pared to all households in the State (15.8 per-
cent and 8.1 percent, respectively); 
‘‘(B) in 2002, nonmarital births accounted 
for 56.8 percent of all live births among Native 
Hawaiians, as compared to 34 percent of all 
live births in the State; 
‘‘(C) the rate of confirmed child abuse and 
neglect among Native Hawaiians has consist-
ently been 3 to 4 times the rates of other major 
ethnic groups, with a 3-year average of 63.9 
cases in 2002, as compared to 12.8 cases for 
the total population of the State; 
‘‘(D) spousal abuse or abuse of an intimate 
partner was highest for Native Hawaiians, as 
compared to all cases of abuse in the State (4.5 
percent and 2.2 percent, respectively); and 
‘‘(E)(i) 1⁄2 of uninsured adults in the State 
have family incomes below 200 percent of the 
Federal poverty level; and 
‘‘(ii) Native Hawaiians residing in the 
State and the continental United States have a 
higher rate of uninsurance than other ethnic 
groups in the State and continental United 
States (14.5 percent and 9.5 percent, respec-
tively). 
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‘‘(10) HEALTH PROFESSIONS EDUCATION AND 
TRAINING.—With respect to health professions edu-
cation and training— 
‘‘(A) in 2003, adult Native Hawaiians had 
a higher rate of high school completion, as com-
pared to the total adult population of the State 
(49.4 percent and 34.4 percent, respectively); 
‘‘(B) Native Hawaiian physicians make up 
4 percent of the total physician workforce in the 
State; and 
‘‘(C) in 2004, Native Hawaiians com-
prised— 
‘‘(i) 11.25 percent of individuals who 
earned bachelor’s degrees; 
‘‘(ii) 6 percent of individuals who 
earned master’s degrees; 
‘‘(iii) 3 percent of individuals who 
earned doctorate degrees; 
‘‘(iv) 7.9 percent of the credited stu-
dent body at the University of Hawai’i; 
‘‘(v) 0.4 percent of the instructional 
faculty at the University of Hawai’i at 
Manoa; and 
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‘‘(vi) 8.4 percent of the instructional 
faculty at the University of Hawai’i Com-
munity Colleges. 
‘‘SEC. 3. DEFINITIONS. 
‘‘In this Act: 
‘‘(1) DEPARTMENT.—The term ‘Department’ 
means the Department of Health and Human Serv-
ices. 
‘‘(2) DISEASE PREVENTION.—The term ‘disease 
prevention’ includes— 
‘‘(A) immunizations; 
‘‘(B) control of high blood pressure; 
‘‘(C) control of sexually transmittable dis-
eases; 
‘‘(D) prevention and control of chronic dis-
eases; 
‘‘(E) control of toxic agents; 
‘‘(F) occupational safety and health; 
‘‘(G) injury prevention; 
‘‘(H) fluoridation of water; 
‘‘(I) control of infectious agents; and 
‘‘(J) provision of mental health care. 
‘‘(3) HEALTH PROMOTION.—The term ‘health 
promotion’ includes— 
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‘‘(A) pregnancy and infant care, including 
prevention of fetal alcohol syndrome; 
‘‘(B) cessation of tobacco smoking; 
‘‘(C) reduction in the misuse of alcohol and 
harmful illicit drugs; 
‘‘(D) improvement of nutrition; 
‘‘(E) improvement in physical fitness; 
‘‘(F) family planning; 
‘‘(G) control of stress; 
‘‘(H) reduction of major behavioral risk 
factors and promotion of healthy lifestyle prac-
tices; and 
‘‘(I) integration of cultural approaches to 
health and well-being (including traditional 
practices relating to the atmosphere (lewa lani), 
land (‘aina), water (wai), and ocean (kai)). 
‘‘(4) HEALTH SERVICE.—The term ‘health serv-
ice’ means— 
‘‘(A) service provided by a physician, phy-
sician’s assistant, nurse practitioner, nurse, 
dentist, or other health professional; 
‘‘(B) a diagnostic laboratory or radiologic 
service; 
‘‘(C) a preventive health service (including 
a perinatal service, well child service, family 
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planning service, nutrition service, home health 
service, sports medicine and athletic training 
service, and, generally, any service associated 
with enhanced health and wellness); 
‘‘(D) emergency medical service, including 
a service provided by a first responder, emer-
gency medical technician, or mobile intensive 
care technician; 
‘‘(E) a transportation service required for 
adequate patient care; 
‘‘(F) a preventive dental service; 
‘‘(G) a pharmaceutical and medicament 
service; 
‘‘(H) a mental health service, including a 
service provided by a psychologist or social 
worker; 
‘‘(I) a genetic counseling service; 
‘‘(J) a health administration service, in-
cluding a service provided by a health program 
administrator; 
‘‘(K) a health research service, including a 
service provided by an individual with an ad-
vanced degree in medicine, nursing, psychology, 
social work, or any other related health pro-
gram; 
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‘‘(L) an environmental health service, in-
cluding a service provided by an epidemiologist, 
public health official, medical geographer, or 
medical anthropologist, or an individual special-
izing in biological, chemical, or environmental 
health determinants; 
‘‘(M) a primary care service that may lead 
to specialty or tertiary care; and 
‘‘(N) a complementary healing practice, in-
cluding a practice performed by a traditional 
Native Hawaiian healer. 
‘‘(5) NATIVE
HAWAIIAN.—The term ‘Native 
Hawaiian’ means any individual who is Kanaka 
Maoli (a descendant of the aboriginal people who, 
prior to 1778, occupied and exercised sovereignty in 
the area that now constitutes the State), as evi-
denced by— 
‘‘(A) genealogical records; 
‘‘(B) kama‘aina witness verification from 
Native Hawaiian Kupuna (elders); or 
‘‘(C) birth records of the State or any 
other State or territory of the United States. 
‘‘(6) NATIVE
HAWAIIAN
HEALTH
CARE
SYS-
TEM.—The term ‘Native Hawaiian health care sys-
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tem’ means any of up to 8 entities in the State 
that— 
‘‘(A) is organized under the laws of the 
State; 
‘‘(B) provides or arranges for the provision 
of health services for Native Hawaiians in the 
State; 
‘‘(C) is a public or nonprofit private entity; 
‘‘(D) has Native Hawaiians significantly 
participating in the planning, management, pro-
vision, monitoring, and evaluation of health 
services; 
‘‘(E) addresses the health care needs of an 
island’s Native Hawaiian population; and 
‘‘(F) is recognized by Papa Ola Lokahi— 
‘‘(i) for the purpose of planning, con-
ducting, or administering programs, or 
portions of programs, authorized by this 
Act for the benefit of Native Hawaiians; 
and 
‘‘(ii) as having the qualifications and 
the capacity to provide the services and 
meet the requirements under— 
‘‘(I) the contract that each Na-
tive Hawaiian health care system en-
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ters into with the Secretary under this 
Act; or 
‘‘(II) the grant each Native Ha-
waiian health care system receives 
from the Secretary under this Act. 
‘‘(7) NATIVE HAWAIIAN HEALTH CENTER.—The 
term ‘Native Hawaiian Health Center’ means any 
organization that is a primary health care provider 
that— 
‘‘(A) has a governing board composed of 
individuals, at least 50 percent of whom are 
Native Hawaiians; 
‘‘(B) has demonstrated cultural com-
petency in a predominantly Native Hawaiian 
community; 
‘‘(C) serves a patient population that— 
‘‘(i) is made up of individuals at least 
50 percent of whom are Native Hawaiian; 
or 
‘‘(ii) has not less than 2,500 Native 
Hawaiians as annual users of services; and 
‘‘(D) is recognized by Papa Ola Lokahi as 
having met each of the criteria described in 
subparagraphs (A) through (C). 
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‘‘(8) 
NATIVE
HAWAIIAN
HEALTH
TASK 
FORCE.—The term ‘Native Hawaiian Health Task 
Force’ means a task force established by the State 
Council of Hawaiian Homestead Associations to im-
plement health and wellness strategies in Native Ha-
waiian communities. 
‘‘(9) NATIVE
HAWAIIAN
ORGANIZATION.—The 
term ‘Native Hawaiian organization’ means any or-
ganization that— 
‘‘(A) serves the interests of Native Hawai-
ians; and 
‘‘(B)(i) is recognized by Papa Ola Lokahi 
for planning, conducting, or administering pro-
grams authorized under this Act for the benefit 
of Native Hawaiians; and 
‘‘(ii) is a public or nonprofit private entity. 
‘‘(10) OFFICE
OF
HAWAIIAN
AFFAIRS.—The 
term ‘Office of Hawaiian Affairs’ means the govern-
mental entity that— 
‘‘(A) is established under article XII, sec-
tions 5 and 6, of the Hawai’i State Constitu-
tion; and 
‘‘(B) charged with the responsibility to for-
mulate policy relating to the affairs of Native 
Hawaiians. 
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‘‘(11) PAPA OLA LOKAHI.— 
‘‘(A) IN GENERAL.—The term ‘Papa Ola 
Lokahi’ means an organization that— 
‘‘(i) is composed of public agencies 
and private organizations focusing on im-
proving the health status of Native Hawai-
ians; and 
‘‘(ii) governed by a board the mem-
bers of which may include representation 
from— 
‘‘(I) E Ola Mau; 
‘‘(II) the Office of Hawaiian Af-
fairs; 
‘‘(III) Alu Like, Inc.; 
‘‘(IV) the University of Hawaii; 
‘‘(V) the Hawai’i State Depart-
ment of Health; 
‘‘(VI) 
the 
Native 
Hawaiian 
Health Task Force; 
‘‘(VII) the Hawai’i State Primary 
Care Association; 
‘‘(VIII) Ahahui O Na Kauka, the 
Native Hawaiian Physicians Associa-
tion; 
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‘‘(IX) Ho‘ola Lahui Hawaii, or a 
health care system serving the islands 
of Kaua‘i or Ni‘ihau (which may be 
composed of as many health care cen-
ters as are necessary to meet the 
health care needs of the Native Ha-
waiians of those islands); 
‘‘(X) Ke Ola Mamo, or a health 
care system serving the island of 
O‘ahu (which may be composed of as 
many health care centers as are nec-
essary to meet the health care needs 
of the Native Hawaiians of that is-
land); 
‘‘(XI) Na Pu‘uwai or a health 
care system serving the islands of 
Moloka‘i or Lana‘i (which may be 
composed of as many health care cen-
ters as are necessary to meet the 
health care needs of the Native Ha-
waiians of those islands); 
‘‘(XII) Hui No Ke Ola Pono, or 
a health care system serving the is-
land of Maui (which may be composed 
of as many health care centers as are 
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necessary to meet the health care 
needs of the Native Hawaiians of that 
island); 
‘‘(XIII) Hui Malama Ola Na 
‘Oiwi, or a health care system serving 
the island of Hawai’i (which may be 
composed of as many health care cen-
ters as are necessary to meet the 
health care needs of the Native Ha-
waiians of that island); 
‘‘(XIV) such other Native Hawai-
ian health care systems as are cer-
tified and recognized by Papa Ola 
Lokahi in accordance with this Act; 
and 
‘‘(XV) such other member orga-
nizations as the Board of Papa Ola 
Lokahi shall admit from time to time, 
based on satisfactory demonstration of 
a record of contribution to the health 
and well-being of Native Hawaiians. 
‘‘(B) EXCLUSION.—The term ‘Papa Ola 
Lokahi’ does not include any organization de-
scribed in subparagraph (A) for which the Sec-
retary has made a determination that the orga-
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nization has not developed a mission statement 
that includes— 
‘‘(i) clearly defined goals and objec-
tives for the contributions the organization 
will make to— 
‘‘(I) Native Hawaiian health care 
systems; and 
‘‘(II) the national policy de-
scribed in section 4; and 
‘‘(ii) an action plan for carrying out 
those goals and objectives. 
‘‘(12) 
SECRETARY.—The 
term 
‘Secretary’ 
means the Secretary of Health and Human Services. 
‘‘(13) STATE.—The term ‘State’ means the 
State of Hawaii. 
‘‘(14) TRADITIONAL NATIVE HAWAIIAN HEAL-
ER.—The term ‘traditional Native Hawaiian healer’ 
means a practitioner— 
‘‘(A) who— 
‘‘(i) is of Native Hawaiian ancestry; 
and 
‘‘(ii) has the knowledge, skills, and ex-
perience in direct personal health care of 
individuals; and 
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‘‘(B) the knowledge, skills, and experience 
of whom are based on demonstrated learning of 
Native Hawaiian healing practices acquired 
by— 
‘‘(i) direct practical association with 
Native Hawaiian elders; and 
‘‘(ii) oral traditions transmitted from 
generation to generation. 
‘‘SEC. 4. DECLARATION OF NATIONAL NATIVE HAWAIIAN 
HEALTH POLICY. 
‘‘(a) DECLARATION.—Congress declares that it is the 
policy of the United States, in fulfillment of special re-
sponsibilities and legal obligations of the United States to 
the indigenous people of Hawai’i resulting from the unique 
and historical relationship between the United States and 
the indigenous people of Hawaii— 
‘‘(1) to raise the health status of Native Hawai-
ians to the highest practicable health level; and 
‘‘(2) to provide Native Hawaiian health care 
programs with all resources necessary to effectuate 
that policy. 
‘‘(b) INTENT OF CONGRESS.—It is the intent of Con-
gress that— 
‘‘(1) health care programs having a dem-
onstrated effect of substantially reducing or elimi-
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nating the overrepresentation of Native Hawaiians 
among those suffering from chronic and acute dis-
ease and illness, and addressing the health needs of 
Native Hawaiians (including perinatal, early child 
development, and family-based health education 
needs), shall be established and implemented; and 
‘‘(2) the United States— 
‘‘(A) raise the health status of Native Ha-
waiians by the year 2010 to at least the levels 
described in the goals contained within Healthy 
People 2010 (or successor standards); and 
‘‘(B) incorporate within health programs in 
the United States activities defined and identi-
fied by Kanaka Maoli, such as— 
‘‘(i) incorporating and supporting the 
integration of cultural approaches to health 
and well-being, including programs using 
traditional practices relating to the atmos-
phere (lewa lani), land (’aina), water (wai), 
or ocean (kai); 
‘‘(ii) increasing the number of Native 
Hawaiian health and allied-health pro-
viders who provide care to or have an im-
pact on the health status of Native Hawai-
ians; 
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‘‘(iii) increasing the use of traditional 
Native Hawaiian foods in— 
‘‘(I) the diets and dietary pref-
erences of people, including those of 
students; and 
‘‘(II) school feeding programs; 
‘‘(iv) identifying and instituting Na-
tive Hawaiian cultural values and practices 
within the corporate cultures of organiza-
tions and agencies providing health serv-
ices to Native Hawaiians; 
‘‘(v) facilitating the provision of Na-
tive Hawaiian healing practices by Native 
Hawaiian healers for individuals desiring 
that assistance; 
‘‘(vi) supporting training and edu-
cation activities and programs in tradi-
tional Native Hawaiian healing practices 
by Native Hawaiian healers; and 
‘‘(vii) demonstrating the integration of 
health services for Native Hawaiians, par-
ticularly those that integrate mental, phys-
ical, and dental services in health care. 
‘‘(c) REPORT.—The Secretary shall submit to the 
President, for inclusion in each report required to be sub-
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mitted to Congress under section 12, a report on the 
progress made toward meeting the national policy de-
scribed in this section. 
‘‘SEC. 5. COMPREHENSIVE HEALTH CARE MASTER PLAN 
FOR NATIVE HAWAIIANS. 
‘‘(a) DEVELOPMENT.— 
‘‘(1) IN GENERAL.—The Secretary may make a 
grant to, or enter into a contract with, Papa Ola 
Lokahi for the purpose of coordinating, imple-
menting, and updating a Native Hawaiian com-
prehensive health care master plan that is de-
signed— 
‘‘(A) to promote comprehensive health pro-
motion and disease prevention services; 
‘‘(B) to maintain and improve the health 
status of Native Hawaiians; and 
‘‘(C) to support community-based initia-
tives that are reflective of holistic approaches to 
health. 
‘‘(2) CONSULTATION.— 
‘‘(A) IN GENERAL.—In carrying out this 
section, Papa Ola Lokahi and the Office of Ha-
waiian Affairs shall consult with representatives 
of— 
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‘‘(i) the Native Hawaiian health care 
systems; 
‘‘(ii) the Native Hawaiian health cen-
ters; and 
‘‘(iii) the Native Hawaiian commu-
nity. 
‘‘(B) MEMORANDA OF UNDERSTANDING.— 
Papa Ola Lokahi and the Office of Hawaiian 
Affairs may enter into memoranda of under-
standing or agreement for the purpose of ac-
quiring joint funding, or for such other pur-
poses as are necessary, to accomplish the objec-
tives of this section. 
‘‘(3) HEALTH
CARE
FINANCING
STUDY
RE-
PORT.— 
‘‘(A) IN
GENERAL.—Not later than 18 
months after the date of enactment of the Na-
tive Hawaiian Health Care Improvement Reau-
thorization Act of 2009, Papa Ola Lokahi, in 
cooperation with the Office of Hawaiian Affairs 
and other appropriate agencies and organiza-
tions in the State (including the Department of 
Health and the Department of Human Services 
of the State) and appropriate Federal agencies 
(including the Centers for Medicare and Med-
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icaid Services), shall submit to Congress a re-
port that describes the impact of Federal and 
State health care financing mechanisms and 
policies on the health and well-being of Native 
Hawaiians. 
‘‘(B) COMPONENTS.—The report shall in-
clude— 
‘‘(i) information concerning the im-
pact on Native Hawaiian health and well- 
being of— 
‘‘(I) cultural competency; 
‘‘(II) risk assessment data; 
‘‘(III) 
eligibility 
requirements 
and exemptions; and 
‘‘(IV) reimbursement policies and 
capitation rates in effect as of the 
date of the report for service pro-
viders; 
‘‘(ii) such other similar information as 
may be important to improving the health 
status of Native Hawaiians, as that infor-
mation relates to health care financing (in-
cluding barriers to health care); and 
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‘‘(iii) recommendations for submission 
to the Secretary, for review and consulta-
tion with the Native Hawaiian community. 
‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated such sums as are nec-
essary to carry out subsection (a). 
‘‘SEC. 6. FUNCTIONS OF PAPA OLA LOKAHI. 
‘‘(a) IN GENERAL.—Papa Ola Lokahi— 
‘‘(1) shall be responsible for— 
‘‘(A) the coordination, implementation, and 
updating, as appropriate, of the comprehensive 
health care master plan under section 5; 
‘‘(B) the training and education of individ-
uals providing health services; 
‘‘(C) the identification of and research (in-
cluding behavioral, biomedical, epidemiological, 
and health service research) into the diseases 
that are most prevalent among Native Hawai-
ians; and 
‘‘(D) the development and maintenance of 
an institutional review board for all research 
projects involving all aspects of Native Hawai-
ian health, including behavioral, biomedical, epi-
demiological, and health service research; 
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‘‘(2) may receive special project funds (includ-
ing research endowments under section 736 of the 
Public Health Service Act (42 U.S.C. 293)) made 
available for the purpose of— 
‘‘(A) research on the health status of Na-
tive Hawaiians; or 
‘‘(B) addressing the health care needs of 
Native Hawaiians; and 
‘‘(3) shall serve as a clearinghouse for— 
‘‘(A) the collection and maintenance of 
data associated with the health status of Native 
Hawaiians; 
‘‘(B) the identification and research into 
diseases affecting Native Hawaiians; 
‘‘(C) the availability of Native Hawaiian 
project funds, research projects, and publica-
tions; 
‘‘(D) the collaboration of research in the 
area of Native Hawaiian health; and 
‘‘(E) the timely dissemination of informa-
tion pertinent to the Native Hawaiian health 
care systems. 
‘‘(b) CONSULTATION.— 
‘‘(1) IN GENERAL.—The Secretary and the Sec-
retary of each other Federal agency shall— 
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‘‘(A) consult with Papa Ola Lokahi; and 
‘‘(B) provide Papa Ola Lokahi and the Of-
fice of Hawaiian Affairs, at least once annually, 
an accounting of funds and services provided by 
the Secretary to assist in accomplishing the 
purposes described in section 4. 
‘‘(2) COMPONENTS OF ACCOUNTING.—The ac-
counting under paragraph (1)(B) shall include an 
identification of— 
‘‘(A) the amount of funds expended explic-
itly for and benefitting Native Hawaiians; 
‘‘(B) the number of Native Hawaiians af-
fected by those funds; 
‘‘(C) the collaborations between the appli-
cable Federal agency and Native Hawaiian 
groups and organizations in the expenditure of 
those funds; and 
‘‘(D) the amount of funds used for— 
‘‘(i) Federal administrative purposes; 
and 
‘‘(ii) the provision of direct services to 
Native Hawaiians. 
‘‘(c) FISCAL ALLOCATION AND COORDINATION OF 
PROGRAMS AND SERVICES.— 
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‘‘(1) RECOMMENDATIONS.—Papa Ola Lokahi 
shall provide annual recommendations to the Sec-
retary with respect to the allocation of all amounts 
made available under this Act. 
‘‘(2) COORDINATION.—Papa Ola Lokahi shall, 
to the maximum extent practicable, coordinate and 
assist the health care programs and services pro-
vided to Native Hawaiians under this Act and other 
Federal laws. 
‘‘(3) REPRESENTATION ON COMMISSION.—The 
Secretary, in consultation with Papa Ola Lokahi, 
shall make recommendations for Native Hawaiian 
representation on the President’s Advisory Commis-
sion on Asian Americans and Pacific Islanders. 
‘‘(d) TECHNICAL SUPPORT.—Papa Ola Lokahi shall 
provide statewide infrastructure to provide technical sup-
port and coordination of training and technical assistance 
to— 
‘‘(1) the Native Hawaiian health care systems; 
and 
‘‘(2) the Native Hawaiian health centers. 
‘‘(e) RELATIONSHIPS WITH OTHER AGENCIES.— 
‘‘(1) AUTHORITY.—Papa Ola Lokahi may enter 
into agreements or memoranda of understanding 
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with relevant institutions, agencies, or organizations 
that are capable of providing— 
‘‘(A) health-related resources or services to 
Native Hawaiians and the Native Hawaiian 
health care systems; or 
‘‘(B) resources or services for the imple-
mentation of the national policy described in 
section 4. 
‘‘(2) HEALTH CARE FINANCING.— 
‘‘(A) FEDERAL CONSULTATION.— 
‘‘(i) IN
GENERAL.—Before adopting 
any policy, rule, or regulation that may af-
fect the provision of services or health in-
surance coverage for Native Hawaiians, a 
Federal agency that provides health care 
financing and carries out health care pro-
grams (including the Centers for Medicare 
and Medicaid Services) shall consult with 
representatives of— 
‘‘(I) the Native Hawaiian com-
munity; 
‘‘(II) Papa Ola Lokahi; and 
‘‘(III) 
organizations 
providing 
health care services to Native Hawai-
ians in the State. 
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‘‘(ii) IDENTIFICATION OF EFFECTS.— 
Any consultation by a Federal agency 
under clause (i) shall include an identifica-
tion of the effect of any policy, rule, or 
regulation proposed by the Federal agency. 
‘‘(B) STATE CONSULTATION.—Before mak-
ing any change in an existing program or im-
plementing any new program relating to Native 
Hawaiian health, the State shall engage in 
meaningful consultation with representatives 
of— 
‘‘(i) the Native Hawaiian community; 
‘‘(ii) Papa Ola Lokahi; and 
‘‘(iii) organizations providing health 
care services to Native Hawaiians in the 
State. 
‘‘(C) 
CONSULTATION
ON
FEDERAL 
HEALTH INSURANCE PROGRAMS.— 
‘‘(i) IN GENERAL.—The Office of Ha-
waiian Affairs, in collaboration with Papa 
Ola Lokahi, may develop consultative, con-
tractual, or other arrangements, including 
memoranda of understanding or agree-
ment, with— 
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‘‘(I) the Centers for Medicare 
and Medicaid Services; 
‘‘(II) the agency of the State that 
administers or supervises the adminis-
tration of the State plan or waiver ap-
proved under title XVIII, XIX, or 
XXI of the Social Security Act (42 
U.S.C. 1395 et seq.) for the payment 
of all or a part of the health care 
services provided to Native Hawaiians 
who are eligible for medical assistance 
under the State plan or waiver; or 
‘‘(III) any other Federal agency 
providing full or partial health insur-
ance to Native Hawaiians. 
‘‘(ii) 
CONTENTS
OF
ARRANGE-
MENTS.—An arrangement under clause (i) 
may address— 
‘‘(I) appropriate reimbursement 
for health care services, including 
capitation rates and fee-for-service 
rates for Native Hawaiians who are 
entitled to or eligible for insurance; 
‘‘(II) the scope of services; or 
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‘‘(III) other matters that would 
enable Native Hawaiians to maximize 
health insurance benefits provided by 
Federal and State health insurance 
programs. 
‘‘(3) TRADITIONAL HEALERS.— 
‘‘(A) IN
GENERAL.—The provision of 
health services under any program operated by 
the Department or another Federal agency (in-
cluding the Department of Veterans Affairs) 
may include the services of— 
‘‘(i) traditional Native Hawaiian heal-
ers; or 
‘‘(ii) traditional healers providing tra-
ditional health care practices (as those 
terms are defined in section 4 of the In-
dian Health Care Improvement Act (25 
U.S.C. 1603). 
‘‘(B) EXEMPTION.—Services described in 
subparagraph (A) shall be exempt from national 
accreditation reviews, including reviews con-
ducted by— 
‘‘(i) the Joint Commission on Accredi-
tation of Healthcare Organizations; and 
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‘‘(ii) the Commission on Accreditation 
of Rehabilitation Facilities. 
‘‘SEC. 7. NATIVE HAWAIIAN HEALTH CARE. 
‘‘(a) COMPREHENSIVE HEALTH PROMOTION, DIS-
EASE PREVENTION, AND OTHER HEALTH SERVICES.— 
‘‘(1) GRANTS AND CONTRACTS.—The Secretary, 
in consultation with Papa Ola Lokahi, may make 
grants to, or enter into contracts with 1 or more Na-
tive Hawaiian health care systems for the purpose of 
providing comprehensive health promotion and dis-
ease prevention services, as well as other health serv-
ices, to Native Hawaiians who desire and are com-
mitted to bettering their own health. 
‘‘(2) LIMITATION ON NUMBER OF ENTITIES.— 
The Secretary may make a grant to, or enter into 
a contract with, not more than 8 Native Hawaiian 
health care systems under this subsection for any 
fiscal year. 
‘‘(b) PLANNING GRANT OR CONTRACT.—In addition 
to grants and contracts under subsection (a), the Sec-
retary may make a grant to, or enter into a contract with, 
Papa Ola Lokahi for the purpose of planning Native Ha-
waiian health care systems to serve the health needs of 
Native Hawaiian communities on each of the islands of 
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O‘ahu, 
Moloka‘i, 
Maui, 
Hawai‘i, 
Lana‘i, 
Kaua‘i, 
Kaho‘lawe, and Ni‘ihau in the State. 
‘‘(c) HEALTH SERVICES TO BE PROVIDED.— 
‘‘(1) IN
GENERAL.—Each recipient of funds 
under subsection (a) may provide or arrange for— 
‘‘(A) outreach services to inform and assist 
Native Hawaiians in accessing health services; 
‘‘(B) education in health promotion and 
disease prevention for Native Hawaiians that, 
wherever practicable, is provided by— 
‘‘(i) Native Hawaiian health care 
practitioners; 
‘‘(ii) community outreach workers; 
‘‘(iii) counselors; 
‘‘(iv) cultural educators; and 
‘‘(v) other disease prevention pro-
viders; 
‘‘(C) services of individuals providing 
health services; 
‘‘(D) collection of data relating to the pre-
vention of diseases and illnesses among Native 
Hawaiians; and 
‘‘(E) support of culturally appropriate ac-
tivities that enhance health and wellness, in-
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cluding land-based, water-based, ocean-based, 
and spiritually based projects and programs. 
‘‘(2) TRADITIONAL HEALERS.—The health care 
services referred to in paragraph (1) that are pro-
vided under grants or contracts under subsection (a) 
may be provided by traditional Native Hawaiian 
healers, as appropriate. 
‘‘(d) FEDERAL TORT CLAIMS ACT.—An individual 
who provides a medical, dental, or other service referred 
to in subsection (a)(1) for a Native Hawaiian health care 
system, including a provider of a traditional Native Ha-
waiian healing service, shall be— 
‘‘(1) treated as if the individual were a member 
of the Public Health Service; and 
‘‘(2) subject to section 224 of the Public Health 
Service Act (42 U.S.C. 233). 
‘‘(e) SITE FOR OTHER FEDERAL PAYMENTS.— 
‘‘(1) IN GENERAL.—A Native Hawaiian health 
care system that receives funds under subsection (a) 
may serve as a Federal loan repayment facility. 
‘‘(2) REMISSION OF PAYMENTS.—A facility de-
scribed in paragraph (1) shall be designed to enable 
health and allied-health professionals to remit pay-
ments with respect to loans provided to the profes-
sionals under any Federal loan program. 
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‘‘(f) RESTRICTION ON USE OF GRANT AND CON-
TRACT FUNDS.—The Secretary shall not make a grant to, 
or enter into a contract with, an entity under subsection 
(a) unless the entity agrees that amounts received under 
the grant or contract will not, directly or through contract, 
be expended— 
‘‘(1) for any service other than a service de-
scribed in subsection (c)(1); 
‘‘(2) to purchase or improve real property 
(other than minor remodeling of existing improve-
ments to real property); or 
‘‘(3) to purchase major medical equipment. 
‘‘(g) LIMITATION ON CHARGES FOR SERVICES.—The 
Secretary shall not make a grant to, or enter into a con-
tract with, an entity under subsection (a) unless the entity 
agrees that, whether health services are provided directly 
or under a contract— 
‘‘(1) any health service under the grant or con-
tract will be provided without regard to the ability 
of an individual receiving the health service to pay 
for the health service; and 
‘‘(2) the entity will impose for the delivery of 
such a health service a charge that is— 
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‘‘(A) made according to a schedule of 
charges that is made available to the public; 
and 
‘‘(B) adjusted to reflect the income of the 
individual involved. 
‘‘(h) AUTHORIZATION OF APPROPRIATIONS.— 
‘‘(1) GENERAL GRANTS.—There are authorized 
to be appropriated such sums as are necessary to 
carry out subsection (a) for each of fiscal years 2009 
through 2014. 
‘‘(2) PLANNING GRANTS.—There are authorized 
to be appropriated such sums as are necessary to 
carry out subsection (b) for each of fiscal years 2009 
through 2014. 
‘‘(3) HEALTH SERVICES.—There are authorized 
to be appropriated such sums as are necessary to 
carry out subsection (c) for each of fiscal years 2009 
through 2014. 
‘‘SEC. 8. ADMINISTRATIVE GRANT FOR PAPA OLA LOKAHI. 
‘‘(a) IN GENERAL.—In addition to any other grant 
or contract under this Act, the Secretary may make grants 
to, or enter into contracts with, Papa Ola Lokahi for— 
‘‘(1) coordination, implementation, and updat-
ing (as appropriate) of the comprehensive health 
care master plan developed under section 5; 
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‘‘(2) training and education for providers of 
health services; 
‘‘(3) identification of and research (including 
behavioral, biomedical, epidemiologic, and health 
service research) into the diseases that are most 
prevalent among Native Hawaiians; 
‘‘(4) a clearinghouse function for— 
‘‘(A) the collection and maintenance of 
data associated with the health status of Native 
Hawaiians; 
‘‘(B) the identification and research into 
diseases affecting Native Hawaiians; and 
‘‘(C) the availability of Native Hawaiian 
project funds, research projects, and publica-
tions; 
‘‘(5) the establishment and maintenance of an 
institutional review board for all health-related re-
search involving Native Hawaiians; 
‘‘(6) the coordination of the health care pro-
grams and services provided to Native Hawaiians; 
and 
‘‘(7) the administration of special project funds. 
‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated such sums as are nec-
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essary to carry out subsection (a) for each of fiscal years 
2009 through 2014. 
‘‘SEC. 9. ADMINISTRATION OF GRANTS AND CONTRACTS. 
‘‘(a) TERMS AND CONDITIONS.—The Secretary shall 
include in any grant made or contract entered into under 
this Act such terms and conditions as the Secretary con-
siders necessary or appropriate to ensure that the objec-
tives of the grant or contract are achieved. 
‘‘(b) PERIODIC REVIEW.—The Secretary shall peri-
odically evaluate the performance of, and compliance with, 
grants and contracts under this Act. 
‘‘(c) ADMINISTRATIVE REQUIREMENTS.—The Sec-
retary shall not make a grant or enter into a contract 
under this Act with an entity unless the entity— 
‘‘(1) agrees to establish such procedures for fis-
cal control and fund accounting as the Secretary de-
termines are necessary to ensure proper disburse-
ment and accounting with respect to the grant or 
contract; 
‘‘(2) agrees to ensure the confidentiality of 
records maintained on individuals receiving health 
services under the grant or contract; 
‘‘(3) with respect to providing health services to 
any population of Native Hawaiians, a substantial 
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portion of which has a limited ability to speak the 
English language— 
‘‘(A) has developed and has the ability to 
carry out a reasonable plan to provide health 
services under the grant or contract through in-
dividuals who are able to communicate with the 
population involved in the language and cultural 
context that is most appropriate; and 
‘‘(B) has designated at least 1 individual 
who is fluent in English and the appropriate 
language to assist in carrying out the plan; 
‘‘(4) with respect to health services that are 
covered under a program under title XVIII, XIX, or 
XXI of the Social Security Act (42 U.S.C. 1395 et 
seq.) (including any State plan), or under any other 
Federal health insurance plan— 
‘‘(A) if the entity will provide under the 
grant or contract any of those health services 
directly— 
‘‘(i) has entered into a participation 
agreement under each such plan; and 
‘‘(ii) is qualified to receive payments 
under the plan; and 
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‘‘(B) if the entity will provide under the 
grant or contract any of those health services 
through a contract with an organization— 
‘‘(i) ensures that the organization has 
entered into a participation agreement 
under each such plan; and 
‘‘(ii) ensures that the organization is 
qualified to receive payments under the 
plan; and 
‘‘(5) agrees to submit to the Secretary and 
Papa Ola Lokahi an annual report that— 
‘‘(A) describes the use and costs of health 
services provided under the grant or contract 
(including the average cost of health services 
per user); and 
‘‘(B) provides such other information as 
the Secretary determines to be appropriate. 
‘‘(d) CONTRACT EVALUATION.— 
‘‘(1) DETERMINATION OF NONCOMPLIANCE.— 
If, as a result of evaluations conducted by the Sec-
retary, the Secretary determines that an entity has 
not complied with or satisfactorily performed a con-
tract entered into under section 7, the Secretary 
shall, before renewing the contract— 
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‘‘(A) attempt to resolve the areas of non-
compliance or unsatisfactory performance; and 
‘‘(B) modify the contract to prevent future 
occurrences of the noncompliance or unsatisfac-
tory performance. 
‘‘(2) NONRENEWAL.—If the Secretary deter-
mines that the noncompliance or unsatisfactory per-
formance described in paragraph (1) with respect to 
an entity cannot be resolved and prevented in the fu-
ture, the Secretary— 
‘‘(A) shall not renew the contract with the 
entity; and 
‘‘(B) may enter into a contract under sec-
tion 7 with another entity referred to in section 
7(a)(3) that provides services to the same popu-
lation of Native Hawaiians served by the entity 
the contract with which was not renewed by 
reason of this paragraph. 
‘‘(3) CONSIDERATION OF RESULTS.—In deter-
mining whether to renew a contract entered into 
with an entity under this Act, the Secretary shall 
consider the results of the evaluations conducted 
under this section. 
‘‘(4) APPLICATION OF FEDERAL LAWS.—Each 
contract entered into by the Secretary under this 
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Act shall be in accordance with all Federal con-
tracting laws (including regulations), except that, in 
the discretion of the Secretary, such a contract 
may— 
‘‘(A) be negotiated without advertising; 
and 
‘‘(B) be exempted from subchapter III of 
chapter 31, United States Code. 
‘‘(5) PAYMENTS.—A payment made under any 
contract entered into under this Act— 
‘‘(A) may be made— 
‘‘(i) in advance; 
‘‘(ii) by means of reimbursement; or 
‘‘(iii) in installments; and 
‘‘(B) shall be made on such conditions as 
the Secretary determines to be necessary to 
carry out this Act. 
‘‘(e) REPORT.— 
‘‘(1) IN GENERAL.—For each fiscal year during 
which an entity receives or expends funds under a 
grant or contract under this Act, the entity shall 
submit to the Secretary and to Papa Ola Lokahi an 
annual report that describes— 
‘‘(A) the activities conducted by the entity 
under the grant or contract; 
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