B) diagnostic laboratory and radiologic

17 services;

18 ‘‘(C) preventive health services including

19 perinatal services, well child services, family

20 planning services, nutrition services, home

21 health services, and, generally, all those services

22 associated with enhanced health and wellness.

23 ‘‘(D) emergency medical services;

24 ‘‘(E) transportation services as required

25 for adequate patient care;
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1 ‘‘(F) preventive dental services;

2 ‘‘(G) pharmaceutical and medicament serv3 ices;

4 ‘‘(H) primary care services that may lead

5 to specialty or tertiary care; and

6 ‘‘(I) complimentary healing practices, in7 cluding those performed by traditional Native

8 Hawaiian healers.

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

10 means the Secretary of Health and Human Services.

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

13 means a practitioner—

14 ‘‘(A) who—

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

16 and

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

19 individuals; and

20 ‘‘(B) whose knowledge, skills, and experi21 ence are based on demonstrated learning of Na22 tive Hawaiian healing practices acquired by—

23 ‘‘(i) direct practical association with

24 Native Hawaiian elders; and
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1 ‘‘(ii) oral traditions transmitted from

2 generation to generation.

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

4 HEALTH POLICY.

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

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

7 responsibilities and legal obligations to the indigenous peo8 ples of Hawaii resulting from the unique and historical

9 relationship between the United States and the indigenous

10 peoples of Hawaii—

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

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

14 care programs with all resources necessary to effec15 tuate this policy.

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

17 Congress that—

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

21 among those suffering from chronic and acute dis22 ease and illness and addressing the health needs, in23 cluding perinatal, early child development, and fam24 ily-based health education, of Native Hawaiians shall

25 be established and implemented; and
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1 ‘‘(2) the Nation raise the health status of Na2 tive Hawaiians by the year 2010 to at least the lev3 els set forth in the goals contained within Healthy

4 People 2010 or successor standards and to incor5 porate within health programs, activities defined and

6 identified by Kanaka Maoli which may include—

7 ‘‘(A) incorporating and supporting the in8 tegration of cultural approaches to health and

9 well-being, including programs using traditional

10 practices relating to the atmosphere (lewa lani),

11 land (’aina), water (wai), or ocean (kai);

12 ‘‘(B) increasing the number of health and

13 allied-health care providers who are trained to

14 provide culturally competent care to Native Ha15 waiians;

16 ‘‘(C) increasing the use of traditional Na17 tive Hawaiian foods in peoples’ diets and die18 tary preferences including those of students and

19 the use of these traditional foods in school feed20 ing programs;

21 ‘‘(D) identifying and instituting Native

22 Hawaiian cultural values and practices within

23 the ‘corporate cultures’ of organizations and

24 agencies providing health services to Native Ha25 waiians;
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1 ‘‘(E) facilitating the provision of Native

2 Hawaiian healing practices by Native Hawaiian

3 healers for those clients desiring such assist4 ance; and

5 ‘‘(F) supporting training and education ac6 tivities and programs in traditional Native Ha7 waiian healing practices by Native Hawaiian

8 healers.

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

10 President, for inclusion in each report required to be

11 transmitted to Congress under section 12, a report on the

12 progress made towards meeting the National policy as set

13 forth in this section.

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

15 FOR NATIVE HAWAIIANS.

16 ‘‘(a) DEVELOPMENT.—

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

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

19 Lokahi for the purpose of coordinating, imple20 menting and updating a Native Hawaiian com21 prehensive health care master plan designed to pro22 mote comprehensive health promotion and disease

23 prevention services and to maintain and improve the

24 health status of Native Hawaiians, and to support
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1 community-based initiatives that are reflective of ho2 listic approaches to health.

3 ‘‘(2) CONSULTATION.—

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

5 the Office of Hawaiian Affairs shall consult

6 with the Native Hawaiian health care systems,

7 Native Hawaiian health centers, and the Native

8 Hawaiian community in carrying out this sec9 tion.

10 ‘‘(B) MEMORANDA OF UNDERSTANDING.—

11 Papa Ola Lokahi and the Office of Hawaiian

12 Affairs may enter into memoranda of under13 standing or agreement for the purposes of ac14 quiring joint funding and for other issues as

15 may be necessary to accomplish the objectives

16 of this section.

17 ‘‘(3) HEALTH CARE FINANCING STUDY RE18 PORT.—Not later than 18 months after the date of

19 enactment of this Act, Papa Ola Lokahi in coopera20 tion with the Office of Hawaiian Affairs and other

21 appropriate agencies of the State of Hawaii, includ22 ing the Department of Health and the Department

23 of Human Services and the Native Hawaiian health

24 care systems and Native Hawaiian health centers,

25 shall submit to Congress a report detailing the im-
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1 pact of current Federal and State health care fi2 nancing mechanisms and policies on the health and

3 well-being of Native Hawaiians. Such report shall

4 include—

5 ‘‘(A) information concerning the impact of

6 cultural competency, risk assessment data, eligi7 bility requirements and exemptions, and reim8 bursement policies and capitation rates cur9 rently in effect for service providers;

10 ‘‘(B) any other such information as may be

11 important to improving the health status of Na12 tive Hawaiians as such information relates to

13 health care financing including barriers to

14 health care; and

15 ‘‘(C) the recommendations for submission

16 to the Secretary for review and consultation

17 with Native Hawaiians.

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

19 are authorized to be appropriated such sums as may be

20 necessary to carry out subsection (a).

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

22 HAWAIIAN AFFAIRS.

23 ‘‘(a) RESPONSIBILITY.—Papa Ola Lokahi shall be re24 sponsible for the—
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1 ‘‘(1) coordination, implementation, and updat2 ing, as appropriate, of the comprehensive health care

3 master plan developed pursuant to section 5;

4 ‘‘(2) training for the persons described in sub5 paragraphs (B) and (C) of section 7(c)(1);

6 ‘‘(3) identification of and research into the dis7 eases that are most prevalent among Native Hawai8 ians, including behavioral, biomedical, epidemiolog9 ical, and health services;

10 ‘‘(4) development and maintenance of an insti11 tutional review board for all research projects involv12 ing all aspects of Native Hawaiian health, including

13 behavioral, biomedical, epidemiological, and health

14 services studies; and

15 ‘‘(5) the maintenance of an action plan out16 lining the contributions that each member organiza17 tion of Papa Ola Lokahi will make in carrying out

18 the policy of this Act.

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

20 may receive special project funds that may be appro21 priated for the purpose of research on the health status

22 of Native Hawaiians or for the purpose of addressing the

23 health care needs of Native Hawaiians.

24 ‘‘(c) CLEARINGHOUSE.—
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1 ‘‘(1) IN GENERAL.—Papa Ola Lokahi shall

2 serve as a clearinghouse for—

3 ‘‘(A) the collection and maintenance of

4 data associated with the health status of Native

5 Hawaiians;

6 ‘‘(B) the identification and research into

7 diseases affecting Native Hawaiians;

8 ‘‘(C) the availability of Native Hawaiian

9 project funds, research projects and publica10 tions;

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

12 area of Native Hawaiian health; and

13 ‘‘(E) the timely dissemination of informa14 tion pertinent to the Native Hawaiian health

15 care systems.

16 ‘‘(2) CONSULTATION.—The Secretary shall pro17 vide Papa Ola Lokahi and the Office of Hawaiian

18 Affairs, at least once annually, an accounting of

19 funds and services provided to States and to non20 profit groups and organizations from the Depart21 ment for the purposes set forth in section 4. Such

22 accounting shall include—

23 ‘‘(A) the amount of funds expended explic24 itly for and benefiting Native Hawaiians;
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1 ‘‘(B) the number of Native Hawaiians im2 pacted by these funds;

3 ‘‘(C) the identification of collaborations

4 made with Native Hawaiian groups and organi5 zations in the expenditure of these funds; and

6 ‘‘(D) the amount of funds used for Federal

7 administrative purposes and for the provision of

8 direct services to Native Hawaiians.

9 ‘‘(d) FISCAL ALLOCATION AND COORDINATION OF

10 PROGRAMS AND SERVICES.—

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

12 shall provide annual recommendations to the Sec13 retary with respect to the allocation of all amounts

14 appropriated under this Act.

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

16 to the maximum extent possible, coordinate and as17 sist the health care programs and services provided

18 to Native Hawaiians.

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

20 Secretary, in consultation with Papa Ola Lokahi,

21 shall make recommendations for Native Hawaiian

22 representation on the President’s Advisory Commis23 sion on Asian Americans and Pacific Islanders.

24 ‘‘(e) TECHNICAL SUPPORT.—Papa Ola Lokahi may

25 act as a statewide infrastructure to provide technical sup-
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1 port and coordination of training and technical assistance

2 to the Native Hawaiian health care systems and to Native

3 Hawaiian health centers.

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

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

6 into agreements or memoranda of understanding

7 with relevant institutions, agencies or organizations

8 that are capable of providing health-related re9 sources or services to Native Hawaiians and the Na10 tive Hawaiian health care systems or of providing

11 resources or services for the implementation of the

12 National policy as set forth in section 4.

13 ‘‘(2) HEALTH CARE FINANCING.—

14 ‘‘(A) FEDERAL CONSULTATION.—Federal

15 agencies providing health care financing and

16 carrying out health care programs, including

17 the Health Care Financing Administration,

18 shall consult with Native Hawaiians and organi19 zations providing health care services to Native

20 Hawaiians prior to the adoption of any policy

21 or regulation that may impact on the provision

22 of services or health insurance coverage. Such

23 consultation shall include the identification of

24 the impact of any proposed policy, rule, or reg25 ulation.
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1 ‘‘(B) STATE CONSULTATION.—The State

2 of Hawaii shall engage in meaningful consulta3 tion with Native Hawaiians and organizations

4 providing health care services to Native Hawai5 ians in the State of Hawaii prior to making any

6 changes or initiating new programs.

7 ‘‘(C) CONSULTATION ON FEDERAL

8 HEALTH INSURANCE PROGRAMS.

9 ‘‘(i) IN GENERAL.—The Office of Ha10 waiian Affairs, in collaboration with Papa

11 Ola Lokahi, may develop consultative, con12 tractual or other arrangements, including

13 memoranda of understanding or agree14 ment, with—

15 ‘‘(I) the Health Care Financing

16 Administration;

17 ‘‘(II) the agency of the State of

18 Hawaii that administers or supervises

19 the administration of the State plan

20 or waiver approved under title XVIII,

21 XIX, or XXI of the Social Security

22 Act for the payment of all or a part

23 of the health care services provided to

24 Native Hawaiians who are eligible for
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1 medical assistance under the State

2 plan or waiver; or

3 ‘‘(III) any other Federal agency

4 or agencies providing full or partial

5 health insurance to Native Hawaiians.

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

8 may address—

9 ‘‘(I) appropriate reimbursement

10 for health care services including capi11 tation rates and fee-for-service rates

12 for Native Hawaiians who are entitled

13 to or eligible for insurance;

14 ‘‘(II) the scope of services; or

15 ‘‘(III) other matters that would

16 enable Native Hawaiians to maximize

17 health insurance benefits provided by

18 Federal and State health insurance

19 programs.

20 ‘‘(3) TRADITIONAL HEALERS.—The provision of

21 health services under any program operated by the

22 Department or another Federal agency including the

23 Department of Veterans Affairs, may include the

24 services of ‘traditional Native Hawaiian healers’ as

25 defined in this Act or ‘traditional healers’ providing
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1 ‘traditional health care practices’ as defined in sec2 tion 4(r) of Public Law 94–437. Such services shall

3 be exempt from national accreditation reviews, in4 cluding reviews conducted by the Joint Accreditation

5 Commission on Health Organizations and the Reha6 bilitation Accreditation Commission.

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

8 ‘‘(a) COMPREHENSIVE HEALTH PROMOTION, DIS9 EASE PREVENTION, AND PRIMARY HEALTH SERVICES.—

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

11 in consultation with Papa Ola Lokahi, may make

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

13 entity for the purpose of providing comprehensive

14 health promotion and disease prevention services, as

15 well as primary health services, to Native Hawaiians

16 who desire and are committed to bettering their own

17 health.

18 ‘‘(2) PREFERENCE.—In making grants and en19 tering into contracts under this subsection, the Sec20 retary shall give preference to Native Hawaiian

21 health care systems and Native Hawaiian organiza22 tions and, to the extent feasible, health promotion

23 and disease prevention services shall be performed

24 through Native Hawaiian health care systems.
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1 ‘‘(3) QUALIFIED ENTITY.—An entity is a quali2 fied entity for purposes of paragraph (1) if the enti3 ty is a Native Hawaiian health care system or a Na4 tive Hawaiian Center.

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

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

7 a contract with, not more than 8 Native Hawaiian

8 health care systems under this subsection during

9 any fiscal year.

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

11 to grants and contracts under subsection (a), the Sec12 retary may make a grant to, or enter into a contract with,

13 Papa Ola Lokahi for the purpose of planning Native Ha14 waiian health care systems to serve the health needs of

15 Native Hawaiian communities on each of the islands of

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

17 Ni‘ihau in the State of Hawaii.

18 ‘‘(c) SERVICES TO BE PROVIDED.—

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

20 under subsection (a) shall ensure that the following

21 services either are provided or arranged for:

22 ‘‘(A) Outreach services to inform Native

23 Hawaiians of the availability of health services.

24 ‘‘(B) Education in health promotion and

25 disease prevention of the Native Hawaiian pop-
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1 ulation by, wherever possible, Native Hawaiian

2 health care practitioners, community outreach

3 workers, counselors, and cultural educators.

4 ‘‘(C) Services of physicians, physicians’ as5 sistants, nurse practitioners or other health and

6 allied-health professionals.

7 ‘‘(D) Immunizations.

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

9 high blood pressure, and otitis media.

10 ‘‘(F) Pregnancy and infant care.

11 ‘‘(G) Improvement of nutrition.

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

13 and reduction of the incidence of preventable

14 illnesses and conditions endemic to Native Ha15 waiians.

16 ‘‘(I) Collection of data related to the pre17 vention of diseases and illnesses among Native

18 Hawaiians.

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

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

21 and ‘primary health services’, as such terms are

22 defined in section 3, which are not specifically

23 referred to in subsection (a).

24 ‘‘(K) Support of culturally appropriate ac25 tivities enhancing health and wellness including
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1 land-based, water-based, ocean-based, and spir2 itually-based projects and programs.

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

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

6 may be provided by traditional Native Hawaiian

7 healers.

8 ‘‘(d) FEDERAL TORT CLAIMS ACT.—Individuals who

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

10 subsection (a)(1) for Native Hawaiian health care sys11 tems, including providers of traditional Native Hawaiian

12 healing services, shall be treated as if such individuals

13 were members of the Public Health Service and shall be

14 covered under the provisions of section 224 of the Public

15 Health Service Act.

16 ‘‘(e) SITE FOR OTHER FEDERAL PAYMENTS.—A Na17 tive Hawaiian health care system that receives funds

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

19 appropriate staff to serve as a Federal loan repayment fa20 cility. Such facility shall be designed to enable health and

21 allied-health professionals to remit payments with respect

22 to loans provided to such professionals under any Federal

23 loan program.

24 ‘‘(f) RESTRICTION ON USE OF GRANT AND CON25 TRACT FUNDS.—The Secretary may not make a grant to,
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1 or enter into a contract with, an entity under subsection

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

3 such grant or contract will not, directly or through con4 tract, be expended—

5 ‘‘(1) for any services other than the services de6 scribed in subsection (c)(1); or

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

8 (other than minor remodeling of existing improve9 ments to real property) or to purchase major med10 ical equipment.

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

12 Secretary may not make a grant to, or enter into a con13 tract with, an entity under subsection (a) unless the entity

14 agrees that, whether health services are provided directly

15 or through contract—

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

17 will be provided without regard to ability to pay for

18 the health services; and

19 ‘‘(2) the entity will impose a charge for the de20 livery of health services, and such charge—

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

22 of charges that is made available to the public;

23 and

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

25 of the individual involved.
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1 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—

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

3 to be appropriated such sums as may be necessary

4 for each of fiscal years 2001 through 2011 to carry

5 out subsection (a).

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

7 to be appropriated such sums as may be necessary

8 for each of fiscal years 2001 through 2011 to carry

9 out subsection (b).

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

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

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

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

14 ‘‘(1) coordination, implementation, and updat15 ing (as appropriate) of the comprehensive health

16 care master plan developed pursuant to section 5;

17 ‘‘(2) training for the persons described section

18 7(c)(1);

19 ‘‘(3) identification of and research into the dis20 eases that are most prevalent among Native Hawai21 ians, including behavioral, biomedical, epidemiologic,

22 and health services;

23 ‘‘(4) the maintenance of an action plan out24 lining the contributions that each member organiza-
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1 tion of Papa Ola Lokahi will make in carrying out

2 the policy of this Act;

3 ‘‘(5) a clearinghouse function for—

4 ‘‘(A) the collection and maintenance of

5 data associated with the health status of Native

6 Hawaiians;

7 ‘‘(B) the identification and research into

8 diseases affecting Native Hawaiians; and

9 ‘‘(C) the availability of Native Hawaiian

10 project funds, research projects and publica11 tions;

12 ‘‘(6) the establishment and maintenance of an

13 institutional review board for all health-related re14 search involving Native Hawaiians;

15 ‘‘(7) the coordination of the health care pro16 grams and services provided to Native Hawaiians;

17 and

18 ‘‘(8) the administration of special project funds.

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

20 is authorized to be appropriated such sums as may be nec21 essary for each of fiscal years 2001 through 2011 to carry

22 out subsection (a).

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

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

25 include in any grant made or contract entered into under
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1 this Act such terms and conditions as the Secretary con2 siders necessary or appropriate to ensure that the objec3 tives of such grant or contract are achieved.

4 ‘‘(b) PERIODIC REVIEW.—The Secretary shall peri5 odically evaluate the performance of, and compliance with,

6 grants and contracts under this Act.

7 ‘‘(c) ADMINISTRATIVE REQUIREMENTS.—The Sec8 retary may not make a grant or enter into a contract

9 under this Act with an entity unless the entity—

10 ‘‘(1) agrees to establish such procedures for fis11 cal control and fund accounting as may be necessary

12 to ensure proper disbursement and accounting with

13 respect to the grant or contract;

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

15 records maintained on individuals receiving health

16 services under the grant or contract;

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

18 any population of Native Hawaiians, a substantial

19 portion of which has a limited ability to speak the

20 English language—

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

22 carry out a reasonable plan to provide health

23 services under the grant or contract through in24 dividuals who are able to communicate with the
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1 population involved in the language and cultural

2 context that is most appropriate; and

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

4 fluent in both English and the appropriate lan5 guage, to assist in carrying out the plan;

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

7 covered under programs under titles XVIII, XIX, or

8 XXI of the Social Security Act, including any State

9 plan, or under any other Federal health insurance

10 plan—

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

12 grant or contract any such health services

13 directly—

14 ‘‘(i) the entity has entered into a par15 ticipation agreement under such plans; and

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

17 payments under such plan; and

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

19 grant or contract any such health services

20 through a contract with an organization—

21 ‘‘(i) the organization has entered into

22 a participation agreement under such plan;

23 and

24 ‘‘(ii) the organization is qualified to

25 receive payments under such plan; and
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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
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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) REPORT.—
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1 ‘‘(1) IN GENERAL.—For each fiscal year during

2 which an entity receives or expends funds pursuant

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

4 shall submit to the Secretary and to Papa Ola

5 Lokahi an annual report—

6 ‘‘(A) on the activities conducted by the en7 tity under the grant or contract;

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

9 which Federal funds were expended; and

10 ‘‘(C) containing such other information as

11 the Secretary may request.

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

13 entity concerning any grant or contract under this

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

15 Inspector General of the Department of Health and

16 Human Services, and the Comptroller General of the

17 United States.

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

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

20 under this Act the cost of an annual private audit con21 ducted by a certified public accountant.

22 ‘‘SEC. 10. ASSIGNMENT OF PERSONNEL.

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

24 agreement with any entity under which the Secretary may

25 assign personnel of the Department of Health and Human
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1 Services with expertise identified by such entity to such

2 entity on detail for the purposes of providing comprehen3 sive health promotion and disease prevention services to

4 Native Hawaiians.

5 ‘‘(b) APPLICABLE FEDERAL PERSONNEL PROVI6 SIONS.—Any assignment of personnel made by the Sec7 retary under any agreement entered into under subsection

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

9 to a local government that is made in accordance with sub10 chapter VI of chapter 33 of title 5, United States Code.

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

12 FELLOWSHIPS.

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

14 amounts appropriated under subsection (c), the Secretary

15 shall provide funds through a direct grant or a cooperative

16 agreement to Kamehameha Schools or another Native Ha17 waiian organization or health care organization with expe18 rience in the administration of educational scholarships or

19 placement services for the purpose of providing scholar20 ship assistance to students who—

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

22 the Public Health Service Act, except for assistance

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

24 ‘‘(2) are Native Hawaiians.
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1 ‘‘(b) PRIORITY.—A priority for scholarships under

2 subsection (a) may be provided to employees of the Native

3 Hawaiian Health Care Systems and the Native Hawaiian

4 Health Centers.

5 ‘‘(c) TERMS AND CONDITIONS.—

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

7 under subsection (a) shall be provided under the

8 same terms and subject to the same conditions, reg9 ulations, and rules as apply to scholarship assistance

10 provided under section 338A of the Public Health

11 Service Act (except as provided for in paragraph

12 (2)), except that—

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

14 type of health care profession training shall cor15 respond to the need for each type of health care

16 professional to serve the Native Hawaiian com17 munity as identified by Papa Ola Lokahi;

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

19 the Secretary shall select scholarship recipients

20 from a list of eligible applicants submitted by

21 the Kamehameha Schools or the Native Hawai22 ian organization administering the program;

23 ‘‘(C) the obligated service requirement for

24 each scholarship recipient (except for those re25 ceiving assistance under paragraph (2)) shall be
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1 fulfilled through service, in order of priority,

2 in—

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

4 health care systems or Native Hawaiian

5 health centers;

6 ‘‘(ii) health professions shortage

7 areas, medically underserved areas, or geo8 graphic areas or facilities similarly des9 ignated by the United States Public Health

10 Service in the State of Hawaii; or

11 ‘‘(iii) a geographical area, facility, or

12 organization that serves a significant Na13 tive Hawaiian population;

14 ‘‘(D) the scholarship’s placement service

15 shall assign Native Hawaiian scholarship recipi16 ents to appropriate sites for service.

17 ‘‘(E) the provision of counseling, retention

18 and other support services shall not be limited

19 to scholarship recipients, but shall also include

20 recipients of other scholarship and financial aid

21 programs enrolled in appropriate health profes22 sions training programs.

23 ‘‘(F) financial assistance may be provided

24 to scholarship recipients in those health profes25 sions designated in such section 338A of the
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1 Public Health Service Act while they are ful2 filling their service requirement in any one of

3 the Native Hawaiian health care systems or

4 community health centers.

5 ‘‘(2) FELLOWSHIPS.—Financial assistance

6 through fellowships may be provided to Native Ha7 waiian community health representatives, outreach

8 workers, and health program administrators in pro9 fessional training programs, and to Native Hawai10 ians in certificated programs provided by traditional

11 Native Hawaiian healers in any of the traditional

12 Native Hawaiian healing practices including lomi13 lomi, la‘au lapa‘au, and ho‘oponopono. Such assist14 ance may include a stipend or reimbursement for

15 costs associated with participation in the program.

16 ‘‘(3) RIGHTS AND BENEFITS.—Scholarship re17 cipients in health professions designated in section

18 338A of the Public Health Service Act while ful19 filling their service requirements shall have all the

20 same rights and benefits of members of the National

21 Health Service Corps during their period of service.

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

23 INCOME.—Financial assistance provided under sec24 tion 11 shall be deemed ‘Qualified Scholarships’ for
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1 purposes of the section amended by section 123(a)

2 of Public Law 99–514, as amended.

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

4 is authorized to be appropriated such sums as may be nec5 essary for each of fiscal years 2001 through 2011 for the

6 purpose of funding the scholarship assistance program

7 under subsection (a) and fellowship assistance under sub8 section (c)(2).

9 ‘‘SEC. 12. REPORT.

10 ‘‘The President shall, at the time the budget is sub11 mitted under section 1105 of title 31, United States Code,

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

13 progress made in meeting the objectives of this Act, in14 cluding a review of programs established or assisted pur15 suant to this Act and an assessment and recommendations

16 of additional programs or additional assistance necessary

17 to, at a minimum, provide health services to Native Ha18 waiians, and ensure a health status for Native Hawaiians,

19 which are at a parity with the health services available

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

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

22 SOURCES OF SUPPLY.

23 ‘‘(a) IN GENERAL.—The Secretary shall permit orga24 nizations that receive contracts or grants under this Act,

25 in carrying out such contracts or grants, to use existing
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1 facilities and all equipment therein or under the jurisdic2 tion of the Secretary under such terms and conditions as

3 may be agreed upon for the use and maintenance of such

4 facilities or equipment.

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

6 donate to organizations that receive contracts or grants

7 under this Act any personal or real property determined

8 to be in excess of the needs of the Department or the Gen9 eral Services Administration for purposes of carrying out

10 such contracts or grants.

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

12 Secretary may acquire excess or surplus Federal Govern13 ment personal or real property for donation to organiza14 tions that receive contracts or grants under this Act if the

15 Secretary determines that the property is appropriate for

16 the use by the organization for the purpose for which a

17 contract or grant is authorized under this Act.

18 ‘‘SEC. 14. DEMONSTRATION PROJECTS OF NATIONAL SIG19 NIFICANCE.

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

21 Secretary, in consultation with Papa Ola Lokahi, may allo22 cate amounts appropriated under this Act, or any other

23 Act, to carry out Native Hawaiian demonstration projects

24 of national significance. The areas of interest of such

25 projects may include—
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1 ‘‘(1) the development of a centralized database

2 and information system relating to the health care

3 status, health care needs, and wellness of Native

4 Hawaiians;

5 ‘‘(2) the education of health professionals, and

6 other individuals in institutions of higher learning,

7 in health and allied health programs in healing prac8 tices, including Native Hawaiian healing practices;

9 ‘‘(3) the integration of Western medicine with

10 complementary healing practices including tradi11 tional Native Hawaiian healing practices;

12 ‘‘(4) the use of tele-wellness and telecommuni13 cations in chronic disease management and health

14 promotion and disease prevention;

15 ‘‘(5) the development of appropriate models of

16 health care for Native Hawaiians and other indige17 nous peoples including the provision of culturally

18 competent health services, related activities focusing

19 on wellness concepts, the development of appropriate

20 kupuna care programs, and the development of fi21 nancial mechanisms and collaborative relationships

22 leading to universal access to health care; and

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

24 Center of Excellence for Nursing at the University

25 of Hawaii at Hilo, a Native Hawaiian Center of Ex-
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1 cellence for Mental Health at the University of Ha2 waii at Manoa, a Native Hawaiian Center of Excel3 lence for Maternal Health and Nutrition at the

4 Waimanalo Health Center, and a Native Hawaiian

5 Center of Excellence for Research, Training, Inte6 grated Medicine at Molokai General Hospital and a

7 Native Hawaiian Center of Excellence for Com8 plimentary Health and Health Education and Train9 ing at the Waianae Coast Comprehensive Health

10 Center.

11 ‘‘(b) NONREDUCTION IN OTHER FUNDING.—The al12 location of funds for demonstration projects under sub13 section (a) shall not result in a reduction in funds required

14 by the Native Hawaiian health care systems, the Native

15 Hawaiian Health Centers, the Native Hawaiian Health

16 Scholarship Program, or Papa Ola Lokahi to carry out

17 their respective responsibilities under this Act.

18 ‘‘SEC. 15. NATIONAL BIPARTISAN COMMISSION ON NATIVE

19 HAWAIIAN HEALTH CARE ENTITLEMENT.

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

21 a National Bipartisan Native Hawaiian Health Care Enti22 tlement Commission (referred to in this Act as the ‘Com23 mission’).

24 ‘‘(b) MEMBERSHIP.—The Commission shall be com25 posed of 21 members to be appointed as follows:
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1 ‘‘(1) CONGRESSIONAL MEMBERS.—

2 ‘‘(A) APPOINTMENT.—Eight members of

3 the Commission shall be members of Congress,

4 of which—

5 ‘‘(i) two members shall be from the

6 House of Representatives and shall be ap7 pointed by the Majority Leader;

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

9 House of Representatives and shall be ap10 pointed by the Minority Leader;

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

12 Senate and shall be appointed by the Ma13 jority Leader; and

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

15 Senate and shall be appointed by the Mi16 nority Leader.

17 ‘‘(B) RELEVANT COMMITTEE MEMBER18 SHIP.—The members of the Commission ap19 pointed under subparagraph (A) shall each be

20 members of the committees of Congress that

21 consider legislation affecting the provision of

22 health care to Native Hawaiians and other Na23 tive Americans.

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

25 Commission appointed under subparagraph (A)
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1 shall elect the chairperson and vice-chairperson

2 of the Commission.

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

4 members of the Commission shall be appointed by

5 Hawaiian health entities, of which—

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

7 the Native Hawaiian Health Care Systems;

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

9 Hawaii State Primary Care Association;

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

11 Papa Ola Lokahi;

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

13 Native Hawaiian Health Task Force;

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

15 Office of Hawaiian Affairs; and

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

17 the Association of Hawaiian Civic Clubs and

18 shall represent Native Hawaiian populations re19 siding in the continental United States.

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

21 of the Commission shall be appointed by the Sec22 retary and shall possess knowledge of Native Hawai23 ian health concerns and wellness.

24 ‘‘(c) TERMS.—
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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 the rec24 onciliation of their relationship with the United

25 States.
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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, compile, qualify, and analyze

10 data necessary to understand the extent of Na11 tive Hawaiian needs with regard to the provi12 sion of health services, including holding hear13 ings and soliciting the views of Native Hawai14 ians and Native Hawaiian organizations, and

15 which may include authorizing and funding fea16 sibility studies of various models for all Native

17 Hawaiian beneficiaries and their families, in18 cluding those that live in the continental United

19 States;

20 ‘‘(B) make recommendations to the Com21 mission for legislation that will provide for the

22 culturally-competent and appropriate provision

23 of health services for Native Hawaiians as an

24 entitlement, which shall, at a minimum, address

25 issues of eligibility and benefits to be provided,
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1 including recommendations regarding from

2 whom such health services are to be provided

3 and the cost and mechanisms for funding of the

4 health services to be provided;

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

6 of such recommendations on the existing system

7 of delivery of health services for Native Hawai8 ians;

9 ‘‘(D) determine the effect of a health serv10 ice entitlement program for Native Hawaiian

11 individuals on their self-determination and the

12 reconciliation of their relationship with the

13 United States;

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

15 date of the appointment of all members of the

16 Commission, make a written report of its find17 ings and recommendations to the Commission,

18 which report shall include a statement of the

19 minority and majority position of the committee

20 and which shall be disseminated, at a minimum,

21 to Native Hawaiian organizations and agencies

22 and health organizations referred to in sub23 section (b)(2) for comment to the Commission;

24 and
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1 ‘‘(F) report regularly to the full Commis2 sion regarding the findings and recommenda3 tions developed by the committee in the course

4 of carrying out its duties under this section.

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

6 of the appointment of all members of the Commis7 sion, submit a written report to Congress containing

8 a recommendation of policies and legislation to im9 plement a policy that would establish a health care

10 system for Native Hawaiians, grounded in their cul11 ture, and based on the delivery of health services as

12 an entitlement, together with a determination of the

13 implications of such an entitlement system on exist14 ing health care delivery systems for Native Hawai15 ians and their self-determination and the reconcili16 ation of their relationship with the United States.

17 ‘‘(e) ADMINISTRATIVE PROVISIONS.—

18 ‘‘(1) COMPENSATION AND EXPENSES.—

19 ‘‘(A) CONGRESSIONAL MEMBERS.—Each

20 member of the Commission appointed under

21 subsection (b)(1) shall not receive any addi22 tional compensation, allowances, or benefits by

23 reason of their service on the Commission. Such

24 members shall receive travel expenses and per

25 diem in lieu of subsistence in accordance with
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1 sections 5702 and 5703 of title 5, United

2 States Code.

3 ‘‘(B) OTHER MEMBERS.—The members of

4 the Commission appointed under paragraphs

5 (2) and (3) of subsection (b) shall, while serv6 ing on the business of the Commission (includ7 ing travel time), receive compensation at the

8 per diem equivalent of the rate provided for in9 dividuals under level IV of the Executive Sched10 ule under section 5315 of title 5, United States

11 Code, and while serving away from their home

12 or regular place of business, be allowed travel

13 expenses, as authorized by the chairperson of

14 the Commission.

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

16 of compensation (other than compensation of

17 the members of the Commission) and employ18 ment benefits, rights, and privileges, all per19 sonnel of the Commission shall be treated as if

20 they were employees of the Senate.

21 ‘‘(2) MEETINGS AND QUORUM.—

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

23 meet at the call of the chairperson.
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1 ‘‘(B) QUORUM.—A quorum of the Commis2 sion shall consist of not less than 12 members,

3 of which—

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

5 shall be appointees under subsection

6 (b)(1);

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

8 shall be appointees under subsection

9 (b)(2); and

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

11 shall be an appointee under subsection

12 (b)(3).

13 ‘‘(3) DIRECTOR AND STAFF.—

14 ‘‘(A) EXECUTIVE DIRECTOR.—The mem15 bers of the Commission shall appoint an execu16 tive director of the Commission. The executive

17 director shall be paid the rate of basic pay

18 equal to that under level V of the Executive

19 Schedule under section 5316 of title 5, United

20 States Code.

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

22 Commission, the executive director may appoint

23 such personnel as the executive director deems

24 appropriate.
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1 ‘‘(C) APPLICABILITY OF CIVIL SERVICE

2 LAWS.—The staff of the Commission shall be

3 appointed without regard to the provisions of

4 title 5, United States Code, governing appoint5 ments in the competitive service, and shall be

6 paid without regard to the provisions of chapter

7 51 and subchapter III of chapter 53 of such

8 title (relating to classification and General

9 Schedule pay rates).

10 ‘‘(D) EXPERTS AND CONSULTANTS.—With

11 the approval of the Commission, the executive

12 director may procure temporary and intermit13 tent services under section 3109(b) of title 5,

14 United States Code.

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

16 the General Services Administration shall locate

17 suitable office space for the operations of the

18 Commission in Washington, D.C. and in the

19 State of Hawaii. The Washington, D.C. facili20 ties shall serve as the headquarters of the Com21 mission while the Hawaii office shall serve a li22 aison function. Both such offices shall include

23 all necessary equipment and incidentals re24 quired for the proper functioning of the Com25 mission.
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1 ‘‘(f) POWERS.—

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

3 purposes of carrying out its duties, the Commission

4 may hold such hearings and undertake such other

5 activities as the Commission determines to be nec6 essary to carry out its duties, except that at least 8

7 hearings shall be held on each of the Hawaiian Is8 lands and 3 hearings in the continental United

9 States in areas where a significant population of Na10 tive Hawaiians reside. Such hearings shall be held to

11 solicit the views of Native Hawaiians regarding the

12 delivery of health care services to such individuals.

13 To constitute a hearing under this paragraph, at

14 least 4 members of the Commission, including at

15 least 1 member of Congress, must be present. Hear16 ings held by the study committee established under

17 subsection (d)(3) may be counted towards the num18 ber of hearings required under this paragraph.

19 ‘‘(2) STUDIES BY THE GENERAL ACCOUNTING

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

21 Comptroller General shall conduct such studies or

22 investigations as the Commission determines to be

23 necessary to carry out its duties.

24 ‘‘(3) COST ESTIMATES.—
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1 ‘‘(A) IN GENERAL.—The Director of the

2 Congressional Budget Office or the Chief Actu3 ary of the Health Care Financing Administra4 tion, or both, shall provide to the Commission,

5 upon the request of the Commission, such cost

6 estimates as the Commission determines to be

7 necessary to carry out its duties.

8 ‘‘(B) REIMBURSEMENTS.—The Commis9 sion shall reimburse the Director of the Con10 gressional Budget Office for expenses relating

11 to the employment in the office of the Director

12 of such additional staff as may be necessary for

13 the Director to comply with requests by the

14 Commission under subparagraph (A).

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

16 the request of the Commission, the head of any Fed17 eral agency is authorized to detail, without reim18 bursement, any of the personnel of such agency to

19 the Commission to assist the Commission in car20 rying out its duties. Any such detail shall not inter21 rupt or otherwise affect the civil service status or

22 privileges of the Federal employees.

23 ‘‘(5) TECHNICAL ASSISTANCE.—Upon the re24 quest of the Commission, the head of any Federal

25 agency shall provide such technical assistance to the
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1 Commission as the Commission determines to be

2 necessary to carry out its duties.

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

4 the United States mails in the same manner and

5 under the same conditions as Federal agencies and

6 shall, for purposes of the frank, be considered a

7 commission of Congress as described in section 3215

8 of title 39, United States Code.

9 ‘‘(7) OBTAINING INFORMATION.—The Commis10 sion may secure directly from any Federal agency

11 information necessary to enable the Commission to

12 carry out its duties, if the information may be dis13 closed under section 552 of title 5, United States

14 Code. Upon request of the chairperson of the Com15 mission, the head of such agency shall furnish such

16 information to the Commission.

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

18 the Commission, the Administrator of General Serv19 ices shall provide to the Commission on a reimburs20 able basis such administrative support services as

21 the Commission may request.

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

23 to printing and binding, including the cost of per24 sonnel detailed from the Government Printing Of-
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1 fice, the Commission shall be deemed to be a com2 mittee of Congress.

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

4 is authorized to be appropriated such sums as may be nec5 essary to carry out this section. The amount appropriated

6 under this subsection shall not result in a reduction in

7 any other appropriation for health care or health services

8 for Native Hawaiians.

9 ‘‘SEC. 16. RULE OF CONSTRUCTION.

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

11 the authority of the State of Hawaii to license health prac12 titioners.

13 ‘‘SEC. 17. COMPLIANCE WITH BUDGET ACT.

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

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

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

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

19 provided for in appropriation Acts.

20 ‘‘SEC. 18. SEVERABILITY.

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

22 any such provision to any person or circumstances is held

23 to be invalid, the remainder of this Act, and the applica24 tion of such provision or amendment to persons or cir-
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1 cumstances other than those to which it is held invalid,

2 shall not be affected thereby.’’.

Passed the Senate September 26 (legislative day,

September 22), 2000.

Attest:

Secretary.

106TH CONGRESS

2D SESSION S. 1929

AN ACT

To amend the Native Hawaiian Health Care

Improvement Act to revise and extend such Act.