II

Calendar No. 765

106TH CONGRESS

2D SESSION S. 1929

[Report No. 106–389]

To amend the Native Hawaiian Health Care Improvement Act to revise

and extend such Act.

IN THE SENATE OF THE UNITED STATES

NOVEMBER 16, 1999

Mr. INOUYE (for himself and Mr. AKAKA) introduced the following bill; which

was read twice and referred to the Committee on Indian Affairs

AUGUST 25, 2000

Reported under authority of the order of the Senate of July 26, 2000, by Mr.

CAMPBELL, with an amendment

[Strike out all after the enacting clause and insert the part printed in italic]

A BILL

To amend the Native Hawaiian Health Care Improvement

Act to revise and extend such Act.

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

3 SECTION 1. SHORT TITLE.

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

5 Health Care Improvement Act Reauthorization of 1999’’.
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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 policy.

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

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

‘‘Sec. 7. Native Hawaiian Health Care Systems.

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

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

‘‘Sec. 10. Assignment of personnel.

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

‘‘Sec. 12. Report.

‘‘Sec. 13. Demonstration projects of national significance.

‘‘Sec. 14. National Bipartisan Commission on Native Hawaiian Health

Care Entitlement.

‘‘Sec. 15. Rule of construction.

‘‘Sec. 16. Compliance with Budget Act.

‘‘Sec. 17. Severability.

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 people with a historical continuity

3 to the original inhabitants of the Hawaiian archi4 pelago and have a distinct society organized almost

5 2,000 years ago.

6 ‘‘(3) Native Hawaiians have never directly relin7 quished to the United States their claims to their in8 herent sovereignty as a people or over their national

9 lands, either through their monarchy or through a

10 plebiscite or referendum.

11 ‘‘(4) The health and well-being of Native Ha12 waiians are intrinsically tied to their deep feelings

13 and attachment to their lands and seas.

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

15 changes in Hawaii over the 19th and early 20th cen16 turies have been devastating to the health and well17 being of Native Hawaiians.

18 ‘‘(6) The Native Hawaiian people are deter19 mined to preserve, develop and transmit to future

20 generations their ancestral territory, and their cul21 tural identity in accordance with their own spiritual

22 and traditional beliefs, customs, practices, language,

23 and social institutions. In referring to themselves,

24 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 people in Hawaii in 1778, the Native Ha14 waiian people lived in a highly organized, self-suffi15 cient, 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) Further, the United States has acknowl19 edged the significance of these events and has apolo20 gized to Native Hawaiians on behalf of the people of

21 the United States for the overthrow of the Kingdom

22 of Hawaii with the participation of agents and citi23 zens of the United States, and the resulting depriva24 tion of the rights of Native Hawaiians to self-deter-
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1 mination in legislation in 1993 (Public Law 103–

2 150; 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 people

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 pro19 vide for the admission of the State of Hawaii into

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

21 the United States transferred responsibility for the

22 administration 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 pro5 vide for the admission of the State of Hawaii into

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

7 the United States transferred responsibility for ad8 ministration over portions of the ceded public lands

9 trust not retained by the United States to the State

10 of Hawaii but reaffirmed the trust relationship

11 which existed between the United States and the

12 Native Hawaiian people by retaining the legal re13 sponsibility of the State for the betterment of the

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

15 such Act.

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

17 Constitution to legislate in matters affecting the ab18 original or indigenous peoples of the United States

19 includes the authority to legislate in matters affect20 ing the native peoples of Alaska and Hawaii.

21 ‘‘(23) Further, the United States has recog22 nized the authority of the Native Hawaiian people to

23 continue to work towards an appropriate form of

24 sovereignty as defined by the Native Hawaiian peo25 ple themselves in provisions set forth in legislation
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1 returning the Hawaiian Island of Kaho‘olawe to cus2 todial management by the State of Hawaii in 1994.

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

4 for the betterment of the conditions of Native Ha5 waiians, the United States has established a pro6 gram for the provision of comprehensive health pro7 motion and disease prevention services to maintain

8 and improve the health status of the Hawaiian peo9 ple. This program is conducted by the Native Ha10 waiian Health Care Systems, the Native Hawaiian

11 Health Scholarship Program and Papa Ola Lokahi.

12 Health initiatives from these and other health insti13 tutions and agencies using Federal assistance have

14 begun to lower the century-old morbidity and mor15 tality rates of Native Hawaiian people by providing

16 comprehensive disease prevention, health promotion

17 activities and increasing the number of Native Ha18 waiians in the health and allied health professions.

19 This has been accomplished through the Native Ha20 waiian Health Care Act of 1988 (Public Law 100–

21 579) and its reauthorization in section 9168 of Pub22 lic Law 102–396 (106 Stat. 1948).

23 ‘‘(25) This historical and unique legal relation24 ship has been consistently recognized and affirmed

25 by Congress through the enactment of Federal laws
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1 which extend to the Native Hawaiian people the

2 same rights and privileges accorded to American In3 dian, Alaska Native, Eskimo, and Aleut commu4 nities, including the Native American Programs Act

5 of 1974 (42 U.S.C. 2991 et seq.), the American In6 dian Religious Freedom Act (42 U.S.C. 1996), the

7 National Museum of the American Indian Act (20

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

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

10 3001 et seq.).

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

12 and reaffirmed the trust relationship to the Native

13 Hawaiian people through legislation which author14 izes the provision of services to Native Hawaiians,

15 specifically, the Older Americans Act of 1965 (42

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

17 Assistance and Bill of Rights Act Amendments of

18 1987, the Veterans’ Benefits and Services Act of

19 1988, the Rehabilitation Act of 1973 (29 U.S.C. 701

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

21 1988 (Public Law 100–579), the Health Professions

22 Reauthorization Act of 1988, the Nursing Shortage

23 Reduction and Education Extension Act of 1988,

24 the Handicapped Programs Technical Amendments

25 Act of 1988, the Indian Health Care Amendments
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1 of 1988, and the Disadvantaged Minority Health

2 Improvement Act of 1990.

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

4 historical and unique legal relationship to the Ha5 waiian people by authorizing the provision of serv6 ices to Native Hawaiians to address problems of al7 cohol and drug abuse under the Anti-Drug Abuse

8 Act of 1986 (Public Law 99–570).

9 ‘‘(28) Further, the United States has recog10 nized that Native Hawaiians, as aboriginal, indige11 nous, native peoples of Hawaii, are a unique popu12 lation group in Hawaii and in the continental United

13 States and has so declared in Office of Management

14 and Budget Circular 15 in 1997 and Presidential

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

16 ‘‘(29) Despite the United States having ex17 pressed its commitment to a policy of reconciliation

18 with the Native Hawaiian people for past grievances

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

20 health needs of the Native Hawaiian people remain

21 severe and their health status continues to be far

22 below that of the general population of the United

23 States.

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

25 Congress finds that the unmet needs and serious health
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1 disparities that adversely affect the Native Hawaiian peo2 ple include the following:

3 ‘‘(1) CHRONIC DISEASE AND ILLNESS.—

4 ‘‘(A) CANCER.—

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

6 cancer—

7 ‘‘(I) Native Hawaiians have the

8 highest cancer mortality rates in the

9 State of Hawaii (231.0 out of every

10 100,000 residents), 45 percent higher

11 than that for the total State popu12 lation (159.7 out of every 100,000

13 residents);

14 ‘‘(II) Native Hawaiian males

15 have the highest cancer mortality

16 rates in the State of Hawaii for can17 cers of the lung, liver and pancreas

18 and for all cancers combined;

19 ‘‘(III) Native Hawaiian females

20 ranked highest in the State of Hawaii

21 for cancers of the lung, liver, pan22 creas, breast, cervix uteri, corpus

23 uteri, stomach, and rectum, and for

24 all cancers combined;
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1 ‘‘(IV) Native Hawaiian males

2 have the highest years of productive

3 life lost from cancer in the State of

4 Hawaii with 8.7 years compared to

5 6.4 years for other males; and

6 ‘‘(V) Native Hawaiian females

7 have 8.2 years of productive life lost

8 from cancer in the State of Hawaii as

9 compared to 6.4 years for other fe10 males in the State of Hawaii;

11 ‘‘(ii) BREAST CANCER.—With respect

12 to breast cancer—

13 ‘‘(I) Native Hawaiians have the

14 highest mortality rates in the State of

15 Hawaii from breast cancer (37.96 out

16 of every 100,000 residents), which is

17 25 percent higher than that for Cau18 casian Americans (30.25 out of every

19 100,000 residents) and 106 percent

20 higher than that for Chinese Ameri21 cans (18.39 out of every 100,000 resi22 dents); and

23 ‘‘(II) nationally, Native Hawai24 ians have the third highest mortality

25 rates due to breast cancer (25.0 out
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1 of every 100,000 residents) following

2 African Americans (31.4 out of every

3 100,000 residents) and Caucasian

4 Americans (27.0 out of every 100,000

5 residents).

6 ‘‘(iii) CANCER OF THE CERVIX.—Na7 tive Hawaiians have the highest mortality

8 rates from cancer of the cervix in the State

9 of Hawaii (3.82 out of every 100,000 resi10 dents) followed by Filipino Americans

11 (3.33 out of every 100,000 residents) and

12 Caucasian Americans (2.61 out of every

13 100,000 residents).

14 ‘‘(iv) LUNG CANCER.—Native Hawai15 ians have the highest mortality rates from

16 lung cancer in the State of Hawaii (90.70

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

18 61 percent higher than Caucasian Ameri19 cans, who rank second and 161 percent

20 higher than Japanese Americans, who rank

21 third.

22 ‘‘(v) PROSTATE CANCER.—Native Ha23 waiian males have the second highest mor24 tality rates due to prostate cancer in the

25 State of Hawaii (25.86 out of every
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1 100,000 residents) with Caucasian Ameri2 cans having the highest mortality rate

3 from prostate cancer (30.55 out of every

4 100,000 residents).

5 ‘‘(B) DIABETES.—With respect to diabe6 tes, for the years 1989 through 1991—

7 ‘‘(i) Native Hawaiians had the highest

8 mortality rate due to diabetes mellitis

9 (34.7 out of every 100,000 residents) in

10 the State of Hawaii which is 130 percent

11 higher than the statewide rate for all other

12 races (15.1 out of every 100,000 resi13 dents);

14 ‘‘(ii) full-blood Hawaiians had a mor15 tality rate of 93.3 out of every 100,000

16 residents, which is 518 percent higher than

17 the rate for the statewide population of all

18 other races; and

19 ‘‘(iii) Native Hawaiians who are less

20 than full-blood had a mortality rate of 27.1

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

22 percent higher than the rate for the state23 wide population of all other races.

24 ‘‘(C) ASTHMA.—With respect to asthma—
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1 ‘‘(i) in 1990, Native Hawaiians com2 prised 44 percent of all asthma cases in

3 the State of Hawaii for those 18 years of

4 age and younger, and 35 percent of all

5 asthma cases reported; and

6 ‘‘(ii) in 1992, the Native Hawaiian

7 rate for asthma was 81.7 out of every

8 1000 residents, which was 73 percent high9 er than the rate for the total statewide

10 population of 47.3 out of every 1000 resi11 dents.

12 ‘‘(D) CIRCULATORY DISEASES.—

13 ‘‘(i) HEART DISEASE.—With respect

14 to heart disease—

15 ‘‘(I) the death rate for Native

16 Hawaiians from heart disease (333.4

17 out of every 100,000 residents) is 66

18 percent higher than for the entire

19 State of Hawaii (201.1 out of every

20 100,000 residents); and

21 ‘‘(II) Native Hawaiian males

22 have the greatest years of productive

23 life lost in the State of Hawaii where

24 Native Hawaiian males lose an aver25 age of 15.5 years and Native Hawai-
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1 ian females lose an average of 8.2

2 years due to heart disease, as com3 pared to 7.5 years for all males in the

4 State of Hawaii and 6.4 years for all

5 females.

6 ‘‘(ii) HYPERTENSION.—The death

7 rate for Native Hawaiians from hyper8 tension (3.5 out of every 100,000 resi9 dents) is 84 percent higher than that for

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

11 residents).

12 ‘‘(iii) STROKE.—The death rate for

13 Native Hawaiians from stroke (58.3 out of

14 every 100,000 residents) is 13 percent

15 higher than that for the entire State (51.8

16 out of every 100,000 residents).

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

18 incidence of AIDS for Native Hawaiians is at least

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

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

21 State of Hawaii.

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

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

24 from accidents (38.8 out of every 100,000 resi25 dents) is 45 percent higher than that for the
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1 entire State (26.8 out of every 100,000 resi2 dents);

3 ‘‘(B) Native Hawaiian males lose an aver4 age of 14 years of productive life lost from acci5 dents as compared to 9.8 years for all other

6 males in Hawaii; and

7 ‘‘(C) Native Hawaiian females lose and av8 erage of 4 years of productive life lost from ac9 cidents but this rate is the highest rate among

10 all females in the State of Hawaii.

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

12 health—

13 ‘‘(A) Native Hawaiian children exhibit

14 among the highest rates of dental caries in the

15 nation, and the highest in the State of Hawaii

16 as compared to the 5 other major ethnic groups

17 in the State;

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

19 filled primary teeth for Native Hawaiian chil20 dren ages 5 through 9 years was 4.3 as com21 pared with 3.7 for the entire State of Hawaii

22 and 1.9 for the United States; and

23 ‘‘(C) the proportion of Native Hawaiian

24 children ages 5 through 12 years with unmet

25 treatment needs (defined as having active den-
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1 tal caries requiring treatment) is 40 percent as

2 compared with 33 percent for all other races in

3 the State of Hawaii.

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

5 expectancy—

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

7 expectancy of all population groups in the State

8 of Hawaii;

9 ‘‘(B) between 1910 and 1980, the life ex10 pectancy of Native Hawaiians from birth has

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

12 overall State population average; and

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

14 Native Hawaiian life expectancy at birth (74.27

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

16 total State population (78.85 years).

17 ‘‘(6) MATERNAL AND CHILD HEALTH.—

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

19 prenatal care—

20 ‘‘(i) as of 1996, Native Hawaiian

21 women have the highest prevalence (21

22 percent) of having had no prenatal care

23 during their first trimester of pregnancy

24 when compared to the 5 largest ethnic

25 groups in the State of Hawaii;
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1 ‘‘(ii) of the mothers in the State of

2 Hawaii who received no prenatal care

3 throughout their pregnancy in 1996, 44

4 percent were Native Hawaiian;

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

6 to Healthy Start in fiscal years 1996 and

7 1997 were Native Hawaiian newborns; and

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

9 Hawaii, many Native Hawaiian newborns

10 begin life in a potentially hazardous cir11 cumstance, far higher than any other ra12 cial group.

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

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

15 births to Native Hawaiian mothers were

16 infants born to single mothers which sta17 tistics indicate put infants at higher risk of

18 low birth weight and infant mortality;

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

20 Hawaiian single mothers, 8 percent were

21 low birth weight (under 2500 grams); and

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

23 born to single mothers in the State of Ha24 waii, 44 percent were Native Hawaiian.
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1 ‘‘(C) TEEN PREGNANCIES.—With respect

2 to births—

3 ‘‘(i) in 1993 and 1994, Native Hawai4 ians had the highest percentage of teen

5 (individuals who were less than 18 years of

6 age) births (8.1 percent) compared to the

7 rate for all other races in the State of Ha8 waii (3.6 percent);

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

10 mothers in Hawaii under 18 years of age

11 were Native Hawaiian;

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

13 lower than for the statewide population)

14 among Hawaiian women may account in

15 part, for the higher percentage of live

16 births;

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

18 age 14 years and younger in Hawaii, 66

19 percent were Native Hawaiian; and

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

21 same group, 48 percent were Native Ha22 waiian.

23 ‘‘(D) FETAL MORTALITY.—In 1996, Na24 tive Hawaiian fetal mortality rates comprised

25 15 percent of all fetal deaths for the State of
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1 Hawaii. However, for fetal deaths occurring in

2 mothers under the age of 18 years, 32 percent

3 were Native Hawaiian, and for mothers 18

4 through 24 years of age, 28 percent were Na5 tive Hawaiians.

6 ‘‘(7) MENTAL HEALTH.—

7 ‘‘(A) ALCOHOL AND DRUG ABUSE.—With

8 respect to alcohol and drug abuse—

9 ‘‘(i) Native Hawaiians represent 38

10 percent of the total admissions to Depart11 ment of Health, Alcohol, Drugs and Other

12 Drugs, funded substance abuse treatment

13 programs;

14 ‘‘(ii) in 1997, the prevalence of smok15 ing by Native Hawaiians was 28.5 percent,

16 a rate that is 53 percent higher than that

17 for all other races in the State of Hawaii

18 which is 18.6 percent;

19 ‘‘(iii) Native Hawaiians have the high20 est prevalence rates of acute drinking (31

21 percent), a rate that is 79 percent higher

22 than that for all other races in the State

23 of Hawaii;

24 ‘‘(iv) the chronic drinking rate among

25 Native Hawaiians is 54 percent higher
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1 than that for all other races in the State

2 of Hawaii;

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

4 Hawaiian adults surveyed reported having

5 used marijuana compared with 30 percent

6 for all other races in the State of Hawaii;

7 and

8 ‘‘(vi) nine percent of the Native Ha9 waiian adults surveyed reported that they

10 are current users (within the past year) of

11 marijuana, compared with 6 percent for all

12 other races in the State of Hawaii.

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

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

15 were made for property crimes in the State

16 of Hawaii, arrests of Native Hawaiians

17 comprised 20 percent of that total;

18 ‘‘(ii) Native Hawaiian juveniles com19 prised a third of all juvenile arrests in

20 1996;

21 ‘‘(iii) In 1996, Native Hawaiians rep22 resented 21 percent of the 8,000 adults ar23 rested for violent crimes in the State of

24 Hawaii, and 38 percent of the 4,066 juve25 nile arrests;
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1 ‘‘(iv) Native Hawaiians are over-rep2 resented in the prison population in Ha3 waii;

4 ‘‘(v) in 1995 and 1996 Native Hawai5 ians comprised 36.5 percent of the sen6 tenced felon prison population in Hawaii,

7 as compared to 20.5 percent for Caucasian

8 Americans, 3.7 percent for Japanese

9 Americans, and 6 percent for Chinese

10 Americans;

11 ‘‘(vi) in 1995 and 1996 Native Ha12 waiians made up 45.4 percent of the tech13 nical violator population, and at the Ha14 waii Youth Correctional Facility, Native

15 Hawaiians constituted 51.6 percent of all

16 detainees in fiscal year 1997; and

17 ‘‘(vii) based on anecdotal information

18 from inmates at the Halawa Correction

19 Facilities, Native Hawaiians are estimated

20 to comprise between 60 and 70 percent of

21 all inmates.

22 ‘‘(8) HEALTH PROFESSIONS EDUCATION AND

23 TRAINING.—With respect to health professions edu24 cation and training—
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1 ‘‘(A) Native Hawaiians age 25 years and

2 older have a comparable rate of high school

3 completion, however, the rates of baccalaureate

4 degree achievement amongst Native Hawaiians

5 are less than the norm in the State of Hawaii

6 (6.9 percent and 15.76 percent respectively);

7 ‘‘(B) Native Hawaiian physicians make up

8 4 percent of the total physician workforce in the

9 State of Hawaii; and

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

11 comprised 8 percent of those individuals who

12 earned Bachelor’s Degrees, 14 percent of those

13 individuals who earned professional diplomas, 6

14 percent of those individuals who earned Mas15 ter’s Degrees, and less than 1 percent of indi16 viduals who earned doctoral degrees at the Uni17 versity of Hawaii.

18 ‘‘SEC. 3. DEFINITIONS.

19 ‘‘In this Act:

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

21 prevention’ includes—

22 ‘‘(A) immunizations;

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

24 ‘‘(C) control of sexually transmittable dis25 eases;
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1 ‘‘(D) prevention and control of diabetes;

2 ‘‘(E) control of toxic agents;

3 ‘‘(F) occupational safety and health;

4 ‘‘(G) accident prevention;

5 ‘‘(H) fluoridation of water;

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

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

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

9 promotion’ includes—

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

11 prevention of fetal alcohol syndrome;

12 ‘‘(B) cessation of tobacco smoking;

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

14 drugs;

15 ‘‘(D) improvement of nutrition;

16 ‘‘(E) improvement in physical fitness;

17 ‘‘(F) family planning;

18 ‘‘(G) control of stress;

19 ‘‘(H) reduction of major behavioral risk

20 factors and promotion of healthy lifestyle prac21 tices; and

22 ‘‘(I) integration of cultural approaches to

23 health and well-being, including traditional

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

25 (wai), and ocean (kai).
28

•S 1929 RS

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

2 Hawaiian’ means any individual who is Kanaka

3 Maoli (a descendant of the aboriginal people who,

4 prior to 1778, occupied and exercised sovereignty in

5 the area that now constitutes the State of Hawaii)

6 as evidenced by—

7 ‘‘(A) genealogical records,

8 ‘‘(B) Kupuna (elders) or Kama‘aina (long9 term community residents) verification; or

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

11 ‘‘(4) NATIVE HAWAIIAN HEALTH CARE SYS12 TEM.—The term ‘Native Hawaiian health care sys13 tem’ means an entity—

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

15 the State of Hawaii;

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

17 care services through practitioners licensed by

18 the State of Hawaii, where licensure require19 ments are applicable;

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

21 entity;

22 ‘‘(D) in which Native Hawaiian health

23 practitioners significantly participate in the

24 planning, management, monitoring, and evalua25 tion of health care services;
29

•S 1929 RS

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

2 as 8 Native Hawaiian health care systems as

3 necessary to meet the health care needs of each

4 island’s Native Hawaiians; and

5 ‘‘(F) which is—

6 ‘‘(i) recognized by Papa Ola Lokahi

7 for the purpose of planning, conducting, or

8 administering programs, or portions of

9 programs, authorized by this chapter for

10 the benefit of Native Hawaiians; and

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

12 having the qualifications and the capacity

13 to provide the services and meet the re14 quirements under the contract the Native

15 Hawaiian health care system enters into

16 with the Secretary or the grant the Native

17 Hawaiian health care system receives from

18 the Secretary pursuant to this Act.

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

20 term ‘Native Hawaiian organization’ means any

21 organization—

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

23 Hawaiians; and

24 ‘‘(B) which is—
30

•S 1929 RS

1 ‘‘(i) recognized by Papa Ola Lokahi

2 for the purpose of planning, conducting, or

3 administering programs (or portions of

4 programs) authorized under this Act for

5 the benefit of Native Hawaiians; and

6 ‘‘(ii) a public or nonprofit private enti7 ty.

8 ‘‘(6) PAPA OLA LOKAHI.—

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

10 Lokahi’ means an organization that is com11 posed of public agencies and private organiza12 tions focusing on improving the health status of

13 Native Hawaiians. Board members of such or14 ganization may include representation from—

15 ‘‘(i) E Ola Mau;

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

17 the State of Hawaii;

18 ‘‘(iii) Alu Like Inc.;

19 ‘‘(iv) the University of Hawaii;

20 ‘‘(v) the Hawaii State Department of

21 Health;

22 ‘‘(vi) the Kamehameha Schools

23 Bishop Estate, or other Native Hawaiian

24 organization responsible for the adminis-
31

•S 1929 RS

1 tration of the Native Hawaiian Health

2 Scholarship Program;

3 ‘‘(vii) the Hawaii State Primary Care

4 Association, or other organizations respon5 sible for the placement of scholars from

6 the Native Hawaiian Health Scholarship

7 Program;

8 ‘‘(viii) Ahahui O Na Kauka, the Na9 tive Hawaiian Physicians Association;

10 ‘‘(ix) Ho‘ola Lahui Hawaii, or a

11 health care system serving Kaua‘i or

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

13 many health care centers as are necessary

14 to meet the health care needs of the Native

15 Hawaiians of those islands;

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 Moloka‘i or Lana‘i, and which

24 may be composed of as many health care

25 centers as are necessary to meet the health
32

•S 1929 RS

1 care needs of the Native Hawaiians of

2 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 Ha ‘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

21 may admit from time to time, based upon

22 satisfactory demonstration of a record of

23 contribution to the health and well-being of

24 Native Hawaiians.
33

•S 1929 RS

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,

8 and an action plan for carrying out those goals

9 and objectives.

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

11 ‘primary health services’ means—

12 ‘‘(A) services of physicians, physicians’ as13 sistants, nurse practitioners, and other health

14 professionals;

15 ‘‘(B) diagnostic laboratory and radiologic

16 services;

17 ‘‘(C) preventive health services including

18 perinatal services, well child services, family

19 planning services, nutrition services, home

20 health services, and, generally, all those services

21 associated with enhanced health and wellness.

22 ‘‘(D) emergency medical services;

23 ‘‘(E) transportation services as required

24 for adequate patient care;

25 ‘‘(F) preventive dental services; and
34

•S 1929 RS

1 ‘‘(G) pharmaceutical and nutraceutical

2 services.

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

4 the Secretary of Health and Human Services.

5 ‘‘(9) TRADITIONAL NATIVE HAWAIIAN HEAL6 ER.—The term ‘traditional Native Hawaiian healer’

7 means a practitioner—

8 ‘‘(A) who—

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

10 and

11 ‘‘(ii) has the knowledge, skills, and ex12 perience in direct personal health care of

13 individuals; and

14 ‘‘(B) whose knowledge, skills, and experi15 ence are based on demonstrated learning of Na16 tive Hawaiian healing practices acquired by—

17 ‘‘(i) direct practical association with

18 Native Hawaiian elders; and

19 ‘‘(ii) oral traditions transmitted from

20 generation to generation.

21 ‘‘SEC. 4. DECLARATION OF POLICY.

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

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

24 responsibilities and legal obligations to the indigenous peo25 ple of Hawaii resulting from the unique and historical re-
35

•S 1929 RS

1 lationship between the United States and the indigenous

2 people of Hawaii—

3 ‘‘(1) to raise the health status of Native Hawai4 ians to the highest possible health level; and

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

6 care programs with all resources necessary to effec7 tuate this policy.

8 ‘‘(b) INTENT OF CONGRESS.—

9 ‘‘(1) IN GENERAL.—It is the intent of the Con10 gress that—

11 ‘‘(A) health care programs having a dem12 onstrated effect of substantially reducing or

13 eliminating the over-representation of Native

14 Hawaiians among those suffering from chronic

15 and acute disease and illness and addressing

16 the health needs of Native Hawaiians shall be

17 established and implemented; and

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

19 2010 and Kanaka Maoli health objectives de20 scribed in paragraph (2) by the year 2010.

21 ‘‘(2) HEALTHY PEOPLE AND KANAKA MAOLI

22 HEALTH OBJECTIVES.—The Healthy People 2010

23 and Kanaka Maoli health objectives described in this

24 paragraph are the following:

25 ‘‘(A) CHRONIC DISEASE AND ILLNESS.—
36

•S 1929 RS

1 ‘‘(i) CARDIOVASCULAR DISEASE.—

2 With respect to cardiovascular disease—

3 ‘‘(I) to increase to 75 percent the

4 proportion of females who are aware

5 that cardiovascular disease (heart dis6 ease and stroke) is the leading cause

7 of death for all females.

8 ‘‘(II) to increase to at least 95

9 percent the proportion of adults who

10 have had their blood pressure meas11 ured within the preceding 2 years and

12 can state whether their blood pressure

13 was normal or high; and

14 ‘‘(III) to increase to at least 75

15 percent the proportion of adults who

16 have had their blood cholesterol

17 checked within the preceding 5 years.

18 ‘‘(ii) DIABETES.—With respect to

19 diabetes—

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

21 proportion of persons with diabetes

22 whose condition has been diagnosed;

23 ‘‘(II) to increase to at least 20

24 percent the proportion of patients

25 with diabetes who annually obtain
37

•S 1929 RS

1 lipid assessment (total cholesterol,

2 LDL cholesterol, HDL cholesterol,

3 triglyceride); and

4 ‘‘(III) to increase to 52 percent

5 the proportion of persons with diabe6 tes who have received formal diabetes

7 education.

8 ‘‘(iii) CANCER.—With respect to

9 cancer—

10 ‘‘(I) to increase to at least 95

11 percent the proportion of women age

12 18 and older who have ever received a

13 Pap test and to at least 85 percent

14 those who have received a Pap test

15 within the preceding 3 years; and

16 ‘‘(II) to increase to at least 40

17 percent the proportion of women age

18 40 and older who have received a

19 breast examination and a mammo20 gram within the preceding 2 years.

21 ‘‘(iv) DENTAL HEALTH.—With respect

22 to dental health—

23 ‘‘(I) to reduce untreated cavities

24 in the primary and permanent teeth

25 (mixed dentition) so that the propor-
38

•S 1929 RS

1 tion of children with decayed teeth not

2 filled is not more than 12 percent

3 among children ages 2 through 4, 22

4 percent among children ages 6

5 through 8, and 15 percent among

6 adolescents ages 8 through 15;

7 ‘‘(II) to increase to at least 70

8 percent the proportion of children

9 ages 8 through 14 who have received

10 protective sealants in permanent

11 molar teeth; and

12 ‘‘(III) to increase to at least 70

13 percent the proportion of adults age

14 18 and older using the oral health

15 care system each year.

16 ‘‘(v) MENTAL HEALTH.—With respect

17 to mental health—

18 ‘‘(I) to incorporate or support

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

20 or the ocean(kai)-based programs

21 within the context of mental health

22 activities; and

23 ‘‘(II) to reduce the anger and

24 frustration levels within ‘ohana’ focus25 ing on building positive relationships
39

•S 1929 RS

1 and striving for balance in living

2 (lokahi) and achieving a sense of con3 tentment (pono).

4 ‘‘(vi) ASTHMA.—With respect to

5 asthma—

6 ‘‘(I) to increase to at least 40

7 percent the proportion of people with

8 asthma who receive formal patient

9 education, including information

10 about community and self-help re11 sources, as an integral part of the

12 management of their condition;

13 ‘‘(II) to increase to at least 75

14 percent the proportion of patients who

15 receive counseling from health care

16 providers on how to recognize early

17 signs of worsening asthma and how to

18 respond appropriately; and

19 ‘‘(III) to increase to at least 75

20 percent the proportion of primary care

21 providers who are trained to provide

22 culturally competent care to ethnic

23 minorities (Native Hawaiians) seeking

24 health care for chronic obstructive

25 pulmonary disease.
40

•S 1929 RS

1 ‘‘(B) INFECTIOUS DISEASE AND ILL2 NESS.—

3 ‘‘(i) IMMUNIZATIONS.—With respect

4 to immunizations—

5 ‘‘(I) to reduce indigenous cases of

6 vaccine-preventable disease;

7 ‘‘(II) to achieve immunization

8 coverage of at least 90 percent among

9 children between 19 and 35 months of

10 age; and

11 ‘‘(III) to increase to 90 percent

12 the rate of immunization coverage

13 among adults 65 years of age or

14 older, and 60 percent for high-risk

15 adults between 18 and 64 years of

16 age.

17 ‘‘(ii) SEXUALLY TRANSMITTED DIS18 EASES, HIV; AIDS.—To increase the num19 ber of HIV-infected adolescents and adults

20 in care who receive treatment consistent

21 with current public health treatment guide22 lines.

23 ‘‘(C) WELLNESS.—

24 ‘‘(i) EXERCISE.—With respect to

25 exercise—
41

•S 1929 RS

1 ‘‘(I) to increase to 85 percent the

2 proportion of people ages 18 and older

3 who engage in any leisure time phys4 ical activity; and

5 ‘‘(II) to increase to at least 30

6 percent the proportion of people ages

7 18 and older who engage regularly,

8 preferably daily, in sustained physical

9 activity for at least 30 minutes per

10 day.

11 ‘‘(ii) NUTRITION.—With respect to

12 nutrition—

13 ‘‘(I) to increase to at least 60

14 percent the prevalence of healthy

15 weight (defined as body mass index

16 equal to or greater than 19.0 and less

17 than 25.0) among all people age 20

18 and older;

19 ‘‘(II) to increase to at least 75

20 percent the proportion of people age 2

21 and older who meet the dietary guide22 lines’ minimum average daily goal of

23 at least 5 servings of vegetables and

24 fruits; and
42

•S 1929 RS

1 ‘‘(III) to increase the use of tra2 ditional Native Hawaiian foods in all

3 peoples’ diets and dietary preferences.

4 ‘‘(iii) LIFESTYLE.—With respect to

5 lifestyle—

6 ‘‘(I) to reduce cigarette smoking

7 among pregnant women to a preva8 lence of not more than 2 percent;

9 ‘‘(II) to reduce the prevalence of

10 respiratory disease, cardiovascular dis11 ease, and cancer resulting from expo12 sure to tobacco smoke;

13 ‘‘(III) to increase to at least 70

14 percent the proportion of all preg15 nancies among women between the

16 ages of 15 and 44 that are planned

17 (intended); and

18 ‘‘(IV) to reduce deaths caused by

19 unintentional injuries to not more

20 than 25.9 per 100,000.

21 ‘‘(iv) CULTURE.—With respect to

22 culture—

23 ‘‘(I) to develop and implement

24 cultural values within the context of

25 the corporate cultures of the Native
43

•S 1929 RS

1 Hawaiian health care systems, the

2 Native Hawaiian Health Scholarship

3 Program, and Papa Ola Lokahi; and

4 ‘‘(II) to facilitate the provision of

5 Native Hawaiian healing practices by

6 Native Hawaiian healers for those cli7 ents desiring such assistance.

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

9 ‘‘(i) to increase the proportion of pa10 tients who have coverage for clinical pre11 ventive services as part of their health in12 surance; and

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

14 percent the proportion of individuals and

15 families who report that they did not ob16 tain all the health care that they needed.

17 ‘‘(E) HEALTH PROFESSIONS TRAINING

18 AND EDUCATION.—With respect to health pro19 fessions training and education—

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

21 degrees in the health professions and allied

22 and associated health professions fields

23 awarded to members of underrepresented

24 racial and ethnic minority groups; and
44

•S 1929 RS

1 ‘‘(ii) to support training activities and

2 programs in traditional Native Hawaiian

3 healing practices by Native Hawaiian heal4 ers.

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

6 President, for inclusion in each report required to be

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

8 progress made in each toward meeting each of the objec9 tives described in subsection (b)(2).

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

11 FOR NATIVE HAWAIIANS.

12 ‘‘(a) DEVELOPMENT.—

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

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

15 Lokahi for the purpose of coordinating, imple16 menting and updating a Native Hawaiian com17 prehensive health care master plan designed to pro18 mote comprehensive health promotion and disease

19 prevention services and to maintain and improve the

20 health status of Native Hawaiians, and to support

21 community-based initiatives that are reflective of ho22 listic approaches to health.

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

24 shall collaborate with the Office of Hawaiian Affairs

25 in carrying out this section.
45

•S 1929 RS

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

2 are authorized to be appropriated such sums as may be

3 necessary to carry out subsection (a).

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

5 ‘‘(a) RESPONSIBILITY.—Papa Ola Lokahi shall be re6 sponsible for the—

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

9 master plan developed pursuant to section 5;

10 ‘‘(2) training for the persons described in sub11 paragraphs (B) and (C) of section 7(c)(1);

12 ‘‘(3) identification of and research into the dis13 eases that are most prevalent among Native Hawai14 ians, including behavioral, biomedical, epidemiolog15 ical, and health services; and

16 ‘‘(4) the development of an action plan out17 lining the contributions that each member organiza18 tion of Papa Ola Lokahi will make in carrying out

19 the policy of this Act.

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

21 may receive special project funds that may be appro22 priated for the purpose of research on the health status

23 of Native Hawaiians or for the purpose of addressing the

24 health care needs of Native Hawaiians.

25 ‘‘(c) CLEARINGHOUSE.—
46

•S 1929 RS

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 con17 sult periodically with Papa Ola Lokahi for the pur18 poses of maintaining the clearinghouse under para19 graph (1) and providing information about programs

20 in the Department that specifically address Native

21 Hawaiian issues and concerns.

22 ‘‘(d) FISCAL ALLOCATION AND COORDINATION OF

23 PROGRAMS AND SERVICES.—

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

25 shall provide annual recommendations to the Sec-
47

•S 1929 RS

1 retary with respect to the allocation of all amounts

2 appropriated under this Act.

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

4 to the maximum extent possible, coordinate and as5 sist the health care programs and services provided

6 to Native Hawaiians.

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

8 Secretary, in consultation with Papa Ola Lokahi,

9 shall make recommendations for Native Hawaiian

10 representation on the President’s Advisory Commis11 sion on Asian Americans and Pacific Islanders.

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

13 act as a statewide infrastructure to provide technical sup14 port and coordination of training and technical assistance

15 to the Native Hawaiian health care systems.

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

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

18 into agreements or memoranda of understanding

19 with relevant agencies or organizations that are ca20 pable of providing resources or services to the Native

21 Hawaiian health care systems.

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

23 Lokahi shall develop or make every reasonable effort

24 to—
48

•S 1929 RS

1 ‘‘(A) develop a contractual or other ar2 rangement, through memoranda of under3 standing or agreement, with the Health Care

4 Financing Administration or the agency of the

5 State which administers or supervises the ad6 ministration of a State plan or waiver approved

7 under title XVIII, XIX or title XXI of the So8 cial Security Act for payment of all or a part

9 of the health care services to persons who are

10 eligible for medical assistance under such a

11 State plan or waiver; and

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

13 reimbursement for health care services to per14 sons who are entitled to insurance under title

15 XVIII of the Social Security Act.

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

17 ‘‘(a) COMPREHENSIVE HEALTH PROMOTION, DIS18 EASE PREVENTION, AND PRIMARY HEALTH SERVICES.—

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

20 in consultation with Papa Ola Lokahi, may make

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

22 entity for the purpose of providing comprehensive

23 health promotion and disease prevention services, as

24 well as primary health services, to Native Hawaiians
49

•S 1929 RS

1 who desire and are committed to bettering their own

2 health.

3 ‘‘(2) PREFERENCE.—In making grants and en4 tering into contracts under this subsection, the Sec5 retary shall give preference to Native Hawaiian

6 health care systems and Native Hawaiian organiza7 tions and, to the extent feasible, health promotion

8 and disease prevention services shall be performed

9 through Native Hawaiian health care systems.

10 ‘‘(3) QUALIFIED ENTITY.—An entity is a quali11 fied entity for purposes of paragraph (1) if the enti12 ty is a Native Hawaiian health care system.

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

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

15 a contract with, not more than 8 Native Hawaiian

16 health care systems under this subsection during

17 any fiscal year.

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

19 to grants and contracts under subsection (a), the Sec20 retary may make a grant to, or enter into a contract with,

21 Papa Ola Lokahi for the purpose of planning Native Ha22 waiian health care systems to serve the health needs of

23 Native Hawaiian communities on each of the islands of

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

25 Ni‘ihau in the State of Hawaii.
50

•S 1929 RS

1 ‘‘(c) SERVICES TO BE PROVIDED.—

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

3 under subsection (a) shall ensure that the following

4 services either are provided or arranged for:

5 ‘‘(A) Outreach services to inform Native

6 Hawaiians of the availability of health services.

7 ‘‘(B) Education in health promotion and

8 disease prevention of the Native Hawaiian pop9 ulation by, wherever possible, Native Hawaiian

10 health care practitioners, community outreach

11 workers, counselors, and cultural educators.

12 ‘‘(C) Services of physicians, physicians’ as13 sistants, nurse practitioners or other health and

14 allied-health professionals.

15 ‘‘(D) Immunizations.

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

17 high blood pressure, and otitis media.

18 ‘‘(F) Pregnancy and infant care.

19 ‘‘(G) Improvement of nutrition.

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

21 and reduction of the incidence of preventable

22 illnesses and conditions endemic to Native Ha23 waiians.
51

•S 1929 RS

1 ‘‘(I) Collection of data related to the pre2 vention of diseases and illnesses among Native

3 Hawaiians.

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

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

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

7 defined in section 3, which are not specifically

8 referred to in subsection (a).

9 ‘‘(K) Support of culturally appropriate ac10 tivities enhancing health and wellness including

11 land-based, water-based, ocean-based, and spir12 itually-based projects and programs.

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

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

16 may be provided by traditional Native Hawaiian

17 healers.

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

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

20 subsection (a)(1) for Native Hawaiian health care sys21 tems, including providers of traditional Native Hawaiian

22 healing services, shall be treated as if such individuals

23 were members of the Public Health Service and shall be

24 covered under the provisions of section 224 of the Public

25 Health Service Act.
52

•S 1929 RS

1 ‘‘(e) SITE FOR OTHER FEDERAL PAYMENTS.—A Na2 tive Hawaiian health care system that receives funds

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

4 appropriate staff to serve as a Federal loan repayment fa5 cility. Such facility shall be designed to enable health and

6 allied-health professionals to remit payments with respect

7 to loans provided to such professionals under any Federal

8 loan program.

9 ‘‘(f) RESTRICTION ON USE OF GRANT AND CON10 TRACT FUNDS.—The Secretary may not make a grant to,

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

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

13 such grant or contract will not, directly or through con14 tract, be expended—

15 ‘‘(1) for any services other than the services de16 scribed in subsection (c)(1);

17 ‘‘(2) to provide inpatient services;

18 ‘‘(3) to make cash payments to intended recipi19 ents of health services; or

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

21 (other than minor remodeling of existing improve22 ments to real property) or to purchase major med23 ical equipment.

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

25 Secretary may not make a grant to, or enter into a con-
53

•S 1929 RS

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

2 agrees that, whether health services are provided directly

3 or through contract—

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

5 will be provided without regard to ability to pay for

6 the health services; and

7 ‘‘(2) the entity will impose a charge for the de8 livery of health services, and such charge—

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

10 of charges that is made available to the public;

11 and

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

13 of the individual involved.

14 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—

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

16 to be appropriated such sums as may be necessary

17 for each of fiscal years 2000 through 2010 to carry

18 out subsection (a).

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

20 to be appropriated such sums as may be necessary

21 for each of fiscal years 2000 through 2010 to carry

22 out subsection (b).
54

•S 1929 RS

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

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

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

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

5 ‘‘(1) coordination, implementation, and updat6 ing (as appropriate) of the comprehensive health

7 care master plan developed pursuant to section 5;

8 ‘‘(2) training for the persons described in sub9 paragraphs (B) and (C) of section 7(c)(1);

10 ‘‘(3) identification of and research into the dis11 eases that are most prevalent among Native Hawai12 ians, including behavioral, biomedical, epidemiolog13 ical, and health services;

14 ‘‘(4) the development of an action plan out15 lining the contributions that each member organiza16 tion of Papa Ola Lokahi will make in carrying out

17 the policy of this Act;

18 ‘‘(5) a clearinghouse function for—

19 ‘‘(A) the collection and maintenance of

20 data associated with the health status of Native

21 Hawaiians;

22 ‘‘(B) the identification and research into

23 diseases affecting Native Hawaiians; and

24 ‘‘(C) the availability of Native Hawaiian

25 project funds, research projects and publica26 tions;
55

•S 1929 RS

1 ‘‘(6) the coordination of the health care pro2 grams and services provided to Native Hawaiians;

3 and

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

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

6 is authorized to be appropriated such sums as may be nec7 essary for each of fiscal years 2000 through 2010 to carry

8 out subsection (a).

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

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

11 include in any grant made or contract entered into under

12 this Act such terms and conditions as the Secretary con13 siders necessary or appropriate to ensure that the objec14 tives of such grant or contract are achieved.

15 ‘‘(b) PERIODIC REVIEW.—The Secretary shall peri16 odically evaluate the performance of, and compliance with,

17 grants and contracts under this Act.

18 ‘‘(c) ADMINISTRATIVE REQUIREMENTS.—The Sec19 retary may not make a grant or enter into a contract

20 under this Act with an entity unless the entity—

21 ‘‘(1) agrees to establish such procedures for fis22 cal control and fund accounting as may be necessary

23 to ensure proper disbursement and accounting with

24 respect to the grant or contract;
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1 ‘‘(2) agrees to ensure the confidentiality of

2 records maintained on individuals receiving health

3 services under the grant or contract;

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

5 any population of Native Hawaiians, a substantial

6 portion of which has a limited ability to speak the

7 English language—

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

9 carry out a reasonable plan to provide health

10 services under the grant or contract through in11 dividuals who are able to communicate with the

12 population involved in the language and cultural

13 context that is most appropriate; and

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

15 fluent in both English and the appropriate lan16 guage, to assist in carrying out the plan;

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

18 covered in the plan of the State of Hawaii approved

19 under title XIX of the Social Security Act—

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

21 grant or contract any such health services

22 directly—

23 ‘‘(i) the entity has entered into a par24 ticipation agreement under such plans; and
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1 ‘‘(ii) the entity is qualified to receive

2 payments under such plan; and

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

4 grant or contract any such health services

5 through a contract with an organization—

6 ‘‘(i) the organization has entered into

7 a participation agreement under such plan;

8 and

9 ‘‘(ii) the organization is qualified to

10 receive payments under such plan; and

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

12 Papa Ola Lokahi an annual report that describes

13 the use and costs of health services provided under

14 the grant or contract (including the average cost of

15 health services per user) and that provides such

16 other information as the Secretary determines to be

17 appropriate.

18 ‘‘(d) CONTRACT EVALUATION.—

19 ‘‘(1) DETERMINATION OF NONCOMPLIANCE.—

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

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

24 shall, prior to renewing such contract, attempt to re25 solve the areas of noncompliance or unsatisfactory
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1 performance and modify such contract to prevent fu2 ture occurrences of such noncompliance or unsatis3 factory performance.

4 ‘‘(2) NONRENEWAL.—If the Secretary deter5 mines that the noncompliance or unsatisfactory per6 formance described in paragraph (1) with respect to

7 an entity cannot be resolved and prevented in the fu8 ture, the Secretary shall not renew the contract with

9 such entity and may enter into a contract under sec10 tion 7 with another entity referred to in subsection

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

12 same population of Native Hawaiians which is

13 served by the entity whose contract is not renewed

14 by reason of this paragraph.

15 ‘‘(3) CONSIDERATION OF RESULTS.—In deter16 mining whether to renew a contract entered into

17 with an entity under this Act, the Secretary shall

18 consider the results of the evaluations conducted

19 under this section.

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

21 contracts entered into by the Secretary under this

22 Act shall be in accordance with all Federal con23 tracting laws and regulations, except that, in the

24 discretion of the Secretary, such contracts may be

25 negotiated without advertising and may be exempted
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1 from the provisions of the Act of August 24, 1935

2 (40 U.S.C. 270a et seq.).

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

4 contract entered into under this Act may be made

5 in advance, by means of reimbursement, or in in6 stallments and shall be made on such conditions as

7 the Secretary deems necessary to carry out the pur8 poses of this Act.

9 ‘‘(e) LIMITATION ON USE OF FUNDS FOR ADMINIS10 TRATIVE EXPENSES.—Except with respect to grants and

11 contracts under section 8, the Secretary may not make

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

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

14 expend more than 15 percent of the amounts received pur15 suant to this Act for the purpose of administering the

16 grant or contract.

17 ‘‘(f) REPORT.—

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

19 which an entity receives or expends funds pursuant

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

21 shall submit to the Secretary and to Papa Ola

22 Lokahi an annual report—

23 ‘‘(A) on the activities conducted by the en24 tity under the grant or contract;
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1 ‘‘(B) on the amounts and purposes for

2 which Federal funds were expended; and

3 ‘‘(C) containing such other information as

4 the Secretary may request.

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

6 entity concerning any grant or contract under this

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

8 Inspector General of the Department of Health and

9 Human Services, and the Comptroller General of the

10 United States.

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

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

13 under this Act the cost of an annual private audit con14 ducted by a certified public accountant.

15 ‘‘SEC. 10. ASSIGNMENT OF PERSONNEL.

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

17 agreement with any entity under which the Secretary may

18 assign personnel of the Department of Health and Human

19 Services with expertise identified by such entity to such

20 entity on detail for the purposes of providing comprehen21 sive health promotion and disease prevention services to

22 Native Hawaiians.

23 ‘‘(b) APPLICABLE FEDERAL PERSONNEL PROVI24 SIONS.—Any assignment of personnel made by the Sec25 retary under any agreement entered into under subsection
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1 (a) shall be treated as an assignment of Federal personnel

2 to a local government that is made in accordance with sub3 chapter VI of chapter 33 of title 5, United States Code.

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

5 FELLOWSHIPS.

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

7 amounts appropriated under subsection (c), the Secretary

8 shall provide funds through a direct grant or a cooperative

9 agreement to Kamehameha Schools Bishop Estate or an10 other Native Hawaiian organization or health care organi11 zation with experience in the administration of educational

12 scholarships or placement services for the purpose of pro13 viding scholarship assistance to students who—

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

15 the Public Health Service Act, except for assistance

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

17 ‘‘(2) are Native Hawaiians.

18 ‘‘(b) TERMS AND CONDITIONS.—

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

20 under subsection (a) shall be provided under the

21 same terms and subject to the same conditions, reg22 ulations, and rules as apply to scholarship assistance

23 provided under section 338A of the Public Health

24 Service Act (except as provided for in paragraph

25 (2)), except that—
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1 ‘‘(A) the provision of scholarships in each

2 type of health care profession training shall cor3 respond to the need for each type of health care

4 professional to serve the Native Hawaiian

5 health care systems identified by Papa Ola

6 Lokahi;

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

8 the Secretary shall select scholarship recipients

9 from a list of eligible applicants submitted by

10 the Kamehameha Schools Bishop Estate or the

11 Native Hawaiian organization administering the

12 program;

13 ‘‘(C) the obligated service requirement for

14 each scholarship recipient (except for those re15 ceiving assistance under paragraph (2)) shall be

16 fulfilled through service, in order of priority,

17 in—

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

19 health care systems; or

20 ‘‘(ii) health professions shortage

21 areas, medically underserved areas, or geo22 graphic areas or facilities similarly des23 ignated by the United States Public Health

24 Service in the State of Hawaii;
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1 ‘‘(D) the provision of counseling, retention

2 and other support services shall not be limited

3 to scholarship recipients, but shall also include

4 recipients of other scholarship and financial aid

5 programs enrolled in appropriate health profes6 sions training programs.

7 ‘‘(E) financial assistance may be provided

8 to scholarship recipients in those health profes9 sions designated in such section 338A while

10 they are fulfilling their service requirement in

11 any one of the Native Hawaiian health care sys12 tems or community health centers.

13 ‘‘(2) FELLOWSHIPS.—Financial assistance

14 through fellowships may be provided to Native Ha15 waiian applicants accepted and participating in a

16 certificated program provided by a traditional Native

17 Hawaiian healer in traditional Native Hawaiian

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

19 and ho‘oponopono. Such assistance may include a

20 stipend or reimbursement for costs associated with

21 participation in the program.

22 ‘‘(3) RIGHTS AND BENEFITS.—Scholarship re23 cipients in health professions designated in section

24 338A of the Public Health Service Act while ful25 filling their service requirements shall have all the
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•S 1929 RS

1 same rights and benefits of members of the National

2 Health Service Corps during their period of service.

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

4 INCOME.—Financial assistance provided to scholar5 ship recipients for tuition, books and other school-re6 lated expenditures under this section shall not be in7 cluded in gross income for purposes of the Internal

8 Revenue Code of 1986.

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

10 is authorized to be appropriated such sums as may be nec11 essary for each of fiscal years 2000 through 2010 for the

12 purpose of funding the scholarship assistance program

13 under subsection (a).

14 ‘‘SEC. 12. REPORT.

15 ‘‘The President shall, at the time the budget is sub16 mitted under section 1105 of title 31, United States Code,

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

18 progress made in meeting the objectives of this Act, in19 cluding a review of programs established or assisted pur20 suant to this Act and an assessment and recommendations

21 of additional programs or additional assistance necessary

22 to, at a minimum, provide health services to Native Ha23 waiians, and ensure a health status for Native Hawaiians,

24 which are at a parity with the health services available

25 to, and the health status of, the general population.
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1 ‘‘SEC. 13. DEMONSTRATION PROJECTS OF NATIONAL SIG2 NIFICANCE.

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

4 Secretary, in consultation with Papa Ola Lokahi, may allo5 cate amounts appropriated under this Act, or any other

6 Act, to carry out Native Hawaiian demonstration projects

7 of national significance. The areas of interest of such

8 projects may include—

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

10 other individuals in institutions of higher learning,

11 in health and allied health programs in complemen12 tary healing practices, including Native Hawaiian

13 healing practices;

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

15 complementary healing practices including tradi16 tional Native Hawaiian healing practices;

17 ‘‘(3) the use of tele-wellness and telecommuni18 cations in chronic disease management and health

19 promotion and disease prevention;

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

21 health care for Native Hawaiians and other indige22 nous people including the provision of culturally

23 competent health services, related activities focusing

24 on wellness concepts, the development of appropriate

25 kupuna care programs, and the development of fi-
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•S 1929 RS

1 nancial mechanisms and collaborative relationships

2 leading to universal access to health care;

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

4 and information system relating to the health care

5 status, health care needs, and wellness of Native

6 Hawaiians; and

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

8 Center of Excellence for Nursing at the University

9 of Hawaii at Hilo, a Native Hawaiian Center of Ex10 cellence for Mental Health at the University of Ha11 waii at Manoa, a Native Hawaiian Center of Excel12 lence for Maternal Health and Nutrition at the

13 Waimanalo Health Center, and a Native Hawaiian

14 Center of Excellence for Research, Training, and In15 tegrated Medicine at Molokai General Hospital.

16 ‘‘(b) NONREDUCTION IN OTHER FUNDING.—The al17 location of funds for demonstration projects under sub18 section (a) shall not result in a reduction in funds required

19 by the Native Hawaiian health care systems, the Native

20 Hawaiian Health Scholarship Program, or Papa Ola

21 Lokahi to carry out their respective responsibilities under

22 this Act.
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1 ‘‘SEC. 14. NATIONAL BIPARTISAN COMMISSION ON NATIVE

2 HAWAIIAN HEALTH CARE ENTITLEMENT.

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

4 a National Bipartisan Native Hawaiian Health Care Enti5 tlement Commission (referred to in this Act as the ‘Com6 mission’).

7 ‘‘(b) MEMBERSHIP.—The Commission shall be com8 posed of 21 members to be appointed as follows:

9 ‘‘(1) CONGRESSIONAL MEMBERS.—

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

11 the Commission shall be members of Congress,

12 of which—

13 ‘‘(i) two members shall be from the

14 House of Representatives and shall be ap15 pointed by the Majority Leader;

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

17 House of Representatives and shall be ap18 pointed by the Minority Leader;

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

20 Senate and shall be appointed by the Ma21 jority Leader; and

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

23 Senate and shall be appointed by the Mi24 nority Leader.

25 ‘‘(B) RELEVANT COMMITTEE MEMBER26 SHIP.—The members of the Commission ap-
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1 pointed under subparagraph (A) shall each be

2 members of the committees of Congress that

3 consider legislation affecting the provision of

4 health care to Native Hawaiians and other Na5 tive American.

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

7 Commission appointed under subparagraph (A)

8 shall elect the chairperson and vice-chairperson

9 of the Commission.

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

11 members of the Commission shall be appointed by

12 Hawaiian health entities, of which—

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

14 the Native Hawaiian Health Care Systems;

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

16 Hawaii State Primary Care Association;

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

18 Papa Ola Lokahi;

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

20 State Council of Hawaiian Homestead Associa21 tions;

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

23 Office of Hawaiian Affairs; and

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

25 the Association of Hawaiian Civic Clubs and
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1 shall represent Native Hawaiian populations on

2 the United States continent.

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

4 of the Commission shall be appointed by the Sec5 retary and shall possess knowledge of the health

6 concerns and wellness issues facing Native Hawai7 ians.

8 ‘‘(c) TERMS.—

9 ‘‘(1) IN GENERAL.—The members of the Com10 mission shall serve for the life of the Commission.

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

12 The members of the Commission shall be appointed

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

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

15 members of the Commission shall be appointed not

16 later than 60 days after the date on which the mem17 bers are appointed under such subsection (b)(1).

18 ‘‘(3) VACANCIES.—A vacancy in the member19 ship of the Commission shall be filled in the manner

20 in which the original appointment was made.

21 ‘‘(d) DUTIES OF THE COMMISSION.—The Commis22 sion shall carry out the following duties and functions:

23 ‘‘(1) Review and analyze the recommendations

24 of the report of the study committee established

25 under paragraph (3).
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1 ‘‘(2) Make recommendations to Congress for

2 the provision of health services to Native Hawaiian

3 individuals as an entitlement, giving due regard to

4 the effects of a program on existing health care de5 livery systems for Native Hawaiians and the effect

6 of such programs on self-determination and their

7 reconciliation.

8 ‘‘(3) Establish a study committee to be com9 posed of at least 10 members from the Commission,

10 including 4 members of the members appointed

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

12 under subsection (b)(2), and 1 of the members ap13 pointed by the Secretary under subsection (b)(3),

14 which shall—

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

16 its duties, collect and compile data necessary to

17 understand the extent of Native Hawaiian

18 needs with regards to the provision of health

19 services, including holding hearings and solic20 iting the views of Native Hawaiians and Native

21 Hawaiian organizations, and which may include

22 authorizing and funding feasibility studies of

23 various models for all Native Hawaiian bene24 ficiaries and their families, including those that

25 live on the United States continent;
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1 ‘‘(B) make recommendations to the Com2 mission for legislation that will provide for the

3 culturally-competent and appropriate provision

4 of health services for Native Hawaiians as an

5 entitlement, which shall, at a minimum, address

6 issues of eligibility and benefits to be provided,

7 including recommendations regarding from

8 whom such health services are to be provided

9 and the cost and mechanisms for funding of the

10 health services to be provided;

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

12 of such recommendations on the existing system

13 of delivery of health services for Native Hawai14 ians;

15 ‘‘(D) determine the effect of a health serv16 ice entitlement program for Native Hawaiian

17 individuals on their self-determination and the

18 reconciliation of their relationship with the

19 United States;

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

21 date of the appointment of all members of the

22 Commission, make a written report of its find23 ings and recommendations to the Commission,

24 which report shall include a statement of the

25 minority and majority position of the committee
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1 and which shall be disseminated, at a minimum,

2 to Native Hawaiian organizations and agencies

3 and health organizations referred to in sub4 section (b)(2) for comment to the Commission;

5 and

6 ‘‘(F) report regularly to the full Commis7 sion regarding the findings and recommenda8 tions developed by the committee in the course

9 of carrying out its duties under this section.

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

11 of the appointment of all members of the Commis12 sion, submit a written report to Congress containing

13 a recommendation of policies and legislation to im14 plement a policy that would establish a health care

15 system for Native Hawaiians, grounded in their cul16 ture, and based on the delivery of health services as

17 an entitlement, together with a determination of the

18 implications of such an entitlement system on exist19 ing health care delivery systems for Native Hawai20 ians and their self-determination and the reconcili21 ation of their relationship with the United States.

22 ‘‘(e) ADMINISTRATIVE PROVISIONS.—

23 ‘‘(1) COMPENSATION AND EXPENSES.—

24 ‘‘(A) CONGRESSIONAL MEMBERS.—Each

25 member of the Commission appointed under
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1 subsection (b)(1) shall not receive any addi2 tional compensation, allowances, or benefits by

3 reason of their service on the Commission. Such

4 members shall receive travel expenses and per

5 diem in lieu of subsistence in accordance with

6 sections 5702 and 5703 of title 5, United

7 States Code.

8 ‘‘(B) OTHER MEMBERS.—The members of

9 the Commission appointed under paragraphs

10 (2) and (3) of subsection (b) shall, while serv11 ing on the business of the Commission (includ12 ing travel time), receive compensation at the

13 per diem equivalent of the rate provided for in14 dividuals under level IV of the Executive Sched15 ule under section 5315 of title 5, United States

16 Code, and while serving away from their home

17 or regular place of business, be allowed travel

18 expenses, as authorized by the chairperson of

19 the Commission.

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

21 of compensation (other than compensation of

22 the members of the Commission) and employ23 ment benefits, rights, and privileges, all per24 sonnel of the Commission shall be treated as if

25 they were employees of the Senate.
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1 ‘‘(2) MEETINGS AND QUORUM.—

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

3 meet at the call of the chairperson.

4 ‘‘(B) QUORUM.—A quorum of the Commis5 sion shall consist of not less than 12 members,

6 of which—

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

8 shall be appointees under subsection

9 (b)(1)l;

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

11 shall be appointees under subsection

12 (b)(2); and

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

14 shall be an appointee under subsection

15 (b)(3).

16 ‘‘(3) DIRECTOR AND STAFF.—

17 ‘‘(A) EXECUTIVE DIRECTOR.—The mem18 bers of the Commission shall appoint an execu19 tive director of the Commission. The executive

20 director shall be paid the rate of basic pay

21 equal to that under level V of the Executive

22 Schedule under section 5316 of title 5, United

23 States Code.

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

25 Commission, the executive director may appoint
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1 such personnel as the executive director deems

2 appropriate.

3 ‘‘(C) APPLICABILITY OF CIVIL SERVICE

4 LAWS.—The staff of the Commission shall be

5 appointed without regard to the provisions of

6 title 5, United States Code, governing appoint7 ments in the competitive service, and shall be

8 paid without regard to the provisions of chapter

9 51 and subchapter III of chapter 53 of such

10 title (relating to classification and General

11 Schedule pay rates).

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

13 the approval of the Commission, the executive

14 director may procure temporary and intermit15 tent services under section 3109(b) of title 5,

16 United States Code.

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

18 the General Services Administration shall locate

19 suitable office space for the operations of the

20 Commission in the State of Hawaii. The facili21 ties shall serve as the headquarters of the Com22 mission and shall include all necessary equip23 ment and incidentals required for the proper

24 functioning of the Commission.

25 ‘‘(f) POWERS.—
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1 ‘‘(1) HEARINGS AND OTHER ACTIVITIES.—For

2 purposes of carrying out its duties, the Commission

3 may hold such hearings and undertake such other

4 activities as the Commission determines to be nec5 essary to carry out its duties, except that at least 8

6 hearings shall be held on each of the Hawaiian Is7 lands and 3 hearings in the continental United

8 States in areas where large numbers of Native Ha9 waiians are present. Such hearings shall be held to

10 solicit the views of Native Hawaiians regarding the

11 delivery of health care services to such individuals.

12 To constitute a hearing under this paragraph, at

13 least 4 members of the Commission, including at

14 least 1 member of Congress, must be present. Hear15 ings held by the study committee established under

16 subsection (d)(3) may be counted towards the num17 ber of hearings required under this paragraph.

18 ‘‘(2) STUDIES BY THE GENERAL ACCOUNTING

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

20 Comptroller General shall conduct such studies or

21 investigations as the Commission determines to be

22 necessary to carry out its duties.

23 ‘‘(3) COST ESTIMATES.—

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

25 Congressional Budget Office or the Chief Actu-
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1 ary of the Health Care Financing Administra2 tion, or both, shall provide to the Commission,

3 upon the request of the Commission, such cost

4 estimates as the Commission determines to be

5 necessary to carry out its duties.

6 ‘‘(B) REIMBURSEMENTS.—The Commis7 sion shall reimburse the Director of the Con8 gressional Budget Office for expenses relating

9 to the employment in the office of the Director

10 of such additional staff as may be necessary for

11 the Director to comply with requests by the

12 Commission under subparagraph (A).

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

14 the request of the Commission, the head of any Fed15 eral agency is authorized to detail, without reim16 bursement, any of the personnel of such agency to

17 the Commission to assist the Commission in car18 rying out its duties. Any such detail shall not inter19 rupt or otherwise affect the civil service status or

20 privileges of the Federal employees.

21 ‘‘(5) TECHNICAL ASSISTANCE.—Upon the re22 quest of the Commission, the head of any Federal

23 agency shall provide such technical assistance to the

24 Commission as the Commission determines to be

25 necessary to carry out its duties.
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1 ‘‘(6) USE OF MAILS.—The Commission may use

2 the United States mails in the same manner and

3 under the same conditions as Federal agencies and

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

5 commission of Congress as described in section 3215

6 of title 39, United States Code.

7 ‘‘(7) OBTAINING INFORMATION.—The Commis8 sion may secure directly from any Federal agency

9 information necessary to enable the Commission to

10 carry out its duties, if the information may be dis11 closed under section 552 of title 5, United States

12 Code. Upon request of the chairperson of the Com13 mission, the head of such agency shall furnish such

14 information to the Commission.

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

16 the Commission, the Administrator of General Serv17 ices shall provide to the Commission on a reimburs18 able basis such administrative support services as

19 the Commission may request.

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

21 to printing and binding, including the cost of per22 sonnel detailed from the Government Printing Of23 fice, the Commission shall be deemed to be a com24 mittee of Congress.
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1 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There

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

3 this section. The amount appropriated under this sub4 section shall not result in a reduction in any other appro5 priation for health care or health services for Native Ha6 waiians.

7 ‘‘SEC. 15. RULE OF CONSTRUCTION.

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

9 the authority of the State of Hawaii to license health prac10 titioners.

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

12 ‘‘Any new spending authority (described in subpara13 graph (A) of (B) of section 401(c)(2) of the Congressional

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

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

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

17 provided for in appropriation Acts.

18 ‘‘SEC. 17. SEVERABILITY.

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

20 any such provision to any person or circumstances is held

21 to be invalid, the remainder of this Act, and the applica22 tion of such provision or amendment to persons or cir23 cumstances other than those to which it is held invalid,

24 shall not be affected thereby.’’.
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1 SECTION 1. SHORT TITLE.

2 This Act may be cited as the ‘‘Native Hawaiian Health

3 Care Improvement Act Reauthorization of 2000’’.

4 SEC. 2. AMENDMENT TO THE NATIVE HAWAIIAN HEALTH

5 CARE IMPROVEMENT ACT.

6 The Native Hawaiian Health Care Improvement Act

7 (42 U.S.C. 11701 et seq.) is amended to read as follows:

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

9 ‘‘(a) SHORT TITLE.—This Act may be cited as the ‘Na10 tive Hawaiian Health Care Improvement Act’.

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

12 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.

13 ‘‘SEC. 2. FINDINGS.

14 ‘‘(a) GENERAL FINDINGS.—Congress makes the fol15 lowing findings:
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1 ‘‘(1) Native Hawaiians begin their story with

2 the Kumulipo which details the creation and inter-re3 lationship of all things, including their evolvement as

4 healthy and well people.

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

6 unique indigenous peoples with a historical con7 tinuity to the original inhabitants of the Hawaiian

8 archipelago within Ke Moananui, the Pacific Ocean,

9 and have a distinct society organized almost 2,000

10 years ago.

11 ‘‘(3) The health and well-being of Native Hawai12 ians are intrinsically tied to their deep feelings and

13 attachment to their lands and seas.

14 ‘‘(4) The long-range economic and social changes

15 in Hawaii over the 19th and early 20th centuries

16 have been devastating to the health and well-being of

17 Native Hawaiians.

18 ‘‘(5) Native Hawaiians have never directly relin19 quished to the United States their claims to their in20 herent sovereignty as a people or over their national

21 territory, either through their monarchy or through a

22 plebiscite or referendum.

23 ‘‘(6) The Native Hawaiian people are deter24 mined to preserve, develop and transmit to future

25 generations their ancestral territory, and their cul-
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1 tural identity in accordance with their own spiritual

2 and traditional beliefs, customs, practices, language,

3 and social institutions. In referring to themselves, Na4 tive Hawaiians use the term ‘Kanaka Maoli’, a term

5 frequently used in the 19th century to describe the na6 tive people of Hawaii.

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

8 Hawaii—

9 ‘‘(A) acknowledge the distinct land rights of

10 Native Hawaiian people as beneficiaries of the

11 public lands trust; and

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

13 of the Native Hawaiian people to practice and

14 perpetuate their cultural and religious customs,

15 beliefs, practices, and language.

16 ‘‘(8) At the time of the arrival of the first non17 indigenous peoples in Hawaii in 1778, the Native

18 Hawaiian people lived in a highly organized, self-suf19 ficient, subsistence social system based on communal

20 land tenure with a sophisticated language, culture,

21 and religion.

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

23 Hawaiian Islands was established in 1810 under Ka24 mehameha I, the first King of Hawaii.
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1 ‘‘(10) Throughout the 19th century and until

2 1893, the United States—

3 ‘‘(A) recognized the independence of the Ha4 waiian Nation;

5 ‘‘(B) extended full and complete diplomatic

6 recognition to the Hawaiian Government; and

7 ‘‘(C) entered into treaties and conventions

8 with the Hawaiian monarchs to govern com9 merce and navigation in 1826, 1842, 1849, 1875

10 and 1887.

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

12 States Minister assigned to the sovereign and inde13 pendent Kingdom of Hawaii, conspired with a small

14 group of non-Hawaiian residents of the Kingdom, in15 cluding citizens of the United States, to overthrow the

16 indigenous and lawful government of Hawaii.

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

18 United States Minister and the naval representative

19 of the United States caused armed naval forces of the

20 United States to invade the sovereign Hawaiian Na21 tion in support of the overthrow of the indigenous and

22 lawful Government of Hawaii and the United States

23 Minister thereupon extended diplomatic recognition of

24 a provisional government formed by the conspirators

25 without the consent of the native people of Hawaii or
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1 the lawful Government of Hawaii in violation of trea2 ties between the 2 nations and of international law.

3 ‘‘(13) In a message to Congress on December 18,

4 1893, then President Grover Cleveland reported fully

5 and accurately on these illegal actions, and acknowl6 edged that by these acts, described by the President as

7 acts of war, the government of a peaceful and friendly

8 people was overthrown, and the President concluded

9 that a ‘substantial wrong has thus been done which

10 a due regard for our national character as well as the

11 rights of the injured people required that we should

12 endeavor to repair’.

13 ‘‘(14) Queen Lili‘uokalani, the lawful monarch of

14 Hawaii, and the Hawaiian Patriotic League, rep15 resenting the aboriginal citizens of Hawaii, promptly

16 petitioned the United States for redress of these

17 wrongs and for restoration of the indigenous govern18 ment of the Hawaiian nation, but this petition was

19 not acted upon.

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

21 significance of these events and has apologized to Na22 tive Hawaiians on behalf of the people of the United

23 States for the overthrow of the Kingdom of Hawaii

24 with the participation of agents and citizens of the

25 United States, and the resulting deprivation of the
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1 rights of Native Hawaiians to self-determination in

2 legislation enacted into law in 1993 (Public Law

3 103–150; 107 Stat. 1510).

4 ‘‘(16) In 1898, the United States annexed Ha5 waii through the Newlands Resolution without the

6 consent of or compensation to the indigenous peoples

7 of Hawaii or their sovereign government who were

8 thereby denied the mechanism for expression of their

9 inherent sovereignty through self-government and self10 determination, their lands and ocean resources.

11 ‘‘(17) Through the Newlands Resolution and the

12 1900 Organic Act, the Congress received 1,750,000

13 acres of lands formerly owned by the Crown and Gov14 ernment of the Hawaiian Kingdom and exempted the

15 lands from then existing public land laws of the

16 United States by mandating that the revenue and

17 proceeds from these lands be ‘used solely for the ben18 efit of the inhabitants of the Hawaiian Islands for

19 education and other public purposes’, thereby estab20 lishing a special trust relationship between the United

21 States and the inhabitants 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 stating,

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

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

8 we are trustees, are falling off rapidly in numbers

9 and many of them are in poverty.’.

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

11 unique status of the Native Hawaiian people by in12 cluding in the Act of June 20, 1938 (52 Stat. 781 et

13 seq.), a provision to lease lands within the extension

14 to Native Hawaiians and to permit fishing in the

15 area ‘only by native Hawaiian residents of said area

16 or of adjacent villages and by visitors under their

17 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 Na25 tive Hawaiian people by retaining the exclusive
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1 power to enforce the trust, including the power to ap2 prove land exchanges, and legislative amendments af3 fecting 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 Ha10 waii but reaffirmed the trust relationship which ex11 isted between the United States and the Native Ha12 waiian people by retaining the legal responsibility of

13 the State for the betterment of the conditions of Native

14 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 Hawaiian

17 Affairs and assigned to that body the authority to ac18 cept and hold real and personal property transferred

19 from any source in trust for the Native Hawaiian

20 people, to receive payments from the State of Hawaii

21 due to the Native Hawaiian people in satisfaction of

22 the pro rata share of the proceeds of the Public Land

23 Trust created under section 5 of the Admission Act of

24 1959 (Public Law 83–3), to act as the lead State

25 agency for matters affecting the Native Hawaiian
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1 people, and to formulate policy on affairs relating to

2 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 affecting

7 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 Hawai17 ians, the United States has established a program for

18 the provision of comprehensive health promotion and

19 disease prevention services to maintain and improve

20 the health status of the Hawaiian people. This pro21 gram is conducted by the Native Hawaiian Health

22 Care Systems, the Native Hawaiian Health Scholar23 ship Program and Papa Ola Lokahi. Health initia24 tives from these and other health institutions and

25 agencies using Federal assistance have been respon-
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1 sible for reducing the century-old morbidity and mor2 tality rates of Native Hawaiian people by providing

3 comprehensive disease prevention, health promotion

4 activities and increasing the number of Native Ha5 waiians in the health and allied health professions.

6 This has been accomplished through the Native Ha7 waiian Health Care Act of 1988 (Public Law 100–

8 579) and its reauthorization in section 9168 of Public

9 Law 102–396 (106 Stat. 1948).

10 ‘‘(26) This historical and unique legal relation11 ship has been consistently recognized and affirmed by

12 Congress through the enactment of Federal laws which

13 extend to the Native Hawaiian people the same rights

14 and privileges accorded to American Indian, Alaska

15 Native, Eskimo, and Aleut communities, including

16 the Native American Programs Act of 1974 (42

17 U.S.C. 2991 et seq.), the American Indian Religious

18 Freedom Act (42 U.S.C. 1996), the National Museum

19 of the American Indian Act (20 U.S.C. 80q et seq.),

20 and the Native American Graves Protection and Re21 patriation Act (25 U.S.C. 3001 et seq.).

22 ‘‘(27) The United States has also recognized and

23 reaffirmed the trust relationship to the Native Hawai24 ian people through legislation which authorizes the

25 provision of services to Native Hawaiians, specifi-
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1 cally, the Older Americans Act of 1965 (42 U.S.C.

2 3001 et seq.), the Developmental Disabilities Assist3 ance and Bill of Rights Act Amendments of 1987, the

4 Veterans’ Benefits and Services Act of 1988, the Reha5 bilitation Act of 1973 (29 U.S.C. 701 et seq.), the Na6 tive Hawaiian Health Care Act of 1988 (Public Law

7 100–579), the Health Professions Reauthorization Act

8 of 1988, the Nursing Shortage Reduction and Edu9 cation Extension Act of 1988, the Handicapped Pro10 grams Technical Amendments Act of 1988, the Indian

11 Health Care Amendments of 1988, and the Disadvan12 taged Minority Health Improvement Act of 1990.

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

14 historical and unique legal relationship to the Hawai15 ian people by authorizing the provision of services to

16 Native Hawaiians to address problems of alcohol and

17 drug abuse under the Anti-Drug Abuse Act of 1986

18 (Public Law 99–570).

19 ‘‘(29) Further, the United States has recognized

20 that Native Hawaiians, as aboriginal, indigenous,

21 native peoples of Hawaii, are a unique population

22 group in Hawaii and in the continental United

23 States and has so declared in Office of Management

24 and Budget Circular 15 in 1997 and Presidential Ex25 ecutive Order No. 13125, dated June 7, 1999.
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1 ‘‘(30) Despite the United States having expressed

2 its commitment to a policy of reconciliation with the

3 Native Hawaiian people for past grievances in Public

4 Law 103–150 (107 Stat. 1510) the unmet health

5 needs of the Native Hawaiian people remain severe

6 and their health status continues to be far below that

7 of the general population of the United States.

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

9 Congress finds that the unmet needs and serious health dis10 parities that adversely affect the Native Hawaiian people

11 include the following:

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

13 ‘‘(A) CANCER.—

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

15 cancer—

16 ‘‘(I) Native Hawaiians have the

17 highest cancer mortality rates in the

18 State of Hawaii (231.0 out of every

19 100,000 residents), 45 percent higher

20 than that for the total State population

21 (159.7 out of every 100,000 residents);

22 ‘‘(II) Native Hawaiian males

23 have the highest cancer mortality rates

24 in the State of Hawaii for cancers of
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1 the lung, liver and pancreas and for

2 all cancers combined;

3 ‘‘(III) Native Hawaiian females

4 ranked highest in the State of Hawaii

5 for cancers of the lung, liver, pancreas,

6 breast, cervix uteri, corpus uteri, stom7 ach, and rectum, and for all cancers

8 combined;

9 ‘‘(IV) Native Hawaiian males

10 have the highest years of productive life

11 lost from cancer in the State of Ha12 waii with 8.7 years compared to 6.4

13 years for all males; and

14 ‘‘(V) Native Hawaiian females

15 have 8.2 years of productive life lost

16 from cancer in the State of Hawaii as

17 compared to 6.4 years for all females

18 in the State of Hawaii;

19 ‘‘(ii) BREAST CANCER.—With respect

20 to breast cancer—

21 ‘‘(I) Native Hawaiians have the

22 highest mortality rates in the State of

23 Hawaii from breast cancer (37.96 out

24 of every 100,000 residents), which is 25

25 percent higher than that for Caucasian
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1 Americans (30.25 out of every 100,000

2 residents) and 106 percent higher than

3 that for Chinese Americans (18.39 out

4 of every 100,000 residents); and

5 ‘‘(II) nationally, Native Hawai6 ians have the third highest mortality

7 rates due to breast cancer (25.0 out of

8 every 100,000 residents) following Afri9 can Americans (31.4 out of every

10 100,000 residents) and Caucasian

11 Americans (27.0 out of every 100,000

12 residents).

13 ‘‘(iii) CANCER OF THE CERVIX.—Na14 tive Hawaiians have the highest mortality

15 rates from cancer of the cervix in the State

16 of Hawaii (3.82 out of every 100,000 resi17 dents) followed by Filipino Americans (3.33

18 out of every 100,000 residents) and Cauca19 sian Americans (2.61 out of every 100,000

20 residents).

21 ‘‘(iv) LUNG CANCER.—Native Hawai22 ians have the highest mortality rates from

23 lung cancer in the State of Hawaii (90.70

24 out of every 100,000 residents), which is 61

25 percent higher than Caucasian Americans,
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1 who rank second and 161 percent higher

2 than Japanese Americans, who rank third.

3 ‘‘(v) PROSTATE CANCER.—Native Ha4 waiian males have the second highest mor5 tality rates due to prostate cancer in the

6 State of Hawaii (25.86 out of every 100,000

7 residents) with Caucasian Americans hav8 ing the highest mortality rate from prostate

9 cancer (30.55 out of every 100,000 resi10 dents).

11 ‘‘(B) DIABETES.—With respect to diabetes,

12 for the years 1989 through 1991—

13 ‘‘(i) Native Hawaiians had the highest

14 mortality rate due to diabetes mellitis (34.7

15 out of every 100,000 residents) in the State

16 of Hawaii which is 130 percent higher than

17 the statewide rate for all other races (15.1

18 out of every 100,000 residents);

19 ‘‘(ii) full-blood Hawaiians had a mor20 tality rate of 93.3 out of every 100,000 resi21 dents, which is 518 percent higher than the

22 rate for the statewide population of all other

23 races; and

24 ‘‘(iii) Native Hawaiians who are less

25 than full-blood had a mortality rate of 27.1
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1 out of every 100,000 residents, which is 79

2 percent higher than the rate for the state3 wide population of all other races.

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

5 ‘‘(i) in 1990, Native Hawaiians com6 prised 44 percent of all asthma cases in the

7 State of Hawaii for those 18 years of age

8 and younger, and 35 percent of all asthma

9 cases reported; and

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

11 rate for asthma was 81.7 out of every 1000

12 residents, which was 73 percent higher than

13 the rate for the total statewide population of

14 47.3 out of every 1000 residents.

15 ‘‘(D) CIRCULATORY DISEASES.—

16 ‘‘(i) HEART DISEASE.—With respect to

17 heart disease—

18 ‘‘(I) the death rate for Native Ha19 waiians from heart disease (333.4 out

20 of every 100,000 residents) is 66 per21 cent higher than for the entire State of

22 Hawaii (201.1 out of every 100,000

23 residents); and

24 ‘‘(II) Native Hawaiian males

25 have the greatest years of productive
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1 life lost in the State of Hawaii where

2 Native Hawaiian males lose an aver3 age of 15.5 years and Native Hawai4 ian females lose an average of 8.2

5 years due to heart disease, as compared

6 to 7.5 years for all males in the State

7 of Hawaii and 6.4 years for all fe8 males.

9 ‘‘(ii) HYPERTENSION.—The death rate

10 for Native Hawaiians from hypertension

11 (3.5 out of every 100,000 residents) is 84

12 percent higher than that for the entire State

13 (1.9 out of every 100,000 residents).

14 ‘‘(iii) STROKE.—The death rate for

15 Native Hawaiians from stroke (58.3 out of

16 every 100,000 residents) is 13 percent high17 er than that for the entire State (51.8 out

18 of every 100,000 residents).

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

20 incidence of AIDS for Native Hawaiians is at least

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

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

23 State of Hawaii.

24 ‘‘(3) INJURIES.—With respect to injuries—
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1 ‘‘(A) the death rate for Native Hawaiians

2 from injuries (38.8 out of every 100,000 resi3 dents) is 45 percent higher than that for the en4 tire State (26.8 out of every 100,000 residents);

5 ‘‘(B) Native Hawaiian males lose an aver6 age of 14 years of productive life lost from inju7 ries as compared to 9.8 years for all other males

8 in Hawaii; and

9 ‘‘(C) Native Hawaiian females lose and av10 erage of 4 years of productive life lost from inju11 ries but this rate is the highest rate among all

12 females in the State of Hawaii.

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

14 health—

15 ‘‘(A) Native Hawaiian children exhibit

16 among the highest rates of dental caries in the

17 nation, and the highest in the State of Hawaii

18 as compared to the 5 other major ethnic groups

19 in the State;

20 ‘‘(B) the average number of decayed or filled

21 primary teeth for Native Hawaiian children ages

22 5 through 9 years was 4.3 as compared with 3.7

23 for the entire State of Hawaii and 1.9 for the

24 United States; and
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1 ‘‘(C) the proportion of Native Hawaiian

2 children ages 5 through 12 years with unmet

3 treatment needs (defined as having active dental

4 caries requiring treatment) is 40 percent as com5 pared with 33 percent for all other races in the

6 State of Hawaii.

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

8 expectancy—

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

10 expectancy of all population groups in the State

11 of Hawaii;

12 ‘‘(B) between 1910 and 1980, the life expect13 ancy of Native Hawaiians from birth has ranged

14 from 5 to 10 years less than that of the overall

15 State population average; and

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

17 Native Hawaiian life expectancy at birth (74.27

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

19 total State population (78.85 years).

20 ‘‘(6) MATERNAL AND CHILD HEALTH.—

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

22 prenatal care—

23 ‘‘(i) as of 1996, Native Hawaiian

24 women have the highest prevalence (21 per25 cent) of having had no prenatal care during
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1 their first trimester of pregnancy when com2 pared to the 5 largest ethnic groups in the

3 State of Hawaii;

4 ‘‘(ii) of the mothers in the State of Ha5 waii who received no prenatal care through6 out their pregnancy in 1996, 44 percent

7 were Native Hawaiian;

8 ‘‘(iii) over 65 percent of the referrals to

9 Healthy Start in fiscal years 1996 and

10 1997 were Native Hawaiian newborns; and

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

12 Hawaii, many Native Hawaiian newborns

13 begin life in a potentially hazardous cir14 cumstance, far higher than any other racial

15 group.

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

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

18 births to Native Hawaiian mothers were in19 fants born to single mothers which statistics

20 indicate put infants at higher risk of low

21 birth weight and infant mortality;

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

23 Hawaiian single mothers, 8 percent were

24 low birth weight (under 2500 grams); and
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1 ‘‘(iii) of all low birth weight babies

2 born to single mothers in the State of Ha3 waii, 44 percent were Native Hawaiian.

4 ‘‘(C) TEEN PREGNANCIES.—With respect to

5 births—

6 ‘‘(i) in 1993 and 1994, Native Hawai7 ians had the highest percentage of teen (in8 dividuals who were less than 18 years of

9 age) births (8.1 percent) compared to the

10 rate for all other races in the State of Ha11 waii (3.6 percent);

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

13 mothers in Hawaii under 18 years of age

14 were Native Hawaiian;

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

16 lower than for the statewide population)

17 among Hawaiian women may account in

18 part, for the higher percentage of live births;

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

20 age 14 years and younger in Hawaii, 66

21 percent were Native Hawaiian; and

22 ‘‘(v) in 1996, of the births in this same

23 group, 48 percent were Native Hawaiian.

24 ‘‘(D) FETAL MORTALITY.—In 1996, Native

25 Hawaiian fetal mortality rates comprised 15
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1 percent of all fetal deaths for the State of Ha2 waii. However, for fetal deaths occurring in

3 mothers under the age of 18 years, 32 percent

4 were Native Hawaiian, and for mothers 18

5 through 24 years of age, 28 percent were Native

6 Hawaiians.

7 ‘‘(7) MENTAL HEALTH.—

8 ‘‘(A) ALCOHOL AND DRUG ABUSE.—With

9 respect to alcohol and drug abuse—

10 ‘‘(i) Native Hawaiians represent 38

11 percent of the total admissions to Depart12 ment of Health, Alcohol, Drugs and Other

13 Drugs, funded substance abuse treatment

14 programs;

15 ‘‘(ii) in 1997, the prevalence of ciga16 rette smoking by Native Hawaiians was

17 28.5 percent, a rate that is 53 percent high18 er than that for all other races in the State

19 of Hawaii which is 18.6 percent;

20 ‘‘(iii) Native Hawaiians have the high21 est prevalence rates of acute alcohol drink22 ing (31 percent), a rate that is 79 percent

23 higher than that for all other races in the

24 State of Hawaii;
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1 ‘‘(iv) the chronic alcohol drinking rate

2 among Native Hawaiians is 54 percent

3 higher than that for all other races in the

4 State of Hawaii;

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

6 Hawaiian adults surveyed reported having

7 used marijuana compared with 30 percent

8 for all other races in the State of Hawaii;

9 and

10 ‘‘(vi) nine percent of the Native Ha11 waiian adults surveyed reported that they

12 are current users (within the past year) of

13 marijuana, compared with 6 percent for all

14 other races in the State of Hawaii.

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

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

17 were made for property crimes in the State

18 of Hawaii, arrests of Native Hawaiians

19 comprised 20 percent of that total;

20 ‘‘(ii) Native Hawaiian juveniles com21 prised a third of all juvenile arrests in

22 1996;

23 ‘‘(iii) In 1996, Native Hawaiians rep24 resented 21 percent of the 8,000 adults ar25 rested for violent crimes in the State of Ha-
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1 waii, and 38 percent of the 4,066 juvenile

2 arrests;

3 ‘‘(iv) Native Hawaiians are over-rep4 resented in the prison population in Ha5 waii;

6 ‘‘(v) in 1995 and 1996 Native Hawai7 ians comprised 36.5 percent of the sentenced

8 felon prison population in Hawaii, as com9 pared to 20.5 percent for Caucasian Ameri10 cans, 3.7 percent for Japanese Americans,

11 and 6 percent for Chinese Americans;

12 ‘‘(vi) in 1995 and 1996 Native Hawai13 ians made up 45.4 percent of the technical

14 violator population, and at the Hawaii

15 Youth Correctional Facility, Native Hawai16 ians constituted 51.6 percent of all detainees

17 in fiscal year 1997; and

18 ‘‘(vii) based on anecdotal information

19 from inmates at the Halawa Correction Fa20 cilities, Native Hawaiians are estimated to

21 comprise between 60 and 70 percent of all

22 inmates.

23 ‘‘(8) HEALTH PROFESSIONS EDUCATION AND

24 TRAINING.—With respect to health professions edu25 cation and training—
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1 ‘‘(A) Native Hawaiians age 25 years and

2 older have a comparable rate of high school com3 pletion, however, the rates of baccalaureate de4 gree achievement amongst Native Hawaiians are

5 less than the norm in the State of Hawaii (6.9

6 percent and 15.76 percent respectively);

7 ‘‘(B) Native Hawaiian physicians make up

8 4 percent of the total physician workforce in the

9 State of Hawaii; and

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

11 comprised 8 percent of those individuals who

12 earned Bachelor’s Degrees, 14 percent of those in13 dividuals who earned professional diplomas, 6

14 percent of those individuals who earned Master’s

15 Degrees, and less than 1 percent of individuals

16 who earned doctoral degrees at the University of

17 Hawaii.

18 ‘‘SEC. 3. DEFINITIONS.

19 ‘‘In this Act:

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

21 means the Department of Health and Human Serv22 ices.

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

24 prevention’ includes—

25 ‘‘(A) immunizations;
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1 ‘‘(B) control of high blood pressure;

2 ‘‘(C) control of sexually transmittable dis3 eases;

4 ‘‘(D) prevention and control of chronic dis5 eases;

6 ‘‘(E) control of toxic agents;

7 ‘‘(F) occupational safety and health;

8 ‘‘(G) injury prevention;

9 ‘‘(H) fluoridation of water;

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

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

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

13 promotion’ includes—

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

15 prevention of fetal alcohol syndrome;

16 ‘‘(B) cessation of tobacco smoking;

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

18 harmful illicit drugs;

19 ‘‘(D) improvement of nutrition;

20 ‘‘(E) improvement in physical fitness;

21 ‘‘(F) family planning;

22 ‘‘(G) control of stress;

23 ‘‘(H) reduction of major behavioral risk fac24 tors and promotion of healthy lifestyle practices;

25 and
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1 ‘‘(I) integration of cultural approaches to

2 health and well-being, including traditional

3 practices relating to the atmosphere (lewa lani),

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

5 ‘‘(4) NATIVE HAWAIIAN.—The term ‘Native Ha6 waiian’ means any individual who is Kanaka Maoli

7 (a descendant of the aboriginal people who, prior to

8 1778, occupied and exercised sovereignty in the area

9 that now constitutes the State of Hawaii) as evi10 denced by—

11 ‘‘(A) genealogical records,

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

13 Native Hawaiian Kupuna (elders); or

14 ‘‘(C) birth records of the State of Hawaii or

15 any State or territory of the United States.

16 ‘‘(5) NATIVE HAWAIIAN HEALTH CARE SYSTEM.—

17 The term ‘Native Hawaiian health care system’

18 means an entity—

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

20 the State of Hawaii;

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

22 care services through practitioners licensed by

23 the State of Hawaii, where licensure require24 ments are applicable;
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1 ‘‘(C) which is a public or nonprofit private

2 entity;

3 ‘‘(D) in which Native Hawaiian health

4 practitioners significantly participate in the

5 planning, management, monitoring, and evalua6 tion of health care services;

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

8 8 Native Hawaiian health care systems as nec9 essary to meet the health care needs of each is10 land’s Native Hawaiians; and

11 ‘‘(F) which is—

12 ‘‘(i) recognized by Papa Ola Lokahi for

13 the purpose of planning, conducting, or ad14 ministering programs, or portions of pro15 grams, authorized by this chapter for the

16 benefit of Native Hawaiians; and

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

18 having the qualifications and the capacity

19 to provide the services and meet the require20 ments under the contract the Native Hawai21 ian health care system enters into with the

22 Secretary or the grant the Native Hawaiian

23 health care system receives from the Sec24 retary pursuant to this Act.
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1 ‘‘(6) NATIVE HAWAIIAN HEALTH CENTER.—The

2 term ‘Native Hawaiian Health Center’ means any or3 ganization that is a primary care provider and

4 that—

5 ‘‘(A) has a governing board that is com6 posed of individuals, at least 50 percent of whom

7 are Native Hawaiians;

8 ‘‘(B) has demonstrated cultural competency

9 in a predominantly Native Hawaiian commu10 nity;

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

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

13 50 percent of whom are Native Hawaiian;

14 or

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

16 Hawaiians as annual users of services; and

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

18 having met all the criteria of this paragraph.

19 ‘‘(7) NATIVE HAWAIIAN HEALTH TASK FORCE.—

20 The term ‘Native Hawaiian Health Task Force’

21 means a task force established by the State Council of

22 Hawaiian Homestead Associations to implement

23 health and wellness strategies in Native Hawaiian

24 communities.
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1 ‘‘(8) NATIVE HAWAIIAN ORGANIZATION.—The

2 term ‘Native Hawaiian organization’ means any

3 organization—

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

5 Hawaiians; and

6 ‘‘(B) which is—

7 ‘‘(i) recognized by Papa Ola Lokahi for

8 the purpose of planning, conducting, or ad9 ministering programs (or portions of pro10 grams) authorized under this Act for the

11 benefit of Native Hawaiians; and

12 ‘‘(ii) a public or nonprofit private en13 tity.

14 ‘‘(9) OFFICE OF HAWAIIAN AFFAIRS.—The terms

15 ‘Office of Hawaiian Affairs’ and ‘OHA’ mean the

16 governmental entity established under Article XII,

17 sections 5 and 6 of the Hawaii State Constitution

18 and charged with the responsibility to formulate pol19 icy relating to the affairs of Native Hawaiians.

20 ‘‘(10) PAPA OLA LOKAHI.—

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

22 Lokahi’ means an organization that is composed

23 of public agencies and private organizations fo24 cusing on improving the health status of Native
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1 Hawaiians. Board members of such organization

2 may include representation from—

3 ‘‘(i) E Ola Mau;

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

5 the State of Hawaii;

6 ‘‘(iii) Alu Like, Inc.;

7 ‘‘(iv) the University of Hawaii;

8 ‘‘(v) the Hawaii State Department of

9 Health;

10 ‘‘(vi) the Kamehameha Schools, or

11 other Native Hawaiian organization re12 sponsible for the administration of the Na13 tive Hawaiian Health Scholarship Pro14 gram;

15 ‘‘(vii) the Hawaii State Primary Care

16 Association, or Native Hawaiian Health

17 Centers whose patient populations are pre18 dominantly Native Hawaiian;

19 ‘‘(viii) Ahahui O Na Kauka, the Na20 tive Hawaiian Physicians Association;

21 ‘‘(ix) Ho‘ola Lahui Hawaii, or a

22 health care system serving the islands of

23 Kaua‘i or Ni‘ihau, and which may be com24 posed of as many health care centers as are
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1 necessary to meet the health care needs of

2 the Native Hawaiians of those islands;

3 ‘‘(x) Ke Ola Mamo, or a health care

4 system serving the island of O‘ahu and

5 which may be composed of as many health

6 care centers as are necessary to meet the

7 health care needs of the Native Hawaiians

8 of that island;

9 ‘‘(xi) Na Pu‘uwai or a health care sys10 tem serving the islands of Moloka‘i or

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

12 many health care centers as are necessary to

13 meet the health care needs of the Native Ha14 waiians of those islands;

15 ‘‘(xii) Hui No Ke Ola Pono, or a

16 health care system serving the island of

17 Maui, and which may be composed of as

18 many health care centers as are necessary to

19 meet the health care needs of the Native Ha20 waiians of that island;

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

22 a health care system serving the island of

23 Hawaii, and which may be composed of as

24 many health care centers as are necessary to
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1 meet the health care needs of the Native Ha2 waiians of that island;

3 ‘‘(xiv) other Native Hawaiian health

4 care systems as certified and recognized by

5 Papa Ola Lokahi in accordance with this

6 Act; and

7 ‘‘(xv) such other member organizations

8 as the Board of Papa Ola Lokahi will

9 admit from time to time, based upon satis10 factory demonstration of a record of con11 tribution to the health and well-being of Na12 tive Hawaiians.

13 ‘‘(B) LIMITATION.—Such term does not in14 clude any organization described in subpara15 graph (A) if the Secretary determines that such

16 organization has not developed a mission state17 ment with clearly defined goals and objectives for

18 the contributions the organization will make to

19 the Native Hawaiian health care systems, the

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

21 action plan for carrying out those goals and ob22 jectives.

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

24 ‘primary health services’ means—
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1 ‘‘(A) services of physicians, physicians’ as2 sistants, nurse practitioners, and other health

3 professionals;

4 ‘‘(B) diagnostic laboratory and radiologic

5 services;

6 ‘‘(C) preventive health services including

7 perinatal services, well child services, family

8 planning services, nutrition services, home health

9 services, and, generally, all those services associ10 ated with enhanced health and wellness.

11 ‘‘(D) emergency medical services;

12 ‘‘(E) transportation services as required for

13 adequate patient care;

14 ‘‘(F) preventive dental services;

15 ‘‘(G) pharmaceutical and medicament serv16 ices;

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

18 to specialty or tertiary care; and

19 ‘‘(I) complimentary healing practices, in20 cluding those performed by traditional Native

21 Hawaiian healers.

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

23 the Secretary of Health and Human Services.
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1 ‘‘(13) TRADITIONAL NATIVE HAWAIIAN HEAL2 ER.—The term ‘traditional Native Hawaiian healer’

3 means a practitioner—

4 ‘‘(A) who—

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

6 and

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

9 individuals; and

10 ‘‘(B) whose knowledge, skills, and experience

11 are based on demonstrated learning of Native

12 Hawaiian healing practices acquired by—

13 ‘‘(i) direct practical association with

14 Native Hawaiian elders; and

15 ‘‘(ii) oral traditions transmitted from

16 generation to generation.

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

18 HEALTH POLICY.

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

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

21 responsibilities and legal obligations to the indigenous peo22 ples of Hawaii resulting from the unique and historical re23 lationship between the United States and the indigenous

24 peoples of Hawaii—
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1 ‘‘(1) to raise the health status of Native Hawai2 ians to the highest possible health level; and

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

4 care programs with all resources necessary to effec5 tuate this policy.

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

7 Congress that—

8 ‘‘(1) health care programs having a dem9 onstrated effect of substantially reducing or elimi10 nating the over-representation of Native Hawaiians

11 among those suffering from chronic and acute disease

12 and illness and addressing the health needs, including

13 perinatal, early child development, and family-based

14 health education, of Native Hawaiians shall be estab15 lished and implemented; and

16 ‘‘(2) the Nation raise the health status of Native

17 Hawaiians by the year 2010 to at least the levels set

18 forth in the goals contained within Healthy People

19 2010 or successor standards and to incorporate with20 in health programs, activities defined and identified

21 by Kanaka Maoli which may include—

22 ‘‘(A) incorporating and supporting the inte23 gration of cultural approaches to health and

24 well-being, including programs using traditional
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1 practices relating to the atmosphere (lewa lani),

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

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

4 allied-health care providers who are trained to

5 provide culturally competent care to Native Ha6 waiians;

7 ‘‘(C) increasing the use of traditional Na8 tive Hawaiian foods in peoples’ diets and die9 tary preferences including those of students and

10 the use of these traditional foods in school feeding

11 programs;

12 ‘‘(D) identifying and instituting Native

13 Hawaiian cultural values and practices within

14 the ‘corporate cultures’ of organizations and

15 agencies providing health services to Native Ha16 waiians;

17 ‘‘(E) facilitating the provision of Native

18 Hawaiian healing practices by Native Hawaiian

19 healers for those clients desiring such assistance;

20 and

21 ‘‘(F) supporting training and education ac22 tivities and programs in traditional Native Ha23 waiian healing practices by Native Hawaiian

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

2 President, for inclusion in each report required to be trans3 mitted to Congress under section 12, a report on the

4 progress made towards meeting the National policy as set

5 forth in this section.

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

7 FOR NATIVE HAWAIIANS.

8 ‘‘(a) DEVELOPMENT.—

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

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

11 Lokahi for the purpose of coordinating, implementing

12 and updating a Native Hawaiian comprehensive

13 health care master plan designed to promote com14 prehensive health promotion and disease prevention

15 services and to maintain and improve the health sta16 tus of Native Hawaiians, and to support community17 based initiatives that are reflective of holistic ap18 proaches to health.

19 ‘‘(2) CONSULTATION.—

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

21 the Office of Hawaiian Affairs shall consult with

22 the Native Hawaiian health care systems, Native

23 Hawaiian health centers, and the Native Hawai24 ian community in carrying out this section.
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•S 1929 RS

1 ‘‘(B) MEMORANDA OF UNDERSTANDING.—

2 Papa Ola Lokahi and the Office of Hawaiian

3 Affairs may enter into memoranda of under4 standing or agreement for the purposes of acquir5 ing joint funding and for other issues as may be

6 necessary to accomplish the objectives of this sec7 tion.

8 ‘‘(3) HEALTH CARE FINANCING STUDY RE9 PORT.—Not later than 18 months after the date of en10 actment of this Act, Papa Ola Lokahi in cooperation

11 with the Office of Hawaiian Affairs and other appro12 priate agencies of the State of Hawaii, including the

13 Department of Health and the Department of Human

14 Services and the Native Hawaiian health care sys15 tems and Native Hawaiian health centers, shall sub16 mit to Congress a report detailing the impact of cur17 rent Federal and State health care financing mecha18 nisms and policies on the health and well-being of

19 Native Hawaiians. Such report shall include—

20 ‘‘(A) information concerning the impact of

21 cultural competency, risk assessment data, eligi22 bility requirements and exemptions, and reim23 bursement policies and capitation rates currently

24 in effect for service providers;
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•S 1929 RS

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

2 important to improving the health status of Na3 tive Hawaiians as such information relates to

4 health care financing including barriers to

5 health care; and

6 ‘‘(C) the recommendations for submission to

7 the Secretary for review and consultation with

8 Native Hawaiians.

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

10 are authorized to be appropriated such sums as may be nec11 essary to carry out subsection (a).

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

13 HAWAIIAN AFFAIRS.

14 ‘‘(a) RESPONSIBILITY.—Papa Ola Lokahi shall be re15 sponsible for the—

16 ‘‘(1) coordination, implementation, and updat17 ing, as appropriate, of the comprehensive health care

18 master plan developed pursuant to section 5;

19 ‘‘(2) training for the persons described in sub20 paragraphs (B) and (C) of section 7(c)(1);

21 ‘‘(3) identification of and research into the dis22 eases that are most prevalent among Native Hawai23 ians, including behavioral, biomedical, epidemiolog24 ical, and health services;
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•S 1929 RS

1 ‘‘(4) development and maintenance of an institu2 tional review board for all research projects involving

3 all aspects of Native Hawaiian health, including be4 havioral, biomedical, epidemiological, and health

5 services studies; and

6 ‘‘(5) the maintenance of an action plan outlining

7 the contributions that each member organization of

8 Papa Ola Lokahi will make in carrying out the pol9 icy of this Act.

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

11 may receive special project funds that may be appropriated

12 for the purpose of research on the health status of Native

13 Hawaiians or for the purpose of addressing the health care

14 needs of Native Hawaiians.

15 ‘‘(c) CLEARINGHOUSE.—

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

17 as a clearinghouse for—

18 ‘‘(A) the collection and maintenance of data

19 associated with the health status of Native Ha20 waiians;

21 ‘‘(B) the identification and research into

22 diseases affecting Native Hawaiians;

23 ‘‘(C) the availability of Native Hawaiian

24 project funds, research projects and publications;
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•S 1929 RS

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

2 area of Native Hawaiian health; and

3 ‘‘(E) the timely dissemination of informa4 tion pertinent to the Native Hawaiian health

5 care systems.

6 ‘‘(2) CONSULTATION.—The Secretary shall pro7 vide Papa Ola Lokahi and the Office of Hawaiian Af8 fairs, at least once annually, an accounting of funds

9 and services provided to States and to nonprofit

10 groups and organizations from the Department for

11 the purposes set forth in section 4. Such accounting

12 shall include—

13 ‘‘(A) the amount of funds expended explic14 itly for and benefiting Native Hawaiians;

15 ‘‘(B) the number of Native Hawaiians im16 pacted by these funds;

17 ‘‘(C) the identification of collaborations

18 made with Native Hawaiian groups and organi19 zations in the expenditure of these funds; and

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

21 administrative purposes and for the provision of

22 direct services to Native Hawaiians.

23 ‘‘(d) FISCAL ALLOCATION AND COORDINATION OF PRO24 GRAMS AND SERVICES.—
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1 ‘‘(1) RECOMMENDATIONS.—Papa Ola Lokahi

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

4 appropriated under this Act.

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

6 the maximum extent possible, coordinate and assist

7 the health care programs and services provided to Na8 tive Hawaiians.

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

10 Secretary, in consultation with Papa Ola Lokahi,

11 shall make recommendations for Native Hawaiian

12 representation on the President’s Advisory Commis13 sion on Asian Americans and Pacific Islanders.

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

15 act as a statewide infrastructure to provide technical sup16 port and coordination of training and technical assistance

17 to the Native Hawaiian health care systems and to Native

18 Hawaiian health centers.

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

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

21 into agreements or memoranda of understanding with

22 relevant institutions, agencies or organizations that

23 are capable of providing health-related resources or

24 services to Native Hawaiians and the Native Hawai25 ian health care systems or of providing resources or
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1 services for the implementation of the National policy

2 as set forth in section 4.

3 ‘‘(2) HEALTH CARE FINANCING.—

4 ‘‘(A) FEDERAL CONSULTATION.—Federal

5 agencies providing health care financing and

6 carrying out health care programs, including the

7 Health Care Financing Administration, shall

8 consult with Native Hawaiians and organiza9 tions providing health care services to Native

10 Hawaiians prior to the adoption of any policy

11 or regulation that may impact on the provision

12 of services or health insurance coverage. Such

13 consultation shall include the identification of

14 the impact of any proposed policy, rule, or regu15 lation.

16 ‘‘(B) STATE CONSULTATION.—The State of

17 Hawaii shall engage in meaningful consultation

18 with Native Hawaiians and organizations pro19 viding health care services to Native Hawaiians

20 in the State of Hawaii prior to making any

21 changes or initiating new programs.

22 ‘‘(C) CONSULTATION ON FEDERAL HEALTH

23 INSURANCE PROGRAMS.

24 ‘‘(i) IN GENERAL.—The Office of Ha25 waiian Affairs, in collaboration with Papa
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1 Ola Lokahi, may develop consultative, con2 tractual or other arrangements, including

3 memoranda of understanding or agreement,

4 with—

5 ‘‘(I) the Health Care Financing

6 Administration;

7 ‘‘(II) the agency of the State of

8 Hawaii that administers or supervises

9 the administration of the State plan or

10 waiver approved under title XVIII,

11 XIX, or XXI of the Social Security Act

12 for the payment of all or a part of the

13 health care services provided to Native

14 Hawaiians who are eligible for medical

15 assistance under the State plan or

16 waiver; or

17 ‘‘(III) any other Federal agency

18 or agencies providing full or partial

19 health insurance to Native Hawaiians.

20 ‘‘(ii) CONTENTS OF ARRANGEMENTS.—

21 Arrangements under clause (i) may

22 address—

23 ‘‘(I) appropriate reimbursement

24 for health care services including capi25 tation rates and fee-for-service rates for
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1 Native Hawaiians who are entitled to

2 or eligible for insurance;

3 ‘‘(II) the scope of services; or

4 ‘‘(III) other matters that would

5 enable Native Hawaiians to maximize

6 health insurance benefits provided by

7 Federal and State health insurance

8 programs.

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

10 health services under any program operated by the

11 Department or another Federal agency including the

12 Department of Veterans Affairs, may include the serv13 ices of ‘traditional Native Hawaiian healers’ as de14 fined in this Act or ‘traditional healers’ providing

15 ‘traditional health care practices’ as defined in sec16 tion 4(r) of Public Law 94–437. Such services shall

17 be exempt from national accreditation reviews, in18 cluding reviews conducted by the Joint Accreditation

19 Commission on Health Organizations and the Reha20 bilitation Accreditation Commission.

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

22 ‘‘(a) COMPREHENSIVE HEALTH PROMOTION, DISEASE

23 PREVENTION, AND PRIMARY HEALTH SERVICES.—

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

25 in consultation with Papa Ola Lokahi, may make
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•S 1929 RS

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

2 entity for the purpose of providing comprehensive

3 health promotion and disease prevention services, as

4 well as primary health services, to Native Hawaiians

5 who desire and are committed to bettering their own

6 health.

7 ‘‘(2) PREFERENCE.—In making grants and en8 tering into contracts under this subsection, the Sec9 retary shall give preference to Native Hawaiian

10 health care systems and Native Hawaiian organiza11 tions and, to the extent feasible, health promotion and

12 disease prevention services shall be performed through

13 Native Hawaiian health care systems.

14 ‘‘(3) QUALIFIED ENTITY.—An entity is a quali15 fied entity for purposes of paragraph (1) if the entity

16 is a Native Hawaiian health care system or a Native

17 Hawaiian Center.

18 ‘‘(4) LIMITATION ON NUMBER OF ENTITIES.—The

19 Secretary may make a grant to, or enter into a con20 tract with, not more than 8 Native Hawaiian health

21 care systems under this subsection during any fiscal

22 year.

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

24 grants and contracts under subsection (a), the Secretary

25 may make a grant to, or enter into a contract with, Papa
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1 Ola Lokahi for the purpose of planning Native Hawaiian

2 health care systems to serve the health needs of Native Ha3 waiian communities on each of the islands of O‘ahu,

4 Moloka‘i, Maui, Hawai‘i, Lana‘i, Kaua‘i, and Ni‘ihau in

5 the State of Hawaii.

6 ‘‘(c) SERVICES TO BE PROVIDED.—

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

8 under subsection (a) shall ensure that the following

9 services either are provided or arranged for:

10 ‘‘(A) Outreach services to inform Native

11 Hawaiians of the availability of health services.

12 ‘‘(B) Education in health promotion and

13 disease prevention of the Native Hawaiian popu14 lation by, wherever possible, Native Hawaiian

15 health care practitioners, community outreach

16 workers, counselors, and cultural educators.

17 ‘‘(C) Services of physicians, physicians’ as18 sistants, nurse practitioners or other health and

19 allied-health professionals.

20 ‘‘(D) Immunizations.

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

22 high blood pressure, and otitis media.

23 ‘‘(F) Pregnancy and infant care.

24 ‘‘(G) Improvement of nutrition.
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1 ‘‘(H) Identification, treatment, control, and

2 reduction of the incidence of preventable illnesses

3 and conditions endemic to Native Hawaiians.

4 ‘‘(I) Collection of data related to the preven5 tion of diseases and illnesses among Native Ha6 waiians.

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

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

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

10 defined in section 3, which are not specifically

11 referred to in subsection (a).

12 ‘‘(K) Support of culturally appropriate ac13 tivities enhancing health and wellness including

14 land-based, water-based, ocean-based, and spir15 itually-based projects and programs.

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

17 services referred to in paragraph (1) which are pro18 vided under grants or contracts under subsection (a)

19 may be provided by traditional Native Hawaiian

20 healers.

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

22 provide medical, dental, or other services referred to in sub23 section (a)(1) for Native Hawaiian health care systems, in24 cluding providers of traditional Native Hawaiian healing

25 services, shall be treated as if such individuals were mem-
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1 bers of the Public Health Service and shall be covered under

2 the provisions of section 224 of the Public Health Service

3 Act.

4 ‘‘(e) SITE FOR OTHER FEDERAL PAYMENTS.—A Na5 tive Hawaiian health care system that receives funds under

6 subsection (a) shall provide a designated area and appro7 priate staff to serve as a Federal loan repayment facility.

8 Such facility shall be designed to enable health and allied9 health professionals to remit payments with respect to loans

10 provided to such professionals under any Federal loan pro11 gram.

12 ‘‘(f) RESTRICTION ON USE OF GRANT AND CONTRACT

13 FUNDS.—The Secretary may not make a grant to, or enter

14 into a contract with, an entity under subsection (a) unless

15 the entity agrees that amounts received under such grant

16 or contract will not, directly or through contract, be

17 expended—

18 ‘‘(1) for any services other than the services de19 scribed in subsection (c)(1); or

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

21 than minor remodeling of existing improvements to

22 real property) or to purchase major medical equip23 ment.

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

25 Secretary may not make a grant to, or enter into a contract
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1 with, an entity under subsection (a) unless the entity agrees

2 that, whether health services are provided directly or

3 through contract—

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

5 will be provided without regard to ability to pay for

6 the health services; and

7 ‘‘(2) the entity will impose a charge for the deliv8 ery of health services, and such charge—

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

10 of charges that is made available to the public;

11 and

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

13 of the individual involved.

14 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—

15 ‘‘(1) GENERAL GRANTS.—There is authorized to

16 be appropriated such sums as may be necessary for

17 each of fiscal years 2001 through 2011 to carry out

18 subsection (a).

19 ‘‘(2) PLANNING GRANTS.—There is authorized to

20 be appropriated such sums as may be necessary for

21 each of fiscal years 2001 through 2011 to carry out

22 subsection (b).
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1 ‘‘SEC. 8. ADMINISTRATIVE GRANT FOR PAPA OLA LOKAHI.

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

3 contract under this Act, the Secretary may make grants to,

4 or enter into contracts with, Papa Ola Lokahi for—

5 ‘‘(1) coordination, implementation, and updat6 ing (as appropriate) of the comprehensive health care

7 master plan developed pursuant to section 5;

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

9 7(c)(1);

10 ‘‘(3) identification of and research into the dis11 eases that are most prevalent among Native Hawai12 ians, including behavioral, biomedical, epidemiologic,

13 and health services;

14 ‘‘(4) the maintenance of an action plan outlining

15 the contributions that each member organization of

16 Papa Ola Lokahi will make in carrying out the pol17 icy of this Act;

18 ‘‘(5) a clearinghouse function for—

19 ‘‘(A) the collection and maintenance of data

20 associated with the health status of Native Ha21 waiians;

22 ‘‘(B) the identification and research into

23 diseases affecting Native Hawaiians; and

24 ‘‘(C) the availability of Native Hawaiian

25 project funds, research projects and publications;
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1 ‘‘(6) the establishment and maintenance of an

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

4 ‘‘(7) the coordination of the health care programs

5 and services provided to Native Hawaiians; and

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

7 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There is

8 authorized to be appropriated such sums as may be nec9 essary for each of fiscal years 2001 through 2011 to carry

10 out subsection (a).

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

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

13 include in any grant made or contract entered into under

14 this Act such terms and conditions as the Secretary con15 siders necessary or appropriate to ensure that the objectives

16 of such grant or contract are achieved.

17 ‘‘(b) PERIODIC REVIEW.—The Secretary shall periodi18 cally evaluate the performance of, and compliance with,

19 grants and contracts under this Act.

20 ‘‘(c) ADMINISTRATIVE REQUIREMENTS.—The Sec21 retary may not make a grant or enter into a contract under

22 this Act with an entity unless the entity—

23 ‘‘(1) agrees to establish such procedures for fiscal

24 control and fund accounting as may be necessary to
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1 ensure proper disbursement and accounting with re2 spect to the grant or contract;

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

4 records maintained on individuals receiving health

5 services under the grant or contract;

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

7 any population of Native Hawaiians, a substantial

8 portion of which has a limited ability to speak the

9 English language—

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

11 carry out a reasonable plan to provide health

12 services under the grant or contract through in13 dividuals who are able to communicate with the

14 population involved in the language and cultural

15 context that is most appropriate; and

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

17 fluent in both English and the appropriate lan18 guage, to assist in carrying out the plan;

19 ‘‘(4) with respect to health services that are cov20 ered under programs under titles XVIII, XIX, or XXI

21 of the Social Security Act, including any State plan,

22 or under any other Federal health insurance plan—

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

24 grant or contract any such health services

25 directly—
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1 ‘‘(i) the entity has entered into a par2 ticipation agreement under such plans; and

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

4 payments under such plan; and

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

6 grant or contract any such health services

7 through a contract with an organization—

8 ‘‘(i) the organization has entered into

9 a participation agreement under such plan;

10 and

11 ‘‘(ii) the organization is qualified to

12 receive payments under such plan; and

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

14 Papa Ola Lokahi an annual report that describes the

15 use and costs of health services provided under the

16 grant or contract (including the average cost of health

17 services per user) and that provides such other infor18 mation as the Secretary determines to be appropriate.

19 ‘‘(d) CONTRACT EVALUATION.—

20 ‘‘(1) DETERMINATION OF NONCOMPLIANCE.—If,

21 as a result of evaluations conducted by the Secretary,

22 the Secretary determines that an entity has not com23 plied with or satisfactorily performed a contract en24 tered into under section 7, the Secretary shall, prior

25 to renewing such contract, attempt to resolve the
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1 areas of noncompliance or unsatisfactory performance

2 and modify such contract to prevent future occur3 rences of such noncompliance or unsatisfactory per4 formance.

5 ‘‘(2) NONRENEWAL.—If the Secretary determines

6 that the noncompliance or unsatisfactory performance

7 described in paragraph (1) with respect to an entity

8 cannot be resolved and prevented in the future, the

9 Secretary shall not renew the contract with such enti10 ty and may enter into a contract under section 7

11 with another entity referred to in subsection (a)(3) of

12 such section that provides services to the same popu13 lation of Native Hawaiians which is served by the en14 tity whose contract is not renewed by reason of this

15 paragraph.

16 ‘‘(3) CONSIDERATION OF RESULTS.—In deter17 mining whether to renew a contract entered into with

18 an entity under this Act, the Secretary shall consider

19 the results of the evaluations conducted under this sec20 tion.

21 ‘‘(4) APPLICATION OF FEDERAL LAWS.—All con22 tracts entered into by the Secretary under this Act

23 shall be in accordance with all Federal contracting

24 laws and regulations, except that, in the discretion of

25 the Secretary, such contracts may be negotiated with-
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1 out advertising and may be exempted from the provi2 sions of the Act of August 24, 1935 (40 U.S.C. 270a

3 et seq.).

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

5 contract entered into under this Act may be made in

6 advance, by means of reimbursement, or in install7 ments and shall be made on such conditions as the

8 Secretary deems necessary to carry out the purposes

9 of this Act.

10 ‘‘(e) REPORT.—

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

12 which an entity receives or expends funds pursuant to

13 a grant or contract under this Act, such entity shall

14 submit to the Secretary and to Papa Ola Lokahi an

15 annual report—

16 ‘‘(A) on the activities conducted by the enti17 ty under the grant or contract;

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

19 which Federal funds were expended; and

20 ‘‘(C) containing such other information as

21 the Secretary may request.

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

23 entity concerning any grant or contract under this

24 Act shall be subject to audit by the Secretary, the In25 spector General of the Department of Health and
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1 Human Services, and the Comptroller General of the

2 United States.

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

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

5 under this Act the cost of an annual private audit con6 ducted by a certified public accountant.

7 ‘‘SEC. 10. ASSIGNMENT OF PERSONNEL.

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

9 agreement with any entity under which the Secretary may

10 assign personnel of the Department of Health and Human

11 Services with expertise identified by such entity to such en12 tity on detail for the purposes of providing comprehensive

13 health promotion and disease prevention services to Native

14 Hawaiians.

15 ‘‘(b) APPLICABLE FEDERAL PERSONNEL PROVI16 SIONS.—Any assignment of personnel made by the Sec17 retary under any agreement entered into under subsection

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

19 to a local government that is made in accordance with sub20 chapter VI of chapter 33 of title 5, United States Code.

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

22 FELLOWSHIPS.

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

24 amounts appropriated under subsection (c), the Secretary

25 shall provide funds through a direct grant or a cooperative
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1 agreement to Kamehameha Schools or another Native Ha2 waiian organization or health care organization with expe3 rience in the administration of educational scholarships or

4 placement services for the purpose of providing scholarship

5 assistance to students who—

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

7 Public Health Service Act, except for assistance as

8 provided for under subsection (b)(2); and

9 ‘‘(2) are Native Hawaiians.

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

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

12 Hawaiian Health Care Systems and the Native Hawaiian

13 Health Centers.

14 ‘‘(c) TERMS AND CONDITIONS.—

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

16 under subsection (a) shall be provided under the same

17 terms and subject to the same conditions, regulations,

18 and rules as apply to scholarship assistance provided

19 under section 338A of the Public Health Service Act

20 (except as provided for in paragraph (2)), except

21 that—

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

23 type of health care profession training shall cor24 respond to the need for each type of health care
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1 professional to serve the Native Hawaiian com2 munity as identified by Papa Ola Lokahi;

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

4 the Secretary shall select scholarship recipients

5 from a list of eligible applicants submitted by the

6 Kamehameha Schools or the Native Hawaiian

7 organization administering the program;

8 ‘‘(C) the obligated service requirement for

9 each scholarship recipient (except for those re10 ceiving assistance under paragraph (2)) shall be

11 fulfilled through service, in order of priority,

12 in—

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

14 health care systems or Native Hawaiian

15 health centers;

16 ‘‘(ii) health professions shortage areas,

17 medically underserved areas, or geographic

18 areas or facilities similarly designated by

19 the United States Public Health Service in

20 the State of Hawaii; or

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

22 organization that serves a significant Na23 tive Hawaiian population;
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1 ‘‘(D) the scholarship’s placement service

2 shall assign Native Hawaiian scholarship recipi3 ents to appropriate sites for service.

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

5 and other support services shall not be limited to

6 scholarship recipients, but shall also include re7 cipients of other scholarship and financial aid

8 programs enrolled in appropriate health profes9 sions training programs.

10 ‘‘(F) financial assistance may be provided

11 to scholarship recipients in those health profes12 sions designated in such section 338A of the Pub13 lic Health Service Act while they are fulfilling

14 their service requirement in any one of the Na15 tive Hawaiian health care systems or community

16 health centers.

17 ‘‘(2) FELLOWSHIPS.—Financial assistance

18 through fellowships may be provided to Native Ha19 waiian community health representatives, outreach

20 workers, and health program administrators in pro21 fessional training programs, and to Native Hawai22 ians in certificated programs provided by traditional

23 Native Hawaiian healers in any of the traditional

24 Native Hawaiian healing practices including lomi25 lomi, la‘au lapa‘au, and ho‘oponopono. Such assist-
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1 ance may include a stipend or reimbursement for

2 costs associated with participation in the program.

3 ‘‘(3) RIGHTS AND BENEFITS.—Scholarship re4 cipients in health professions designated in section

5 338A of the Public Health Service Act while fulfilling

6 their service requirements shall have all the same

7 rights and benefits of members of the National Health

8 Service Corps during their period of service.

9 ‘‘(4) NO INCLUSION OF ASSISTANCE IN GROSS IN10 COME.—Financial assistance provided under section

11 11 shall be deemed ‘Qualified Scholarships’ for pur12 poses of the section amended by section 123(a) of Pub13 lic Law 99–514, as amended.

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

15 authorized to be appropriated such sums as may be nec16 essary for each of fiscal years 2001 through 2011 for the

17 purpose of funding the scholarship assistance program

18 under subsection (a) and fellowship assistance under sub19 section (c)(2).

20 ‘‘SEC. 12. REPORT.

21 ‘‘The President shall, at the time the budget is sub22 mitted under section 1105 of title 31, United States Code,

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

24 progress made in meeting the objectives of this Act, includ25 ing a review of programs established or assisted pursuant
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1 to this Act and an assessment and recommendations of ad2 ditional programs or additional assistance necessary to, at

3 a minimum, provide health services to Native Hawaiians,

4 and ensure a health status for Native Hawaiians, which

5 are at a parity with the health services available to, and

6 the health status of, the general population.

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

8 SOURCES OF SUPPLY.

9 ‘‘(a) IN GENERAL.—The Secretary shall permit orga10 nizations that receive contracts or grants under this Act,

11 in carrying out such contracts or grants, to use existing

12 facilities and all equipment therein or under the jurisdic13 tion of the Secretary under such terms and conditions as

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

15 facilities or equipment.

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

17 donate to organizations that receive contracts or grants

18 under this Act any personal or real property determined

19 to be in excess of the needs of the Department or the General

20 Services Administration for purposes of carrying out such

21 contracts or grants.

22 ‘‘(c) ACQUISITION OF SURPLUS PROPERTY.—The Sec23 retary may acquire excess or surplus Federal Government

24 personal or real property for donation to organizations that

25 receive contracts or grants under this Act if the Secretary
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•S 1929 RS

1 determines that the property is appropriate for the use by

2 the organization for the purpose for which a contract or

3 grant is authorized under this Act.

4 ‘‘SEC. 14. DEMONSTRATION PROJECTS OF NATIONAL SIG5 NIFICANCE.

6 ‘‘(a) AUTHORITY AND AREAS OF INTEREST.—The Sec7 retary, in consultation with Papa Ola Lokahi, may allocate

8 amounts appropriated under this Act, or any other Act, to

9 carry out Native Hawaiian demonstration projects of na10 tional significance. The areas of interest of such projects

11 may include—

12 ‘‘(1) the development of a centralized database

13 and information system relating to the health care

14 status, health care needs, and wellness of Native Ha15 waiians;

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

17 other individuals in institutions of higher learning,

18 in health and allied health programs in healing prac19 tices, including Native Hawaiian healing practices;

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

21 complementary healing practices including tradi22 tional Native Hawaiian healing practices;

23 ‘‘(4) the use of tele-wellness and telecommuni24 cations in chronic disease management and health

25 promotion and disease prevention;
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1 ‘‘(5) the development of appropriate models of

2 health care for Native Hawaiians and other indige3 nous peoples including the provision of culturally

4 competent health services, related activities focusing

5 on wellness concepts, the development of appropriate

6 kupuna care programs, and the development of finan7 cial mechanisms and collaborative relationships lead8 ing to universal access to health care; and

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

10 Center of Excellence for Nursing at the University of

11 Hawaii at Hilo, a Native Hawaiian Center of Excel12 lence for Mental Health at the University of Hawaii

13 at Manoa, a Native Hawaiian Center of Excellence

14 for Maternal Health and Nutrition at the Waimanalo

15 Health Center, and a Native Hawaiian Center of Ex16 cellence for Research, Training, Integrated Medicine

17 at Molokai General Hospital and a Native Hawaiian

18 Center of Excellence for Complimentary Health and

19 Health Education and Training at the Waianae

20 Coast Comprehensive Health Center.

21 ‘‘(b) NONREDUCTION IN OTHER FUNDING.—The allo22 cation of funds for demonstration projects under subsection

23 (a) shall not result in a reduction in funds required by the

24 Native Hawaiian health care systems, the Native Hawaiian

25 Health Centers, the Native Hawaiian Health Scholarship
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•S 1929 RS

1 Program, or Papa Ola Lokahi to carry out their respective

2 responsibilities under this Act.

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

4 HAWAIIAN HEALTH CARE ENTITLEMENT.

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

6 National Bipartisan Native Hawaiian Health Care Enti7 tlement Commission (referred to in this Act as the ‘Commis8 sion’).

9 ‘‘(b) MEMBERSHIP.—The Commission shall be com10 posed of 21 members to be appointed as follows:

11 ‘‘(1) CONGRESSIONAL MEMBERS.—

12 ‘‘(A) APPOINTMENT.—Eight members of the

13 Commission shall be members of Congress, of

14 which—

15 ‘‘(i) two members shall be from the

16 House of Representatives and shall be ap17 pointed by the Majority Leader;

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

19 House of Representatives and shall be ap20 pointed by the Minority Leader;

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

22 Senate and shall be appointed by the Major23 ity Leader; and
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1 ‘‘(iv) two members shall be from the

2 Senate and shall be appointed by the Mi3 nority Leader.

4 ‘‘(B) RELEVANT COMMITTEE MEMBER5 SHIP.—The members of the Commission ap6 pointed under subparagraph (A) shall each be

7 members of the committees of Congress that con8 sider legislation affecting the provision of health

9 care to Native Hawaiians and other Native

10 Americans.

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

12 Commission appointed under subparagraph (A)

13 shall elect the chairperson and vice-chairperson

14 of the Commission.

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

16 members of the Commission shall be appointed by

17 Hawaiian health entities, of which—

18 ‘‘(A) five members shall be appointed by the

19 Native Hawaiian Health Care Systems;

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

21 Hawaii State Primary Care Association;

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

23 Papa Ola Lokahi;

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

25 Native Hawaiian Health Task Force;
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1 ‘‘(E) one member shall be appointed by the

2 Office of Hawaiian Affairs; and

3 ‘‘(F) two members shall be appointed by the

4 Association of Hawaiian Civic Clubs and shall

5 represent Native Hawaiian populations residing

6 in the continental United States.

7 ‘‘(3) SECRETARIAL MEMBERS.—Two members of

8 the Commission shall be appointed by the Secretary

9 and shall possess knowledge of Native Hawaiian

10 health concerns and wellness.

11 ‘‘(c) TERMS.—

12 ‘‘(1) IN GENERAL.—The members of the Commis13 sion shall serve for the life of the Commission.

14 ‘‘(2) INITIAL APPOINTMENT OF MEMBERS.—The

15 members of the Commission shall be appointed under

16 subsection (b)(1) not later than 90 days after the date

17 of enactment of this Act, and the remaining members

18 of the Commission shall be appointed not later than

19 60 days after the date on which the members are ap20 pointed under such subsection (b)(1).

21 ‘‘(3) VACANCIES.—A vacancy in the membership

22 of the Commission shall be filled in the manner in

23 which the original appointment was made.

24 ‘‘(d) DUTIES OF THE COMMISSION.—The Commission

25 shall carry out the following duties and functions:
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1 ‘‘(1) Review and analyze the recommendations of

2 the report of the study committee established under

3 paragraph (3).

4 ‘‘(2) Make recommendations to Congress for the

5 provision of health services to Native Hawaiian indi6 viduals as an entitlement, giving due regard to the ef7 fects of a program on existing health care delivery

8 systems for Native Hawaiians and the effect of such

9 programs on self-determination and the reconciliation

10 of their relationship with the United States.

11 ‘‘(3) Establish a study committee to be composed

12 of at least 10 members from the Commission, includ13 ing 4 members of the members appointed under sub14 section (b)(1), 5 of the members appointed under sub15 section (b)(2), and 1 of the members appointed by the

16 Secretary under subsection (b)(3), which shall—

17 ‘‘(A) to the extent necessary to carry out its

18 duties, collect, compile, qualify, and analyze

19 data necessary to understand the extent of Native

20 Hawaiian needs with regard to the provision of

21 health services, including holding hearings and

22 soliciting the views of Native Hawaiians and

23 Native Hawaiian organizations, and which may

24 include authorizing and funding feasibility stud25 ies of various models for all Native Hawaiian
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1 beneficiaries and their families, including those

2 that live in the continental United States;

3 ‘‘(B) make recommendations to the Commis4 sion for legislation that will provide for the cul5 turally-competent and appropriate provision of

6 health services for Native Hawaiians as an enti7 tlement, which shall, at a minimum, address

8 issues of eligibility and benefits to be provided,

9 including recommendations regarding from

10 whom such health services are to be provided and

11 the cost and mechanisms for funding of the

12 health services to be provided;

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

14 such recommendations on the existing system of

15 delivery of health services for Native Hawaiians;

16 ‘‘(D) determine the effect of a health service

17 entitlement program for Native Hawaiian indi18 viduals on their self-determination and the rec19 onciliation of their relationship with the United

20 States;

21 ‘‘(E) not later than 12 months after the date

22 of the appointment of all members of the Com23 mission, make a written report of its findings

24 and recommendations to the Commission, which

25 report shall include a statement of the minority
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1 and majority position of the committee and

2 which shall be disseminated, at a minimum, to

3 Native Hawaiian organizations and agencies

4 and health organizations referred to in sub5 section (b)(2) for comment to the Commission;

6 and

7 ‘‘(F) report regularly to the full Commission

8 regarding the findings and recommendations de9 veloped by the committee in the course of car10 rying out its duties under this section.

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

12 the appointment of all members of the Commission,

13 submit a written report to Congress containing a rec14 ommendation of policies and legislation to implement

15 a policy that would establish a health care system for

16 Native Hawaiians, grounded in their culture, and

17 based on the delivery of health services as an entitle18 ment, together with a determination of the implica19 tions of such an entitlement system on existing health

20 care delivery systems for Native Hawaiians and their

21 self-determination and the reconciliation of their rela22 tionship with the United States.

23 ‘‘(e) ADMINISTRATIVE PROVISIONS.—

24 ‘‘(1) COMPENSATION AND EXPENSES.—
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1 ‘‘(A) CONGRESSIONAL MEMBERS.—Each

2 member of the Commission appointed under sub3 section (b)(1) shall not receive any additional

4 compensation, allowances, or benefits by reason

5 of their service on the Commission. Such mem6 bers shall receive travel expenses and per diem in

7 lieu of subsistence in accordance with sections

8 5702 and 5703 of title 5, United States Code.

9 ‘‘(B) OTHER MEMBERS.—The members of

10 the Commission appointed under paragraphs (2)

11 and (3) of subsection (b) shall, while serving on

12 the business of the Commission (including travel

13 time), receive compensation at the per diem

14 equivalent of the rate provided for individuals

15 under level IV of the Executive Schedule under

16 section 5315 of title 5, United States Code, and

17 while serving away from their home or regular

18 place of business, be allowed travel expenses, as

19 authorized by the chairperson of the Commission.

20 ‘‘(C) OTHER PERSONNEL.—For purposes of

21 compensation (other than compensation of the

22 members of the Commission) and employment

23 benefits, rights, and privileges, all personnel of

24 the Commission shall be treated as if they were

25 employees of the Senate.
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1 ‘‘(2) MEETINGS AND QUORUM.—

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

3 meet at the call of the chairperson.

4 ‘‘(B) QUORUM.—A quorum of the Commis5 sion shall consist of not less than 12 members, of

6 which—

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

8 shall be appointees under subsection (b)(1);

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

10 shall be appointees under subsection (b)(2);

11 and

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

13 shall be an appointee under subsection

14 (b)(3).

15 ‘‘(3) DIRECTOR AND STAFF.—

16 ‘‘(A) EXECUTIVE DIRECTOR.—The members

17 of the Commission shall appoint an executive di18 rector of the Commission. The executive director

19 shall be paid the rate of basic pay equal to that

20 under level V of the Executive Schedule under

21 section 5316 of title 5, United States Code.

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

23 Commission, the executive director may appoint

24 such personnel as the executive director deems

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

2 LAWS.—The staff of the Commission shall be ap3 pointed without regard to the provisions of title

4 5, United States Code, governing appointments

5 in the competitive service, and shall be paid

6 without regard to the provisions of chapter 51

7 and subchapter III of chapter 53 of such title

8 (relating to classification and General Schedule

9 pay rates).

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

11 the approval of the Commission, the executive di12 rector may procure temporary and intermittent

13 services under section 3109(b) of title 5, United

14 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. facilities

20 shall serve as the headquarters of the Commission

21 while the Hawaii office shall serve a liaison

22 function. Both such offices shall include all nec23 essary equipment and incidentals required for

24 the proper functioning of the Commission.

25 ‘‘(f) POWERS.—
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1 ‘‘(1) HEARINGS AND OTHER ACTIVITIES.—For

2 purposes of carrying out its duties, the Commission

3 may hold such hearings and undertake such other ac4 tivities as the Commission determines to be necessary

5 to carry out its duties, except that at least 8 hearings

6 shall be held on each of the Hawaiian Islands and 3

7 hearings in the continental United States in areas

8 where a significant population of Native Hawaiians

9 reside. Such hearings shall be held to solicit the views

10 of Native Hawaiians regarding the delivery of health

11 care services to such individuals. To constitute a

12 hearing under this paragraph, at least 4 members of

13 the Commission, including at least 1 member of Con14 gress, must be present. Hearings held by the study

15 committee established under subsection (d)(3) may be

16 counted towards the number of hearings required

17 under this paragraph.

18 ‘‘(2) STUDIES BY THE GENERAL ACCOUNTING OF19 FICE.—Upon the request of the Commission, the

20 Comptroller General shall conduct such studies or in21 vestigations as the Commission determines to be nec22 essary to carry out its duties.

23 ‘‘(3) COST ESTIMATES.—

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

25 Congressional Budget Office or the Chief Actuary
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1 of the Health Care Financing Administration, or

2 both, shall provide to the Commission, upon the

3 request of the Commission, such cost estimates as

4 the Commission determines to be necessary to

5 carry out its duties.

6 ‘‘(B) REIMBURSEMENTS.—The Commission

7 shall reimburse the Director of the Congressional

8 Budget Office for expenses relating to the em9 ployment in the office of the Director of such ad10 ditional staff as may be necessary for the Direc11 tor to comply with requests by the Commission

12 under subparagraph (A).

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

14 the request of the Commission, the head of any Fed15 eral agency is authorized to detail, without reim16 bursement, any of the personnel of such agency to the

17 Commission to assist the Commission in carrying out

18 its duties. Any such detail shall not interrupt or oth19 erwise affect the civil service status or privileges of the

20 Federal employees.

21 ‘‘(5) TECHNICAL ASSISTANCE.—Upon the request

22 of the Commission, the head of any Federal agency

23 shall provide such technical assistance to the Commis24 sion as the Commission determines to be necessary to

25 carry out its duties.
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1 ‘‘(6) USE OF MAILS.—The Commission may use

2 the United States mails in the same manner and

3 under the same conditions as Federal agencies and

4 shall, for purposes of the frank, be considered a com5 mission of Congress as described in section 3215 of

6 title 39, United States Code.

7 ‘‘(7) OBTAINING INFORMATION.—The Commis8 sion may secure directly from any Federal agency in9 formation necessary to enable the Commission to

10 carry out its duties, if the information may be dis11 closed under section 552 of title 5, United States

12 Code. Upon request of the chairperson of the Commis13 sion, the head of such agency shall furnish such infor14 mation to the Commission.

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

16 the Commission, the Administrator of General Serv17 ices shall provide to the Commission on a reimburs18 able basis such administrative support services as the

19 Commission may request.

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

21 to printing and binding, including the cost of per22 sonnel detailed from the Government Printing Office,

23 the Commission shall be deemed to be a committee of

24 Congress.
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1 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There is

2 authorized to be appropriated such sums as may be nec3 essary to carry out this section. The amount appropriated

4 under this subsection shall not result in a reduction in any

5 other appropriation for health care or health services for

6 Native Hawaiians.

7 ‘‘SEC. 16. RULE OF CONSTRUCTION.

8 ‘‘Nothing in this Act shall be construed to restrict the

9 authority of the State of Hawaii to license health practi10 tioners.

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

12 ‘‘Any new spending authority (described in subpara13 graph (A) of (B) of section 401(c)(2) of the Congressional

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

15 is provided under this Act shall be effective for any fiscal

16 year only to such extent or in such amounts as are provided

17 for in appropriation Acts.

18 ‘‘SEC. 18. SEVERABILITY.

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

20 such provision to any person or circumstances is held to

21 be invalid, the remainder of this Act, and the application

22 of such provision or amendment to persons or circumstances

23 other than those to which it is held invalid, shall not be

24 affected thereby.’’.
Calendar No. 765

106TH CONGRESS

2D SESSION S. 1929

[Report No. 106–389]

A BILL

To amend the Native Hawaiian Health Care

Improvement Act to revise and extend such Act.

AUGUST 25, 2000

Reported with an amendment