[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 1929 Reported in Senate (RS)]






                                                       Calendar No. 765
106th CONGRESS
  2d Session
                                S. 1929

                          [Report No. 106-389]

To amend the Native Hawaiian Health Care Improvement Act to revise and 
                            extend such Act.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           November 16, 1999

 Mr. Inouye (for himself and Mr. Akaka) introduced the following bill; 
  which was read twice and referred to the Committee on Indian Affairs

                            August 25, 2000

 Reported under authority of the order of the Senate of July 26, 2000, 
                   by Mr. Campbell, with an amendment
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]

_______________________________________________________________________

                                 A BILL


 
To amend the Native Hawaiian Health Care Improvement Act to revise and 
                            extend such Act.

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

<DELETED>SECTION 1. SHORT TITLE.</DELETED>

<DELETED>    This Act may be cited as the ``Native Hawaiian Health Care 
Improvement Act Reauthorization of 1999''.</DELETED>

<DELETED>SEC. 2. AMENDMENT TO THE NATIVE HAWAIIAN HEALTH CARE 
              IMPROVEMENT ACT.</DELETED>

<DELETED>    The Native Hawaiian Health Care Improvement Act (42 U.S.C. 
11701 et seq.) is amended to read as follows:</DELETED>

<DELETED>``SECTION 1. SHORT TITLE; TABLE OF CONTENTS.</DELETED>

<DELETED>    ``(a) Short Title.--This Act may be cited as the `Native 
Hawaiian Health Care Improvement Act'.</DELETED>
<DELETED>    ``(b) Table of Contents.--The table of contents of this 
Act is as follows:</DELETED>

        <DELETED>``Sec. 1. Short title; table of contents.
        <DELETED>``Sec. 2. Findings.
        <DELETED>``Sec. 3. Definitions.
        <DELETED>``Sec. 4. Declaration of policy.
        <DELETED>``Sec. 5. Comprehensive health care master plan for 
                            Native Hawaiians.
        <DELETED>``Sec. 6. Functions of Papa Ola Lokahi.
        <DELETED>``Sec. 7. Native Hawaiian Health Care Systems.
        <DELETED>``Sec. 8. Administrative grant for Papa Ola Lokahi.
        <DELETED>``Sec. 9. Administration of grants and contracts.
        <DELETED>``Sec. 10. Assignment of personnel.
        <DELETED>``Sec. 11. Native Hawaiian health scholarships and 
                            fellowships.
        <DELETED>``Sec. 12. Report.
        <DELETED>``Sec. 13. Demonstration projects of national 
                            significance.
        <DELETED>``Sec. 14. National Bipartisan Commission on Native 
                            Hawaiian Health Care Entitlement.
        <DELETED>``Sec. 15. Rule of construction.
        <DELETED>``Sec. 16. Compliance with Budget Act.
        <DELETED>``Sec. 17. Severability.

<DELETED>``SEC. 2. FINDINGS.</DELETED>

<DELETED>    ``(a) General Findings.--Congress makes the following 
findings:</DELETED>
        <DELETED>    ``(1) Native Hawaiians begin their story with the 
        Kumulipo which details the creation and inter-relationship of 
        all things, including their evolvement as healthy and well 
        people.</DELETED>
        <DELETED>    ``(2) Native Hawaiians are a distinct and unique 
        indigenous people with a historical continuity to the original 
        inhabitants of the Hawaiian archipelago and have a distinct 
        society organized almost 2,000 years ago.</DELETED>
        <DELETED>    ``(3) Native Hawaiians have never directly 
        relinquished to the United States their claims to their 
        inherent sovereignty as a people or over their national lands, 
        either through their monarchy or through a plebiscite or 
        referendum.</DELETED>
        <DELETED>    ``(4) The health and well-being of Native 
        Hawaiians are intrinsically tied to their deep feelings and 
        attachment to their lands and seas.</DELETED>
        <DELETED>    ``(5) The long-range economic and social changes 
        in Hawaii over the 19th and early 20th centuries have been 
        devastating to the health and well-being of Native 
        Hawaiians.</DELETED>
        <DELETED>    ``(6) The Native Hawaiian people are determined to 
        preserve, develop and transmit to future generations their 
        ancestral territory, and their cultural identity in accordance 
        with their own spiritual and traditional beliefs, customs, 
        practices, language, and social institutions. In referring to 
        themselves, Native Hawaiians use the term ``Kanaka Maoli'', a 
        term frequently used in the 19th century to describe the native 
        people of Hawaii.</DELETED>
        <DELETED>    ``(7) The constitution and statutes of the State 
        of Hawaii--</DELETED>
                <DELETED>    ``(A) acknowledge the distinct land rights 
                of Native Hawaiian people as beneficiaries of the 
                public lands trust; and</DELETED>
                <DELETED>    ``(B) reaffirm and protect the unique 
                right of the Native Hawaiian people to practice and 
                perpetuate their cultural and religious customs, 
                beliefs, practices, and language.</DELETED>
        <DELETED>    ``(8) At the time of the arrival of the first 
        nonindigenous people in Hawaii in 1778, the Native Hawaiian 
        people lived in a highly organized, self-sufficient, 
        subsistence social system based on communal land tenure with a 
        sophisticated language, culture, and religion.</DELETED>
        <DELETED>    ``(9) A unified monarchical government of the 
        Hawaiian Islands was established in 1810 under Kamehameha I, 
        the first King of Hawaii.</DELETED>
        <DELETED>    ``(10) Throughout the 19th century and until 1893, 
        the United States--</DELETED>
                <DELETED>    ``(A) recognized the independence of the 
                Hawaiian Nation;</DELETED>
                <DELETED>    ``(B) extended full and complete 
                diplomatic recognition to the Hawaiian Government; 
                and</DELETED>
                <DELETED>    ``(C) entered into treaties and 
                conventions with the Hawaiian monarchs to govern 
                commerce and navigation in 1826, 1842, 1849, 1875 and 
                1887.</DELETED>
        <DELETED>    ``(11) In 1893, John L. Stevens, the United States 
        Minister assigned to the sovereign and independent Kingdom of 
        Hawaii, conspired with a small group of non-Hawaiian residents 
        of the Kingdom, including citizens of the United States, to 
        overthrow the indigenous and lawful government of 
        Hawaii.</DELETED>
        <DELETED>    ``(12) In pursuance of that conspiracy, the United 
        States Minister and the naval representative of the United 
        States caused armed naval forces of the United States to invade 
        the sovereign Hawaiian Nation in support of the overthrow of 
        the indigenous and lawful Government of Hawaii and the United 
        States Minister thereupon extended diplomatic recognition of a 
        provisional government formed by the conspirators without the 
        consent of the native people of Hawaii or the lawful Government 
        of Hawaii in violation of treaties between the 2 nations and of 
        international law.</DELETED>
        <DELETED>    ``(13) In a message to Congress on December 18, 
        1893, then President Grover Cleveland reported fully and 
        accurately on these illegal actions, and acknowledged that by 
        these acts, described by the President as acts of war, the 
        government of a peaceful and friendly people was overthrown, 
        and the President concluded that a ``substantial wrong has thus 
        been done which a due regard for our national character as well 
        as the rights of the injured people required that we should 
        endeavor to repair''.</DELETED>
        <DELETED>    ``(14) Queen Lili`uokalani, the lawful monarch of 
        Hawaii, and the Hawaiian Patriotic League, representing the 
        aboriginal citizens of Hawaii, promptly petitioned the United 
        States for redress of these wrongs and for restoration of the 
        indigenous government of the Hawaiian nation, but this petition 
        was not acted upon.</DELETED>
        <DELETED>    ``(15) Further, the United States has acknowledged 
        the significance of these events and has apologized to Native 
        Hawaiians on behalf of the people of the United States for the 
        overthrow of the Kingdom of Hawaii with the participation of 
        agents and citizens of the United States, and the resulting 
        deprivation of the rights of Native Hawaiians to self-
        determination in legislation in 1993 (Public Law 103-150; 107 
        Stat. 1510).</DELETED>
        <DELETED>    ``(16) In 1898, the United States annexed Hawaii 
        through the Newlands Resolution without the consent of or 
        compensation to the indigenous people of Hawaii or their 
        sovereign government who were thereby denied the mechanism for 
expression of their inherent sovereignty through self-government and 
self-determination, their lands and ocean resources.</DELETED>
        <DELETED>    ``(17) Through the Newlands Resolution and the 
        1900 Organic Act, the Congress received 1,750,000 acres of 
        lands formerly owned by the Crown and Government of the 
        Hawaiian Kingdom and exempted the lands from then existing 
        public land laws of the United States by mandating that the 
        revenue and proceeds from these lands be ``used solely for the 
        benefit of the inhabitants of the Hawaiian Islands for 
        education and other public purposes'', thereby establishing a 
        special trust relationship between the United States and the 
        inhabitants of Hawaii.</DELETED>
        <DELETED>    ``(18) In 1921, Congress enacted the Hawaiian 
        Homes Commission Act, 1920, which designated 200,000 acres of 
        the ceded public lands for exclusive homesteading by Native 
        Hawaiians, thereby affirming the trust relationship between the 
        United States and the Native Hawaiians, as expressed by then 
        Secretary of the Interior Franklin K. Lane who was cited in the 
        Committee Report of the Committee on Territories of the House 
        of Representatives as stating, ``One thing that impressed me . 
        . . was the fact that the natives of the islands . . . for whom 
        in a sense we are trustees, are falling off rapidly in numbers 
        and many of them are in poverty.''.</DELETED>
        <DELETED>    ``(19) In 1938, Congress again acknowledged the 
        unique status of the Native Hawaiian people by including in the 
        Act of June 20, 1938 (52 Stat. 781 et seq.), a provision to 
        lease lands within the extension to Native Hawaiians and to 
        permit fishing in the area ``only by native Hawaiian residents 
        of said area or of adjacent villages and by visitors under 
        their guidance''.</DELETED>
        <DELETED>    ``(20) Under the Act entitled ``An Act to provide 
        for the admission of the State of Hawaii into the Union'', 
        approved March 18, 1959 (73 Stat. 4), the United States 
        transferred responsibility for the administration of the 
        Hawaiian Home Lands to the State of Hawaii but reaffirmed the 
        trust relationship which existed between the United States and 
        the Native Hawaiian people by retaining the exclusive power to 
        enforce the trust, including the power to approve land 
        exchanges, and legislative amendments affecting the rights of 
        beneficiaries under such Act.</DELETED>
        <DELETED>    ``(21) Under the Act entitled ``An Act to provide 
        for the admission of the State of Hawaii into the Union'', 
        approved March 18, 1959 (73 Stat. 4), the United States 
        transferred responsibility for administration over portions of 
        the ceded public lands trust not retained by the United States 
        to the State of Hawaii but reaffirmed the trust relationship 
        which existed between the United States and the Native Hawaiian 
        people by retaining the legal responsibility of the State for 
        the betterment of the conditions of Native Hawaiians under 
        section 5(f) of such Act.</DELETED>
        <DELETED>    ``(22) The authority of the Congress under the 
        Constitution to legislate in matters affecting the aboriginal 
        or indigenous peoples of the United States includes the 
        authority to legislate in matters affecting the native peoples 
        of Alaska and Hawaii.</DELETED>
        <DELETED>    ``(23) Further, the United States has recognized 
        the authority of the Native Hawaiian people to continue to work 
        towards an appropriate form of sovereignty as defined by the 
        Native Hawaiian people themselves in provisions set forth in 
        legislation returning the Hawaiian Island of Kaho`olawe to 
        custodial management by the State of Hawaii in 1994.</DELETED>
        <DELETED>    ``(24) In furtherance of the trust responsibility 
        for the betterment of the conditions of Native Hawaiians, the 
        United States has established a program for the provision of 
        comprehensive health promotion and disease prevention services 
        to maintain and improve the health status of the Hawaiian 
        people. This program is conducted by the Native Hawaiian Health 
        Care Systems, the Native Hawaiian Health Scholarship Program 
        and Papa Ola Lokahi. Health initiatives from these and other 
        health institutions and agencies using Federal assistance have 
        begun to lower the century-old morbidity and mortality rates of 
        Native Hawaiian people by providing comprehensive disease 
        prevention, health promotion activities and increasing the 
        number of Native Hawaiians in the health and allied health 
        professions. This has been accomplished through the Native 
        Hawaiian Health Care Act of 1988 (Public Law 100-579) and its 
        reauthorization in section 9168 of Public Law 102-396 (106 
        Stat. 1948).</DELETED>
        <DELETED>    ``(25) This historical and unique legal 
        relationship has been consistently recognized and affirmed by 
        Congress through the enactment of Federal laws which extend to 
        the Native Hawaiian people the same rights and privileges 
        accorded to American Indian, Alaska Native, Eskimo, and Aleut 
        communities, including the Native American Programs Act of 1974 
        (42 U.S.C. 2991 et seq.), the American Indian Religious Freedom 
        Act (42 U.S.C. 1996), the National Museum of the American 
        Indian Act (20 U.S.C. 80q et seq.), and the Native American 
        Graves Protection and Repatriation Act (25 U.S.C. 3001 et 
        seq.).</DELETED>
        <DELETED>    ``(26) The United States has also recognized and 
        reaffirmed the trust relationship to the Native Hawaiian people 
        through legislation which authorizes the provision of services 
        to Native Hawaiians, specifically, the Older Americans Act of 
        1965 (42 U.S.C. 3001 et seq.), the Developmental Disabilities 
        Assistance and Bill of Rights Act Amendments of 1987, the 
        Veterans' Benefits and Services Act of 1988, the Rehabilitation 
        Act of 1973 (29 U.S.C. 701 et seq.), the Native Hawaiian Health 
        Care Act of 1988 (Public Law 100-579), the Health Professions 
        Reauthorization Act of 1988, the Nursing Shortage Reduction and 
        Education Extension Act of 1988, the Handicapped Programs 
        Technical Amendments Act of 1988, the Indian Health Care 
        Amendments of 1988, and the Disadvantaged Minority Health 
        Improvement Act of 1990.</DELETED>
        <DELETED>    ``(27) The United States has also affirmed the 
        historical and unique legal relationship to the Hawaiian people 
        by authorizing the provision of services to Native Hawaiians to 
        address problems of alcohol and drug abuse under the Anti-Drug 
        Abuse Act of 1986 (Public Law 99-570).</DELETED>
        <DELETED>    ``(28) Further, the United States has recognized 
        that Native Hawaiians, as aboriginal, indigenous, native 
        peoples of Hawaii, are a unique population group in Hawaii and 
        in the continental United States and has so declared in Office 
        of Management and Budget Circular 15 in 1997 and Presidential 
        Executive Order No. 13125, dated June 7, 1999.</DELETED>
        <DELETED>    ``(29) Despite the United States having expressed 
        its commitment to a policy of reconciliation with the Native 
        Hawaiian people for past grievances in Public Law 103-150 (107 
        Stat. 1510) the unmet health needs of the Native Hawaiian 
        people remain severe and their health status continues to be 
        far below that of the general population of the United 
        States.</DELETED>
<DELETED>    ``(b) Unmet Needs and Health Disparities.--Congress finds 
that the unmet needs and serious health disparities that adversely 
affect the Native Hawaiian people include the following:</DELETED>
        <DELETED>    ``(1) Chronic disease and illness.--</DELETED>
                <DELETED>    ``(A) Cancer.--</DELETED>
                        <DELETED>    ``(i) In general.--With respect to 
                        all cancer--</DELETED>
                                <DELETED>    ``(I) Native Hawaiians 
                                have the highest cancer mortality rates 
                                in the State of Hawaii (231.0 out of 
                                every 100,000 residents), 45 percent 
                                higher than that for the total State 
                                population (159.7 out of every 100,000 
                                residents);</DELETED>
                                <DELETED>    ``(II) Native Hawaiian 
                                males have the highest cancer mortality 
                                rates in the State of Hawaii for 
                                cancers of the lung, liver and pancreas 
                                and for all cancers combined;</DELETED>
                                <DELETED>    ``(III) Native Hawaiian 
                                females ranked highest in the State of 
                                Hawaii for cancers of the lung, liver, 
                                pancreas, breast, cervix uteri, corpus 
                                uteri, stomach, and rectum, and for all 
                                cancers combined;</DELETED>
                                <DELETED>    ``(IV) Native Hawaiian 
                                males have the highest years of 
                                productive life lost from cancer in the 
                                State of Hawaii with 8.7 years compared 
                                to 6.4 years for other males; 
                                and</DELETED>
                                <DELETED>    ``(V) Native Hawaiian 
                                females have 8.2 years of productive 
                                life lost from cancer in the State of 
                                Hawaii as compared to 6.4 years for 
                                other females in the State of 
                                Hawaii;</DELETED>
                        <DELETED>    ``(ii) Breast cancer.--With 
                        respect to breast cancer--</DELETED>
                                <DELETED>    ``(I) Native Hawaiians 
                                have the highest mortality rates in the 
                                State of Hawaii from breast cancer 
                                (37.96 out of every 100,000 residents), 
                                which is 25 percent higher than that 
                                for Caucasian Americans (30.25 out of 
                                every 100,000 residents) and 106 
                                percent higher than that for Chinese 
                                Americans (18.39 out of every 100,000 
                                residents); and</DELETED>
                                <DELETED>    ``(II) nationally, Native 
                                Hawaiians have the third highest 
                                mortality rates due to breast cancer 
                                (25.0 out of every 100,000 residents) 
                                following African Americans (31.4 out 
                                of every 100,000 residents) and 
                                Caucasian Americans (27.0 out of every 
                                100,000 residents).</DELETED>
                        <DELETED>    ``(iii) Cancer of the cervix.--
                        Native Hawaiians have the highest mortality 
                        rates from cancer of the cervix in the State of 
                        Hawaii (3.82 out of every 100,000 residents) 
                        followed by Filipino Americans (3.33 out of 
                        every 100,000 residents) and Caucasian 
                        Americans (2.61 out of every 100,000 
                        residents).</DELETED>
                        <DELETED>    ``(iv) Lung cancer.--Native 
                        Hawaiians have the highest mortality rates from 
                        lung cancer in the State of Hawaii (90.70 out 
                        of every 100,000 residents), which is 61 
                        percent higher than Caucasian Americans, who 
                        rank second and 161 percent higher than 
                        Japanese Americans, who rank third.</DELETED>
                        <DELETED>    ``(v) Prostate cancer.--Native 
                        Hawaiian males have the second highest 
                        mortality rates due to prostate cancer in the 
                        State of Hawaii (25.86 out of every 100,000 
                        residents) with Caucasian Americans having the 
                        highest mortality rate from prostate cancer 
                        (30.55 out of every 100,000 
                        residents).</DELETED>
                <DELETED>    ``(B) Diabetes.--With respect to diabetes, 
                for the years 1989 through 1991--</DELETED>
                        <DELETED>    ``(i) Native Hawaiians had the 
                        highest mortality rate due to diabetes mellitis 
                        (34.7 out of every 100,000 residents) in the 
                        State of Hawaii which is 130 percent higher 
                        than the statewide rate for all other races 
                        (15.1 out of every 100,000 
                        residents);</DELETED>
                        <DELETED>    ``(ii) full-blood Hawaiians had a 
                        mortality rate of 93.3 out of every 100,000 
                        residents, which is 518 percent higher than the 
                        rate for the statewide population of all other 
                        races; and</DELETED>
                        <DELETED>    ``(iii) Native Hawaiians who are 
                        less than full-blood had a mortality rate of 
                        27.1 out of every 100,000 residents, which is 
                        79 percent higher than the rate for the 
                        statewide population of all other 
                        races.</DELETED>
                <DELETED>    ``(C) Asthma.--With respect to asthma--
                </DELETED>
                        <DELETED>    ``(i) in 1990, Native Hawaiians 
                        comprised 44 percent of all asthma cases in the 
                        State of Hawaii for those 18 years of age and 
                        younger, and 35 percent of all asthma cases 
                        reported; and</DELETED>
                        <DELETED>    ``(ii) in 1992, the Native 
                        Hawaiian rate for asthma was 81.7 out of every 
                        1000 residents, which was 73 percent higher 
                        than the rate for the total statewide 
                        population of 47.3 out of every 1000 
                        residents.</DELETED>
                <DELETED>    ``(D) Circulatory diseases.--</DELETED>
                        <DELETED>    ``(i) Heart Disease.--With respect 
                        to heart disease--</DELETED>
                                <DELETED>    ``(I) the death rate for 
                                Native Hawaiians from heart disease 
                                (333.4 out of every 100,000 residents) 
                                is 66 percent higher than for the 
                                entire State of Hawaii (201.1 out of 
                                every 100,000 residents); and</DELETED>
                                <DELETED>    ``(II) Native Hawaiian 
                                males have the greatest years of 
                                productive life lost in the State of 
                                Hawaii where Native Hawaiian males lose 
                                an average of 15.5 years and Native 
                                Hawaiian females lose an average of 8.2 
                                years due to heart disease, as compared 
                                to 7.5 years for all males in the State 
                                of Hawaii and 6.4 years for all 
                                females.</DELETED>
                        <DELETED>    ``(ii) Hypertension.--The death 
                        rate for Native Hawaiians from hypertension 
                        (3.5 out of every 100,000 residents) is 84 
                        percent higher than that for the entire State 
                        (1.9 out of every 100,000 residents).</DELETED>
                        <DELETED>    ``(iii) Stroke.--The death rate 
                        for Native Hawaiians from stroke (58.3 out of 
                        every 100,000 residents) is 13 percent higher 
                        than that for the entire State (51.8 out of 
                        every 100,000 residents).</DELETED>
        <DELETED>    ``(2) Infectious disease and illness.--The 
        incidence of AIDS for Native Hawaiians is at least twice as 
        high per 100,000 residents (10.5 percent) than that for any 
        other non-Caucasian group in the State of Hawaii.</DELETED>
        <DELETED>    ``(3) Accidents.--With respect to accidents--
        </DELETED>
                <DELETED>    ``(A) the death rate for Native Hawaiians 
                from accidents (38.8 out of every 100,000 residents) is 
                45 percent higher than that for the entire State (26.8 
                out of every 100,000 residents);</DELETED>
                <DELETED>    ``(B) Native Hawaiian males lose an 
                average of 14 years of productive life lost from 
                accidents as compared to 9.8 years for all other males 
                in Hawaii; and</DELETED>
                <DELETED>    ``(C) Native Hawaiian females lose and 
                average of 4 years of productive life lost from 
                accidents but this rate is the highest rate among all 
                females in the State of Hawaii.</DELETED>
        <DELETED>    ``(4) Dental health.--With respect to dental 
        health--</DELETED>
                <DELETED>    ``(A) Native Hawaiian children exhibit 
                among the highest rates of dental caries in the nation, 
                and the highest in the State of Hawaii as compared to 
                the 5 other major ethnic groups in the State;</DELETED>
                <DELETED>    ``(B) the average number of decayed or 
                filled primary teeth for Native Hawaiian children ages 
                5 through 9 years was 4.3 as compared with 3.7 for the 
                entire State of Hawaii and 1.9 for the United States; 
                and</DELETED>
                <DELETED>    ``(C) the proportion of Native Hawaiian 
                children ages 5 through 12 years with unmet treatment 
                needs (defined as having active dental caries requiring 
                treatment) is 40 percent as compared with 33 percent 
                for all other races in the State of Hawaii.</DELETED>
        <DELETED>    ``(5) Life expectancy.--With respect to life 
        expectancy--</DELETED>
                <DELETED>    ``(A) Native Hawaiians have the lowest 
                life expectancy of all population groups in the State 
                of Hawaii;</DELETED>
                <DELETED>    ``(B) between 1910 and 1980, the life 
                expectancy of Native Hawaiians from birth has ranged 
                from 5 to 10 years less than that of the overall State 
                population average; and</DELETED>
                <DELETED>    ``(C) the most recent tables for 1990 show 
                Native Hawaiian life expectancy at birth (74.27 years) 
                to be about 5 years less than that of the total State 
                population (78.85 years).</DELETED>
        <DELETED>    ``(6) Maternal and child health.--</DELETED>
                <DELETED>    ``(A) Prenatal care.--With respect to 
                prenatal care--</DELETED>
                        <DELETED>    ``(i) as of 1996, Native Hawaiian 
                        women have the highest prevalence (21 percent) 
                        of having had no prenatal care during their 
                        first trimester of pregnancy when compared to 
                        the 5 largest ethnic groups in the State of 
                        Hawaii;</DELETED>
                        <DELETED>    ``(ii) of the mothers in the State 
                        of Hawaii who received no prenatal care 
                        throughout their pregnancy in 1996, 44 percent 
                        were Native Hawaiian;</DELETED>
                        <DELETED>    ``(iii) over 65 percent of the 
                        referrals to Healthy Start in fiscal years 1996 
                        and 1997 were Native Hawaiian newborns; 
                        and</DELETED>
                        <DELETED>    ``(iv) in every region of the 
                        State of Hawaii, many Native Hawaiian newborns 
                        begin life in a potentially hazardous 
                        circumstance, far higher than any other racial 
                        group.</DELETED>
                <DELETED>    ``(B) Births.--With respect to births--
                </DELETED>
                        <DELETED>    ``(i) in 1996, 45 percent of the 
                        live births to Native Hawaiian mothers were 
                        infants born to single mothers which statistics 
                        indicate put infants at higher risk of low 
                        birth weight and infant mortality;</DELETED>
                        <DELETED>    ``(ii) in 1996, of the births to 
                        Native Hawaiian single mothers, 8 percent were 
                        low birth weight (under 2500 grams); 
                        and</DELETED>
                        <DELETED>    ``(iii) of all low birth weight 
                        babies born to single mothers in the State of 
                        Hawaii, 44 percent were Native 
                        Hawaiian.</DELETED>
                <DELETED>    ``(C) Teen pregnancies.--With respect to 
                births--</DELETED>
                        <DELETED>    ``(i) in 1993 and 1994, Native 
                        Hawaiians had the highest percentage of teen 
                        (individuals who were less than 18 years of 
                        age) births (8.1 percent) compared to the rate 
                        for all other races in the State of Hawaii (3.6 
                        percent);</DELETED>
                        <DELETED>    ``(ii) in 1996, nearly 53 percent 
                        of all mothers in Hawaii under 18 years of age 
                        were Native Hawaiian;</DELETED>
                        <DELETED>    ``(iii) lower rates of abortion (a 
                        third lower than for the statewide population) 
                        among Hawaiian women may account in part, for 
                        the higher percentage of live births;</DELETED>
                        <DELETED>    ``(iv) in 1995, of the births to 
                        mothers age 14 years and younger in Hawaii, 66 
                        percent were Native Hawaiian; and</DELETED>
                        <DELETED>    ``(v) in 1996, of the births in 
                        this same group, 48 percent were Native 
                        Hawaiian.</DELETED>
                <DELETED>    ``(D) Fetal mortality.--In 1996, Native 
                Hawaiian fetal mortality rates comprised 15 percent of 
                all fetal deaths for the State of Hawaii. However, for 
                fetal deaths occurring in mothers under the age of 18 
                years, 32 percent were Native Hawaiian, and for mothers 
                18 through 24 years of age, 28 percent were Native 
                Hawaiians.</DELETED>
        <DELETED>    ``(7) Mental health.--</DELETED>
                <DELETED>    ``(A) Alcohol and drug abuse.--With 
                respect to alcohol and drug abuse--</DELETED>
                        <DELETED>    ``(i) Native Hawaiians represent 
                        38 percent of the total admissions to 
                        Department of Health, Alcohol, Drugs and Other 
                        Drugs, funded substance abuse treatment 
                        programs;</DELETED>
                        <DELETED>    ``(ii) in 1997, the prevalence of 
                        smoking by Native Hawaiians was 28.5 percent, a 
                        rate that is 53 percent higher than that for 
                        all other races in the State of Hawaii which is 
                        18.6 percent;</DELETED>
                        <DELETED>    ``(iii) Native Hawaiians have the 
                        highest prevalence rates of acute drinking (31 
                        percent), a rate that is 79 percent higher than 
                        that for all other races in the State of 
                        Hawaii;</DELETED>
                        <DELETED>    ``(iv) the chronic drinking rate 
                        among Native Hawaiians is 54 percent higher 
                        than that for all other races in the State of 
                        Hawaii;</DELETED>
                        <DELETED>    ``(v) in 1991, 40 percent of the 
                        Native Hawaiian adults surveyed reported having 
                        used marijuana compared with 30 percent for all 
other races in the State of Hawaii; and</DELETED>
                        <DELETED>    ``(vi) nine percent of the Native 
                        Hawaiian adults surveyed reported that they are 
                        current users (within the past year) of 
                        marijuana, compared with 6 percent for all 
                        other races in the State of Hawaii.</DELETED>
                <DELETED>    ``(B) Crime.--With respect to crime--
                </DELETED>
                        <DELETED>    ``(i) in 1996, of the 5,944 
                        arrests that were made for property crimes in 
                        the State of Hawaii, arrests of Native 
                        Hawaiians comprised 20 percent of that 
                        total;</DELETED>
                        <DELETED>    ``(ii) Native Hawaiian juveniles 
                        comprised a third of all juvenile arrests in 
                        1996;</DELETED>
                        <DELETED>    ``(iii) In 1996, Native Hawaiians 
                        represented 21 percent of the 8,000 adults 
                        arrested for violent crimes in the State of 
                        Hawaii, and 38 percent of the 4,066 juvenile 
                        arrests;</DELETED>
                        <DELETED>    ``(iv) Native Hawaiians are over-
                        represented in the prison population in 
                        Hawaii;</DELETED>
                        <DELETED>    ``(v) in 1995 and 1996 Native 
                        Hawaiians comprised 36.5 percent of the 
                        sentenced felon prison population in Hawaii, as 
                        compared to 20.5 percent for Caucasian 
                        Americans, 3.7 percent for Japanese Americans, 
                        and 6 percent for Chinese Americans;</DELETED>
                        <DELETED>    ``(vi) in 1995 and 1996 Native 
                        Hawaiians made up 45.4 percent of the technical 
                        violator population, and at the Hawaii Youth 
                        Correctional Facility, Native Hawaiians 
                        constituted 51.6 percent of all detainees in 
                        fiscal year 1997; and</DELETED>
                        <DELETED>    ``(vii) based on anecdotal 
                        information from inmates at the Halawa 
                        Correction Facilities, Native Hawaiians are 
                        estimated to comprise between 60 and 70 percent 
                        of all inmates.</DELETED>
        <DELETED>    ``(8) Health professions education and training.--
        With respect to health professions education and training--
        </DELETED>
                <DELETED>    ``(A) Native Hawaiians age 25 years and 
                older have a comparable rate of high school completion, 
                however, the rates of baccalaureate degree achievement 
                amongst Native Hawaiians are less than the norm in the 
                State of Hawaii (6.9 percent and 15.76 percent 
                respectively);</DELETED>
                <DELETED>    ``(B) Native Hawaiian physicians make up 4 
                percent of the total physician workforce in the State 
                of Hawaii; and</DELETED>
                <DELETED>    ``(C) in fiscal year 1997, Native 
                Hawaiians comprised 8 percent of those individuals who 
                earned Bachelor's Degrees, 14 percent of those 
                individuals who earned professional diplomas, 6 percent 
                of those individuals who earned Master's Degrees, and 
                less than 1 percent of individuals who earned doctoral 
                degrees at the University of Hawaii.</DELETED>

<DELETED>``SEC. 3. DEFINITIONS.</DELETED>

<DELETED>    ``In this Act:</DELETED>
        <DELETED>    ``(1) Disease prevention.--The term `disease 
        prevention' includes--</DELETED>
                <DELETED>    ``(A) immunizations;</DELETED>
                <DELETED>    ``(B) control of high blood 
                pressure;</DELETED>
                <DELETED>    ``(C) control of sexually transmittable 
                diseases;</DELETED>
                <DELETED>    ``(D) prevention and control of 
                diabetes;</DELETED>
                <DELETED>    ``(E) control of toxic agents;</DELETED>
                <DELETED>    ``(F) occupational safety and 
                health;</DELETED>
                <DELETED>    ``(G) accident prevention;</DELETED>
                <DELETED>    ``(H) fluoridation of water;</DELETED>
                <DELETED>    ``(I) control of infectious agents; 
                and</DELETED>
                <DELETED>    ``(J) provision of mental health 
                care.</DELETED>
        <DELETED>    ``(2) Health promotion.--The term `health 
        promotion' includes--</DELETED>
                <DELETED>    ``(A) pregnancy and infant care, including 
                prevention of fetal alcohol syndrome;</DELETED>
                <DELETED>    ``(B) cessation of tobacco 
                smoking;</DELETED>
                <DELETED>    ``(C) reduction in the misuse of alcohol 
                and drugs;</DELETED>
                <DELETED>    ``(D) improvement of nutrition;</DELETED>
                <DELETED>    ``(E) improvement in physical 
                fitness;</DELETED>
                <DELETED>    ``(F) family planning;</DELETED>
                <DELETED>    ``(G) control of stress;</DELETED>
                <DELETED>    ``(H) reduction of major behavioral risk 
                factors and promotion of healthy lifestyle practices; 
                and</DELETED>
                <DELETED>    ``(I) integration of cultural approaches 
                to health and well-being, including traditional 
                practices relating to the land (`aina), water (wai), 
                and ocean (kai).</DELETED>
        <DELETED>    ``(3) 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 of 
        Hawaii) as evidenced by--</DELETED>
                <DELETED>    ``(A) genealogical records,</DELETED>
                <DELETED>    ``(B) Kupuna (elders) or Kama`aina (long-
                term community residents) verification; or</DELETED>
                <DELETED>    ``(C) birth records of the State of 
                Hawaii.</DELETED>
        <DELETED>    ``(4) Native hawaiian health care system.--The 
        term `Native Hawaiian health care system' means an entity--
        </DELETED>
                <DELETED>    ``(A) which is organized under the laws of 
                the State of Hawaii;</DELETED>
                <DELETED>    ``(B) which provides or arranges for 
                health care services through practitioners licensed by 
                the State of Hawaii, where licensure requirements are 
                applicable;</DELETED>
                <DELETED>    ``(C) which is a public or nonprofit 
                private entity;</DELETED>
                <DELETED>    ``(D) in which Native Hawaiian health 
                practitioners significantly participate in the 
                planning, management, monitoring, and evaluation of 
                health care services;</DELETED>
                <DELETED>    ``(E) which may be composed of as many as 
                8 Native Hawaiian health care systems as necessary to 
meet the health care needs of each island's Native Hawaiians; 
and</DELETED>
                <DELETED>    ``(F) which is--</DELETED>
                        <DELETED>    ``(i) recognized by Papa Ola 
                        Lokahi for the purpose of planning, conducting, 
                        or administering programs, or portions of 
                        programs, authorized by this chapter for the 
                        benefit of Native Hawaiians; and</DELETED>
                        <DELETED>    ``(ii) certified by Papa Ola 
                        Lokahi as having the qualifications and the 
                        capacity to provide the services and meet the 
                        requirements under the contract the Native 
                        Hawaiian health care system enters into with 
                        the Secretary or the grant the Native Hawaiian 
                        health care system receives from the Secretary 
                        pursuant to this Act.</DELETED>
        <DELETED>    ``(5) Native hawaiian organization.--The term 
        `Native Hawaiian organization' means any organization--
        </DELETED>
                <DELETED>    ``(A) which serves the interests of Native 
                Hawaiians; and</DELETED>
                <DELETED>    ``(B) which is--</DELETED>
                        <DELETED>    ``(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</DELETED>
                        <DELETED>    ``(ii) a public or nonprofit 
                        private entity.</DELETED>
        <DELETED>    ``(6) Papa ola lokahi.--</DELETED>
                <DELETED>    ``(A) In general.--The term `Papa Ola 
                Lokahi' means an organization that is composed of 
                public agencies and private organizations focusing on 
                improving the health status of Native Hawaiians. Board 
                members of such organization may include representation 
                from--</DELETED>
                        <DELETED>    ``(i) E Ola Mau;</DELETED>
                        <DELETED>    ``(ii) the Office of Hawaiian 
                        Affairs of the State of Hawaii;</DELETED>
                        <DELETED>    ``(iii) Alu Like Inc.;</DELETED>
                        <DELETED>    ``(iv) the University of 
                        Hawaii;</DELETED>
                        <DELETED>    ``(v) the Hawaii State Department 
                        of Health;</DELETED>
                        <DELETED>    ``(vi) the Kamehameha Schools 
                        Bishop Estate, or other Native Hawaiian 
                        organization responsible for the administration 
                        of the Native Hawaiian Health Scholarship 
                        Program;</DELETED>
                        <DELETED>    ``(vii) the Hawaii State Primary 
                        Care Association, or other organizations 
                        responsible for the placement of scholars from 
                        the Native Hawaiian Health Scholarship 
                        Program;</DELETED>
                        <DELETED>    ``(viii) Ahahui O Na Kauka, the 
                        Native Hawaiian Physicians 
                        Association;</DELETED>
                        <DELETED>    ``(ix) Ho`ola Lahui Hawaii, or a 
                        health care system serving Kaua`i or Ni`ihau, 
                        and which may be composed of as many health 
                        care centers as are necessary to meet the 
                        health care needs of the Native Hawaiians of 
                        those islands;</DELETED>
                        <DELETED>    ``(x) Ke Ola Mamo, or a health 
                        care system serving the island of O`ahu and 
                        which may be composed of as many health care 
                        centers as are necessary to meet the health 
                        care needs of the Native Hawaiians of that 
                        island;</DELETED>
                        <DELETED>    ``(xi) Na Pu`uwai or a health care 
                        system serving Moloka`i or Lana`i, and which 
                        may be composed of as many health care centers 
                        as are necessary to meet the health care needs 
                        of the Native Hawaiians of those 
                        islands;</DELETED>
                        <DELETED>    ``(xii) Hui No Ke Ola Pono, or a 
                        health care system serving the island of Maui, 
                        and which may be composed of as many health 
                        care centers as are necessary to meet the 
                        health care needs of the Native Hawaiians of 
                        that island;</DELETED>
                        <DELETED>    ``(xiii) Hui Malama Ola Ha `Oiwi, 
                        or a health care system serving the island of 
                        Hawaii, and which may be composed of as many 
                        health care centers as are necessary to meet 
                        the health care needs of the Native Hawaiians 
                        of that island;</DELETED>
                        <DELETED>    ``(xiv) other Native Hawaiian 
                        health care systems as certified and recognized 
                        by Papa Ola Lokahi in accordance with this Act; 
                        and</DELETED>
                        <DELETED>    ``(xv) such other member 
                        organizations as the Board of Papa Ola Lokahi 
                        may admit from time to time, based upon 
                        satisfactory demonstration of a record of 
                        contribution to the health and well-being of 
                        Native Hawaiians.</DELETED>
                <DELETED>    ``(B) Limitation.--Such term does not 
                include any organization described in subparagraph (A) 
                if the Secretary determines that such organization has 
                not developed a mission statement with clearly defined 
                goals and objectives for the contributions the 
                organization will make to the Native Hawaiian health 
                care systems, and an action plan for carrying out those 
                goals and objectives.</DELETED>
        <DELETED>    ``(7) Primary health services.--The term `primary 
        health services' means--</DELETED>
                <DELETED>    ``(A) services of physicians, physicians' 
                assistants, nurse practitioners, and other health 
                professionals;</DELETED>
                <DELETED>    ``(B) diagnostic laboratory and radiologic 
                services;</DELETED>
                <DELETED>    ``(C) preventive health services including 
                perinatal services, well child services, family 
                planning services, nutrition services, home health 
                services, and, generally, all those services associated 
                with enhanced health and wellness.</DELETED>
                <DELETED>    ``(D) emergency medical 
                services;</DELETED>
                <DELETED>    ``(E) transportation services as required 
                for adequate patient care;</DELETED>
                <DELETED>    ``(F) preventive dental services; 
                and</DELETED>
                <DELETED>    ``(G) pharmaceutical and nutraceutical 
                services.</DELETED>
        <DELETED>    ``(8) Secretary.--The term `Secretary' means the 
        Secretary of Health and Human Services.</DELETED>
        <DELETED>    ``(9) Traditional native hawaiian healer.--The 
        term `traditional Native Hawaiian healer' means a 
        practitioner--</DELETED>
                <DELETED>    ``(A) who--</DELETED>
                        <DELETED>    ``(i) is of Native Hawaiian 
                        ancestry; and</DELETED>
                        <DELETED>    ``(ii) has the knowledge, skills, 
                        and experience in direct personal health care 
                        of individuals; and</DELETED>
                <DELETED>    ``(B) whose knowledge, skills, and 
                experience are based on demonstrated learning of Native 
                Hawaiian healing practices acquired by--</DELETED>
                        <DELETED>    ``(i) direct practical association 
                        with Native Hawaiian elders; and</DELETED>
                        <DELETED>    ``(ii) oral traditions transmitted 
                        from generation to generation.</DELETED>

<DELETED>``SEC. 4. DECLARATION OF POLICY.</DELETED>

<DELETED>    ``(a) Congress.--Congress hereby declares that it is the 
policy of the United States in fulfillment of its special 
responsibilities and legal obligations to the indigenous people of 
Hawaii resulting from the unique and historical relationship between 
the United States and the indigenous people of Hawaii--</DELETED>
        <DELETED>    ``(1) to raise the health status of Native 
        Hawaiians to the highest possible health level; and</DELETED>
        <DELETED>    ``(2) to provide existing Native Hawaiian health 
        care programs with all resources necessary to effectuate this 
        policy.</DELETED>
<DELETED>    ``(b) Intent of Congress.--</DELETED>
        <DELETED>    ``(1) In general.--It is the intent of the 
        Congress that--</DELETED>
                <DELETED>    ``(A) health care programs having a 
                demonstrated effect of substantially reducing or 
                eliminating the over-representation of Native Hawaiians 
                among those suffering from chronic and acute disease 
                and illness and addressing the health needs of Native 
                Hawaiians shall be established and implemented; 
                and</DELETED>
                <DELETED>    ``(B) the Nation meet the Healthy People 
                2010 and Kanaka Maoli health objectives described in 
                paragraph (2) by the year 2010.</DELETED>
        <DELETED>    ``(2) Healthy people and kanaka maoli health 
        objectives.--The Healthy People 2010 and Kanaka Maoli health 
        objectives described in this paragraph are the 
        following:</DELETED>
                <DELETED>    ``(A) Chronic disease and illness.--
                </DELETED>
                        <DELETED>    ``(i) Cardiovascular disease.--
                        With respect to cardiovascular disease--
                        </DELETED>
                                <DELETED>    ``(I) to increase to 75 
                                percent the proportion of females who 
                                are aware that cardiovascular disease 
                                (heart disease and stroke) is the 
                                leading cause of death for all 
                                females.</DELETED>
                                <DELETED>    ``(II) to increase to at 
                                least 95 percent the proportion of 
                                adults who have had their blood 
                                pressure measured within the preceding 
                                2 years and can state whether their 
                                blood pressure was normal or high; 
                                and</DELETED>
                                <DELETED>    ``(III) to increase to at 
                                least 75 percent the proportion of 
                                adults who have had their blood 
                                cholesterol checked within the 
                                preceding 5 years.</DELETED>
                        <DELETED>    ``(ii) Diabetes.--With respect to 
                        diabetes--</DELETED>
                                <DELETED>    ``(I) to increase to 80 
                                percent the proportion of persons with 
                                diabetes whose condition has been 
                                diagnosed;</DELETED>
                                <DELETED>    ``(II) to increase to at 
                                least 20 percent the proportion of 
                                patients with diabetes who annually 
                                obtain lipid assessment (total 
                                cholesterol, LDL cholesterol, HDL 
                                cholesterol, triglyceride); 
                                and</DELETED>
                                <DELETED>    ``(III) to increase to 52 
                                percent the proportion of persons with 
                                diabetes who have received formal 
                                diabetes education.</DELETED>
                        <DELETED>    ``(iii) Cancer.--With respect to 
                        cancer--</DELETED>
                                <DELETED>    ``(I) to increase to at 
                                least 95 percent the proportion of 
                                women age 18 and older who have ever 
                                received a Pap test and to at least 85 
                                percent those who have received a Pap 
                                test within the preceding 3 years; 
                                and</DELETED>
                                <DELETED>    ``(II) to increase to at 
                                least 40 percent the proportion of 
                                women age 40 and older who have 
                                received a breast examination and a 
                                mammogram within the preceding 2 
                                years.</DELETED>
                        <DELETED>    ``(iv) Dental health.--With 
                        respect to dental health--</DELETED>
                                <DELETED>    ``(I) to reduce untreated 
                                cavities in the primary and permanent 
                                teeth (mixed dentition) so that the 
                                proportion of children with decayed 
                                teeth not filled is not more than 12 
                                percent among children ages 2 through 
                                4, 22 percent among children ages 6 
                                through 8, and 15 percent among 
                                adolescents ages 8 through 
                                15;</DELETED>
                                <DELETED>    ``(II) to increase to at 
                                least 70 percent the proportion of 
                                children ages 8 through 14 who have 
                                received protective sealants in 
                                permanent molar teeth; and</DELETED>
                                <DELETED>    ``(III) to increase to at 
                                least 70 percent the proportion of 
                                adults age 18 and older using the oral 
                                health care system each year.</DELETED>
                        <DELETED>    ``(v) Mental health.--With respect 
                        to mental health--</DELETED>
                                <DELETED>    ``(I) to incorporate or 
                                support land(`aina)-based, water(wai)-
                                based, or the ocean(kai)-based programs 
                                within the context of mental health 
                                activities; and</DELETED>
                                <DELETED>    ``(II) to reduce the anger 
                                and frustration levels within `ohana' 
                                focusing on building positive 
                                relationships and striving for balance 
                                in living (lokahi) and achieving a 
                                sense of contentment (pono).</DELETED>
                        <DELETED>    ``(vi) Asthma.--With respect to 
                        asthma--</DELETED>
                                <DELETED>    ``(I) to increase to at 
                                least 40 percent the proportion of 
                                people with asthma who receive formal 
                                patient education, including 
                                information about community and self-
                                help resources, as an integral part of 
                                the management of their 
                                condition;</DELETED>
                                <DELETED>    ``(II) to increase to at 
                                least 75 percent the proportion of 
                                patients who receive counseling from 
                                health care providers on how to 
                                recognize early signs of worsening 
                                asthma and how to respond 
                                appropriately; and</DELETED>
                                <DELETED>    ``(III) to increase to at 
                                least 75 percent the proportion of 
                                primary care providers who are trained 
                                to provide culturally competent care to 
                                ethnic minorities (Native Hawaiians) 
                                seeking health care for chronic 
                                obstructive pulmonary 
                                disease.</DELETED>
                <DELETED>    ``(B) Infectious disease and illness.--
                </DELETED>
                        <DELETED>    ``(i) Immunizations.--With respect 
                        to immunizations--</DELETED>
                                <DELETED>    ``(I) to reduce indigenous 
                                cases of vaccine-preventable 
                                disease;</DELETED>
                                <DELETED>    ``(II) to achieve 
                                immunization coverage of at least 90 
                                percent among children between 19 and 
                                35 months of age; and</DELETED>
                                <DELETED>    ``(III) to increase to 90 
                                percent the rate of immunization 
                                coverage among adults 65 years of age 
                                or older, and 60 percent for high-risk 
                                adults between 18 and 64 years of 
                                age.</DELETED>
                        <DELETED>    ``(ii) Sexually transmitted 
                        diseases, hiv; aids.--To increase the number of 
                        HIV-infected adolescents and adults in care who 
                        receive treatment consistent with current 
                        public health treatment guidelines.</DELETED>
                <DELETED>    ``(C) Wellness.--</DELETED>
                        <DELETED>    ``(i) Exercise.--With respect to 
                        exercise--</DELETED>
                                <DELETED>    ``(I) to increase to 85 
                                percent the proportion of people ages 
                                18 and older who engage in any leisure 
                                time physical activity; and</DELETED>
                                <DELETED>    ``(II) to increase to at 
                                least 30 percent the proportion of 
                                people ages 18 and older who engage 
                                regularly, preferably daily, in 
                                sustained physical activity for at 
                                least 30 minutes per day.</DELETED>
                        <DELETED>    ``(ii) Nutrition.--With respect to 
                        nutrition--</DELETED>
                                <DELETED>    ``(I) to increase to at 
                                least 60 percent the prevalence of 
                                healthy weight (defined as body mass 
                                index equal to or greater than 19.0 and 
                                less than 25.0) among all people age 20 
                                and older;</DELETED>
                                <DELETED>    ``(II) to increase to at 
                                least 75 percent the proportion of 
                                people age 2 and older who meet the 
                                dietary guidelines' minimum average 
                                daily goal of at least 5 servings of 
                                vegetables and fruits; and</DELETED>
                                <DELETED>    ``(III) to increase the 
                                use of traditional Native Hawaiian 
                                foods in all peoples' diets and dietary 
                                preferences.</DELETED>
                        <DELETED>    ``(iii) Lifestyle.--With respect 
                        to lifestyle--</DELETED>
                                <DELETED>    ``(I) to reduce cigarette 
                                smoking among pregnant women to a 
                                prevalence of not more than 2 
                                percent;</DELETED>
                                <DELETED>    ``(II) to reduce the 
                                prevalence of respiratory disease, 
                                cardiovascular disease, and cancer 
                                resulting from exposure to tobacco 
                                smoke;</DELETED>
                                <DELETED>    ``(III) to increase to at 
                                least 70 percent the proportion of all 
                                pregnancies among women between the 
                                ages of 15 and 44 that are planned 
                                (intended); and</DELETED>
                                <DELETED>    ``(IV) to reduce deaths 
                                caused by unintentional injuries to not 
                                more than 25.9 per 100,000.</DELETED>
                        <DELETED>    ``(iv) Culture.--With respect to 
                        culture--</DELETED>
                                <DELETED>    ``(I) to develop and 
                                implement cultural values within the 
                                context of the corporate cultures of 
                                the Native Hawaiian health care 
                                systems, the Native Hawaiian Health 
                                Scholarship Program, and Papa Ola 
                                Lokahi; and</DELETED>
                                <DELETED>    ``(II) to facilitate the 
                                provision of Native Hawaiian healing 
                                practices by Native Hawaiian healers 
                                for those clients desiring such 
                                assistance.</DELETED>
                <DELETED>    ``(D) Access.--With respect to access--
                </DELETED>
                        <DELETED>    ``(i) to increase the proportion 
                        of patients who have coverage for clinical 
                        preventive services as part of their health 
                        insurance; and</DELETED>
                        <DELETED>    ``(ii) to reduce to not more than 
                        7 percent the proportion of individuals and 
                        families who report that they did not obtain 
                        all the health care that they needed.</DELETED>
                <DELETED>    ``(E) Health professions training and 
                education.--With respect to health professions training 
                and education--</DELETED>
                        <DELETED>    ``(i) to increase the proportion 
                        of all degrees in the health professions and 
                        allied and associated health professions fields 
                        awarded to members of underrepresented racial 
                        and ethnic minority groups; and</DELETED>
                        <DELETED>    ``(ii) to support training 
                        activities and programs in traditional Native 
                        Hawaiian healing practices by Native Hawaiian 
                        healers.</DELETED>
<DELETED>    ``(c) Report.--The Secretary shall submit to the 
President, for inclusion in each report required to be transmitted to 
Congress under section 11, a report on the progress made in each toward 
meeting each of the objectives described in subsection 
(b)(2).</DELETED>

<DELETED>``SEC. 5. COMPREHENSIVE HEALTH CARE MASTER PLAN FOR NATIVE 
              HAWAIIANS.</DELETED>

<DELETED>    ``(a) Development.--</DELETED>
        <DELETED>    ``(1) In general.--The Secretary may make a grant 
        to, or enter into a contract with, Papa Ola Lokahi for the 
        purpose of coordinating, implementing and updating 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, and to support community-based initiatives 
        that are reflective of holistic approaches to health.</DELETED>
        <DELETED>    ``(2) Collaboration.--The Papa Ola Lokahi shall 
        collaborate with the Office of Hawaiian Affairs in carrying out 
        this section.</DELETED>
<DELETED>    ``(b) Authorization of Appropriations.--There are 
authorized to be appropriated such sums as may be necessary to carry 
out subsection (a).</DELETED>

<DELETED>``SEC. 6. FUNCTIONS OF PAPA OLA LOKAHI.</DELETED>

<DELETED>    ``(a) Responsibility.--Papa Ola Lokahi shall be 
responsible for the--</DELETED>
        <DELETED>    ``(1) coordination, implementation, and updating, 
        as appropriate, of the comprehensive health care master plan 
        developed pursuant to section 5;</DELETED>
        <DELETED>    ``(2) training for the persons described in 
        subparagraphs (B) and (C) of section 7(c)(1);</DELETED>
        <DELETED>    ``(3) identification of and research into the 
        diseases that are most prevalent among Native Hawaiians, 
        including behavioral, biomedical, epidemiological, and health 
        services; and</DELETED>
        <DELETED>    ``(4) the development of an action plan outlining 
        the contributions that each member organization of Papa Ola 
        Lokahi will make in carrying out the policy of this 
        Act.</DELETED>
<DELETED>    ``(b) Special Project Funds.--Papa Ola Lokahi may receive 
special project funds that may be appropriated for the purpose of 
research on the health status of Native Hawaiians or for the purpose of 
addressing the health care needs of Native Hawaiians.</DELETED>
<DELETED>    ``(c) Clearinghouse.--</DELETED>
        <DELETED>    ``(1) In general.--Papa Ola Lokahi shall serve as 
        a clearinghouse for--</DELETED>
                <DELETED>    ``(A) the collection and maintenance of 
                data associated with the health status of Native 
                Hawaiians;</DELETED>
                <DELETED>    ``(B) the identification and research into 
                diseases affecting Native Hawaiians;</DELETED>
                <DELETED>    ``(C) the availability of Native Hawaiian 
                project funds, research projects and 
                publications;</DELETED>
                <DELETED>    ``(D) the collaboration of research in the 
                area of Native Hawaiian health; and</DELETED>
                <DELETED>    ``(E) the timely dissemination of 
                information pertinent to the Native Hawaiian health 
                care systems.</DELETED>
        <DELETED>    ``(2) Consultation.--The Secretary shall consult 
        periodically with Papa Ola Lokahi for the purposes of 
        maintaining the clearinghouse under paragraph (1) and providing 
        information about programs in the Department that specifically 
        address Native Hawaiian issues and concerns.</DELETED>
<DELETED>    ``(d) Fiscal Allocation and Coordination of Programs and 
Services.--</DELETED>
        <DELETED>    ``(1) Recommendations.--Papa Ola Lokahi shall 
        provide annual recommendations to the Secretary with respect to 
        the allocation of all amounts appropriated under this 
        Act.</DELETED>
        <DELETED>    ``(2) Coordination.--Papa Ola Lokahi shall, to the 
        maximum extent possible, coordinate and assist the health care 
        programs and services provided to Native Hawaiians.</DELETED>
        <DELETED>    ``(3) Representation on commission.--The 
        Secretary, in consultation with Papa Ola Lokahi, shall make 
        recommendations for Native Hawaiian representation on the 
        President's Advisory Commission on Asian Americans and Pacific 
        Islanders.</DELETED>
<DELETED>    ``(e) Technical Support.--Papa Ola Lokahi shall act as a 
statewide infrastructure to provide technical support and coordination 
of training and technical assistance to the Native Hawaiian health care 
systems.</DELETED>
<DELETED>    ``(f) Relationships With Other Agencies.--</DELETED>
        <DELETED>    ``(1) Authority.--Papa Ola Lokahi may enter into 
        agreements or memoranda of understanding with relevant agencies 
        or organizations that are capable of providing resources or 
        services to the Native Hawaiian health care systems.</DELETED>
        <DELETED>    ``(2) Medicare, medicaid, schip.--Papa Ola Lokahi 
        shall develop or make every reasonable effort to--</DELETED>
                <DELETED>    ``(A) develop a contractual or other 
                arrangement, through memoranda of understanding or 
                agreement, with the Health Care Financing 
                Administration or the agency of the State which 
                administers or supervises the administration of a State 
                plan or waiver approved under title XVIII, XIX or title 
                XXI of the Social Security Act for payment of all or a 
                part of the health care services to persons who are 
                eligible for medical assistance under such a State plan 
                or waiver; and</DELETED>
                <DELETED>    ``(B) assist in the collection of 
                appropriate reimbursement for health care services to 
                persons who are entitled to insurance under title XVIII 
                of the Social Security Act.</DELETED>

<DELETED>``SEC. 7. NATIVE HAWAIIAN HEALTH CARE SYSTEMS.</DELETED>

<DELETED>    ``(a) Comprehensive Health Promotion, Disease Prevention, 
and Primary Health Services.--</DELETED>
        <DELETED>    ``(1) Grants and contracts.--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 comprehensive health promotion and disease prevention 
        services, as well as primary health services, to Native 
        Hawaiians who desire and are committed to bettering their own 
        health.</DELETED>
        <DELETED>    ``(2) Preference.--In making grants and entering 
        into contracts under this subsection, the Secretary shall give 
        preference to Native Hawaiian health care systems and Native 
        Hawaiian organizations and, to the extent feasible, health 
        promotion and disease prevention services shall be performed 
        through Native Hawaiian health care systems.</DELETED>
        <DELETED>    ``(3) Qualified entity.--An entity is a qualified 
        entity for purposes of paragraph (1) if the entity is a Native 
        Hawaiian health care system.</DELETED>
        <DELETED>    ``(4) 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 during any fiscal year.</DELETED>
<DELETED>    ``(b) Planning Grant or Contract.--In addition to grants 
and contracts under subsection (a), 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 each of the islands of O`ahu, 
Moloka`i, Maui, Hawai`i, Lana`i, Kaua`i, and Ni`ihau in the State of 
Hawaii.</DELETED>
<DELETED>    ``(c) Services To Be Provided.--</DELETED>
        <DELETED>    ``(1) In general.--Each recipient of funds under 
        subsection (a) shall ensure that the following services either 
        are provided or arranged for:</DELETED>
                <DELETED>    ``(A) Outreach services to inform Native 
                Hawaiians of the availability of health 
                services.</DELETED>
                <DELETED>    ``(B) Education in health promotion and 
                disease prevention of the Native Hawaiian population 
                by, wherever possible, Native Hawaiian health care 
                practitioners, community outreach workers, counselors, 
                and cultural educators.</DELETED>
                <DELETED>    ``(C) Services of physicians, physicians' 
                assistants, nurse practitioners or other health and 
                allied-health professionals.</DELETED>
                <DELETED>    ``(D) Immunizations.</DELETED>
                <DELETED>    ``(E) Prevention and control of diabetes, 
                high blood pressure, and otitis media.</DELETED>
                <DELETED>    ``(F) Pregnancy and infant care.</DELETED>
                <DELETED>    ``(G) Improvement of nutrition.</DELETED>
                <DELETED>    ``(H) Identification, treatment, control, 
                and reduction of the incidence of preventable illnesses 
                and conditions endemic to Native Hawaiians.</DELETED>
                <DELETED>    ``(I) Collection of data related to the 
                prevention of diseases and illnesses among Native 
                Hawaiians.</DELETED>
                <DELETED>    ``(J) Services within the meaning of the 
                terms `health promotion', `disease prevention', and 
                `primary health services', as such terms are defined in 
                section 3, which are not specifically referred to in 
                subsection (a).</DELETED>
                <DELETED>    ``(K) Support of culturally appropriate 
                activities enhancing health and wellness including 
                land-based, water-based, ocean-based, and spiritually-
                based projects and programs.</DELETED>
        <DELETED>    ``(2) Traditional healers.--The health care 
        services referred to in paragraph (1) which are provided under 
        grants or contracts under subsection (a) may be provided by 
        traditional Native Hawaiian healers.</DELETED>
<DELETED>    ``(d) Federal Tort Claims Act.--Individuals that provide 
medical, dental, or other services referred to in subsection (a)(1) for 
Native Hawaiian health care systems, including providers of traditional 
Native Hawaiian healing services, shall be treated as if such 
individuals were members of the Public Health Service and shall be 
covered under the provisions of section 224 of the Public Health 
Service Act.</DELETED>
<DELETED>    ``(e) Site for Other Federal Payments.--A Native Hawaiian 
health care system that receives funds under subsection (a) shall 
provide a designated area and appropriate staff to serve as a Federal 
loan repayment facility. Such facility shall be designed to enable 
health and allied-health professionals to remit payments with respect 
to loans provided to such professionals under any Federal loan 
program.</DELETED>
<DELETED>    ``(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 (a) unless the entity agrees that amounts 
received under such grant or contract will not, directly or through 
contract, be expended--</DELETED>
        <DELETED>    ``(1) for any services other than the services 
        described in subsection (c)(1);</DELETED>
        <DELETED>    ``(2) to provide inpatient services;</DELETED>
        <DELETED>    ``(3) to make cash payments to intended recipients 
        of health services; or</DELETED>
        <DELETED>    ``(4) to purchase or improve real property (other 
        than minor remodeling of existing improvements to real 
        property) or to purchase major medical equipment.</DELETED>
<DELETED>    ``(g) Limitation on Charges for Services.--The Secretary 
may not make a grant to, or enter into a contract with, an entity under 
subsection (a) unless the entity agrees that, whether health services 
are provided directly or through contract--</DELETED>
        <DELETED>    ``(1) health services under the grant or contract 
        will be provided without regard to ability to pay for the 
        health services; and</DELETED>
        <DELETED>    ``(2) the entity will impose a charge for the 
        delivery of health services, and such charge--</DELETED>
                <DELETED>    ``(A) will be made according to a schedule 
                of charges that is made available to the public; 
                and</DELETED>
                <DELETED>    ``(B) will be adjusted to reflect the 
                income of the individual involved.</DELETED>
<DELETED>    ``(h) Authorization of Appropriations.--</DELETED>
        <DELETED>    ``(1) General grants.--There is authorized to be 
        appropriated such sums as may be necessary for each of fiscal 
        years 2000 through 2010 to carry out subsection (a).</DELETED>
        <DELETED>    ``(2) Planning grants.--There is authorized to be 
        appropriated such sums as may be necessary for each of fiscal 
        years 2000 through 2010 to carry out subsection (b).</DELETED>

<DELETED>``SEC. 8. ADMINISTRATIVE GRANT FOR PAPA OLA LOKAHI.</DELETED>

<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) coordination, implementation, and updating 
        (as appropriate) of the comprehensive health care master plan 
        developed pursuant to section 5;</DELETED>
        <DELETED>    ``(2) training for the persons described in 
        subparagraphs (B) and (C) of section 7(c)(1);</DELETED>
        <DELETED>    ``(3) identification of and research into the 
        diseases that are most prevalent among Native Hawaiians, 
        including behavioral, biomedical, epidemiological, and health 
        services;</DELETED>
        <DELETED>    ``(4) the development of an action plan outlining 
        the contributions that each member organization of Papa Ola 
        Lokahi will make in carrying out the policy of this 
        Act;</DELETED>
        <DELETED>    ``(5) a clearinghouse function for--</DELETED>
                <DELETED>    ``(A) the collection and maintenance of 
                data associated with the health status of Native 
                Hawaiians;</DELETED>
                <DELETED>    ``(B) the identification and research into 
                diseases affecting Native Hawaiians; and</DELETED>
                <DELETED>    ``(C) the availability of Native Hawaiian 
                project funds, research projects and 
                publications;</DELETED>
        <DELETED>    ``(6) the coordination of the health care programs 
        and services provided to Native Hawaiians; and</DELETED>
        <DELETED>    ``(7) the administration of special project 
        funds.</DELETED>
<DELETED>    ``(b) Authorization of Appropriations.--There is 
authorized to be appropriated such sums as may be necessary for each of 
fiscal years 2000 through 2010 to carry out subsection (a).</DELETED>

<DELETED>``SEC. 9. ADMINISTRATION OF GRANTS AND CONTRACTS.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Periodic Review.--The Secretary shall periodically 
evaluate the performance of, and compliance with, grants and contracts 
under this Act.</DELETED>
<DELETED>    ``(c) Administrative Requirements.--The Secretary may not 
make a grant or enter into a contract under this Act with an entity 
unless the entity--</DELETED>
        <DELETED>    ``(1) agrees to establish such procedures for 
        fiscal control and fund accounting as may be necessary to 
        ensure proper disbursement and accounting with respect to the 
        grant or contract;</DELETED>
        <DELETED>    ``(2) agrees to ensure the confidentiality of 
        records maintained on individuals receiving health services 
        under the grant or contract;</DELETED>
        <DELETED>    ``(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--
        </DELETED>
                <DELETED>    ``(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 communicate with the population involved in the 
                language and cultural context that is most appropriate; 
                and</DELETED>
                <DELETED>    ``(B) has designated at least 1 
                individual, fluent in both English and the appropriate 
                language, to assist in carrying out the plan;</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(A) if the entity will provide under the 
                grant or contract any such health services directly--
                </DELETED>
                        <DELETED>    ``(i) the entity has entered into 
                        a participation agreement under such plans; 
                        and</DELETED>
                        <DELETED>    ``(ii) the entity is qualified to 
                        receive payments under such plan; and</DELETED>
                <DELETED>    ``(B) if the entity will provide under the 
                grant or contract any such health services through a 
                contract with an organization--</DELETED>
                        <DELETED>    ``(i) the organization has entered 
                        into a participation agreement under such plan; 
                        and</DELETED>
                        <DELETED>    ``(ii) the organization is 
                        qualified to receive payments under such plan; 
                        and</DELETED>
        <DELETED>    ``(5) agrees to submit to the Secretary and to 
        Papa Ola Lokahi an annual report that describes the use 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.</DELETED>
<DELETED>    ``(d) Contract Evaluation.--</DELETED>
        <DELETED>    ``(1) Determination of noncompliance.--If, as a 
        result of evaluations conducted by the Secretary, the Secretary 
        determines that an entity has not complied with or 
        satisfactorily performed a contract entered into under section 
        7, the Secretary shall, prior to renewing such contract, 
        attempt to resolve the areas of noncompliance or unsatisfactory 
        performance and modify such contract to prevent future 
        occurrences of such noncompliance or unsatisfactory 
        performance.</DELETED>
        <DELETED>    ``(2) Nonrenewal.--If the Secretary determines 
        that the noncompliance or unsatisfactory performance described 
        in paragraph (1) with respect to an entity cannot be resolved 
        and prevented in the future, the Secretary shall not renew the 
        contract with such entity and may enter into a contract under 
        section 7 with another entity referred to in subsection (a)(3) 
        of such section 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 paragraph.</DELETED>
        <DELETED>    ``(3) Consideration of results.--In determining 
        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.</DELETED>
        <DELETED>    ``(4) Application of federal laws.--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.).</DELETED>
        <DELETED>    ``(5) Payments.--Payments made under any contract 
        entered into under this Act may be made in advance, by means of 
        reimbursement, or in installments and shall be made on such 
        conditions as the Secretary deems necessary to carry out the 
        purposes of this Act.</DELETED>
<DELETED>    ``(e) Limitation on Use of Funds for Administrative 
Expenses.--Except with respect to grants and contracts under section 8, 
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 15 percent of the amounts received pursuant to 
this Act for the purpose of administering the grant or 
contract.</DELETED>
<DELETED>    ``(f) Report.--</DELETED>
        <DELETED>    ``(1) In general.--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 an annual report--</DELETED>
                <DELETED>    ``(A) on the activities conducted by the 
                entity under the grant or contract;</DELETED>
                <DELETED>    ``(B) on the amounts and purposes for 
                which Federal funds were expended; and</DELETED>
                <DELETED>    ``(C) containing such other information as 
                the Secretary may request.</DELETED>
        <DELETED>    ``(2) Audits.--The reports and records of any 
        entity concerning any grant or contract under this Act shall be 
        subject to audit by the Secretary, the Inspector General of the 
        Department of Health and Human Services, and the Comptroller 
        General of the United States.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 10. ASSIGNMENT OF PERSONNEL.</DELETED>

<DELETED>    ``(a) In General.--The Secretary may enter into an 
agreement with any entity under which the Secretary may assign 
personnel of the Department of Health and Human Services 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.</DELETED>
<DELETED>    ``(b) Applicable Federal Personnel Provisions.--Any 
assignment of personnel made by the Secretary under any agreement 
entered into under 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.</DELETED>

<DELETED>``SEC. 11. NATIVE HAWAIIAN HEALTH SCHOLARSHIPS AND 
              FELLOWSHIPS.</DELETED>

<DELETED>    ``(a) Eligibility.--Subject to the availability of amounts 
appropriated under subsection (c), the Secretary shall provide funds 
through a direct grant or a cooperative agreement to Kamehameha Schools 
Bishop Estate or another Native Hawaiian organization or health care 
organization with experience in the administration of educational 
scholarships or placement services for the purpose of providing 
scholarship assistance to students who--</DELETED>
        <DELETED>    ``(1) meet the requirements of section 338A of the 
        Public Health Service Act, except for assistance as provided 
        for under subsection (b)(2); and</DELETED>
        <DELETED>    ``(2) are Native Hawaiians.</DELETED>
<DELETED>    ``(b) Terms and Conditions.--</DELETED>
        <DELETED>    ``(1) In general.--The scholarship assistance 
        under subsection (a) shall be provided under the same terms and 
        subject to the same conditions, regulations, and rules as apply 
        to scholarship assistance provided under section 338A of the 
        Public Health Service Act (except as provided for in paragraph 
        (2)), except that--</DELETED>
                <DELETED>    ``(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 the Native Hawaiian health care 
                systems identified by Papa Ola Lokahi;</DELETED>
                <DELETED>    ``(B) to the maximum extent practicable, 
                the Secretary shall select scholarship recipients from 
                a list of eligible applicants submitted by the 
                Kamehameha Schools Bishop Estate or the Native Hawaiian 
                organization administering the program;</DELETED>
                <DELETED>    ``(C) the obligated service requirement 
                for each scholarship recipient (except for those 
                receiving assistance under paragraph (2)) shall be 
                fulfilled through service, in order of priority, in--
                </DELETED>
                        <DELETED>    ``(i) any one of the Native 
                        Hawaiian health care systems; or</DELETED>
                        <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(D) the provision of counseling, 
                retention and other support services shall not be 
                limited to scholarship recipients, but shall also 
                include recipients of other scholarship and financial 
                aid programs enrolled in appropriate health professions 
                training programs.</DELETED>
                <DELETED>    ``(E) financial assistance may be provided 
                to scholarship recipients in those health professions 
                designated in such section 338A while they are 
                fulfilling their service requirement in any one of the 
                Native Hawaiian health care systems or community health 
                centers.</DELETED>
        <DELETED>    ``(2) Fellowships.--Financial assistance through 
        fellowships may be provided to Native Hawaiian applicants 
        accepted and participating in a certificated program provided 
        by a traditional Native Hawaiian healer in traditional Native 
        Hawaiian healing practices including lomi-lomi, la`au lapa`au, 
        and ho`oponopono. Such assistance may include a stipend or 
        reimbursement for costs associated with participation in the 
        program.</DELETED>
        <DELETED>    ``(3) Rights and benefits.--Scholarship recipients 
        in health professions designated in section 338A of the Public 
        Health Service Act while fulfilling their service requirements 
        shall have all the same rights and benefits of members of the 
        National Health Service Corps during their period of 
        service.</DELETED>
        <DELETED>    ``(4) No inclusion of assistance in gross 
        income.--Financial assistance provided to scholarship 
        recipients for tuition, books and other school-related 
        expenditures under this section shall not be included in gross 
        income for purposes of the Internal Revenue Code of 
        1986.</DELETED>
<DELETED>    ``(c) Authorization of Appropriations.--There is 
authorized to be appropriated such sums as may be necessary for each of 
fiscal years 2000 through 2010 for the purpose of funding the 
scholarship assistance program under subsection (a).</DELETED>

<DELETED>``SEC. 12. REPORT.</DELETED>

<DELETED>    ``The President shall, at the time the budget is submitted 
under section 1105 of title 31, United States Code, for each fiscal 
year transmit to Congress a report on the progress made in meeting the 
objectives of this Act, including a review of programs established or 
assisted pursuant to this Act and an assessment and recommendations of 
additional programs or additional assistance necessary to, at a 
minimum, provide health services to Native Hawaiians, and ensure a 
health status for Native Hawaiians, which are at a parity with the 
health services available to, and the health status of, the general 
population.</DELETED>

<DELETED>``SEC. 13. DEMONSTRATION PROJECTS OF NATIONAL 
              SIGNIFICANCE.</DELETED>

<DELETED>    ``(a) Authority and Areas of Interest.--The Secretary, in 
consultation with Papa Ola Lokahi, may allocate amounts appropriated 
under this Act, or any other Act, to carry out Native Hawaiian 
demonstration projects of national significance. The areas of interest 
of such projects may include--</DELETED>
        <DELETED>    ``(1) the education of health professionals, and 
        other individuals in institutions of higher learning, in health 
and allied health programs in complementary healing practices, 
including Native Hawaiian healing practices;</DELETED>
        <DELETED>    ``(2) the integration of Western medicine with 
        complementary healing practices including traditional Native 
        Hawaiian healing practices;</DELETED>
        <DELETED>    ``(3) the use of tele-wellness and 
        telecommunications in chronic disease management and health 
        promotion and disease prevention;</DELETED>
        <DELETED>    ``(4) the development of appropriate models of 
        health care for Native Hawaiians and other indigenous people 
        including the provision of culturally competent health 
        services, related activities focusing on wellness concepts, the 
        development of appropriate kupuna care programs, and the 
        development of financial mechanisms and collaborative 
        relationships leading to universal access to health 
        care;</DELETED>
        <DELETED>    ``(5) the development of a centralized database 
        and information system relating to the health care status, 
        health care needs, and wellness of Native Hawaiians; 
        and</DELETED>
        <DELETED>    ``(6) the establishment of a Native Hawaiian 
        Center of Excellence for Nursing at the University of Hawaii at 
        Hilo, a Native Hawaiian Center of Excellence for Mental Health 
        at the University of Hawaii at Manoa, a Native Hawaiian Center 
        of Excellence for Maternal Health and Nutrition at the 
        Waimanalo Health Center, and a Native Hawaiian Center of 
        Excellence for Research, Training, and Integrated Medicine at 
        Molokai General Hospital.</DELETED>
<DELETED>    ``(b) Nonreduction in Other Funding.--The allocation of 
funds for demonstration projects under subsection (a) shall not result 
in a reduction in funds required by the Native Hawaiian health care 
systems, the Native Hawaiian Health Scholarship Program, or Papa Ola 
Lokahi to carry out their respective responsibilities under this 
Act.</DELETED>

<DELETED>``SEC. 14. NATIONAL BIPARTISAN COMMISSION ON NATIVE HAWAIIAN 
              HEALTH CARE ENTITLEMENT.</DELETED>

<DELETED>    ``(a) Establishment.--There is hereby established a 
National Bipartisan Native Hawaiian Health Care Entitlement Commission 
(referred to in this Act as the `Commission').</DELETED>
<DELETED>    ``(b) Membership.--The Commission shall be composed of 21 
members to be appointed as follows:</DELETED>
        <DELETED>    ``(1) Congressional members.--</DELETED>
                <DELETED>    ``(A) Appointment.--Eight members of the 
                Commission shall be members of Congress, of which--
                </DELETED>
                        <DELETED>    ``(i) two members shall be from 
                        the House of Representatives and shall be 
                        appointed by the Majority Leader;</DELETED>
                        <DELETED>    ``(ii) two members shall be from 
                        the House of Representatives and shall be 
                        appointed by the Minority Leader;</DELETED>
                        <DELETED>    ``(iii) two members shall be from 
                        the Senate and shall be appointed by the 
                        Majority Leader; and</DELETED>
                        <DELETED>    ``(iv) two members shall be from 
                        the Senate and shall be appointed by the 
                        Minority Leader.</DELETED>
                <DELETED>    ``(B) Relevant committee membership.--The 
                members of the Commission appointed under subparagraph 
                (A) shall each be members of the committees of Congress 
                that consider legislation affecting the provision of 
                health care to Native Hawaiians and other Native 
                American.</DELETED>
                <DELETED>    ``(C) Chairperson.--The members of the 
                Commission appointed under subparagraph (A) shall elect 
                the chairperson and vice-chairperson of the 
                Commission.</DELETED>
        <DELETED>    ``(2) Hawaiian health members.--Eleven members of 
        the Commission shall be appointed by Hawaiian health entities, 
        of which--</DELETED>
                <DELETED>    ``(A) five members shall be appointed by 
                the Native Hawaiian Health Care Systems;</DELETED>
                <DELETED>    ``(B) one member shall be appointed by the 
                Hawaii State Primary Care Association;</DELETED>
                <DELETED>    ``(C) one member shall be appointed by 
                Papa Ola Lokahi;</DELETED>
                <DELETED>    ``(D) one member shall be appointed by the 
                State Council of Hawaiian Homestead 
                Associations;</DELETED>
                <DELETED>    ``(E) one member shall be appointed by the 
                Office of Hawaiian Affairs; and</DELETED>
                <DELETED>    ``(F) two members shall be appointed by 
                the Association of Hawaiian Civic Clubs and shall 
                represent Native Hawaiian populations on the United 
                States continent.</DELETED>
        <DELETED>    ``(3) Secretarial members.--Two members of the 
        Commission shall be appointed by the Secretary and shall 
        possess knowledge of the health concerns and wellness issues 
        facing Native Hawaiians.</DELETED>
<DELETED>    ``(c) Terms.--</DELETED>
        <DELETED>    ``(1) In general.--The members of the Commission 
        shall serve for the life of the Commission.</DELETED>
        <DELETED>    ``(2) Initial appointment of members.--The members 
        of the Commission shall be appointed under subsection (b)(1) 
        not later than 90 days after the date of enactment of this Act, 
        and the remaining members of the Commission shall be appointed 
        not later than 60 days after the date on which the members are 
        appointed under such subsection (b)(1).</DELETED>
        <DELETED>    ``(3) Vacancies.--A vacancy in the membership of 
        the Commission shall be filled in the manner in which the 
        original appointment was made.</DELETED>
<DELETED>    ``(d) Duties of the Commission.--The Commission shall 
carry out the following duties and functions:</DELETED>
        <DELETED>    ``(1) Review and analyze the recommendations of 
        the report of the study committee established under paragraph 
        (3).</DELETED>
        <DELETED>    ``(2) Make recommendations to Congress for the 
        provision of health services to Native Hawaiian individuals as 
        an entitlement, giving due regard to the effects of a program 
        on existing health care delivery systems for Native Hawaiians 
        and the effect of such programs on self-determination and their 
        reconciliation.</DELETED>
        <DELETED>    ``(3) Establish a study committee to be composed 
        of at least 10 members from the Commission, including 4 members 
        of the members appointed under subsection (b)(1), 5 of the 
        members appointed under subsection (b)(2), and 1 of the members 
        appointed by the Secretary under subsection (b)(3), which 
        shall--</DELETED>
                <DELETED>    ``(A) to the extent necessary to carry out 
                its duties, collect and compile data necessary to 
                understand the extent of Native Hawaiian needs with 
                regards to the provision of health services, including 
                holding hearings and soliciting the views of Native 
                Hawaiians and Native Hawaiian organizations, and which 
                may include authorizing and funding feasibility studies 
                of various models for all Native Hawaiian beneficiaries 
                and their families, including those that live on the 
                United States continent;</DELETED>
                <DELETED>    ``(B) make recommendations to the 
                Commission for legislation that will provide for the 
                culturally-competent and appropriate provision of 
                health services for Native Hawaiians as an entitlement, 
                which shall, at a minimum, address issues of 
                eligibility and benefits to be provided, including 
                recommendations regarding from whom such health 
                services are to be provided and the cost and mechanisms 
                for funding of the health services to be 
                provided;</DELETED>
                <DELETED>    ``(C) determine the effect of the 
                enactment of such recommendations on the existing 
                system of delivery of health services for Native 
                Hawaiians;</DELETED>
                <DELETED>    ``(D) determine the effect of a health 
                service entitlement program for Native Hawaiian 
                individuals on their self-determination and the 
                reconciliation of their relationship with the United 
                States;</DELETED>
                <DELETED>    ``(E) not later than 12 months after the 
                date of the appointment of all members of the 
                Commission, make a written report of its findings and 
                recommendations to the Commission, which report shall 
                include a statement of the minority and majority 
                position of the committee and which shall be 
                disseminated, at a minimum, to Native Hawaiian 
                organizations and agencies and health organizations 
                referred to in subsection (b)(2) for comment to the 
                Commission; and</DELETED>
                <DELETED>    ``(F) report regularly to the full 
                Commission regarding the findings and recommendations 
                developed by the committee in the course of carrying 
                out its duties under this section.</DELETED>
        <DELETED>    ``(4) Not later than 18 months after the date of 
        the appointment of all members of the Commission, submit a 
        written report to Congress containing a recommendation of 
        policies and legislation to implement a policy that would 
        establish a health care system for Native Hawaiians, grounded 
        in their culture, and based on the delivery of health services 
        as an entitlement, together with a determination of the 
        implications of such an entitlement system on existing health 
        care delivery systems for Native Hawaiians and their self-
        determination and the reconciliation of their relationship with 
        the United States.</DELETED>
<DELETED>    ``(e) Administrative Provisions.--</DELETED>
        <DELETED>    ``(1) Compensation and expenses.--</DELETED>
                <DELETED>    ``(A) Congressional members.--Each member 
                of the Commission appointed under subsection (b)(1) 
                shall not receive any additional compensation, 
                allowances, or benefits by reason of their service on 
                the Commission. Such members shall receive travel 
                expenses and per diem in lieu of subsistence in 
                accordance with sections 5702 and 5703 of title 5, 
                United States Code.</DELETED>
                <DELETED>    ``(B) Other members.--The members of the 
                Commission appointed under paragraphs (2) and (3) of 
                subsection (b) shall, while serving on the business of 
                the Commission (including travel time), receive 
                compensation at the per diem equivalent of the rate 
                provided for individuals under level IV of the 
                Executive Schedule under section 5315 of title 5, 
                United States Code, and while serving away from their 
                home or regular place of business, be allowed travel 
                expenses, as authorized by the chairperson of the 
                Commission.</DELETED>
                <DELETED>    ``(C) Other personnel.--For purposes of 
                compensation (other than compensation of the members of 
                the Commission) and employment benefits, rights, and 
                privileges, all personnel of the Commission shall be 
                treated as if they were employees of the 
                Senate.</DELETED>
        <DELETED>    ``(2) Meetings and quorum.--</DELETED>
                <DELETED>    ``(A) Meetings.--The Commission shall meet 
                at the call of the chairperson.</DELETED>
                <DELETED>    ``(B) Quorum.--A quorum of the Commission 
                shall consist of not less than 12 members, of which--
                </DELETED>
                        <DELETED>    ``(i) not less than 4 of such 
                        members shall be appointees under subsection 
                        (b)(1)l;</DELETED>
                        <DELETED>    ``(ii) not less than 7 of such 
                        members shall be appointees under subsection 
                        (b)(2); and</DELETED>
                        <DELETED>    ``(iii) not less than 1 of such 
                        members shall be an appointee under subsection 
                        (b)(3).</DELETED>
        <DELETED>    ``(3) Director and staff.--</DELETED>
                <DELETED>    ``(A) Executive director.--The members of 
                the Commission shall appoint an executive director of 
                the Commission. The executive director shall be paid 
                the rate of basic pay equal to that under level V of 
                the Executive Schedule under section 5316 of title 5, 
                United States Code.</DELETED>
                <DELETED>    ``(B) Staff.--With the approval of the 
                Commission, the executive director may appoint such 
                personnel as the executive director deems 
                appropriate.</DELETED>
                <DELETED>    ``(C) Applicability of civil service 
                laws.--The staff of the Commission shall be appointed 
                without regard to the provisions of title 5, United 
                States Code, governing appointments in the competitive 
                service, and shall be paid without regard to the 
                provisions of chapter 51 and subchapter III of chapter 
                53 of such title (relating to classification and 
                General Schedule pay rates).</DELETED>
                <DELETED>    ``(D) Experts and consultants.--With the 
                approval of the Commission, the executive director may 
                procure temporary and intermittent services under 
                section 3109(b) of title 5, United States 
                Code.</DELETED>
                <DELETED>    ``(E) Facilities.--The Administrator of 
                the General Services Administration shall locate 
                suitable office space for the operations of the 
                Commission in the State of Hawaii. The facilities shall 
                serve as the headquarters of the Commission and shall 
                include all necessary equipment and incidentals 
                required for the proper functioning of the 
                Commission.</DELETED>
<DELETED>    ``(f) Powers.--</DELETED>
        <DELETED>    ``(1) Hearings and other activities.--For purposes 
        of carrying out its duties, the Commission may hold such 
        hearings and undertake such other activities as the Commission 
        determines to be necessary to carry out its duties, except that 
        at least 8 hearings shall be held on each of the Hawaiian 
        Islands and 3 hearings in the continental United States in 
        areas where large numbers of Native Hawaiians are present. Such 
        hearings shall be held to solicit the views of Native Hawaiians 
        regarding the delivery of health care services to such 
        individuals. To constitute a hearing under this paragraph, at 
        least 4 members of the Commission, including at least 1 member 
        of Congress, must be present. Hearings held by the study 
        committee established under subsection (d)(3) may be counted 
        towards the number of hearings required under this 
        paragraph.</DELETED>
        <DELETED>    ``(2) Studies by the general accounting office.--
        Upon the request of the Commission, the Comptroller General 
        shall conduct such studies or investigations as the Commission 
        determines to be necessary to carry out its duties.</DELETED>
        <DELETED>    ``(3) Cost estimates.--</DELETED>
                <DELETED>    ``(A) In general.--The Director of the 
                Congressional Budget Office or the Chief Actuary of the 
                Health Care Financing Administration, or both, shall 
                provide to the Commission, upon the request of the 
                Commission, such cost estimates as the Commission 
                determines to be necessary to carry out its 
                duties.</DELETED>
                <DELETED>    ``(B) Reimbursements.--The Commission 
                shall reimburse the Director of the Congressional 
                Budget Office for expenses relating to the employment 
                in the office of the Director of such additional staff 
                as may be necessary for the Director to comply with 
                requests by the Commission under subparagraph 
                (A).</DELETED>
        <DELETED>    ``(4) Detail of federal employees.--Upon the 
        request of the Commission, the head of any Federal agency is 
        authorized to detail, without reimbursement, any of the 
        personnel of such agency to the Commission to assist the 
        Commission in carrying out its duties. Any such detail shall 
        not interrupt or otherwise affect the civil service status or 
        privileges of the Federal employees.</DELETED>
        <DELETED>    ``(5) Technical assistance.--Upon the request of 
        the Commission, the head of any Federal agency shall provide 
        such technical assistance to the Commission as the Commission 
        determines to be necessary to carry out its duties.</DELETED>
        <DELETED>    ``(6) Use of mails.--The Commission may use the 
        United States mails in the same manner and under the same 
        conditions as Federal agencies and shall, for purposes of the 
        frank, be considered a commission of Congress as described in 
        section 3215 of title 39, United States Code.</DELETED>
        <DELETED>    ``(7) Obtaining information.--The Commission may 
        secure directly from any Federal agency information necessary 
        to enable the Commission to carry out its duties, if the 
        information may be disclosed under section 552 of title 5, 
        United States Code. Upon request of the chairperson of the 
        Commission, the head of such agency shall furnish such 
        information to the Commission.</DELETED>
        <DELETED>    ``(8) Support services.--Upon the request of the 
        Commission, the Administrator of General Services shall provide 
        to the Commission on a reimbursable basis such administrative 
        support services as the Commission may request.</DELETED>
        <DELETED>    ``(9) Printing.--For purposes of costs relating to 
        printing and binding, including the cost of personnel detailed 
        from the Government Printing Office, the Commission shall be 
        deemed to be a committee of Congress.</DELETED>
<DELETED>    ``(g) Authorization of Appropriations.--There is 
authorized to be appropriated $1,500,000 to carry out this section. The 
amount appropriated under this subsection shall not result in a 
reduction in any other appropriation for health care or health services 
for Native Hawaiians.</DELETED>

<DELETED>``SEC. 15. RULE OF CONSTRUCTION.</DELETED>

<DELETED>    ``Nothing in this Act shall be construed to restrict the 
authority of the State of Hawaii to license health 
practitioners.</DELETED>

<DELETED>``SEC. 16. COMPLIANCE WITH BUDGET ACT.</DELETED>

<DELETED>    ``Any new spending authority (described in subparagraph 
(A) of (B) of section 401(c)(2) of the Congressional Budget Act of 1974 
(2 U.S.C. 651(c)(2) (A) or (B))) which is provided under this Act shall 
be effective for any fiscal year only to such extent or in such amounts 
as are provided for in appropriation Acts.</DELETED>

<DELETED>``SEC. 17. SEVERABILITY.</DELETED>

<DELETED>    ``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.''.</DELETED>

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Native Hawaiian Health Care 
Improvement Act Reauthorization of 2000''.

SEC. 2. AMENDMENT TO THE NATIVE HAWAIIAN HEALTH CARE IMPROVEMENT 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; TABLE OF CONTENTS.

    ``(a) Short Title.--This Act may be cited as the `Native Hawaiian 
Health Care Improvement Act'.
    ``(b) Table of Contents.--The table of contents of this Act is as 
follows:

        ``Sec. 1. Short title; table of contents.
        ``Sec. 2. Findings.
        ``Sec. 3. Definitions.
        ``Sec. 4. Declaration of national Native Hawaiian health 
                            policy.
        ``Sec. 5. Comprehensive health care master plan for Native 
                            Hawaiians.
        ``Sec. 6. Functions of Papa Ola Lokahi and Office of Hawaiian 
                            Affairs.
        ``Sec. 7. Native Hawaiian health care.
        ``Sec. 8. Administrative grant for Papa Ola Lokahi.
        ``Sec. 9. Administration of grants and contracts.
        ``Sec. 10. Assignment of personnel.
        ``Sec. 11. Native Hawaiian health scholarships and fellowships.
        ``Sec. 12. Report.
        ``Sec. 13. Use of Federal Government facilities and sources of 
                            supply.
        ``Sec. 14. Demonstration projects of national significance.
        ``Sec. 15. National Bipartisan Commission on Native Hawaiian 
                            Health Care Entitlement.
        ``Sec. 16. Rule of construction.
        ``Sec. 17. Compliance with Budget Act.
        ``Sec. 18. Severability.

``SEC. 2. FINDINGS.

    ``(a) General Findings.--Congress makes the following findings:
            ``(1) Native Hawaiians begin their story with the Kumulipo 
        which details the creation and inter-relationship of all 
        things, including their evolvement as healthy and well people.
            ``(2) Native Hawaiians are a distinct and unique indigenous 
        peoples with a historical continuity to the original 
        inhabitants of the Hawaiian archipelago within Ke Moananui, the 
        Pacific Ocean, and have a distinct society organized almost 
        2,000 years ago.
            ``(3) The health and well-being of Native Hawaiians are 
        intrinsically tied to their deep feelings and attachment to 
        their lands and seas.
            ``(4) The long-range economic and social changes in Hawaii 
        over the 19th and early 20th centuries have been devastating to 
        the health and well-being of Native Hawaiians.
            ``(5) Native Hawaiians have never directly relinquished to 
        the United States their claims to their inherent sovereignty as 
        a people or over their national territory, either through their 
        monarchy or through a plebiscite or referendum.
            ``(6) The Native Hawaiian people are determined to 
        preserve, develop and transmit to future generations their 
        ancestral territory, and their cultural identity in accordance 
        with their own spiritual and traditional beliefs, customs, 
        practices, language, and social institutions. In referring to 
        themselves, Native Hawaiians use the term `Kanaka Maoli', a 
        term frequently used in the 19th century to describe the native 
        people of Hawaii.
            ``(7) The constitution and statutes of the State of 
        Hawaii--
                    ``(A) acknowledge the distinct land rights of 
                Native Hawaiian people as beneficiaries of the public 
                lands trust; and
                    ``(B) reaffirm and protect the unique right of the 
                Native Hawaiian people to practice and perpetuate their 
                cultural and religious customs, beliefs, practices, and 
                language.
            ``(8) At the time of the arrival of the first nonindigenous 
        peoples in Hawaii in 1778, the Native Hawaiian people lived in 
        a highly organized, self-sufficient, subsistence social system 
        based on communal land tenure with a sophisticated language, 
        culture, and religion.
            ``(9) A unified monarchical government of the Hawaiian 
        Islands was established in 1810 under Kamehameha I, the first 
        King of Hawaii.
            ``(10) Throughout the 19th century and until 1893, the 
        United States--
                    ``(A) recognized the independence of the Hawaiian 
                Nation;
                    ``(B) extended full and complete diplomatic 
                recognition to the Hawaiian Government; and
                    ``(C) entered into treaties and conventions with 
                the Hawaiian monarchs to govern commerce and navigation 
                in 1826, 1842, 1849, 1875 and 1887.
            ``(11) In 1893, John L. Stevens, the United States Minister 
        assigned to the sovereign and independent Kingdom of Hawaii, 
        conspired with a small group of non-Hawaiian residents of the 
        Kingdom, including citizens of the United States, to overthrow 
        the indigenous and lawful government of Hawaii.
            ``(12) In pursuance of that conspiracy, the United States 
        Minister and the naval representative of the United States 
        caused armed naval forces of the United States to invade the 
        sovereign Hawaiian Nation in support of the overthrow of the 
        indigenous and lawful Government of Hawaii and the United 
        States Minister thereupon extended diplomatic recognition of a 
        provisional government formed by the conspirators without the 
        consent of the native people of Hawaii or the lawful Government 
        of Hawaii in violation of treaties between the 2 nations and of 
        international law.
            ``(13) In a message to Congress on December 18, 1893, then 
        President Grover Cleveland reported fully and accurately on 
        these illegal actions, and acknowledged that by these acts, 
        described by the President as acts of war, the government of a 
        peaceful and friendly people was overthrown, and the President 
        concluded that a `substantial wrong has thus been done which a 
        due regard for our national character as well as the rights of 
        the injured people required that we should endeavor to repair'.
            ``(14) Queen Lili`uokalani, the lawful monarch of Hawaii, 
        and the Hawaiian Patriotic League, representing the aboriginal 
        citizens of Hawaii, promptly petitioned the United States for 
        redress of these wrongs and for restoration of the indigenous 
        government of the Hawaiian nation, but this petition was not 
        acted upon.
            ``(15) The United States has acknowledged the significance 
        of these events and has apologized to Native Hawaiians on 
        behalf of the people of the United States for the overthrow of 
        the Kingdom of Hawaii with the participation of agents and 
        citizens of the United States, and the resulting deprivation of 
        the  rights of Native Hawaiians to self-determination in 
legislation enacted into law in 1993 (Public Law 103-150; 107 Stat. 
1510).
            ``(16) In 1898, the United States annexed Hawaii through 
        the Newlands Resolution without the consent of or compensation 
        to the indigenous peoples of Hawaii or their sovereign 
        government who were thereby denied the mechanism for expression 
        of their inherent sovereignty through self-government and self-
        determination, their lands and ocean resources.
            ``(17) Through the Newlands Resolution and the 1900 Organic 
        Act, the Congress received 1,750,000 acres of lands formerly 
        owned by the Crown and Government of the Hawaiian Kingdom and 
        exempted the lands from then existing public land laws of the 
        United States by mandating that the revenue and proceeds from 
        these lands be `used solely for the benefit of the inhabitants 
        of the Hawaiian Islands for education and other public 
        purposes', thereby establishing a special trust relationship 
        between the United States and the inhabitants of Hawaii.
            ``(18) In 1921, Congress enacted the Hawaiian Homes 
        Commission Act, 1920, which designated 200,000 acres of the 
        ceded public lands for exclusive homesteading by Native 
        Hawaiians, thereby affirming the trust relationship between the 
        United States and the Native Hawaiians, as expressed by then 
        Secretary of the Interior Franklin K. Lane who was cited in the 
        Committee Report of the Committee on Territories of the House 
        of Representatives as stating, `One thing that impressed me . . 
        . was the fact that the natives of the islands . . . for whom 
        in a sense we are trustees, are falling off rapidly in numbers 
        and many of them are in poverty.'.
            ``(19) In 1938, Congress again acknowledged the unique 
        status of the Native Hawaiian people by including in the Act of 
        June 20, 1938 (52 Stat. 781 et seq.), a provision to lease 
        lands within the extension to Native Hawaiians and to permit 
        fishing in the area `only by native Hawaiian residents of said 
        area or of adjacent villages and by visitors under their 
        guidance'.
            ``(20) Under the Act entitled `An Act to provide for the 
        admission of the State of Hawaii into the Union', approved 
        March 18, 1959 (73 Stat. 4), the United States transferred 
        responsibility for the administration of the Hawaiian Home 
        Lands to the State of Hawaii but reaffirmed the trust 
        relationship which existed between the United States and the 
        Native Hawaiian people by retaining the exclusive power to 
        enforce the trust, including the power to approve land 
        exchanges, and legislative amendments affecting the rights of 
        beneficiaries under such Act.
            ``(21) Under the Act entitled `An Act to provide for the 
        admission of the State of Hawaii into the Union', approved 
        March 18, 1959 (73 Stat. 4), the United States transferred 
        responsibility for administration over portions of the ceded 
        public lands trust not retained by the United States to the 
        State of Hawaii but reaffirmed the trust relationship which 
        existed between the United States and the Native Hawaiian 
        people by retaining the legal responsibility of the State for 
        the betterment of the conditions of Native Hawaiians under 
        section 5(f) of such Act.
            ``(22) In 1978, the people of Hawaii amended their 
        Constitution to establish the Office of Hawaiian Affairs and 
        assigned to that body the authority to accept and hold real and 
        personal property transferred from any source in trust for the 
        Native Hawaiian people, to receive payments from the State of 
        Hawaii due to the Native Hawaiian people in satisfaction of the 
        pro rata share of the proceeds of the Public Land Trust created 
        under section 5 of the Admission Act of 1959 (Public Law 83-3), 
        to act as the lead State agency for matters affecting the 
        Native Hawaiian people, and to formulate policy on affairs 
        relating to the Native Hawaiian people.
            ``(23) The authority of the Congress under the Constitution 
        to legislate in matters affecting the aboriginal or indigenous 
        peoples of the United States includes the authority to 
        legislate in matters affecting the native peoples of Alaska and 
        Hawaii.
            ``(24) The United States has recognized the authority of 
        the Native Hawaiian people to continue to work towards an 
        appropriate form of sovereignty as defined by the Native 
        Hawaiian people themselves in provisions set forth in 
        legislation returning the Hawaiian Island of Kaho`olawe to 
        custodial management by the State of Hawaii in 1994.
            ``(25) In furtherance of the trust responsibility for the 
        betterment of the conditions of Native Hawaiians, the United 
        States has established a program for the provision of 
        comprehensive health promotion and disease prevention services 
        to maintain and improve the health status of the Hawaiian 
        people. This program is conducted by the Native Hawaiian Health 
        Care Systems, the Native Hawaiian Health Scholarship Program 
        and Papa Ola Lokahi. Health initiatives from these and other 
        health institutions and agencies using Federal assistance have 
        been responsible for reducing the century-old morbidity and 
        mortality rates of Native Hawaiian people by providing 
        comprehensive disease prevention, health promotion activities 
        and increasing the number of Native Hawaiians in the health and 
        allied health professions. This has been accomplished through 
        the Native Hawaiian Health Care Act of 1988 (Public Law 100-
        579) and its reauthorization in section 9168 of Public Law 102-
        396 (106 Stat. 1948).
            ``(26) This historical and unique legal relationship has 
        been consistently recognized and affirmed by Congress through 
        the enactment of Federal laws which extend to the Native 
        Hawaiian people the same rights and privileges accorded to 
        American Indian, Alaska Native, Eskimo, and Aleut communities, 
        including the Native American Programs Act of 1974 (42 U.S.C. 
        2991 et seq.), the American Indian Religious Freedom Act (42 
        U.S.C. 1996), the National Museum of the American Indian Act 
        (20 U.S.C. 80q et seq.), and the Native American Graves 
        Protection and Repatriation Act (25 U.S.C. 3001 et seq.).
            ``(27) The United States has also recognized and reaffirmed 
        the trust relationship to the Native Hawaiian people through 
        legislation which authorizes the provision of services to 
        Native Hawaiians, specifically, the Older Americans Act of 1965 
        (42 U.S.C. 3001 et seq.), the Developmental Disabilities 
        Assistance and Bill of Rights Act Amendments of 1987, the 
        Veterans' Benefits and Services Act of 1988, the Rehabilitation 
        Act of 1973 (29 U.S.C. 701 et seq.), the Native Hawaiian Health 
        Care Act of 1988 (Public Law 100-579), the Health Professions 
        Reauthorization Act of 1988, the Nursing Shortage Reduction and 
        Education Extension Act of 1988, the Handicapped Programs 
        Technical Amendments Act of 1988, the Indian Health Care 
        Amendments of 1988, and the Disadvantaged Minority Health 
        Improvement Act of 1990.
            ``(28) The United States has also affirmed the historical 
        and unique legal relationship to the Hawaiian people by 
        authorizing the provision of services to Native Hawaiians to 
        address problems of alcohol and drug abuse under the Anti-Drug 
        Abuse Act of 1986 (Public Law 99-570).
            ``(29) Further, the United States has recognized that 
        Native Hawaiians, as aboriginal, indigenous, native peoples of 
        Hawaii, are a unique population group in Hawaii and in the 
        continental United States and has so declared in Office of 
        Management and Budget Circular 15 in 1997 and Presidential 
        Executive Order No. 13125, dated June 7, 1999.
            ``(30) Despite the United States having expressed its 
        commitment to a policy of reconciliation with the Native 
        Hawaiian people for past grievances in Public Law 103-150 (107 
        Stat. 1510) the unmet health needs of the Native Hawaiian 
        people remain severe and their health status continues to be 
        far below that of the general population of the United States.
    ``(b) Unmet Needs and Health Disparities.--Congress finds that the 
unmet needs and serious health disparities that adversely affect the 
Native Hawaiian people include the following:
            ``(1) Chronic disease and illness.--
                    ``(A) Cancer.--
                            ``(i) In general.--With respect to all 
                        cancer--
                                    ``(I) Native Hawaiians have the 
                                highest cancer mortality rates in the 
                                State of Hawaii (231.0 out of every 
                                100,000 residents), 45 percent higher 
                                than that for the total State 
                                population (159.7 out of every 100,000 
                                residents);
                                    ``(II) Native Hawaiian males have 
                                the highest cancer mortality rates in 
                                the State of Hawaii for cancers of the 
                                lung, liver and pancreas and for all 
                                cancers combined;
                                    ``(III) Native Hawaiian females 
                                ranked highest in the State of Hawaii 
                                for cancers of the lung, liver, 
                                pancreas, breast, cervix uteri, corpus 
                                uteri, stomach, and rectum, and for all 
                                cancers combined;
                                    ``(IV) Native Hawaiian males have 
                                the highest years of productive life 
                                lost from cancer in the State of Hawaii 
                                with 8.7 years compared to 6.4 years 
                                for all males; and
                                    ``(V) Native Hawaiian females have 
                                8.2 years of productive life lost from 
                                cancer in the State of Hawaii as 
                                compared to 6.4 years for all females 
                                in the State of Hawaii;
                            ``(ii) Breast cancer.--With respect to 
                        breast cancer--
                                    ``(I) Native Hawaiians have the 
                                highest mortality rates in the State of 
                                Hawaii from breast cancer (37.96 out of 
                                every 100,000 residents), which is 25 
                                percent higher than that for Caucasian 
                                Americans (30.25 out of every 100,000 
                                residents) and 106 percent higher than 
                                that for Chinese Americans (18.39 out 
                                of every 100,000 residents); and
                                    ``(II) nationally, Native Hawaiians 
                                have the third highest mortality rates 
                                due to breast cancer (25.0 out of every 
                                100,000 residents) following African 
                                Americans (31.4 out of every 100,000 
                                residents) and Caucasian Americans 
                                (27.0 out of every 100,000 residents).
                            ``(iii) Cancer of the cervix.--Native 
                        Hawaiians have the highest mortality rates from 
                        cancer of the cervix in the State of Hawaii 
                        (3.82 out of every 100,000 residents) followed 
                        by Filipino Americans (3.33 out of every 
                        100,000 residents) and Caucasian Americans 
                        (2.61 out of every 100,000 residents).
                            ``(iv) Lung cancer.--Native Hawaiians have 
                        the highest mortality rates from lung cancer in 
                        the State of Hawaii (90.70 out of every 100,000 
                        residents), which is 61 percent higher than 
                        Caucasian Americans, who rank second and 161 
                        percent higher than Japanese Americans, who 
                        rank third.
                            ``(v) Prostate cancer.--Native Hawaiian 
                        males have the second highest mortality rates 
                        due to prostate cancer in the State of Hawaii 
                        (25.86 out of every 100,000 residents) with 
                        Caucasian Americans having the highest 
                        mortality rate from prostate cancer (30.55 out 
                        of every 100,000 residents).
                    ``(B) Diabetes.--With respect to diabetes, for the 
                years 1989 through 1991--
                            ``(i) Native Hawaiians had the highest 
                        mortality rate due to diabetes mellitis (34.7 
                        out of every 100,000 residents) in the State of 
                        Hawaii which is 130 percent higher than the 
                        statewide rate for all other races (15.1 out of 
                        every 100,000 residents);
                            ``(ii) full-blood Hawaiians had a mortality 
                        rate of 93.3 out of every 100,000 residents, 
                        which is 518 percent higher than the rate for 
                        the statewide population of all other races; 
                        and
                            ``(iii) Native Hawaiians who are less than 
                        full-blood had a mortality rate of 27.1 out of 
                        every 100,000 residents, which is 79 percent 
                        higher than the rate for the statewide 
                        population of all other races.
                    ``(C) Asthma.--With respect to asthma--
                            ``(i) in 1990, Native Hawaiians comprised 
                        44 percent of all asthma cases in the State of 
                        Hawaii for those 18 years of age and younger, 
                        and 35 percent of all asthma cases reported; 
                        and
                            ``(ii) in 1992, the Native Hawaiian rate 
                        for asthma was 81.7 out of every 1000 
                        residents, which was 73 percent higher than the 
                        rate for the total statewide population of 47.3 
                        out of every 1000 residents.
                    ``(D) Circulatory diseases.--
                            ``(i) Heart Disease.--With respect to heart 
                        disease--
                                    ``(I) the death rate for Native 
                                Hawaiians from heart disease (333.4 out 
                                of every 100,000 residents) is 66 
                                percent higher than for the entire 
                                State of Hawaii (201.1 out of every 
                                100,000 residents); and
                                    ``(II) Native Hawaiian males have 
                                the greatest years of productive  life 
lost in the State of Hawaii where Native Hawaiian males lose an average 
of 15.5 years and Native Hawaiian females lose an average of 8.2 years 
due to heart disease, as compared to 7.5 years for all males in the 
State of Hawaii and 6.4 years for all females.
                            ``(ii) Hypertension.--The death rate for 
                        Native Hawaiians from hypertension (3.5 out of 
                        every 100,000 residents) is 84 percent higher 
                        than that for the entire State (1.9 out of 
                        every 100,000 residents).
                            ``(iii) Stroke.--The death rate for Native 
                        Hawaiians from stroke (58.3 out of every 
                        100,000 residents) is 13 percent higher than 
                        that for the entire State (51.8 out of every 
                        100,000 residents).
            ``(2) Infectious disease and illness.--The incidence of 
        AIDS for Native Hawaiians is at least twice as high per 100,000 
        residents (10.5 percent) than that for any other non-Caucasian 
        group in the State of Hawaii.
            ``(3) Injuries.--With respect to injuries--
                    ``(A) the death rate for Native Hawaiians from 
                injuries (38.8 out of every 100,000 residents) is 45 
                percent higher than that for the entire State (26.8 out 
                of every 100,000 residents);
                    ``(B) Native Hawaiian males lose an average of 14 
                years of productive life lost from injuries as compared 
                to 9.8 years for all other males in Hawaii; and
                    ``(C) Native Hawaiian females lose and average of 4 
                years of productive life lost from injuries but this 
                rate is the highest rate among all females in the State 
                of Hawaii.
            ``(4) Dental health.--With respect to dental health--
                    ``(A) Native Hawaiian children exhibit among the 
                highest rates of dental caries in the nation, and the 
                highest in the State of Hawaii as compared to the 5 
                other major ethnic groups in the State;
                    ``(B) the average number of decayed or filled 
                primary teeth for Native Hawaiian children ages 5 
                through 9 years was 4.3 as compared with 3.7 for the 
                entire State of Hawaii and 1.9 for the United States; 
                and
                    ``(C) the proportion of Native Hawaiian children 
                ages 5 through 12 years with unmet treatment needs 
                (defined as having active dental caries requiring 
                treatment) is 40 percent as compared with 33 percent 
                for all other races in the State of Hawaii.
            ``(5) Life expectancy.--With respect to life expectancy--
                    ``(A) Native Hawaiians have the lowest life 
                expectancy of all population groups in the State of 
                Hawaii;
                    ``(B) between 1910 and 1980, the life expectancy of 
                Native Hawaiians from birth has ranged from 5 to 10 
                years less than that of the overall State population 
                average; and
                    ``(C) the most recent tables for 1990 show Native 
                Hawaiian life expectancy at birth (74.27 years) to be 
                about 5 years less than that of the total State 
                population (78.85 years).
            ``(6) Maternal and child health.--
                    ``(A) Prenatal care.--With respect to prenatal 
                care--
                            ``(i) as of 1996, Native Hawaiian women 
                        have the highest prevalence (21 percent) of 
                        having had no prenatal care during their first 
                        trimester of pregnancy when compared to the 5 
                        largest ethnic groups in the State of Hawaii;
                            ``(ii) of the mothers in the State of 
                        Hawaii who received no prenatal care throughout 
                        their pregnancy in 1996, 44 percent were Native 
                        Hawaiian;
                            ``(iii) over 65 percent of the referrals to 
                        Healthy Start in fiscal years 1996 and 1997 
                        were Native Hawaiian newborns; and
                            ``(iv) in every region of the State of 
                        Hawaii, many Native Hawaiian newborns begin 
                        life in a potentially hazardous circumstance, 
                        far higher than any other racial group.
                    ``(B) Births.--With respect to births--
                            ``(i) in 1996, 45 percent of the live 
                        births to Native Hawaiian mothers were infants 
                        born to single mothers which statistics 
                        indicate put infants at higher risk of low 
                        birth weight and infant mortality;
                            ``(ii) in 1996, of the births to Native 
                        Hawaiian single mothers, 8 percent were low 
                        birth weight (under 2500 grams); and
                            ``(iii) of all low birth weight babies born 
                        to single mothers in the State of Hawaii, 44 
                        percent were Native Hawaiian.
                    ``(C) Teen pregnancies.--With respect to births--
                            ``(i) in 1993 and 1994, Native Hawaiians 
                        had the highest percentage of teen (individuals 
                        who were less than 18 years of age) births (8.1 
                        percent) compared to the rate for all other 
                        races in the State of Hawaii (3.6 percent);
                            ``(ii) in 1996, nearly 53 percent of all 
                        mothers in Hawaii under 18 years of age were 
                        Native Hawaiian;
                            ``(iii) lower rates of abortion (a third 
                        lower than for the statewide population) among 
                        Hawaiian women may account in part, for the 
                        higher percentage of live births;
                            ``(iv) in 1995, of the births to mothers 
                        age 14 years and younger in Hawaii, 66 percent 
                        were Native Hawaiian; and
                            ``(v) in 1996, of the births in this same 
                        group, 48 percent were Native Hawaiian.
                    ``(D) Fetal mortality.--In 1996, Native Hawaiian 
                fetal mortality rates comprised 15  percent of all 
fetal deaths for the State of Hawaii. However, for fetal deaths 
occurring in mothers under the age of 18 years, 32 percent were Native 
Hawaiian, and for mothers 18 through 24 years of age, 28 percent were 
Native Hawaiians.
            ``(7) Mental health.--
                    ``(A) Alcohol and drug abuse.--With respect to 
                alcohol and drug abuse--
                            ``(i) Native Hawaiians represent 38 percent 
                        of the total admissions to Department of 
                        Health, Alcohol, Drugs and Other Drugs, funded 
                        substance abuse treatment programs;
                            ``(ii) in 1997, the prevalence of cigarette 
                        smoking by Native Hawaiians was 28.5 percent, a 
                        rate that is 53 percent higher than that for 
                        all other races in the State of Hawaii which is 
                        18.6 percent;
                            ``(iii) Native Hawaiians have the highest 
                        prevalence rates of acute alcohol drinking (31 
                        percent), a rate that is 79 percent higher than 
                        that for all other races in the State of 
                        Hawaii;
                            ``(iv) the chronic alcohol drinking rate 
                        among Native Hawaiians is 54 percent higher 
                        than that for all other races in the State of 
                        Hawaii;
                            ``(v) in 1991, 40 percent of the Native 
                        Hawaiian adults surveyed reported having used 
                        marijuana compared with 30 percent for all 
other races in the State of Hawaii; and
                            ``(vi) nine percent of the Native Hawaiian 
                        adults surveyed reported that they are current 
                        users (within the past year) of marijuana, 
                        compared with 6 percent for all other races in 
                        the State of Hawaii.
                    ``(B) Crime.--With respect to crime--
                            ``(i) in 1996, of the 5,944 arrests that 
                        were made for property crimes in the State of 
                        Hawaii, arrests of Native Hawaiians comprised 
                        20 percent of that total;
                            ``(ii) Native Hawaiian juveniles comprised 
                        a third of all juvenile arrests in 1996;
                            ``(iii) In 1996, Native Hawaiians 
                        represented 21 percent of the 8,000 adults 
                        arrested for violent crimes in the State of 
                        Hawaii, and 38 percent of the 4,066 juvenile 
                        arrests;
                            ``(iv) Native Hawaiians are over-
                        represented in the prison population in Hawaii;
                            ``(v) in 1995 and 1996 Native Hawaiians 
                        comprised 36.5 percent of the sentenced felon 
                        prison population in Hawaii, as compared to 
                        20.5 percent for Caucasian Americans, 3.7 
                        percent for Japanese Americans, and 6 percent 
                        for Chinese Americans;
                            ``(vi) in 1995 and 1996 Native Hawaiians 
                        made up 45.4 percent of the technical violator 
                        population, and at the Hawaii Youth 
                        Correctional Facility, Native Hawaiians 
                        constituted 51.6 percent of all detainees in 
                        fiscal year 1997; and
                            ``(vii) based on anecdotal information from 
                        inmates at the Halawa Correction Facilities, 
                        Native Hawaiians are estimated to comprise 
                        between 60 and 70 percent of all inmates.
            ``(8) Health professions education and training.--With 
        respect to health professions education and training--
                    ``(A) Native Hawaiians age 25 years and older have 
                a comparable rate of high school completion, however, 
                the rates of baccalaureate degree achievement amongst 
                Native Hawaiians are less than the norm in the State of 
                Hawaii (6.9 percent and 15.76 percent respectively);
                    ``(B) Native Hawaiian physicians make up 4 percent 
                of the total physician workforce in the State of 
                Hawaii; and
                    ``(C) in fiscal year 1997, Native Hawaiians 
                comprised 8 percent of those individuals who earned 
                Bachelor's Degrees, 14 percent of those individuals who 
                earned professional diplomas, 6 percent of those 
                individuals who earned Master's Degrees, and less than 
                1 percent of individuals who earned doctoral degrees at 
                the University of Hawaii.

``SEC. 3. DEFINITIONS.

    ``In this Act:
            ``(1) Department.--The term `department' means the 
        Department of Health and Human Services.
            ``(2) 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 chronic diseases;
                    ``(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--
                    ``(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 practices; 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) 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 of 
        Hawaii) as evidenced by--
                    ``(A) genealogical records,
                    ``(B) kama`aina witness verification from Native 
                Hawaiian Kupuna (elders); or
                    ``(C) birth records of the State of Hawaii or any 
                State or territory of the United States.
            ``(5) Native hawaiian health care system.--The term `Native 
        Hawaiian health care system' 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;
                    ``(D) in which Native Hawaiian health practitioners 
                significantly participate in the planning, management, 
                monitoring, and evaluation of health care services;
                    ``(E) which may be composed of as many as 8 Native 
                Hawaiian health care systems as necessary to meet the 
health care needs of each island's Native Hawaiians; and
                    ``(F) which is--
                            ``(i) recognized by Papa Ola Lokahi for the 
                        purpose of planning, conducting, or 
                        administering programs, or portions of 
                        programs, authorized by this chapter for the 
                        benefit of Native Hawaiians; and
                            ``(ii) certified by Papa Ola Lokahi as 
                        having the qualifications and the capacity to 
                        provide the services and meet the requirements 
                        under the contract the Native Hawaiian health 
                        care system enters into with the Secretary or 
                        the grant the Native Hawaiian health care 
                        system receives from the Secretary pursuant to 
                        this Act.
            ``(6) Native hawaiian health center.--The term `Native 
        Hawaiian Health Center' means any organization that is a 
        primary care provider and that--
                    ``(A) has a governing board that is composed of 
                individuals, at least 50 percent of whom are Native 
                Hawaiians;
                    ``(B) has demonstrated cultural competency 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 has having 
                met all the criteria of this paragraph.
            ``(7) 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 
        implement health and wellness strategies in Native Hawaiian 
        communities.
            ``(8) Native hawaiian organization.--The term `Native 
        Hawaiian organization' means any organization--
                    ``(A) which serves the interests of Native 
                Hawaiians; and
                    ``(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) a public or nonprofit private 
                        entity.
            ``(9) Office of hawaiian affairs.--The terms `Office of 
        Hawaiian Affairs' and `OHA' mean the governmental entity 
        established under Article XII, sections 5 and 6 of the Hawaii 
        State Constitution and charged with the responsibility to 
        formulate policy relating to the affairs of Native Hawaiians.
            ``(10) Papa ola lokahi.--
                    ``(A) In general.--The term `Papa Ola Lokahi' means 
                an organization that is composed of public agencies and 
                private organizations focusing on improving the health 
                status of Native Hawaiians. Board members of such 
                organization may include representation from--
                            ``(i) E Ola Mau;
                            ``(ii) the Office of Hawaiian Affairs of 
                        the State of Hawaii;
                            ``(iii) Alu Like, Inc.;
                            ``(iv) the University of Hawaii;
                            ``(v) the Hawaii State Department of 
                        Health;
                            ``(vi) the Kamehameha Schools, or other 
                        Native Hawaiian organization responsible for 
                        the administration of the Native Hawaiian 
                        Health Scholarship Program;
                            ``(vii) the Hawaii State Primary Care 
                        Association, or Native Hawaiian Health Centers 
                        whose patient populations are predominantly 
                        Native Hawaiian;
                            ``(viii) Ahahui O Na Kauka, the Native 
                        Hawaiian Physicians Association;
                            ``(ix) Ho`ola Lahui Hawaii, or a health 
                        care system serving the islands of Kaua`i or 
                        Ni`ihau, and which may be composed of as many 
                        health care centers as are  necessary to meet 
the health care needs of the Native Hawaiians of those islands;
                            ``(x) Ke Ola Mamo, or a health care system 
                        serving the island of O`ahu and which may be 
                        composed of as many health care centers as are 
                        necessary to meet the health care needs of the 
                        Native Hawaiians of that island;
                            ``(xi) Na Pu`uwai or a health care system 
                        serving the islands of Moloka`i or Lana`i, and 
                        which may be composed of as many health care 
                        centers as are necessary to meet the health 
                        care needs of the Native Hawaiians of those 
                        islands;
                            ``(xii) Hui No Ke Ola Pono, or a health 
                        care system serving the island of Maui, and 
                        which may be composed of as many health care 
                        centers as are 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 
                        Hawaii, and which may be composed of as many 
                        health care centers as are necessary to meet 
                        the health care needs of the Native Hawaiians 
                        of that island;
                            ``(xiv) other Native Hawaiian health care 
                        systems as certified and recognized by Papa Ola 
                        Lokahi in accordance with this Act; and
                            ``(xv) such other member organizations as 
                        the Board of Papa Ola Lokahi will admit from 
                        time to time, based upon satisfactory 
                        demonstration of a record of contribution to 
                        the health and well-being of Native Hawaiians.
                    ``(B) Limitation.--Such term does not include any 
                organization described in subparagraph (A) if the 
                Secretary determines that such organization has not 
                developed a mission statement with clearly defined 
                goals and objectives for the contributions the 
                organization will make to the Native Hawaiian health 
                care systems, the national policy as set forth in 
                section 4, and an action plan for carrying out those 
                goals and objectives.
            ``(11) Primary health services.--The term `primary health 
        services' means--
                    ``(A) services of physicians, physicians' 
                assistants, nurse practitioners, and other health 
                professionals;
                    ``(B) diagnostic laboratory and radiologic 
                services;
                    ``(C) preventive health services including 
                perinatal services, well child services, family 
                planning services, nutrition services, home health 
                services, and, generally, all those services associated 
                with enhanced health and wellness.
                    ``(D) emergency medical services;
                    ``(E) transportation services as required for 
                adequate patient care;
                    ``(F) preventive dental services;
                    ``(G) pharmaceutical and medicament services;
                    ``(H) primary care services that may lead to 
                specialty or tertiary care; and
                    ``(I) complimentary healing practices, including 
                those performed by traditional Native Hawaiian healers.
            ``(12) Secretary.--The term `Secretary' means the Secretary 
        of Health and Human Services.
            ``(13) Traditional native hawaiian healer.--The term 
        `traditional Native Hawaiian healer' means a practitioner--
                    ``(A) who--
                            ``(i) is of Native 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 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) Congress.--Congress hereby declares that it is the policy of 
the United States in fulfillment of its special responsibilities and 
legal obligations to the indigenous peoples of Hawaii resulting from 
the unique and historical relationship between the United States and 
the indigenous peoples of Hawaii--
            ``(1) to raise the health status of Native Hawaiians to the 
        highest possible health level; and
            ``(2) to provide existing Native Hawaiian health care 
        programs with all resources necessary to effectuate this 
        policy.
    ``(b) Intent of Congress.--It is the intent of the Congress that--
            ``(1) health care programs having a demonstrated effect of 
        substantially reducing or eliminating the over-representation 
        of Native Hawaiians among those suffering from chronic and 
        acute disease and illness and addressing the health needs, 
        including perinatal, early child development, and family-based 
        health education, of Native Hawaiians shall be established and 
        implemented; and
            ``(2) the Nation raise the health status of Native 
        Hawaiians by the year 2010 to at least the levels set forth in 
        the goals contained within Healthy People 2010 or successor 
        standards and to incorporate within health programs, activities 
        defined and identified by Kanaka Maoli which may include--
                    ``(A) incorporating and supporting the integration 
                of cultural approaches to health and well-being, 
                including programs using traditional practices relating 
to the atmosphere (lewa lani), land ('aina), water (wai), or ocean 
(kai);
                    ``(B) increasing the number of health and allied-
                health care providers who are trained to provide 
                culturally competent care to Native Hawaiians;
                    ``(C) increasing the use of traditional Native 
                Hawaiian foods in peoples' diets and dietary 
                preferences including those of students and the use of 
                these traditional foods in school feeding programs;
                    ``(D) identifying and instituting Native Hawaiian 
                cultural values and practices within the `corporate 
                cultures' of organizations and agencies providing 
                health services to Native Hawaiians;
                    ``(E) facilitating the provision of Native Hawaiian 
                healing practices by Native Hawaiian healers for those 
                clients desiring such assistance; and
                    ``(F) supporting training and education activities 
                and programs in traditional Native Hawaiian healing 
                practices by Native Hawaiian healers.
    ``(c) Report.--The Secretary shall submit to the President, for 
inclusion in each report required to be transmitted to Congress under 
section 12, a report on the progress made towards meeting the National 
policy as set forth 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, implementing and updating 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, and to support community-based initiatives that are 
        reflective of holistic approaches to health.
            ``(2) Consultation.--
                    ``(A) In general.--Papa Ola Lokahi and the Office 
                of Hawaiian Affairs shall consult with the Native 
                Hawaiian health care systems, Native Hawaiian health 
                centers, and the Native Hawaiian community in carrying 
                out this section.
                    ``(B) Memoranda of understanding.--Papa Ola Lokahi 
                and the Office of Hawaiian Affairs may enter into 
                memoranda of understanding or agreement for the 
                purposes of acquiring joint funding and for other 
                issues as may be necessary to accomplish the objectives 
                of this section.
            ``(3) Health care financing study report.--Not later than 
        18 months after the date of enactment of this Act, Papa Ola 
        Lokahi in cooperation with the Office of Hawaiian Affairs and 
        other appropriate agencies of the State of Hawaii, including 
        the Department of Health and the Department of Human Services 
        and the Native Hawaiian health care systems and Native Hawaiian 
        health centers, shall submit to Congress a report detailing the 
        impact of current Federal and State health care financing 
        mechanisms and policies on the health and well-being of Native 
        Hawaiians. Such report shall include--
                    ``(A) information concerning the impact of cultural 
                competency, risk assessment data, eligibility 
                requirements and exemptions, and reimbursement policies 
                and capitation rates currently in effect for service 
                providers;
                    ``(B) any other such information as may be 
                important to improving the health status of Native 
                Hawaiians as such information relates to health care 
                financing including barriers to health care; and
                    ``(C) the recommendations for submission to the 
                Secretary for review and consultation with Native 
                Hawaiians.
    ``(b) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary to carry out subsection (a).

``SEC. 6. FUNCTIONS OF PAPA OLA LOKAHI AND OFFICE OF HAWAIIAN AFFAIRS.

    ``(a) Responsibility.--Papa Ola Lokahi shall be responsible for 
the--
            ``(1) coordination, implementation, and updating, as 
        appropriate, of the comprehensive health care master plan 
        developed pursuant to section 5;
            ``(2) training for the persons described in subparagraphs 
        (B) and (C) of section 7(c)(1);
            ``(3) identification of and research into the diseases that 
        are most prevalent among Native Hawaiians, including 
        behavioral, biomedical, epidemiological, and health services;
            ``(4) development and maintenance of an institutional 
        review board for all research projects involving all aspects of 
        Native Hawaiian health, including behavioral, biomedical, 
        epidemiological, and health services studies; and
            ``(5) the maintenance of an action plan outlining the 
        contributions that each member organization of Papa Ola Lokahi 
        will make in carrying out the policy of this Act.
    ``(b) Special Project Funds.--Papa Ola Lokahi may receive special 
project funds that may be appropriated for the purpose of research on 
the health status of Native Hawaiians or for the purpose of addressing 
the health care needs of Native Hawaiians.
    ``(c) Clearinghouse.--
            ``(1) In general.--Papa Ola Lokahi 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 publications;
                    ``(D) the collaboration of research in the area of 
                Native Hawaiian health; and
                    ``(E) the timely dissemination of information 
                pertinent to the Native Hawaiian health care systems.
            ``(2) Consultation.--The Secretary shall provide Papa Ola 
        Lokahi and the Office of Hawaiian Affairs, at least once 
        annually, an accounting of funds and services provided to 
        States and to nonprofit groups and organizations from the 
        Department for the purposes set forth in section 4. Such 
        accounting shall include--
                    ``(A) the amount of funds expended explicitly for 
                and benefiting Native Hawaiians;
                    ``(B) the number of Native Hawaiians impacted by 
                these funds;
                    ``(C) the identification of collaborations made 
                with Native Hawaiian groups and organizations in the 
                expenditure of these funds; and
                    ``(D) the amount of funds used for Federal 
                administrative purposes and for the provision of direct 
                services to Native Hawaiians.
    ``(d) Fiscal Allocation and Coordination of Programs and 
Services.--
            ``(1) Recommendations.--Papa Ola Lokahi shall provide 
        annual recommendations to the Secretary with respect to the 
        allocation of all amounts appropriated under this Act.
            ``(2) Coordination.--Papa Ola Lokahi shall, to the maximum 
        extent possible, coordinate and assist the health care programs 
        and services provided to Native Hawaiians.
            ``(3) Representation on commission.--The Secretary, in 
        consultation with Papa Ola Lokahi, shall make recommendations 
        for Native Hawaiian representation on the President's Advisory 
        Commission on Asian Americans and Pacific Islanders.
    ``(e) Technical Support.--Papa Ola Lokahi may act as a statewide 
infrastructure to provide technical support and coordination of 
training and technical assistance to the Native Hawaiian health care 
systems and to Native Hawaiian health centers.
    ``(f) Relationships With Other Agencies.--
            ``(1) Authority.--Papa Ola Lokahi may enter into agreements 
        or memoranda of understanding with relevant institutions, 
        agencies or organizations that are capable of providing health-
        related resources or services to Native Hawaiians and the 
        Native Hawaiian health care systems or of providing resources 
        or services for the implementation of the National policy as 
        set forth in section 4.
            ``(2) Health care financing.--
                    ``(A) Federal consultation.--Federal agencies 
                providing health care financing and carrying out health 
                care programs, including the Health Care Financing 
                Administration, shall consult with Native Hawaiians and 
                organizations providing health care services to Native 
                Hawaiians prior to the adoption of any policy or 
                regulation that may impact on the provision of services 
                or health insurance coverage. Such consultation shall 
                include the identification of the impact of any 
                proposed policy, rule, or regulation.
                    ``(B) State consultation.--The State of Hawaii 
                shall engage in meaningful consultation with Native 
                Hawaiians and organizations providing health care 
                services to Native Hawaiians in the State of Hawaii 
                prior to making any changes or initiating new programs.
                    ``(C) Consultation on federal health insurance 
                programs.
                            ``(i) In general.--The Office of Hawaiian 
                        Affairs, in collaboration with Papa Ola Lokahi, 
                        may develop consultative, contractual or other 
                        arrangements, including memoranda of 
                        understanding or agreement, with--
                                    ``(I) the Health Care Financing 
                                Administration;
                                    ``(II) the agency of the State of 
                                Hawaii that administers or supervises 
                                the administration of the State plan or 
                                waiver approved under title XVIII, XIX, 
                                or XXI of the Social Security Act 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 or 
                                agencies providing full or partial 
                                health insurance to Native Hawaiians.
                            ``(ii) Contents of arrangements.--
                        Arrangements 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
                                    ``(III) other matters that would 
                                enable Native Hawaiians to maximize 
                                health insurance benefits provided by 
                                Federal and State health insurance 
                                programs.
            ``(3) Traditional healers.--The provision of health 
        services under any program operated by the Department or 
        another Federal agency including the Department of Veterans 
        Affairs, may include the services of `traditional Native 
        Hawaiian healers' as defined in this Act or `traditional 
        healers' providing `traditional health care practices' as 
        defined in section 4(r) of Public Law 94-437. Such services 
        shall be exempt from national accreditation reviews, including 
        reviews conducted by the Joint Accreditation Commission on 
        Health Organizations and the Rehabilitation Accreditation 
        Commission.

``SEC. 7. NATIVE HAWAIIAN HEALTH CARE.

    ``(a) Comprehensive Health Promotion, Disease Prevention, and 
Primary Health Services.--
            ``(1) Grants and contracts.--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 
comprehensive health promotion and disease prevention services, as well 
as primary health services, to Native Hawaiians who desire and are 
committed to bettering their own health.
            ``(2) Preference.--In making grants and entering into 
        contracts under this subsection, the Secretary shall give 
        preference to Native Hawaiian health care systems and Native 
        Hawaiian organizations and, to the extent feasible, health 
        promotion and disease prevention services shall be performed 
        through Native Hawaiian health care systems.
            ``(3) Qualified entity.--An entity is a qualified entity 
        for purposes of paragraph (1) if the entity is a Native 
        Hawaiian health care system or a Native Hawaiian Center.
            ``(4) 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 
        during any fiscal year.
    ``(b) Planning Grant or Contract.--In addition to grants and 
contracts under subsection (a), 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 each of the islands of O`ahu, Moloka`i, Maui, 
Hawai`i, Lana`i, Kaua`i, and Ni`ihau in the State of Hawaii.
    ``(c) Services To Be Provided.--
            ``(1) In general.--Each recipient of funds under subsection 
        (a) shall ensure that the following services either are 
        provided or arranged for:
                    ``(A) Outreach services to inform Native Hawaiians 
                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, counselors, 
                and cultural educators.
                    ``(C) Services of physicians, physicians' 
                assistants, nurse practitioners or other health and 
                allied-health professionals.
                    ``(D) Immunizations.
                    ``(E) Prevention and control of diabetes, high 
                blood pressure, and otitis media.
                    ``(F) Pregnancy and infant care.
                    ``(G) Improvement of nutrition.
                    ``(H) Identification, treatment, control, and 
                reduction of the incidence of preventable illnesses and 
                conditions endemic to Native Hawaiians.
                    ``(I) Collection of data related to the prevention 
                of diseases and illnesses among Native Hawaiians.
                    ``(J) Services within the meaning of the terms 
                `health promotion', `disease prevention', and `primary 
                health services', as such terms are defined in section 
                3, which are not specifically referred to in subsection 
                (a).
                    ``(K) Support of culturally appropriate activities 
                enhancing health and wellness including land-based, 
                water-based, ocean-based, and spiritually-based 
                projects and programs.
            ``(2) Traditional healers.--The health care services 
        referred to in paragraph (1) which are provided under grants or 
        contracts under subsection (a) may be provided by traditional 
        Native Hawaiian healers.
    ``(d) Federal Tort Claims Act.--Individuals who provide medical, 
dental, or other services referred to in subsection (a)(1) for Native 
Hawaiian health care systems, including providers of traditional Native 
Hawaiian healing services, shall be treated as if such individuals were 
members of the Public Health Service and shall be covered under the 
provisions of section 224 of the Public Health Service Act.
    ``(e) Site for Other Federal Payments.--A Native Hawaiian health 
care system that receives funds under subsection (a) shall provide a 
designated area and appropriate staff to serve as a Federal loan 
repayment facility. Such facility shall be designed to enable health 
and allied-health professionals to remit payments with respect to loans 
provided to such professionals under any Federal loan program.
    ``(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 (a) unless the entity agrees that amounts 
received under such grant or contract will not, directly or through 
contract, be expended--
            ``(1) for any services other than the services described in 
        subsection (c)(1); or
            ``(2) 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 to, or enter into a contract with, an entity under 
subsection (a) 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 delivery 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.
    ``(h) Authorization of Appropriations.--
            ``(1) General grants.--There is authorized to be 
        appropriated such sums as may be necessary for each of fiscal 
        years 2001 through 2011 to carry out subsection (a).
            ``(2) Planning grants.--There is authorized to be 
        appropriated such sums as may be necessary for each of fiscal 
        years 2001 through 2011 to carry out subsection (b).

``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 updating (as 
        appropriate) of the comprehensive health care master plan 
        developed pursuant to section 5;
            ``(2) training for the persons described section 7(c)(1);
            ``(3) identification of and research into the diseases that 
        are most prevalent among Native Hawaiians, including 
        behavioral, biomedical, epidemiologic, and health services;
            ``(4) the maintenance of an action plan outlining the 
        contributions that each member organization of Papa Ola Lokahi 
        will make in carrying out the policy of this Act;
            ``(5) 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 publications;
            ``(6) the establishment and maintenance of an institutional 
        review board for all health-related research involving Native 
        Hawaiians;
            ``(7) the coordination of the health care programs and 
        services provided to Native Hawaiians; and
            ``(8) the administration of special project funds.
    ``(b) Authorization of Appropriations.--There is authorized to be 
appropriated such sums as may be necessary for each of fiscal years 
2001 through 2011 to carry out subsection (a).

``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 considers necessary or appropriate to 
ensure that the objectives of such grant or contract are achieved.
    ``(b) 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 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 individuals 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, fluent 
                in both English and the appropriate language, to assist 
                in carrying out the plan;
            ``(4) with respect to health services that are covered 
        under programs under titles XVIII, XIX, or XXI of the Social 
        Security Act, including any State plan, or under any other 
        Federal health insurance plan--
                    ``(A) if the entity will provide under the grant or 
                contract any such health services directly--
                            ``(i) the entity has entered into a 
                        participation agreement under such plans; 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 use 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) Determination of noncompliance.--If, as a result of 
        evaluations conducted by the Secretary, the Secretary 
        determines that an entity has not complied with or 
        satisfactorily performed a contract entered into under section 
        7, the Secretary shall, prior to renewing such contract, 
        attempt to resolve the  areas of noncompliance or 
unsatisfactory performance and modify such contract to prevent future 
occurrences of such noncompliance or unsatisfactory performance.
            ``(2) Nonrenewal.--If the Secretary determines that the 
        noncompliance or unsatisfactory performance described in 
        paragraph (1) with respect to an entity cannot be resolved and 
        prevented in the future, the Secretary shall not renew the 
        contract with such entity and may enter into a contract under 
        section 7 with another entity referred to in subsection (a)(3) 
        of such section 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 paragraph.
            ``(3) Consideration of results.--In determining 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.--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.).
            ``(5) Payments.--Payments made under any contract entered 
        into under this Act may be made in advance, by means of 
        reimbursement, or in installments and shall be made on such 
        conditions as the Secretary deems necessary to carry out the 
        purposes of this Act.
    ``(e) Report.--
            ``(1) In general.--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 an annual report--
                    ``(A) on the activities conducted by the entity 
                under the grant or contract;
                    ``(B) on the amounts and purposes for which Federal 
                funds were expended; and
                    ``(C) containing such other information as the 
                Secretary may request.
            ``(2) Audits.--The reports and records of any entity 
        concerning any grant or contract under this Act shall be 
        subject to audit by the Secretary, the Inspector General of the 
        Department of Health and Human Services, and the Comptroller 
        General of the United States.
    ``(f) 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.

``SEC. 10. ASSIGNMENT OF PERSONNEL.

    ``(a) In General.--The Secretary may enter into an agreement with 
any entity under which the Secretary may assign personnel of the 
Department of Health and Human Services 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) Applicable Federal Personnel Provisions.--Any assignment of 
personnel made by the Secretary under any agreement entered into under 
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. 11. NATIVE HAWAIIAN HEALTH SCHOLARSHIPS AND FELLOWSHIPS.

    ``(a) Eligibility.--Subject to the availability of amounts 
appropriated under subsection (c), the Secretary shall provide funds 
through a direct grant or a cooperative agreement to Kamehameha Schools 
or another Native Hawaiian organization or health care organization 
with experience in the administration of educational scholarships or 
placement services for the purpose of providing scholarship assistance 
to students who--
            ``(1) meet the requirements of section 338A of the Public 
        Health Service Act, except for assistance as provided for under 
        subsection (b)(2); and
            ``(2) are Native Hawaiians.
    ``(b) Priority.--A priority for scholarships under subsection (a) 
may be provided to employees of the Native Hawaiian Health Care Systems 
and the Native Hawaiian Health Centers.
    ``(c) Terms and Conditions.--
            ``(1) In general.--The scholarship assistance under 
        subsection (a) shall be provided under the same terms and 
        subject to the same conditions, regulations, and rules as apply 
        to scholarship assistance provided under section 338A of the 
        Public Health Service Act (except as provided for in paragraph 
        (2)), 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 
                the Native Hawaiian community as identified by Papa Ola 
                Lokahi;
                    ``(B) to the maximum extent practicable, the 
                Secretary shall select scholarship recipients from a 
                list of eligible applicants submitted by the Kamehameha 
                Schools or the Native Hawaiian organization 
                administering the program;
                    ``(C) the obligated service requirement for each 
                scholarship recipient (except for those receiving 
                assistance under paragraph (2)) shall be fulfilled 
                through service, in order of priority, in--
                            ``(i) any one of the Native Hawaiian health 
                        care systems or Native Hawaiian health centers;
                            ``(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; or
                            ``(iii) a geographical area, facility, or 
                        organization that serves a significant Native 
                        Hawaiian population;
                    ``(D) the scholarship's placement service shall 
                assign Native Hawaiian scholarship recipients to 
                appropriate sites for service.
                    ``(E) the provision of counseling, retention and 
                other support services shall not be limited to 
                scholarship recipients, but shall also include 
                recipients of other scholarship and financial aid 
                programs enrolled in appropriate health professions 
                training programs.
                    ``(F) financial assistance may be provided to 
                scholarship recipients in those health professions 
                designated in such section 338A of the Public Health 
                Service Act while they are fulfilling their service 
                requirement in any one of the Native Hawaiian health 
                care systems or community health centers.
            ``(2) Fellowships.--Financial assistance through 
        fellowships may be provided to Native Hawaiian community health 
        representatives, outreach workers, and health program 
        administrators in professional training programs, and to Native 
        Hawaiians in certificated programs provided by traditional 
        Native Hawaiian healers in any of the traditional Native 
        Hawaiian healing practices including lomi-lomi, la`au lapa`au, 
        and ho`oponopono. Such assistance may include a stipend or 
        reimbursement for costs associated with participation in the 
        program.
            ``(3) Rights and benefits.--Scholarship recipients in 
        health professions designated in section 338A of the Public 
        Health Service Act while fulfilling their service requirements 
        shall have all the same rights and benefits of members of the 
        National Health Service Corps during their period of service.
            ``(4) No inclusion of assistance in gross income.--
        Financial assistance provided under section 11 shall be deemed 
        `Qualified Scholarships' for purposes of the section amended by 
        section 123(a) of Public Law 99-514, as amended.
    ``(d) Authorization of Appropriations.--There is authorized to be 
appropriated such sums as may be necessary for each of fiscal years 
2001 through 2011 for the purpose of funding the scholarship assistance 
program under subsection (a) and fellowship assistance under subsection 
(c)(2).

``SEC. 12. REPORT.

    ``The President shall, at the time the budget is submitted under 
section 1105 of title 31, United States Code, for each fiscal year 
transmit to Congress a report on the progress made in meeting the 
objectives of this Act, including a review of programs established or 
assisted pursuant to this Act and an assessment and recommendations of 
additional programs or additional assistance necessary to, at a 
minimum, provide health services to Native Hawaiians, and ensure a 
health status for Native Hawaiians, which are at a parity with the 
health services available to, and the health status of, the general 
population.

``SEC. 13. USE OF FEDERAL GOVERNMENT FACILITIES AND SOURCES OF SUPPLY.

    ``(a) In General.--The Secretary shall permit organizations that 
receive contracts or grants under this Act, in carrying out such 
contracts or grants, to use existing facilities and all equipment 
therein or under the jurisdiction of the Secretary under such terms and 
conditions as may be agreed upon for the use and maintenance of such 
facilities or equipment.
    ``(b) Donation of Property.--The Secretary may donate to 
organizations that receive contracts or grants under this Act any 
personal or real property determined to be in excess of the needs of 
the Department or the General Services Administration for purposes of 
carrying out such contracts or grants.
    ``(c) Acquisition of Surplus Property.--The Secretary may acquire 
excess or surplus Federal Government personal or real property for 
donation to organizations that receive contracts or grants under this 
Act if the Secretary determines that the property is appropriate for 
the use by the organization for the purpose for which a contract or 
grant is authorized under this Act.

``SEC. 14. DEMONSTRATION PROJECTS OF NATIONAL SIGNIFICANCE.

    ``(a) Authority and Areas of Interest.--The Secretary, in 
consultation with Papa Ola Lokahi, may allocate amounts appropriated 
under this Act, or any other Act, to carry out Native Hawaiian 
demonstration projects of national significance. The areas of interest 
of such projects may include--
            ``(1) the development of a centralized database and 
        information system relating to the health care status, health 
        care needs, and wellness of Native Hawaiians;
            ``(2) the education of health professionals, and other 
        individuals in institutions of higher learning, in health and 
        allied health programs in healing practices, including Native 
        Hawaiian healing practices;
            ``(3) the integration of Western medicine with 
        complementary healing practices including traditional Native 
        Hawaiian healing practices;
            ``(4) the use of tele-wellness and telecommunications in 
        chronic disease management and health promotion and disease 
        prevention;
            ``(5) the development of appropriate models of health care 
        for Native Hawaiians and other indigenous peoples including the 
        provision of culturally competent health services, related 
        activities focusing on wellness concepts, the development of 
        appropriate kupuna care programs, and the development of 
        financial mechanisms and collaborative relationships leading to 
        universal access to health care; and
            ``(6) the establishment of a Native Hawaiian Center of 
        Excellence for Nursing at the University of Hawaii at Hilo, a 
        Native Hawaiian Center of Excellence for Mental Health at the 
        University of Hawaii at Manoa, a Native Hawaiian Center of 
        Excellence for Maternal Health and Nutrition at the Waimanalo 
        Health Center, and a Native Hawaiian Center of Excellence for 
        Research, Training, Integrated Medicine at Molokai General 
        Hospital and a Native Hawaiian Center of Excellence for 
        Complimentary Health and Health Education and Training at the 
        Waianae Coast Comprehensive Health Center.
    ``(b) Nonreduction in Other Funding.--The allocation of funds for 
demonstration projects under subsection (a) shall not result in a 
reduction in funds required by the Native Hawaiian health care systems, 
the Native Hawaiian Health Centers, the Native Hawaiian Health 
Scholarship  Program, or Papa Ola Lokahi to carry out their respective 
responsibilities under this Act.

``SEC. 15. NATIONAL BIPARTISAN COMMISSION ON NATIVE HAWAIIAN HEALTH 
              CARE ENTITLEMENT.

    ``(a) Establishment.--There is hereby established a National 
Bipartisan Native Hawaiian Health Care Entitlement Commission (referred 
to in this Act as the `Commission').
    ``(b) Membership.--The Commission shall be composed of 21 members 
to be appointed as follows:
            ``(1) Congressional members.--
                    ``(A) Appointment.--Eight members of the Commission 
                shall be members of Congress, of which--
                            ``(i) two members shall be from the House 
                        of Representatives and shall be appointed by 
                        the Majority Leader;
                            ``(ii) two members shall be from the House 
                        of Representatives and shall be appointed by 
                        the Minority Leader;
                            ``(iii) two members shall be from the 
                        Senate and shall be appointed by the Majority 
                        Leader; and
                            ``(iv) two members shall be from the Senate 
                        and shall be appointed by the Minority Leader.
                    ``(B) Relevant committee membership.--The members 
                of the Commission appointed under subparagraph (A) 
                shall each be members of the committees of Congress 
                that consider legislation affecting the provision of 
                health care to Native Hawaiians and other Native 
                Americans.
                    ``(C) Chairperson.--The members of the Commission 
                appointed under subparagraph (A) shall elect the 
                chairperson and vice-chairperson of the Commission.
            ``(2) Hawaiian health members.--Eleven members of the 
        Commission shall be appointed by Hawaiian health entities, of 
        which--
                    ``(A) five members shall be appointed by the Native 
                Hawaiian Health Care Systems;
                    ``(B) one member shall be appointed by the Hawaii 
                State Primary Care Association;
                    ``(C) one member shall be appointed by Papa Ola 
                Lokahi;
                    ``(D) one member shall be appointed by the Native 
                Hawaiian Health Task Force;
                    ``(E) one member shall be appointed by the Office 
                of Hawaiian Affairs; and
                    ``(F) two members shall be appointed by the 
                Association of Hawaiian Civic Clubs and shall represent 
                Native Hawaiian populations residing in the continental 
                United States.
            ``(3) Secretarial members.--Two members of the Commission 
        shall be appointed by the Secretary and shall possess knowledge 
        of Native Hawaiian health concerns and wellness.
    ``(c) Terms.--
            ``(1) In general.--The members of the Commission shall 
        serve for the life of the Commission.
            ``(2) Initial appointment of members.--The members of the 
        Commission shall be appointed under subsection (b)(1) not later 
        than 90 days after the date of enactment of this Act, and the 
        remaining members of the Commission shall be appointed not 
        later than 60 days after the date on which the members are 
        appointed under such subsection (b)(1).
            ``(3) Vacancies.--A vacancy in the membership of the 
        Commission shall be filled in the manner in which the original 
        appointment was made.
    ``(d) Duties of the Commission.--The Commission shall carry out the 
following duties and functions:
            ``(1) Review and analyze the recommendations of the report 
        of the study committee established under paragraph (3).
            ``(2) Make recommendations to Congress for the provision of 
        health services to Native Hawaiian individuals as an 
        entitlement, giving due regard to the effects of a program on 
        existing health care delivery systems for Native Hawaiians and 
        the effect of such programs on self-determination and the 
        reconciliation of their relationship with the United States.
            ``(3) Establish a study committee to be composed of at 
        least 10 members from the Commission, including 4 members of 
        the members appointed under subsection (b)(1), 5 of the members 
        appointed under subsection (b)(2), and 1 of the members 
        appointed by the Secretary under subsection (b)(3), which 
        shall--
                    ``(A) to the extent necessary to carry out its 
                duties, collect, compile, qualify, and analyze data 
                necessary to understand the extent of Native Hawaiian 
                needs with regard to the provision of health services, 
                including holding hearings and soliciting the views of 
                Native Hawaiians and Native Hawaiian organizations, and 
                which may include authorizing and funding feasibility 
                studies of various models for all Native Hawaiian 
                beneficiaries and their families, including those that 
                live in the continental United States;
                    ``(B) make recommendations to the Commission for 
                legislation that will provide for the culturally-
                competent and appropriate provision of health services 
                for Native Hawaiians as an entitlement, which shall, at 
                a minimum, address issues of eligibility and benefits 
                to be provided, including recommendations regarding 
                from whom such health services are to be provided and 
                the cost and mechanisms for funding of the health 
                services to be provided;
                    ``(C) determine the effect of the enactment of such 
                recommendations on the existing system of delivery of 
                health services for Native Hawaiians;
                    ``(D) determine the effect of a health service 
                entitlement program for Native Hawaiian individuals on 
                their self-determination and the reconciliation of 
                their relationship with the United States;
                    ``(E) not later than 12 months after the date of 
                the appointment of all members of the Commission, make 
                a written report of its findings and recommendations to 
                the Commission, which report shall include a statement 
                of the minority  and majority position of the committee 
and which shall be disseminated, at a minimum, to Native Hawaiian 
organizations and agencies and health organizations referred to in 
subsection (b)(2) for comment to the Commission; and
                    ``(F) report regularly to the full Commission 
                regarding the findings and recommendations developed by 
                the committee in the course of carrying out its duties 
                under this section.
            ``(4) Not later than 18 months after the date of the 
        appointment of all members of the Commission, submit a written 
        report to Congress containing a recommendation of policies and 
        legislation to implement a policy that would establish a health 
        care system for Native Hawaiians, grounded in their culture, 
        and based on the delivery of health services as an entitlement, 
        together with a determination of the implications of such an 
        entitlement system on existing health care delivery systems for 
        Native Hawaiians and their self-determination and the 
        reconciliation of their relationship with the United States.
    ``(e) Administrative Provisions.--
            ``(1) Compensation and expenses.--
                    ``(A) Congressional members.--Each member of the 
                Commission appointed under subsection (b)(1) shall not 
                receive any additional compensation, allowances, or 
                benefits by reason of their service on the Commission. 
                Such members shall receive travel expenses and per diem 
                in lieu of subsistence in accordance with sections 5702 
                and 5703 of title 5, United States Code.
                    ``(B) Other members.--The members of the Commission 
                appointed under paragraphs (2) and (3) of subsection 
                (b) shall, while serving on the business of the 
                Commission (including travel time), receive 
                compensation at the per diem equivalent of the rate 
                provided for individuals under level IV of the 
                Executive Schedule under section 5315 of title 5, 
                United States Code, and while serving away from their 
                home or regular place of business, be allowed travel 
                expenses, as authorized by the chairperson of the 
                Commission.
                    ``(C) Other personnel.--For purposes of 
                compensation (other than compensation of the members of 
                the Commission) and employment benefits, rights, and 
                privileges, all personnel of the Commission shall be 
                treated as if they were employees of the Senate.
            ``(2) Meetings and quorum.--
                    ``(A) Meetings.--The Commission shall meet at the 
                call of the chairperson.
                    ``(B) Quorum.--A quorum of the Commission shall 
                consist of not less than 12 members, of which--
                            ``(i) not less than 4 of such members shall 
                        be appointees under subsection (b)(1);
                            ``(ii) not less than 7 of such members 
                        shall be appointees under subsection (b)(2); 
                        and
                            ``(iii) not less than 1 of such members 
                        shall be an appointee under subsection (b)(3).
            ``(3) Director and staff.--
                    ``(A) Executive director.--The members of the 
                Commission shall appoint an executive director of the 
                Commission. The executive director shall be paid the 
                rate of basic pay equal to that under level V of the 
                Executive Schedule under section 5316 of title 5, 
                United States Code.
                    ``(B) Staff.--With the approval of the Commission, 
                the executive director may appoint such personnel as 
                the executive director deems appropriate.
                    ``(C) Applicability of civil service laws.--The 
                staff of the Commission shall be appointed without 
                regard to the provisions of title 5, United States 
                Code, governing appointments in the competitive 
                service, and shall be paid without regard to the 
                provisions of chapter 51 and subchapter III of chapter 
                53 of such title (relating to classification and 
                General Schedule pay rates).
                    ``(D) Experts and consultants.--With the approval 
                of the Commission, the executive director may procure 
                temporary and intermittent services under section 
                3109(b) of title 5, United States Code.
                    ``(E) Facilities.--The Administrator of the General 
                Services Administration shall locate suitable office 
                space for the operations of the Commission in 
                Washington, D.C. and in the State of Hawaii. The 
                Washington, D.C. facilities shall serve as the 
                headquarters of the Commission while the Hawaii office 
                shall serve a liaison function. Both such offices shall 
                include all necessary equipment and incidentals 
                required for the proper functioning of the Commission.
    ``(f) Powers.--
            ``(1) Hearings and other activities.--For purposes of 
        carrying out its duties, the Commission may hold such hearings 
        and undertake such other activities as the Commission 
        determines to be necessary to carry out its duties, except that 
        at least 8 hearings shall be held on each of the Hawaiian 
        Islands and 3 hearings in the continental United States in 
        areas where a significant population of Native Hawaiians 
        reside. Such hearings shall be held to solicit the views of 
        Native Hawaiians regarding the delivery of health care services 
        to such individuals. To constitute a hearing under this 
        paragraph, at least 4 members of the Commission, including at 
        least 1 member of Congress, must be present. Hearings held by 
        the study committee established under subsection (d)(3) may be 
        counted towards the number of hearings required under this 
        paragraph.
            ``(2) Studies by the general accounting office.--Upon the 
        request of the Commission, the Comptroller General shall 
        conduct such studies or investigations as the Commission 
        determines to be necessary to carry out its duties.
            ``(3) Cost estimates.--
                    ``(A) In general.--The Director of the 
                Congressional Budget Office or the Chief Actuary  of 
the Health Care Financing Administration, or both, shall provide to the 
Commission, upon the request of the Commission, such cost estimates as 
the Commission determines to be necessary to carry out its duties.
                    ``(B) Reimbursements.--The Commission shall 
                reimburse the Director of the Congressional Budget 
                Office for expenses relating to the employment in the 
                office of the Director of such additional staff as may 
                be necessary for the Director to comply with requests 
                by the Commission under subparagraph (A).
            ``(4) Detail of federal employees.--Upon the request of the 
        Commission, the head of any Federal agency is authorized to 
        detail, without reimbursement, any of the personnel of such 
        agency to the Commission to assist the Commission in carrying 
        out its duties. Any such detail shall not interrupt or 
        otherwise affect the civil service status or privileges of the 
        Federal employees.
            ``(5) Technical assistance.--Upon the request of the 
        Commission, the head of any Federal agency shall provide such 
        technical assistance to the Commission as the Commission 
        determines to be necessary to carry out its duties.
            ``(6) Use of mails.--The Commission may use the United 
        States mails in the same manner and under the same conditions 
        as Federal agencies and shall, for purposes of the frank, be 
        considered a commission of Congress as described in section 
        3215 of title 39, United States Code.
            ``(7) Obtaining information.--The Commission may secure 
        directly from any Federal agency information necessary to 
        enable the Commission to carry out its duties, if the 
        information may be disclosed under section 552 of title 5, 
        United States Code. Upon request of the chairperson of the 
        Commission, the head of such agency shall furnish such 
        information to the Commission.
            ``(8) Support services.--Upon the request of the 
        Commission, the Administrator of General Services shall provide 
        to the Commission on a reimbursable basis such administrative 
        support services as the Commission may request.
            ``(9) Printing.--For purposes of costs relating to printing 
        and binding, including the cost of personnel detailed from the 
        Government Printing Office, the Commission shall be deemed to 
        be a committee of Congress.
    ``(g) Authorization of Appropriations.--There is authorized to be 
appropriated such sums as may be necessary to carry out this section. 
The amount appropriated under this subsection shall not result in a 
reduction in any other appropriation for health care or health services 
for Native Hawaiians.

``SEC. 16. RULE OF CONSTRUCTION.

    ``Nothing in this Act shall be construed to restrict the authority 
of the State of Hawaii to license health practitioners.

``SEC. 17. COMPLIANCE WITH BUDGET ACT.

    ``Any new spending authority (described in subparagraph (A) of (B) 
of section 401(c)(2) of the Congressional Budget Act of 1974 (2 U.S.C. 
651(c)(2) (A) or (B))) which is provided under this Act shall be 
effective for any fiscal year only to such extent or in such amounts as 
are provided for in appropriation Acts.

``SEC. 18. 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 application of such provision or 
amendment to persons or circumstances other than those to which it is 
held invalid, shall not be affected thereby.''.




                                                       Calendar No. 765

106th CONGRESS

  2d Session

                                S. 1929

                          [Report No. 106-389]

_______________________________________________________________________

                                 A BILL

To amend the Native Hawaiian Health Care Improvement Act to revise and 
                            extend such Act.

_______________________________________________________________________

                            August 25, 2000

                       Reported with an amendment