award of a grant or contract under such sub-
section only if the applicant agrees to make
available (directly or through donations from
public or private entities), in cash, non-Federal
contributions toward such costs in an amount
that—
‘‘(i) for any second fiscal year for
which the applicant receives such a grant,
is not less than 20 percent of such costs;
‘‘(ii) for any third such fiscal year, is
not less than 20 percent of such costs;
‘‘(iii) for any fourth such fiscal year,
is not less than 40 percent of such costs;
‘‘(iv) for any fifth such fiscal year, is
not less than 60 percent of such costs; and
‘‘(v) for any sixth or subsequent such
fiscal year, is not less than 80 percent of
such costs.
‘‘(B) Amounts provided by the Federal
Government may not be included in determin-
ing the amount of non-Federal contributions re-
quired in subparagraph (A).
‘‘(C) The Secretary may not require non-
Federal contributions for the first fiscal year
for which an applicant receives a grant under
subsection (a).
‘‘(c) PREFERENCE IN MAKING AWARDS.—
‘‘(1) IN GENERAL.—Subject to paragraph (2),
in making awards of grants and contracts under
subsection (a), the Secretary shall give preference to
any applicant that has made an arrangement with 1
or more elementary schools, an arrangement with 1
or more secondary schools, an arrangement with 1
or more institutions of higher education, an arrange-
ment with 1 or more health professions schools, and
an arrangement with 1 or more community-based or-
ganizations, the purpose of which arrangements is to
establish a program as follows:
‘‘(A) With respect to the elementary
schools involved, the program carries out the
purposes described in subsection (a)(1).
‘‘(B) After a student identified pursuant to
paragraph (1) enters the secondary school in-
volved, the program continues to carry out such
purposes with respect to the student.
‘‘(C) After graduating from the secondary
school, the student enters the institution of
higher education involved, subject to meeting
reasonable academic requirements, and the pro-
gram continues to carry out such purposes with
respect to the student.
‘‘(D) After graduating from the institution
of higher education, the student enters the
health professions school involved, subject to
meeting reasonable academic requirements.
‘‘(2) REQUIREMENT REGARDING SCHOOLS AND
INSTITUTIONS.—For purposes of paragraph (1), an
applicant may not receive preference unless the
schools or institutions with which arrangements have
been made are schools or institutions whose enroll-
ment of students includes a significant number of
individuals from disadvantaged backgrounds.
‘‘(d) LIMITATION ON YEARS OF FUNDING FOR PAR-
TICULAR ACTIVITIES.—With respect to a particular activ-
ity carried out under paragraph (1) or (3) of subsection
(a) by an entity, the Secretary may not, for the activity
involved, provide more than 6 years of financial assistance
under such subsection to the entity.
‘‘(e) FUNDING.—
‘‘(1) AUTHORIZATION
OF
APPROPRIATIONS.—
For the purpose of carrying out this section and sec-
tion 736, there are authorized to be appropriated
$32,000,000 for fiscal year 1995, $36,000,000 for
fiscal year 1996, and $38,000,000 for fiscal year
1997.
‘‘(2) ALLOCATIONS.—Of the amounts appro-
priated under paragraph (1) for a fiscal year, the
Secretary shall obligate not less than 20 percent for
carrying out subsection (a)(3)(B) and not less than
20 percent for providing scholarships under section
736.’’.
(b) TRANSITIONAL AND SAVINGS PROVISION.—In the
case of an entity that received an award of a grant or
contract for fiscal year 1994 under section 740 of the Pub-
lic Health Service Act, the Secretary of Health and
Human Services may continue in effect the award in ac-
cordance with the terms of the award, subject to the dura-
tion of the award not exceeding the period determined by
the Secretary in first approving the award. The preceding
sentence applies notwithstanding the amendment made by
subsection (a) of this section.
SEC. 306. STUDENT LOANS REGARDING SCHOOLS OF NURS-
ING.
Section 836(b) of the Public Health Service Act (42
U.S.C. 297b(b)) is amended—
(1) in paragraph (1), by striking the period at
the end and inserting a semicolon;
(2) in paragraph (2)—
(A) in subparagraph (A), by striking
‘‘and’’ at the end; and
(B) by inserting before the semicolon at
the end the following: ‘‘, and (C) such addi-
tional periods under the terms of paragraph (8)
of this subsection’’;
(3) in paragraph (7), by striking the period at
the end and inserting ‘‘; and’’; and
(4) by adding at the end the following para-
graph:
‘‘(8) pursuant to uniform criteria established by
the Secretary, the repayment period established
under paragraph (2) for any student borrower who
during the repayment period failed to make consecu-
tive payments and who, during the last 12 months
of the repayment period, has made at least 12 con-
secutive payments may be extended for a period not
to exceed 10 years.’’.
SEC. 307. FEDERALLY-SUPPORTED STUDENT LOAN FUNDS.
(a) AUTHORIZATION OF APPROPRIATIONS REGARD-
ING CERTAIN MEDICAL SCHOOLS.—
(1) IN GENERAL.—Subpart II of part A of title
VII of the Public Health Service Act (42 U.S.C.
292q et seq.) is amended—
(A) by transferring subsection (f) of sec-
tion 735 from the current placement of the sub-
section;
(B) by adding the subsection at the end of
section 723;
(C) by redesignating the subsection as sub-
section (e); and
(D) in subsection (e)(1) of section 723 (as
so redesignated), by striking ‘‘1996’’ and in-
serting ‘‘1997’’.
(2) CONFORMING AMENDMENTS.—Section 723
of the Public Health Service Act (42 U.S.C. 292s),
as amended by paragraph (1) of this subsection, is
amended in subsection (e)(2)(A)—
(A) by striking ‘‘section 723(b)(2)’’ and in-
serting ‘‘subsection (b)(2)’’; and
(B) by striking ‘‘such section’’ and insert-
ing ‘‘such subsection’’.
(b) AUTHORIZATION OF APPROPRIATIONS REGARD-
ING
INDIVIDUALS
FROM
DISADVANTAGED
BACK-
GROUNDS.—Section 724(f)(1) of the Public Health Serv-
ice Act (42 U.S.C. 292t(f)(1)) is amended to read as fol-
lows:
‘‘(1) IN
GENERAL.—With respect to making
Federal capital contributions to student loan funds
for purposes of subsection (a), other than the stu-
dent loan fund of any school of medicine or osteo-
pathic medicine, there is authorized to be appro-
priated $5,000,000 for each of the fiscal years 1995
through 1997.’’.
TITLE IV—RESEARCH
SEC. 401. OFFICE OF RESEARCH ON MINORITY HEALTH.
Section 404 of the Public Health Service Act, as
added by section 151 of Public Law 103–43, is amended
by adding at the end the following subsections:
‘‘(c) PLAN.—Subject to applicable law, the Director
of the Office, in consultation with the advisory committee
established under subsection (d), shall develop and imple-
ment a plan for carrying out the duties established in sub-
section (b). The Director shall review the plan not less
than annually, and revise the plan as appropriate.
‘‘(d) ADVISORY COMMITTEE.—
‘‘(1) In carrying out subsection (b), the Direc-
tor of the Office shall establish an advisory commit-
tee to be known as the Advisory Committee on Re-
search on Minority Health (in this subsection re-
ferred to as the ‘Committee’).
‘‘(2)(A) The Committee shall be composed of
nonvoting, ex offico members designated in accord-
ance with subparagraph (B) and voting members ap-
pointed in accordance with subparagraph (C).
‘‘(B) The Secretary shall designate as ex officio
members of the Committee the Directors of each of
the national research institutes and the Deputy As-
sistant Secretary for Minority Health (except that
any of such officials may designate another officer
or employee of the office or agency involved to serve
as a member of the Committee in lieu of the offi-
cial).
‘‘(C) The Director of the Office shall appoint as
voting members of the Committee not fewer than 12
and not more than 18 individuals who are not offi-
cers or employees of the Federal Government. The
appointments shall be made from among scientists
and health professionals whose clinical practice, re-
search specialization, or professional expertise in-
cludes significant expertise in research on minority
health. The appointed membership of the Advisory
Committee shall be broadly representative of the
various minority groups.
‘‘(3) The Director of the Office shall serve as
the chair of the Committee.
‘‘(4) The Committee shall—
‘‘(A) advise the Director of the Office on
appropriate research activities to be undertaken
by the national research institutes with respect
to—
‘‘(i) research on minority health;
‘‘(ii) research on racial and ethnic dif-
ferences in clinical drug trials, including
responses to pharmacological drugs;
‘‘(iii) research on racial and ethnic
differences in disease etiology, course, and
treatment; and
‘‘(iv) research on minority health con-
ditions which require a multidisciplinary
approach;
‘‘(B) report to the Director of the Office
on such research;
‘‘(C) provide recommendations to such Di-
rector regarding activities of the Office (includ-
ing recommendations on priorities in carrying
out research described in subparagraph (A));
and
‘‘(D) assist in monitoring compliance with
section 492B regarding the inclusion of minori-
ties in clinical research.
‘‘(5)(A) The Advisory Committee shall prepare
biennial reports describing the activities of the Com-
mittee, including findings made by the Committee
regarding—
‘‘(i) compliance with section 492B;
‘‘(ii) the extent of expenditures made for
research on minority health by the agencies of
the National Institutes of Health; and
‘‘(iii) the level of funding needed for such
research.
‘‘(B) Each report under subparagraph (A) shall
be submitted to the Director of NIH for inclusion in
the report required in section 403 for the period in-
volved.
‘‘(e) REPRESENTATION OF MINORITIES AMONG RE-
SEARCHERS.—The Secretary, acting through the Assist-
ant Secretary for Personnel and in collaboration with the
Director of the Office, shall determine the extent to which
the various minority groups are represented among admin-
istrators, senior physicians, and scientists of the national
research institutes and among physicians and scientists
conducting research with funds provided by such insti-
tutes, and as appropriate, carry out activities to increase
the extent of such representation.
SEC. 402. ACTIVITIES OF AGENCY FOR HEALTH CARE POL-
ICY AND RESEARCH.
Title IX of the Public Health Service Act (42 U.S.C.
299 et seq.) is amended—
(1) in section 902, by amending subsection (b)
to read as follows:
‘‘(b) REQUIREMENTS WITH RESPECT TO CERTAIN
POPULATIONS.—In carrying out subsection (a), the Ad-
ministrator shall undertake and support research, dem-
onstration projects, and evaluations with respect to the
health status of, and the delivery of health care to—
‘‘(1) the populations of medically underserved
urban or rural areas (including frontier areas); and
‘‘(2) low-income groups, minority groups, and
the elderly.’’; and
(2) in section 926(a), by adding at the end the
following sentence: ‘‘Of the amounts appropriated
under the preceding sentence for a fiscal year, the
Administrator shall reserve not less than 8 percent
for carrying out section 902(b)(2).’’.
SEC. 403. DATA COLLECTION BY NATIONAL CENTER FOR
HEALTH STATISTICS.
Section 306(n) of the Public Health Service Act (42
U.S.C. 242k(n)), as redesignated by section 501(a)(5)(B)
of Public Law 103–183 (107 Stat. 2237), is amended to
read as follows:
‘‘(n)(1) For health statistical and epidemiological ac-
tivities undertaken or supported under this section, there
are authorized to be appropriated such sums as may be
necessary for each of the fiscal years 1995 through 1998.
‘‘(2) Of the amounts appropriated under paragraph
(1) for a fiscal year, the Secretary shall obligate not less
than an aggregate $5,000,000 for carrying out subsections
(h), (l), and (m) with respect to particular racial and eth-
nic population groups, except that not more than
$100,000 may be expended in the aggregate for the ad-
ministration of activities under subsection (m) and for ac-
tivities described in paragraph (2) of such subsection.’’.
TITLE V—NATIVE HAWAIIAN
HEALTH CARE
SEC. 501. CLARIFICATION OF 1992 AMENDMENTS.
(a) CLARIFICATION OF DATE OF PASSAGE.—Section
9168 of the Department of Defense Appropriations Act,
1993 (106 Stat. 1948) is amended by striking ‘‘September
12, 1992,’’ and inserting ‘‘August 7, 1992,’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) shall take effect as of October 6, 1992.
SEC. 502. AMENDMENT OF NATIVE HAWAIIAN HEALTH
CARE IMPROVEMENT ACT TO REFLECT 1992
AGREEMENT.
Effective on the date of enactment of this Act, the
Native Hawaiian Health Care Improvement Act (42
U.S.C. 11701 et seq.) is amended to read as follows:
‘‘SECTION 1. SHORT TITLE.
‘‘This Act may be cited as the ‘Native Hawaiian
Health Care Improvement Act’.
‘‘SEC. 2. FINDINGS; DECLARATION OF POLICY; INTENT OF
CONGRESS.
‘‘(a) FINDINGS.—The Congress finds that—
‘‘(1) the United States retains the legal respon-
sibility to enforce the administration of the public
trust responsibility of the State of Hawaii for the
betterment of the conditions of Native Hawaiians
under section 5(f) of Public Law 86–3 (73 Stat. 6;
commonly referred to as the ‘Hawaii Statehood Ad-
missions Act’);
‘‘(2) in furtherance of the State of Hawaii’s
public trust responsibility for the betterment of the
conditions of Native Hawaiians, contributions by the
United States to the provision of comprehensive
health promotion and disease prevention services to
maintain and improve the health status of Native
Hawaiians are consistent with the historical and
unique legal relationship of the United States with
the government that represented the indigenous na-
tive people of Hawaii; and
‘‘(3) it is the policy of the United States to
raise the health status of Native Hawaiians to the
highest possible level and to encourage the maximum
participation of Native Hawaiians in order to
achieve this objective.
‘‘(b) DECLARATION OF POLICY.—The Congress here-
by declares that it is the policy of the United States in
fulfillment of its special responsibilities and legal obliga-
tions to the indigenous people of Hawaii resulting from
the unique and historical relationship between the United
States and the Government of the indigenous people of
Hawaii—
‘‘(1) to raise the health status of Native Hawai-
ians to the highest possible health level; and
‘‘(2) to provide existing Native Hawaiian health
care programs with all resources necessary to effec-
tuate this policy.
‘‘(c) INTENT OF CONGRESS.—It is the intent of the
Congress that the Nation meet the following health objec-
tives with respect to Native Hawaiians by the year 2000:
‘‘(1) Reduce coronary heart disease deaths to
no more than 100 per 100,000.
‘‘(2) Reduce stroke deaths to no more than 20
per 100,000.
‘‘(3) Increase control of high blood pressure to
at least 50 percent of people with high blood pres-
sure.
‘‘(4) Reduce blood cholesterol to an average of
no more than 200 mg/dl.
‘‘(5) Slow the rise in lung cancer deaths to
achieve a rate of no more than 42 per 100,000.
‘‘(6) Reduce breast cancer deaths to no more
than 20.6 per 100,000 women.
‘‘(7) Increase Pap tests every 1 to 3 years to
at least 85 percent of women age 18 and older.
‘‘(8) Increase fecal occult blood testing every 1
to 2 years to at least 50 percent of people age 50
and older.
‘‘(9) Reduce diabetes-related deaths to no more
than 34 per 100,000.
‘‘(10) Reduce the most severe complications of
diabetes as follows:
‘‘(A) End-stage renal disease to no more
than 1.4 in 1,000;
‘‘(B) Blindness to no more than 1.4 in
1,000;
‘‘(C) Lower extremity amputation to no
more than 4.9 in 1,000;
‘‘(D) Perinatal mortality to no more than
2 percent; and
‘‘(E) Major congenital malformations to no
more than 4 percent.
‘‘(11) Reduce infant mortality to no more than
7 deaths per 1,000 live births.
‘‘(12) Reduce low birth weight to no more than
5 percent of live births.
‘‘(13) Increase first trimester prenatal care to
at least 90 percent of live births.
‘‘(14) Reduce teenage pregnancies to no more
than 50 per 1,000 girls age 17 and younger.
‘‘(15) Reduce unintended pregnancies to no
more than 30 percent of pregnancies.
‘‘(16) Increase to at least 60 percent the pro-
portion of primary care providers who provide age-
appropriate preconception care and counseling.
‘‘(17) Increase years of healthy life to at least
65 years.
‘‘(18) Eliminate financial barriers to clinical
preventive services.
‘‘(19) Increase childhood immunization levels to
at least 90 percent of 2-year-olds.
‘‘(B) Tetanus among individuals age 25
and younger to 0;
‘‘(C) Polio (wild-type virus) to 0;
‘‘(D) Measles to 0;
‘‘(E) Rubella to 0;
‘‘(F) Congenital Rubella Syndrome to 0;
‘‘(G) Mumps to 500; and
‘‘(H) Pertussis to 1,000; and
‘‘(40) Reduce significant visual impairment to a
prevalence of no more than 30 per 1,000.
‘‘(d) REPORT.—The Secretary shall submit to the
President, for inclusion in each report required to be
transmitted to the Congress under section 9, a report on
the progress made toward meeting each of the objectives
described in subsection (c).
‘‘SEC. 3. COMPREHENSIVE HEALTH CARE MASTER PLAN
FOR NATIVE HAWAIIANS.
‘‘The Secretary may make a grant to, or enter into
a contract with, Papa Ola Lokahi for the purpose of co-
ordinating, implementing, and updating a Native Hawai-
ian comprehensive health care master plan designed to
promote comprehensive health promotion and disease pre-
vention services and to maintain and improve the health
status of Native Hawaiians. The master plan shall be
based upon an assessment of the health care status and
health care needs of Native Hawaiians. To the extent
practicable, assessments made as of the date of such grant
or contract shall be used by Papa Ola Lokahi, except that
any such assessment shall be updated as appropriate.
‘‘SEC. 4. NATIVE HAWAIIAN HEALTH CARE SYSTEMS.
‘‘(a) COMPREHENSIVE HEALTH PROMOTION, DIS-
EASE PREVENTION, AND PRIMARY HEALTH SERVICES.—
(1)(A) The Secretary, in consultation with Papa Ola
Lokahi, may make grants to, or enter into contracts with,
any qualified entity for the purpose of providing com-
prehensive health promotion and disease prevention serv-
ices as well as primary health services to Native Hawai-
ians.
‘‘(B) In making grants and entering into contracts
under this paragraph, the Secretary shall give preference
to Native Hawaiian health care systems and Native Ha-
waiian organizations, and, to the extent feasible, health
promotion and disease prevention services shall be per-
formed through Native Hawaiian health care systems.
‘‘(2) In addition to paragraph (1), the Secretary may
make a grant to, or enter into a contract with, Papa Ola
Lokahi for the purpose of planning Native Hawaiian
health care systems to serve the health needs of Native
Hawaiian communities on the islands of O’ahu, Moloka’i,
Maui, Hawai’i, Lana’i, Kaua’i, and Ni’ihau in the State
of Hawaii.
‘‘(b) QUALIFIED ENTITY.—An entity is a qualified
entity for purposes of subsection (a)(1) if the entity is a
Native Hawaiian health care system.
‘‘(c) SERVICES TO BE PROVIDED.—(1) Each recipi-
ent of funds under subsection (a)(1) shall provide the fol-
lowing services:
‘‘(A) Outreach services to inform Native Hawai-
ians of the availability of health services.
‘‘(B) Education in health promotion and disease
prevention of the Native Hawaiian population by
(wherever possible) Native Hawaiian health care
practitioners, community outreach workers, coun-
selors, and cultural educators.
‘‘(C) Services of physicians, physicians’ assist-
ants, or nurse practitioners.
‘‘(D) Immunizations.
‘‘(E) Prevention and control of diabetes, high
blood pressure, and otitis media.
‘‘(F) Pregnancy and infant care.
‘‘(G) Improvement of nutrition.
‘‘(2) In addition to the mandatory services under
paragraph (1), the following services may be provided pur-
suant to subsection (a)(1):
‘‘(A) Identification, treatment, control, and re-
duction of the incidence of preventable illnesses and
conditions endemic to Native Hawaiians.
‘‘(B) Collection of data related to the preven-
tion of diseases and illnesses among Native Hawai-
ians.
‘‘(C) Services within the meaning of the terms
‘health promotion’, ‘disease prevention’, and ‘pri-
mary health services’, as such terms are defined in
section 10, which are not specifically referred to in
paragraph (1) of this subsection.
‘‘(3) The health care services referred to in para-
graphs (1) and (2) which are provided under grants or
contracts under subsection (a)(1) may be provided by tra-
ditional Native Hawaiian healers.
‘‘(d) LIMITATION ON NUMBER OF ENTITIES.—Dur-
ing a fiscal year, the Secretary under this Act may make
a grant to, or hold a contract with, not more than 5 Native
Hawaiian health care systems.
‘‘(e) MATCHING FUNDS.—(1) The Secretary may not
make a grant or provide funds pursuant to a contract
under subsection (a)(1) to an entity—
‘‘(A) in an amount exceeding 75 percent of the
costs of providing health services under the grant or
contract; and
‘‘(B) unless the entity agrees that the entity
will make available, directly or through donations to
the entity, non-Federal contributions toward such
costs in an amount equal to not less than $1 (in
cash or in kind under paragraph (2)) for each $3 of
Federal funds provided in such grant or contract.
‘‘(2) Non-Federal contributions required in para-
graph (1) may be in cash or in kind, fairly evaluated, in-
cluding plant, equipment, or services. Amounts provided
by the Federal Government or services assisted or sub-
sidized to any significant extent by the Federal Govern-
ment may not be included in determining the amount of
such non-Federal contributions.
‘‘(3) The Secretary may waive the requirement estab-
lished in paragraph (1) if—
‘‘(A) the entity involved is a nonprofit private
entity described in subsection (b); and
‘‘(B) the Secretary, in consultation with Papa
Ola Lokahi, determines that it is not feasible for the
entity to comply with such requirement.
‘‘(f) RESTRICTION ON USE OF GRANT AND CON-
TRACT FUNDS.—The Secretary may not make a grant to,
or enter into a contract with, an entity under subsection
(a)(1) unless the entity agrees that amounts received pur-
suant to such subsection will not, directly or through con-
tract, be expended—
‘‘(1) for any purpose other than the purposes
described in subsection (c);
‘‘(2) to provide inpatient services;
‘‘(3) to make cash payments to intended recipi-
ents of health services; or
‘‘(4) to purchase or improve real property
(other than minor remodeling of existing improve-
ments to real property) or to purchase major medi-
cal equipment.
‘‘(g) LIMITATION ON CHARGES FOR SERVICES.—The
Secretary may not make a grant, or enter into a contract
with, an entity under subsection (a)(1) unless the entity
agrees that, whether health services are provided directly
or through contract—
‘‘(1) health services under the grant or contract
will be provided without regard to ability to pay for
the health services; and
‘‘(2) the entity will impose a charge for the de-
livery of health services, and such charge—
‘‘(A) will be made according to a schedule
of charges that is made available to the public,
and
‘‘(B) will be adjusted to reflect the income
of the individual involved.
‘‘SEC. 5. FUNCTIONS OF, AND GRANTS TO, PAPA OLA
LOKAHI.
‘‘(a) FUNCTIONS.—Papa Ola Lokahi shall—
‘‘(1) coordinate, implement, and update, as ap-
propriate, the comprehensive health care master
plan developed pursuant to section 3;
‘‘(2) to the maximum extent possible, coordi-
nate and assist the health care programs and serv-
ices provided to Native Hawaiians;
‘‘(3) provide for the training of the persons de-
scribed in section 4(c)(1)(B);
‘‘(4) develop an action plan outlining the con-
tributions that each member organization of Papa
Ola Lokahi will make in carrying out this Act;
‘‘(5) serve as a clearinghouse for—
‘‘(A) the collection and maintenance of
data associated with the health status of Native
Hawaiians;
‘‘(B) the identification of and research into
diseases affecting Native Hawaiians;
‘‘(C) the availability of Native Hawaiian
project funds, research projects, and publica-
tions; and
‘‘(D) the timely dissemination of informa-
tion relating to Native Hawaiian health care
systems;
‘‘(6) perform the recognition and certification
functions 
specified 
in 
sections 
10(6)(F) 
and
10(6)(G); and
‘‘(7) provide technical support and coordination
of training and technical assistance to Native Ha-
waiian health care systems.
‘‘(b) SPECIAL PROJECT FUNDS.—Papa Ola Lokahi
may receive project funds that may be appropriated for
the purpose of research on the health status of Native Ha-
waiians or for the purpose of addressing the health care
needs of Native Hawaiians.
‘‘(c) GRANTS.—In addition to any other grant or con-
tract under this Act, the Secretary may make grants to,
or enter into contracts with, Papa Ola Lokahi for—
‘‘(1) carrying out the functions described in
subsection (a); and
‘‘(2) administering any special project funds re-
ceived under the authority of subsection (b).
‘‘(d) RELATIONSHIPS WITH OTHER AGENCIES.—
Papa Ola Lokahi may enter into agreements or memo-
randa of understanding with relevant agencies or organi-
zations that are capable of providing resources or services
to Native Hawaiian health care systems.
‘‘SEC. 6. 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 such 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 may not make a grant or enter into a contract
under this Act with an entity unless the entity—
‘‘(1) agrees to establish such procedures for fis-
cal control and fund accounting as may be necessary
to ensure proper disbursement and accounting with
respect to the grant or contract;
‘‘(2) agrees to ensure the confidentiality of
records maintained on individuals receiving health
services under the grant or contract;
‘‘(3) with respect to providing health services to
any population of Native Hawaiians a substantial
portion of which has a limited ability to speak the
English language—
‘‘(A) has developed and has the ability to
carry out a reasonable plan to provide health
services under the grant or contract through 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 one individ-
ual, fluent in both English and the appropriate
language, to assist in carrying out the plan;
‘‘(4) with respect to health services that are
covered in the plan of the State of Hawaii approved
under title XIX of the Social Security Act—
‘‘(A) if the entity will provide under the
grant or contract any such health services di-
rectly—
‘‘(i) the entity has entered into a par-
ticipation agreement under such plan; and
‘‘(ii) the entity is qualified to receive
payments under such plan; and
‘‘(B) if the entity will provide under the
grant or contract any such health services
through a contract with an organization—
‘‘(i) the organization has entered into
a participation agreement under such plan;
and
‘‘(ii) the organization is qualified to
receive payments under such plan; and
‘‘(5) agrees to submit to the Secretary and to
Papa Ola Lokahi an annual report that describes
the utilization and costs of health services provided
under the grant or contract (including the average
cost of health services per user) and that provides
such other information as the Secretary determines
to be appropriate.
‘‘(d) CONTRACT EVALUATION.—(1) If, as a result of
evaluations conducted by the Secretary, the Secretary de-
termines that an entity has not complied with or satisfac-
torily performed a contract entered into under section 4,
the Secretary shall, prior to renewing such contract, at-
tempt to resolve the areas of noncompliance or unsatisfac-
tory performance and modify such contract to prevent fu-
ture occurrences of such noncompliance or unsatisfactory
performance. If the Secretary determines that such non-
compliance or unsatisfactory performance cannot be re-
solved and prevented in the future, the Secretary shall not
renew such contract with such entity and is authorized
to enter into a contract under section 4 with another en-
tity referred to in section 4(b) that provides services to
the same population of Native Hawaiians which is served
by the entity whose contract is not renewed by reason of
this subsection.
‘‘(2) In determining whether to renew a contract en-
tered into with an entity under this Act, the Secretary
shall consider the results of evaluation under this section.
‘‘(3) All contracts entered into by the Secretary under
this Act shall be in accordance with all Federal contract-
ing laws and regulations except that, in the discretion of
the Secretary, such contracts may be negotiated without
advertising and may be exempted from the provisions of
the Act of August 24, 1935 (40 U.S.C. 270a et seq.).
‘‘(4) Payments made under any contract entered into
under this Act may be made in advance, by means of reim-
bursement, or in installments and shall be made on such
conditions as the Secretary deems necessary to carry out
the purposes of this Act.
‘‘(e) LIMITATION ON USE OF FUNDS FOR ADMINIS-
TRATIVE EXPENSES.—Except for grants and contracts
under section 5(c), the Secretary may not make a grant
to, or enter into a contract with, an entity under this Act
unless the entity agrees that the entity will not expend
more than 10 percent of amounts received pursuant to this
Act for the purpose of administering the grant or contract.
‘‘(f) REPORT.—(1) For each fiscal year during which
an entity receives or expends funds pursuant to a grant
or contract under this Act, such entity shall submit to the
Secretary and to Papa Ola Lokahi a quarterly report on—
‘‘(A) activities conducted by the entity under
the grant or contract;
‘‘(B) the amounts and purposes for which Fed-
eral funds were expended; and
‘‘(C) such other information as the Secretary
may request.
‘‘(2) The reports and records of any entity which con-
cern any grant or contract under this Act shall be subject
to audit by the Secretary, the Inspector General of Health
and Human Services, and the Comptroller General of the
United States.
‘‘(g) ANNUAL PRIVATE AUDIT.—The Secretary shall
allow as a cost of any grant made or contract entered into
under this Act the cost of an annual private audit con-
ducted by a certified public accountant.
‘‘SEC. 7. ASSIGNMENT OF PERSONNEL.
‘‘(a) IN GENERAL.—The Secretary is authorized to
enter into an agreement with any entity under which the
Secretary is authorized to assign personnel of the Depart-
ment of Health and Human Services with expertise identi-
fied by such entity to such entity on detail for the purposes
of providing comprehensive health promotion and disease
prevention services to Native Hawaiians.
‘‘(b) APPLICABLE FEDERAL PERSONNEL PROVI-
SIONS.—Any assignment of personnel made by the Sec-
retary under any agreement entered into under the au-
thority of subsection (a) shall be treated as an assignment
of Federal personnel to a local government that is made
in accordance with subchapter VI of chapter 33 of title
5, United States Code.
‘‘SEC. 8. NATIVE HAWAIIAN HEALTH SCHOLARSHIPS.
‘‘(a) ELIGIBILITY.—The Secretary is authorized to
make scholarship grants to students who—
‘‘(1) meet the requirements of section 338A(b)
of the Public Health Service Act (42 U.S.C.
254l(b)); and
‘‘(2) are Native Hawaiians.
‘‘(b) TERMS
AND
CONDITIONS.—(1) Scholarship
grants provided under subsection (a) shall be provided
under the same terms and subject to the same conditions,
regulations, and rules that apply to scholarship grants
provided under section 338A of the Public Health Service
Act (42 U.S.C. 254l), except that—
‘‘(A) the provision of scholarships in each type
of health care profession training shall correspond to
the need for each type of health care professional to
serve Native Hawaiian health care systems, as iden-
tified by Papa Ola Lokahi;
‘‘(B) in selecting scholarship recipients, the
Secretary shall give priority to individuals included
on a list of eligible applicants submitted by the Ka-
mehameha Schools/Bishop Estate;
‘‘(C) the obligated service requirement for each
scholarship recipient shall be fulfilled through serv-
ice, in order of priority, in—
‘‘(i) any one of the five Native Hawaiian
health care systems which, during the fiscal
year in which the obligated service requirement
is assigned, has received a grant or entered into
a contract pursuant to section 4; or
‘‘(ii) health professions shortage areas,
medically underserved areas, or geographic
areas or facilities similarly designated by the
United States Public Health Service in the
State of Hawaii.
‘‘(2) The Secretary shall enter into a cooperative
agreement with the Kamehameha Schools/Bishop Estate
under which such organization shall provide recruitment,
retention, counseling, and other support services intended
to improve the operation of the scholarship program estab-
lished under this section.
‘‘(3) The Native Hawaiian Health Scholarship pro-
gram shall not be administered by or through the Indian
Health Service.
‘‘SEC. 9. REPORT.
‘‘The President shall, at the time the budget is sub-
mitted under section 1105 of title 31, United States Code,
for each fiscal year transmit to the Congress the report
required pursuant to section 2(d).
‘‘SEC. 10. DEFINITIONS.
‘‘For purposes of this Act:
‘‘(1) 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 diabetes,
‘‘(E) control of toxic agents,
‘‘(F) occupational safety and health,
‘‘(G) accident prevention,
‘‘(H) fluoridation of water,
‘‘(I) control of infectious agents, and
‘‘(J) provision of mental health care.
‘‘(2) HEALTH PROMOTION.—The term ‘health
promotion’ includes—
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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
drugs,
‘‘(D) improvement of nutrition,
‘‘(E) improvement in physical fitness,
‘‘(F) family planning, and
‘‘(G) control of stress.
‘‘(3) NATIVE
HAWAIIAN.—The term ‘Native
Hawaiian’ means any individual who is—
‘‘(A) a citizen of the United States; and
‘‘(B) a descendant of the aboriginal people,
who prior to 1778, occupied and exercised sov-
ereignty in the area that now constitutes the
State of Hawaii, as evidenced by—
‘‘(i) genealogical records;
‘‘(ii) Kupuna (elders) or Kama’aina
(long-term community residents) verifica-
tion; or
‘‘(iii) birth records of the State of Ha-
waii.
‘‘(4) NATIVE HAWAIIAN HEALTH CENTER.—The
term ‘Native Hawaiian health center’ means an en-
tity—
101
‘‘(A) which is organized under the laws of
the State of Hawaii,
‘‘(B) which provides or arranges for health
care services through practitioners licensed by
the State of Hawaii, where licensure require-
ments are applicable,
‘‘(C) which is a public or nonprofit private
entity, and
‘‘(D) in which Native Hawaiian health
practitioners significantly participate in the
planning, management, monitoring, and evalua-
tion of health services.
‘‘(5) NATIVE
HAWAIIAN
ORGANIZATION.—The
term ‘Native Hawaiian organization’ means any or-
ganization—
‘‘(A) which serves the interests of Native
Hawaiians,
‘‘(B) which is—
‘‘(i) recognized by Papa Ola Lokahi
for the purpose of planning, conducting, or
administering programs (or portions of
programs) authorized under this Act for
the benefit of Native Hawaiians, and
‘‘(ii) certified by Papa Ola Lokahi as
having the qualifications and capacity to
102
provide the services, and meet the require-
ments, under the contract the organization
enters into with, or grant the organization
receives from, the Secretary under this
Act,
‘‘(C) in which Native Hawaiian health
practitioners significantly participate in the
planning, management, monitoring, and evalua-
tion of health services, and
‘‘(D) which is a public or nonprofit private
entity.
‘‘(6) NATIVE
HAWAIIAN
HEALTH
CARE
SYS-
TEM.—The term ‘Native Hawaiian health care sys-
tem’ means an entity—
‘‘(A) which is organized under the laws of
the State of Hawaii;
‘‘(B) which provides or arranges for health
care services through practitioners licensed by
the State of Hawaii, where licensure require-
ments are applicable;
‘‘(C) which is a public or nonprofit private
entity;
‘‘(D) in which Native Hawaiian health
practitioners significantly participate in the
103
planning, management, monitoring, and evalua-
tion of health care services;
‘‘(E) which may be composed of as many
Native Hawaiian health centers as necessary to
meet the health care needs of Native Hawaiians
residing on the island or islands served by such
entity;
‘‘(F) which is recognized by Papa Ola
Lokahi for the purpose of providing comprehen-
sive health promotion and disease prevention
services as well as primary health services to
Native Hawaiians under this Act; and
‘‘(G) which is certified by Papa Ola Lokahi
as having the qualifications and the capacity to
provide the services and meet the requirements
of a contract entered into, or a grant received,
under section 4.
‘‘(7) PAPA OLA LOKAHI.—(A) Subject to sub-
paragraph (B), the term ‘Papa Ola Lokahi’ means
an organization composed of—
‘‘(i) E Ola Mau;
‘‘(ii) the Office of Hawaiian Affairs of the
State of Hawaii;
‘‘(iii) Alu Like Inc.;
‘‘(iv) the University of Hawaii;
104
‘‘(v) the Office of Hawaiian Health of the
Hawaii State Department of Health;
‘‘(vi) Ho’ola Lahui Hawaii, or a health
care system serving the islands of Kaua’i and
Ni’ihau;
‘‘(vii) Ke Ola Mamo, or a health care sys-
tem serving the island of O’ahu;
‘‘(viii) Na Pu’uwai or a health care system
serving the islands of Moloka’i and Lana’i;
‘‘(ix) Hui No Ke Ola Pono, or a health
care system serving the island of Maui;
‘‘(x) Hui Malama Ola Ha’Oiwi or a health
care system serving the island of Hawaii; and
‘‘(xi) such other member organizations as
the Board of Papa Ola Lokahi may admit from
time to time, based upon satisfactory dem-
onstration of a record of contribution to the
health and well-being of Native Hawaiians, and
upon satisfactory development of a mission
statement in relation to this Act, including
clearly defined goals and objectives, a 5-year ac-
tion plan outlining the contributions that each
organization will make in carrying out the pol-
icy of this Act, and an estimated budget.
105
‘‘(B) Such term does not include any organiza-
tion identified in subparagraph (A) if the Secretary
determines that such organization does not have a
mission statement with clearly defined goals and ob-
jectives for the contributions the organization will
make to Native Hawaiian health care systems and
an action plan for carrying out such goals and objec-
tives.
‘‘(8) PRIMARY HEALTH SERVICES.—The term
‘primary health services’ means—
‘‘(A) services of physicians, physicians’ as-
sistants and nurse practitioners;
‘‘(B) diagnostic laboratory and radiologic
services;
‘‘(C) preventive health services (including
children’s eye and ear examinations to deter-
mine the need for vision and hearing correction,
perinatal services, well child services, and family
planning services);
‘‘(D) emergency medical services;
‘‘(E) transportation services as required
for adequate patient care;
‘‘(F) preventive dental services; and
‘‘(G) pharmaceutical services, as may be
appropriate for particular health centers.
106
‘‘(9) SECRETARY.—The term ‘Secretary’ means
the Secretary of Health and Human Services.
‘‘(10) TRADITIONAL NATIVE HAWAIIAN HEAL-
ER.—The term ‘traditional Native Hawaiian healer’
means a practitioner—
‘‘(A) who—
‘‘(i) is of Hawaiian ancestry, and
‘‘(ii) has the knowledge, skills, and ex-
perience in direct personal health care of
individuals, and
‘‘(B) whose knowledge, skills, and experi-
ence are based on a 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. 11. RULE OF CONSTRUCTION.
‘‘Nothing in this Act shall be construed to restrict
the authority of the State of Hawaii to license health prac-
titioners.
‘‘SEC. 12. COMPLIANCE WITH BUDGET ACT.
‘‘Any new spending authority (described in subsection
(c)(2) (A) or (B) of section 401 of the Congressional
107
Budget Act of 1974) which is provided under this Act
shall be effective for any fiscal year only to such extent
or in such amounts as are provided in appropriation Acts.
‘‘SEC. 13. SEVERABILITY.
‘‘If any provision of this Act, or the application of
any such provision to any person or circumstances is held
to be invalid, the remainder of this Act, and the applica-
tion of such provision or amendment to persons or cir-
cumstances other than those to which it is held invalid,
shall not be affected thereby.
‘‘SEC. 14. AUTHORIZATION OF APPROPRIATIONS.
‘‘There is authorized to be appropriated for each of
the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and
2000 such sums as may be necessary to carry out the pur-
poses of this Act.
‘‘SEC. 15. PROHIBITION AGAINST EXCLUSION FROM PAR-
TICIPATION.
‘‘Notwithstanding any other provision of this Act, no
person shall, on the basis of race, color, or national origin,
be excluded from participation in, or be denied the benefits
of, or be subjected to discrimination under, any program
or activity receiving Federal financial assistance under
this Act.’’.