Native Hawaiian Health Care Act of 1988
PL 100-579 (S.136), enacted 10/31/1988

102 STAT. 2916 
PUBLIC LAW 100-579—OCT. 31, 1988 
Public Law 100-
100th Congress 
579 
Oct. 31, 1988 
[S. 136] 
Native Hawaiian 
Health Care Act 
of 1988. 
42 u s e 11701 
note. 
42 u s e 11701. 
42 u s e 11702. 
Grants. 
Oontracts. 
42 u s e 11703. 
Grants. 
Contracts. 
An Act 
To improve the health status of Native Hawaiians, and for other purposes. 
Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the "Native Hawaiian Health Care Act 
of 1988". 
SEC. 2. FINDINGS. 
The Congress finds that— 
(1) the United States retains the legal responsibility to enforce 
the administration of the public trust responsibility of the State 
of Hawaii for the betterment of the conditions of Native Hawai-
ians under section 5(f) of Public Law 86-3 (73 Stat. 6; commonly 
referred to as the "Hawaii Statehood Admissions Act"); 
(2) in furtherance of the State of Hawaii's public trust respon-
sibility for the betterment of the conditions of Native Hawai-
ians, 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 native 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. 
SEC. 3. COMPREHENSIVE HEALTH CARE MASTER PLAN FOR NATIVE 
HAWAIIANS. 
(a) DEVELOPMENT.—The Secretary may make a grant to, or enter 
into a contract with, Papa Ola Lokahi for the purpose of developing a 
Native Hawaiian comprehensive health care master plan designed 
to promote comprehensive health promotion and disease prevention 
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. 
(b) AUTHORIZATION OF APPROPRIATIONS.—There is authorized to be 
appropriated $700,000 for fiscal year 1990 to carry out subsection (a). 
SEC. 4. NATIVE HAWAIIAN HEALTH CENTERS. 
(a) COMPREHENSIVE HEALTH PROMOTION, DISEASE 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 comprehen-
PUBLIC LAW 100-579—OCT. 31, 1988 
102 STAT. 2917 
sive health promotion and disease prevention services as well as 
primary health services to Native Hawaiians. 
(B) In making grants and entering into contracts under this 
paragraph, the Secretary shall give preference to Native Hawaiian 
health centers and Native Hawaiian organizations, and, to the 
extent feasible, health promotion and disease prevention services 
shall be performed through Native Hawaiian health centers. 
(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 centers to serve the health needs 
of Native Hawaiian communities on each of 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 (aXD if the entity is— 
(1) a Native Hawaiian health center; 
(2) a Native Hawaiian organization; or 
(3) a public or nonprofit private health provider. 
(c) SERVICES TO BE PROVIDED.—(1) E^ach recipient of funds under 
subsection (aXD shall provide the following services: 
(A) Outreach services to inform Native Hawaiians of the 
avaUability 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 work-
ers, counselors, and cultural educators. 
(C) Services of physicians, physicians' assistants, or nurse 
practitioners. 
(D) Immunizations. 
(E) Prevention and control of diabetes, high blood pressure, 
and otitis media. 
(F) Pr^nancy and infant care. 
(G) Improvement of nutrition. 
(2) In addition to the mandatory services under paragraph (1), the 
following services may be provided pursuant to subsection (aXD: 
(A) Identification, treatment, control, and reduction of the 
incidence of preventable illnesses and conditions endemic to 
Native Hawaiians. 
(B) Collection of data related to the prevention of diseases and 
illnesses among Native Hawaiians. 
(C) Services within the meaning of the terms "health pro-
motion", "disease prevention", and "primary health services", 
as such terms are defined in section 8, which are not specifically 
referred to in paragraph (1) of this subsection. 
(3) The health care services referred to in paragraphs (1) and (2) 
which are provided under grants or contracts under subsection (aXD 
may be provided by traditional Native Hawaiian healers. 
(d) LIMITATION ON NUMBER OF ENTITIES.—During a fiscal year, the Grants. 
Secretary under this Act may make a grant to, or hold a contract Contracts. 
with, not more than nine qualified entities in the State of Hawaii, as 
follows: 
(1) Two entities serving individuals on Kaua'i, from which 
individuals on Ni'ihau shall also be served. 
(2) Two entities serving individuals on O'ahu. 
(3) One entity serving individuals on Moloka'i, from which 
individuals on Lana'i shall also be served. 
(4) Two entities serving individuals on Maui. 
102 STAT. 2918 
PUBLIC LAW 100-579—OCT. 31, 1988 
(5) Two entities serving individuals on Hawai'i. 
(e) MATCHING FUNDS.—(1) The Secretary may not make a grant or 
provide funds pursuant to a contract under subsection (aXD to an 
entity— 
(A) in an amount exceeding 75 percent of the costs of provid-
ing health services under the grant or contract; and 
(B) unless the entity agrees that the entity will make avail-
able, 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 imder paragraph (2)) for each $3 of 
Federal funds provided in such grant or contract. 
(2) Non-Federal contributions required in paragraph (1) may be in 
cash or in kind, fairly evaluated, including plant, equipment, or 
services. Amounts provided by the Federal Government or services 
assisted or subsidized to any significant extent by the Federal 
Government may not be included in determining the amount of 
such non-Federal contributions. 
(3) The Secretary may waive the requirement established in para-
graph (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 CONTRACT FUNDS.—The 
Secretary may not make a grant to, or enter into a contract with, an 
entity under subsection (aXl) unless the entity agrees that amounts 
received pursuant to such subsection will not, directly or through 
contract, be expended— 
(1) for any purpose other than the purposes described in 
subsection (c); 
(2) to provide inpatient services; 
(3) to make cash pa3mients to intended recipients of health 
services; or 
(4) to purchase or improve real property (other than minor 
remodeling of existing improvements to real property) or to 
purchase major medical equipment. 
(g) LIMITATION ON CHARGES FOR SERVICES.—The Secretary may 
not 
make a grant, or enter into a contract with, an entity under 
subsection (aXD unless the entity agrees that, whether health serv-
ices are provided directly or through contract— 
(1) health services under the grant or contract will be pro-
vided without r ^ a r d to ability to pay for the health services; 
and 
(2) the entity will impose a charge for the delivery of health 
services, and such charge— 
Public 
(A) will be made according to a schedule of charges that is 
information. 
made available to the public, and 
(B) will be adjusted to reflect the income of the individual 
involved, 
(h) AUTHORIZATION OF APPROPRIATIONS.—(1) There is authorized to 
be appropriated $5,000,000 for fiscal year 1991 and $10,000,000 for 
fiscal year 1992 to carry out subsection (aXD-
(2) There is authorized to be appropriated for fiscal year 1990 
$900,000 to carry out subsection (aX2). 
PUBLIC LAW 100-579—OCT. 31, 1988 
102 STAT. 2919 
SEC. 5. 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 updating (as appro-
priate) of the comprehensive health care master plan developed 
pursuant to section 3; 
(2) training for the persons described in section 4(cXlXB); or 
(3) identification of and research into the diseases that are 
most prevalent among Native Hawaiians, including behavioral, 
biomedical, epidemiological, and health services. 
(b) AUTHORIZATION OF APPROPRIATIONS.—There is authorized to be 
appropriated $1,000,000 for each of the fiscal years 1990, 1991, and 
1992 to carry out subsection (a). 
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 considers necessary or appropriate to 
ensure that the objectives of such grant or contract are achieved. 
Ob) PERIODIC REVIEW.—The Secretary shall periodically evaluate 
the performance of, and compliance with, grants and contracts 
under this Act. 
(c) ADMINISTRATIVE REQUIREMENTS.—The Secretary 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 fiscal control and 
fund accounting as may be 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 portion of which has a lim-
ited 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 individuals who are able to commu-
nicate with the population involved in the language and 
cultural context that is most appropriate; and 
(B) has designated at least one individual, 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 directly— 
(i) the entity has entered into a participation agree-
ment under such plan; and 
(ii) the entity is qualified to receive pajrments 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 
42 u s e 11704. 
Contracts. 
Research and 
development. 
Diseases, 
42 u s e 11705. 
Classified 
information. 
Records. 
102 STAT. 2920 
PUBLIC LAW 100-579—OCT. 31, 1988 
Reports. 
Records. 
(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 con-
ducted by the Secretary, the Secretary determines that an entity 
has not complied with or satisfactorily performed a contract entered 
into under section 4, the Secretary shall, prior to renewing such 
contract, attempt to resolve the areas of noncompliance or unsatis-
factory performance and modify such contract to prevent future 
occurrences of such noncompliance or unsatisfactory performance. 
If the Secretary determines that such noncompliance or unsatisfac-
tory performance cannot be resolved 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 
entity 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 entered 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 contracting 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 reimbursement, or in install-
ments and shall be made on such conditions as the Secretary deems 
necessary to carry out the purposes of this section. 
(e) LIMITATION ON USE OF FUNDS FOR ADMINISTRATIVE EXPENSES.— 
Except for grants and contracts under section 5, 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 Federal funds were 
expended; £uid 
(C) such other information as the Secretary may request. 
(2) The reports and records of any entity which concern 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 (Jeneral 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 conducted by a certified public accountant. 
PUBLIC LAW 100-579—OCT. 31, 1988 
102 STAT. 2921 
SEC. 7. ASSIGNMENT OF PERSONNEL. 
(a) IN GENERAL.—The Secretary is authorized to enter into an 
agreement with any entity under which the Secretanr is authorized 
to assign personnel of the Department of Health and Human Serv-
ices with expertise identified by such entity to such entity on detail 
for the purposes of providing comprehensive health promotion and 
disease prevention services to Native Hawaiians. 
(b) APPUCABLE FEDERAL PERSONNEL PROVISIONS.—Any assignment 
of personnel made by the Secretary under any eigreement entered 
into under the authority of paragraph (1) 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. 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 diseases, 
(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— 
(A) pregnancy and infant care, including prevention of 
fetal alcohol Sjmdrome, 
(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 has any ancestors that were natives, prior to 
1778, of the area that is now the State of Hawaii as evidenced 
b y -
(A) genealogical records, 
(B) Kupuna (elders) or Kama'aina Gong-term community 
residents) verification, or 
(C) birth records of the State of Hawaii. 
(4) NATIVE HAWAIIAN HEALTH CENTER.—The term "Native 
Hawaiian health center" 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 requirements 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 evaluation of health services. 
42 use 11706. 
Contracts. 
Diseases. 
42 use 11707. 
102 STAT. 2922 
PUBLIC LAW 100-579—OCT. 31, 1988 
(5) NATIVE HAWAIIAN ORGANIZATION.—The term 
"Native 
Hawaiian organization" means any organization— 
(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 quali-
fications and capacity to provide the services, and meet 
the requirements, 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 signifi-
cantly participate in the planning, management, monitor-
ing, and evaluation of health services, and 
(D) which is a public or nonprofit private entity. 
(6) PAPA OLA LOKAHI.—The term "Papa Ola Lokahi" means an 
organization composed of^ 
(A) E Ola Mau; 
(B) the Office of Hawaiian Affairs of the State of Hawaii; 
(C) Alu Like Inc.; 
(D) the University of Hawaii; and 
(E) the Office of Hawaiian Health of the Hawaii State 
Department of Health. 
(7) PRIMARY HEALTH SERVICES.—The term "primary health 
services" means— 
(A) services of physicians, physicians' assistants and 
nurse practitioners; 
(B) diagnostic laboratory and radiologic services; 
(C) preventive health services (including children's eye 
and ear examinations to determine 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. 
(8) SECRETARY.—The term "Secretary" means the Secretary of 
Health and Human Services. 
(9) TRADITIONAL NATIVE HAWAIIAN HEALER.—The term "tradi-
tional Native Hawaiian healer" means a practitioner— 
(A) who— 
(i) is of Hawaiian ancestry, and 
(ii) has the knowledge, skills, and experience in direct 
personal health care of individuals, and 
(B) whose knowledge, skills, and experience are based on 
a demonstrated learning of Native Hawaiian healing prac-
tices acquired by— 
(i) direct practical association with Native Hawaiian 
elders, and 
(ii) oral traditions transmitted from generation to 
generation. 
PUBLIC LAW 100-579—OCT. 31, 1988 
102 STAT. 2923 
SEC. 9. RULE OF CONSTRUCTION. 
42 USC 11708. 
Nothing in this Act shall be construed to restrict the authority 
of the State of Hawaii to license health practitioners. 
SEC. 10. REPEAL OF DEMONSTRATION PROJECT. 
Section 205 of the Indian Health Care Improvement Act, as added 
by section 208(c) of the Indian Health Care Amendments of 1988, is 25 USC I62ld. 
repealed. 
SEC. 11. COMPLIANCE WITH BUDGET ACT. 
42 USC 11709. 
Any new spending authority (described in subsection (cX2) (A) or 
(B) of section 401 of the Congressional 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. 12. SEVERABILITY. 
42 USC 11710. 
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 application of such provision or 
amendment to persons or circumstances other than those to which it 
is held invalid, shall not be affected thereby. 
Approved October 31, 1988. 
LEGISLATIVE HISTORY—S. 136: 
SENATE REPORTS: No. 100-580 (Select Comm. on Indian Affairs). 
CONGRESSIONAL RECORD, Vol. 134 (1988): 
Sept. 30, considered and passed Senate. 
Oct. 12, considered and passed House, amended. 
Oct. 14, Senate concurred in House amendment. 
o