[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 702 Reported in Senate (RS)]






                                                       Calendar No. 796
108th CONGRESS
  2d Session
                                 S. 702

                          [Report No. 108-405]

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


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 25, 2003

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

                           November 10, 2004

  Reported under authority of the order of the Senate of October 11, 
                2004, by Mr. Campbell, without amendment

_______________________________________________________________________

                                 A BILL


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

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Native Hawaiian Health Care 
Improvement Reauthorization Act of 2003''.

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. Rule of construction.
        ``Sec. 16. Compliance with Budget Act.
        ``Sec. 17. Severability.

``SEC. 2. FINDINGS.

    ``(a) General Findings.--Congress finds that--
            ``(1) Native Hawaiians begin their story with the Kumulipo, 
        which details the creation and interrelationship of all things, 
        including the evolvement of Native Hawaiians as healthy and 
        well people;
            ``(2) Native Hawaiians--
                    ``(A) are a distinct and unique indigenous people 
                with a historical continuity to the original 
                inhabitants of the Hawaiian archipelago within Ke 
                Moananui, the Pacific Ocean; and
                    ``(B) have a distinct society that was first 
                organized almost 2,000 years ago;
            ``(3) the health and well-being of Native Hawaiians are 
        intrinsically tied to the deep feelings and attachment of 
        Native Hawaiians 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, in 
        accordance with their own spiritual and traditional beliefs, 
        their customs, practices, language, social institutions, 
        ancestral territory, and cultural identity;
            ``(7) 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;
            ``(8) 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;
            ``(9) 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;
            ``(10) a unified monarchical government of the Hawaiian 
        Islands was established in 1810 under Kamehameha I, the first 
        King of Hawaii;
            ``(11) throughout the 19th century 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;
            ``(12) 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;
            ``(13) in pursuance of that conspiracy--
                    ``(A) the United States Minister and the naval 
                representative of the United States caused armed forces 
                of the United States Navy to invade the sovereign 
                Hawaiian Nation in support of the overthrow of the 
                indigenous and lawful Government of Hawaii; and
                    ``(B) after that overthrow, the United States 
                Minister 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--
                            ``(i) treaties between the Government of 
                        Hawaii and the United States; and
                            ``(ii) international law;
            ``(14) in a message to Congress on December 18, 1893, 
        President Grover Cleveland--
                    ``(A) reported fully and accurately on those 
                illegal actions;
                    ``(B) acknowledged that by those acts, described by 
                the President as acts of war, the government of a 
                peaceful and friendly people was overthrown; and
                    ``(C) 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';
            ``(15) 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 those wrongs and restoration of the indigenous 
        government of the Hawaiian nation, but no action was taken on 
        that petition;
            ``(16) in 1993, Congress enacted Public Law 103-150 (107 
        Stat. 1510), in which Congress--
                    ``(A) acknowledged the significance of those 
                events; and
                    ``(B) 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;
            ``(17) in 1898, the United States--
                    ``(A) annexed Hawaii through Resolution No. 55 
                (commonly known as the `Newlands Resolution') (30 Stat. 
                750), without the consent of, or compensation to, the 
                indigenous people of Hawaii or the sovereign government 
                of those people; and
                    ``(B) denied those people the mechanism for 
                expression of their inherent sovereignty through self-
                government and self-determination of their lands and 
                ocean resources;
            ``(18) through the Newlands Resolution and the Act of April 
        30, 1900 (commonly known as the `1900 Organic Act') (31 Stat. 
        141, chapter 339), Congress--
                    ``(A) received 1,750,000 acres of land formerly 
                owned by the Crown and Government of the Hawaiian 
                Kingdom; and
                    ``(B) exempted the land from then-existing public 
                land laws of the United States by mandating that the 
                revenue and proceeds from that land 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;
            ``(19) in 1921, Congress enacted the Hawaiian Homes 
        Commission Act, 1920 (42 Stat. 108, chapter 42), which--
                    ``(A) designated 200,000 acres of the ceded public 
                land for exclusive homesteading by Native Hawaiians; 
                and
                    ``(B) affirmed the trust relationship between the 
                United States and Native Hawaiians, as expressed by 
                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.';
            ``(20) 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), a provision--
                    ``(A) to lease land within the extension to Native 
                Hawaiians; and
                    ``(B) to permit fishing in the area `only by native 
                Hawaiian residents of said area or of adjacent villages 
                and by visitors under their guidance';
            ``(21) under the Act of March 18, 1959 (48 U.S.C. prec. 491 
        note; 73 Stat. 4), the United States--
                    ``(A) transferred responsibility for the 
                administration of the Hawaiian home lands to the State; 
                but
                    ``(B) reaffirmed the trust relationship that 
                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 that Act;
            ``(22) under the Act referred to in paragraph (21), the 
        United States--
                    ``(A) transferred responsibility for administration 
                over portions of the ceded public lands trust not 
                retained by the United States to the State; but
                    ``(B) reaffirmed the trust relationship that 
                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 that Act (73 
                Stat. 6);
            ``(23) in 1978, the people of Hawaii--
                    ``(A) amended the constitution of Hawaii to 
                establish the Office of Hawaiian Affairs; and
                    ``(B) assigned to that Office the authority--
                            ``(i) to accept and hold in trust for the 
                        Native Hawaiian people real and personal 
                        property transferred from any source;
                            ``(ii) to receive payments from the State 
                        owed to the Native Hawaiian people in 
                        satisfaction of the pro rata share of the 
                        proceeds of the public land trust established 
                        by section 5(f) of the Act of March 18, 1959 
                        (48 U.S.C. prec. 491 note; 73 Stat. 6);
                            ``(iii) to act as the lead State agency for 
                        matters affecting the Native Hawaiian people; 
                        and
                            ``(iv) to formulate policy on affairs 
                        relating to the Native Hawaiian people;
            ``(24) the authority of Congress under the Constitution to 
        legislate in matters affecting the aboriginal or indigenous 
        people of the United States includes the authority to legislate 
        in matters affecting the native people of Alaska and Hawaii;
            ``(25) the United States has recognized the authority of 
        the Native Hawaiian people to continue to work toward an 
        appropriate form of sovereignty, as defined by the Native 
        Hawaiian people in provisions set forth in legislation 
        returning the Hawaiian Island of Kaho`olawe to custodial 
        management by the State in 1994;
            ``(26) 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;
            ``(27) that program is conducted by the Native Hawaiian 
        Health Care Systems and Papa Ola Lokahi;
            ``(28) health initiatives implemented by those 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--
                    ``(A) providing comprehensive disease prevention;
                    ``(B) providing health promotion activities; and
                    ``(C) increasing the number of Native Hawaiians in 
                the health and allied health professions;
            ``(29) those accomplishments have been achieved through 
        implementation of--
                    ``(A) the Native Hawaiian Health Care Act of 1988 
                (Public Law 100-579); and
                    ``(B) the reauthorization of that Act under section 
                9168 of the Department of Defense Appropriations Act, 
                1993 (Public Law 102-396; 106 Stat. 1948);
            ``(30) the historical and unique legal relationship between 
        the United States and Native Hawaiians has been consistently 
        recognized and affirmed by Congress through the enactment of 
        more than 160 Federal laws that extend to the Native Hawaiian 
        people the same rights and privileges accorded to American 
        Indian, Alaska Native, Eskimo, and Aleut communities, 
        including--
                    ``(A) the Native American Programs Act of 1974 (42 
                U.S.C. 2991 et seq.);
                    ``(B) the American Indian Religious Freedom Act (42 
                U.S.C. 1996);
                    ``(C) the National Museum of the American Indian 
                Act (20 U.S.C. 80q et seq.); and
                    ``(D) the Native American Graves Protection and 
                Repatriation Act (25 U.S.C. 3001 et seq.);
            ``(31) the United States has recognized and reaffirmed the 
        trust relationship to the Native Hawaiian people through 
        legislation that authorizes the provision of services to Native 
        Hawaiians, specifically--
                    ``(A) the Older Americans Act of 1965 (42 U.S.C. 
                3001 et seq.);
                    ``(B) the Developmental Disabilities Assistance and 
                Bill of Rights Act Amendments of 1987 (42 U.S.C. 6000 
                et seq.);
                    ``(C) the Veterans' Benefits and Services Act of 
                1988 (Public Law 100-322);
                    ``(D) the Rehabilitation Act of 1973 (29 U.S.C. 701 
                et seq.);
                    ``(E) the Native Hawaiian Health Care Act of 1988 
                (42 U.S.C. 11701 et seq.);
                    ``(F) the Health Professions Reauthorization Act of 
                1988 (Public Law 100-607; 102 Stat. 3122);
                    ``(G) the Nursing Shortage Reduction and Education 
                Extension Act of 1988 (Public Law 100-607; 102 Stat. 
                3153);
                    ``(H) the Handicapped Programs Technical Amendments 
                Act of 1988 (Public Law 100-630);
                    ``(I) the Indian Health Care Amendments of 1988 
                (Public Law 100-713); and
                    ``(J) the Disadvantaged Minority Health Improvement 
                Act of 1990 (Public Law 101-527);
            ``(32) the United States has affirmed that 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 (21 U.S.C. 801 note; Public Law 99-570);
            ``(33) in addition, the United States--
                    ``(A) has recognized that Native Hawaiians, as 
                aboriginal, indigenous, native people of Hawaii, are a 
                unique population group in Hawaii and in the 
                continental United States; and
                    ``(B) has so declared in Office of Management and 
                Budget Circular 15 in 1997 and Presidential Executive 
                Order No. 13125, dated June 7, 1999; and
            ``(34) despite the United States having expressed in Public 
        Law 103-150 (107 Stat. 1510) its commitment to a policy of 
        reconciliation with the Native Hawaiian people for past 
        grievances--
                    ``(A) the unmet health needs of the Native Hawaiian 
                people remain severe; and
                    ``(B) the health status of the Native Hawaiian 
                people continues to be far below that of the general 
                population of the United States.
    ``(b) Finding of 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 (216.8 out of every 100,000 male 
                                residents and 191.6 out of every 
                                100,000 female residents), rates that 
                                are 21 percent higher than the rate for 
                                the total State male population (179.0 
                                out of every 100,000 residents) and 64 
                                percent higher than the rate for the 
                                total State female population (117.0 
                                per 100,000);
                                    ``(II) Native Hawaiian males have 
                                the highest cancer mortality rates in 
                                the State for cancers of the lung, 
                                colon, rectum, and colorectum, and for 
                                all cancers combined;
                                    ``(III) Native Hawaiian females 
                                have the highest cancer mortality rates 
                                in the State for cancers of the lung, 
                                liver, pancreas, breast, corpus uteri, 
                                stomach, colon, and rectum, and for all 
                                cancers combined;
                                    ``(IV) Native Hawaiian males have 
                                8.7 years of productive life lost as a 
                                result of cancer in the State, the 
                                highest years of productive life lost 
                                in that State, as compared with 6.4 
                                years for all males; and
                                    ``(V) Native Hawaiian females have 
                                8.2 years of productive life lost as a 
                                result of cancer in the State as 
                                compared with 6.4 years for all females 
                                in the State.
                            ``(ii) Breast cancer.--With respect to 
                        breast cancer--
                                    ``(I) Native Hawaiians have the 
                                highest mortality rate in the State 
                                from breast cancer (30.79 out of every 
                                100,000 residents), a rate that is 33 
                                percent higher than that for Caucasian 
                                Americans (23.07 out of every 100,000 
                                residents) and 106 percent higher than 
                                that for Chinese Americans (14.96 out 
                                of every 100,000 residents); and
                                    ``(II) nationally, Native Hawaiians 
                                have the third highest mortality rate 
                                as a result of breast cancer (25.0 out 
                                of every 100,000 residents), behind 
                                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 rate as a 
                        result of cancer of the cervix in the State 
                        (3.65 out of every 100,000 residents), followed 
                        by Filipino Americans (2.69 out of every 
                        100,000 residents) and Caucasian Americans 
                        (2.61 out of every 100,000 residents).
                            ``(iv) Lung cancer.--Native Hawaiian males 
                        and females have the highest mortality rates as 
                        a result of lung cancer in the State, at 74.79 
                        per 100,000 for males and 47.84 per 100,000 
                        females, which rates are higher than the rates 
                        for the total State population by 48 percent 
                        for males and 93 percent for females.
                            ``(v) Prostate cancer.--Native Hawaiian 
                        males have the third highest mortality rate as 
                        a result of prostate cancer in the State (21.48 
                        out of every 100,000 residents), with Caucasian 
                        Americans having the highest mortality rate as 
                        a result of prostate cancer (23.96 out of every 
                        100,000 residents).
                    ``(B) Diabetes.--With respect to diabetes, in 
                2000--
                            ``(i) Native Hawaiians had the highest 
                        mortality rate as a result of diabetes mellitis 
                        (38.8 out of every 100,000 residents) in the 
                        State, which rate is 138 percent higher than 
                        the statewide rate for all racial groups (16.3 
                        out of every 100,000 residents); and
                            ``(ii) full-blood Hawaiians had a mortality 
                        as a result of diabetes mellitis of 93.3 out of 
                        every 100,000 residents, which is 518 percent 
                        higher than the rate for the statewide 
population of all other racial groups.
                    ``(C) Asthma.--With respect to asthma--
                            ``(i) in 1990, Native Hawaiians comprised 
                        44 percent of all asthma cases in the State for 
                        those 18 years of age and younger, and 35 
                        percent of all asthma cases reported; and
                            ``(ii) in 1999, the Native Hawaiian 
                        prevalence rate for asthma was 129.6 out of 
                        every 1,000 residents, which was 69 percent 
                        higher than the rate for all others combined in 
                        the State (76.7 out of every 1,000 residents).
                    ``(D) Circulatory diseases.--
                            ``(i) Heart disease.--With respect to heart 
                        disease--
                                    ``(I) the mortality rate for Native 
                                Hawaiians as a result of heart disease 
                                (372.3 out of every 100,000 residents) 
                                is 68 percent higher than the rate for 
                                the entire State (221.9 out of every 
                                100,000 residents); and
                                    ``(II) Native Hawaiian males have 
                                the greatest years of productive life 
                                lost in the State, because Native 
                                Hawaiian males lose an average of 15.5 
                                years and Native Hawaiian females lose 
                                an average of 8.2 years as a result of 
                                heart disease, as compared with 7.5 
years for all males, and 6.4 years for all females, in the State.
                            ``(ii) Hypertension.--With respect to 
                        hypertension--
                                    ``(I) the mortality rate for Native 
                                Hawaiians as a result of 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);
                                    ``(II) Native Hawaiians have 
                                substantially higher prevalence rates 
                                of hypertension than--
                                            ``(aa) those observed 
                                        statewide; and
                                            ``(bb) those of any other 
                                        ethnic group in Hawaii; and
                                    ``(III) the prevalence rate of 
                                hypertension for Native Hawaiians is 
                                37.9 percent, 11 percent higher than 
                                that for all others in the State (34.1 
                                percent).
                            ``(iii) Stroke.--The mortality rate for 
                        Native Hawaiians as a result of stroke (72.0 
                        out of every 100,000 residents) is 20 percent 
                        higher than that for the entire State (60 out 
                        of every 100,000 residents).
            ``(2) Infectious disease and illness.--With respect to 
        infectious disease and illness--
                    ``(A) in 1998, Native Hawaiians comprised 20 
                percent of all deaths resulting from infectious 
                diseases in the State for all ages; and
                    ``(B) the incidence of acquired immune deficiency 
                syndrome 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.
            ``(3) Injuries.--With respect to injuries--
                    ``(A) the mortality rate for Native Hawaiians as a 
                result of injuries (32.0 out of every 100,000 
                residents) is 16 percent higher than that for the 
                entire State (27.5 out of every 100,000 residents);
                    ``(B) 32 percent of all deaths of individuals 
                between the ages of 18 and 24 years of age resulting 
                from injuries were Native Hawaiian; and
                    ``(C) the 2 primary causes of Native Hawaiian 
                deaths in that age group were motor vehicle accidents 
                (30 percent) and intentional self-harm (39 percent).
            ``(4) Dental health.--With respect to dental health--
                    ``(A) Native Hawaiian children exhibit among the 
                highest rates of dental caries in the United States, 
                and the highest in the State as compared with the 5 
                other major ethnic groups in the State;
                    ``(B) the average number of decayed or filled 
                primary teeth for Native Hawaiian children aged 5 
                through 9 years was 4.3, as compared with 3.7 for all 
                children in the State and 1.9 for all children in the 
                United States; and
                    ``(C) the proportion of Native Hawaiian children 
                aged 5 through 12 years with unmet dental treatment 
                needs (defined as having active dental caries requiring 
                treatment) is 40 percent, as compared with 33 percent 
                for all other racial groups in the State.
            ``(5) Life expectancy.--With respect to life expectancy--
                    ``(A) Native Hawaiians have the lowest life 
                expectancy of all population groups in the State;
                    ``(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 
                approximately 5 years less than that of the total State 
                population (78.85 years).
            ``(6) Maternal and child health.--
                    ``(A) In general.--With respect to maternal and 
                child health, for 2000--
                            ``(i) 39 percent of all deaths of children 
                        under the age of 18 years in the State were 
                        Native Hawaiian; and
                            ``(ii) perinatal conditions accounted for 
                        38 percent of all Native Hawaiian deaths in 
                        that age group.
                    ``(B) Prenatal care.--With respect to prenatal 
                care--
                            ``(i) as of 1998, Native Hawaiian women 
                        have the highest prevalence (24 percent) of 
                        having had no prenatal care during the first 
                        trimester of pregnancy, as compared with the 5 
                        largest ethnic groups in the State;
                            ``(ii) of the mothers in the State who 
                        received no prenatal care throughout their 
                        pregnancies in 1996, 44 percent were Native 
                        Hawaiian;
                            ``(iii) more than 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, many 
                        Native Hawaiian newborns begin life in a 
                        potentially hazardous circumstance, far higher 
                        than any other racial group.
                    ``(C) Births.--With respect to births--
                            ``(i) in 1996, 45 percent of the live 
                        births to Native Hawaiian mothers were infants 
                        born to single mothers, a circumstance which 
                        statistics indicate puts 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 (defined as a weight of less than 
                        2,500 grams); and
                            ``(iii) of all low birth weight infants 
                        born to single mothers in the State, 44 percent 
                        were Native Hawaiian.
                    ``(D) 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), as compared with the rate for all 
                        other racial groups in the State (3.6 percent);
                            ``(ii) in 1998, nearly 49 percent of all 
                        mothers in the State under 19 years of age were 
                        Native Hawaiian;
                            ``(iii) in 1998, Native Hawaiians comprised 
                        31 percent (1,425) of all live births to 
                        mothers with medical risk factors in the State 
                        (4,559); and
                            ``(iv) lower rates of abortion 
                        (approximately 33 percent lower than for the 
                        statewide population) among Hawaiian women may 
                        account, in part, for that higher percentage of 
                        live births.
                    ``(E) Fetal mortality.--With respect to fetal 
                mortality--
                            ``(i) in 2000, Native Hawaiians had the 
                        highest number of fetal deaths in the State; 
                        and
                            ``(ii)(I) 21 percent all fetal deaths in 
                        the State were associated with expectant Native 
                        Hawaiian mothers; and
                            ``(II) 37 percent of those Native Hawaiian 
                        mothers were under the age of 25 years.
            ``(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 substance abuse 
                        treatment programs funded by the Department of 
                        Health, Alcohol, Drugs and Other Drugs of the 
                        State;
                            ``(ii) in 2000, the prevalence of cigarette 
                        smoking by Native Hawaiians was 31.0 percent, a 
                        rate that is 57 percent higher than that for 
                        the total population in the State, which is 
                        19.7 percent;
                            ``(iii) Native Hawaiians have the highest 
                        prevalence rate of acute alcohol drinking (19.6 
                        percent), a rate that is 40 percent higher than 
                        that for the total population in the State;
                            ``(iv) the chronic alcohol drinking rate 
                        among Native Hawaiians is 54 percent higher 
                        than that for all other racial groups in the 
                        State;
                            ``(v) in 1991, 40 percent of Native 
                        Hawaiian adults surveyed reported having used 
                        marijuana, as compared with 30 percent for all 
                        other racial groups in the State; and
                            ``(vi) 9 percent of the Native Hawaiian 
                        adults surveyed reported that they use or have 
                        used marijuana within the year preceding the 
                        survey, as compared with 6 percent for all 
                        other racial groups in the State.
                    ``(B) Crime.--With respect to crime--
                            ``(i) in 1998, of the 7,789 arrests that 
                        were made for property crimes in the State, 
                        arrests of Native Hawaiians comprised 23 
                        percent;
                            ``(ii) Native Hawaiians comprised 40 
                        percent of juvenile arrests in 1998, the 
                        largest percentage of all juvenile arrests in 
                        that year;
                            ``(iii) in the period of 1996 through 1998, 
                        the overrepresentation of Native Hawaiian 
                        juvenile arrests for index crimes and Part II 
                        offenses increased by 6 percent and 2 percent, 
                        respectively;
                            ``(iv) in 1998, Native Hawaiians 
                        represented 22 percent of the 2,423 adults 
                        arrested for drug-related offenses in the 
                        State;
                            ``(v) Native Hawaiians are overrepresented 
                        in the prison population in the State;
                            ``(vi) of the 2,260 incarcerated Native 
                        Hawaiians, 70 percent are between 20 and 40 
                        years of age;
                            ``(vii) in 1995 and 1996, Native Hawaiians 
                        comprised 36.5 percent of the sentenced felon 
                        prison population in Hawaii, as compared with 
                        20.5 percent for Caucasian Americans, 3.7 
                        percent for Japanese Americans, and 6 percent 
                        for Chinese Americans;
                            ``(viii) in 2002, Native Hawaiians 
                        comprised 40 percent of the total sentenced 
                        felon population in the State, as compared with 
                        25 percent for Caucasian Americans, 12 percent 
                        for Filipino Americans, 6 percent for Japanese 
                        Americans, and 5 percent for Samoans; and
                            ``(ix) 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 in the 
                        State.
            ``(8) Obesity.--Native Hawaiians have the highest 
        prevalence rate of overweightness and obesity (69.4 percent), a 
        rate that is 38 percent higher than that for the total State 
        population (50.2 percent).
            ``(9) Health professions education and training.--With 
        respect to health professions education and training--
                    ``(A)(i) Native Hawaiians who are at least 25 years 
                of age have a comparable rate of high school completion 
as compared with all people in the State who are at least 25 years of 
age; but
                    ``(ii) the rate of baccalaureate degree achievement 
                among Native Hawaiians is 6.9 percent, which is less 
                than the average in the State (15.76 percent);
                    ``(B) Native Hawaiian physicians make up 4 percent 
                of the total physician workforce in the State; and
                    ``(C)(i) in fiscal year 1999, Native Hawaiians 
                comprised--
                            ``(I) 9 percent of those individuals who 
                        earned Bachelor's degrees;
                            ``(II) 15 percent of those individuals who 
                        earned 2-year diplomas; and
                            ``(III) 6 percent of those individuals who 
                        earned Master's degrees; and
                    ``(ii) in 1997, Native Hawaiians comprised 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) Health service.--The term `health service' means--
                    ``(A) service provided by a physician, physician's 
                assistant, nurse practitioner, nurse, dentist, or other 
                health professional;
                    ``(B) a diagnostic laboratory or radiologic 
                service;
                    ``(C) a preventive health service (including a 
                perinatal service, well child service, family planning 
                service, nutrition service, home health service, sports 
                medicine and athletic training service, and, generally, 
                any service associated with enhanced health and 
                wellness);
                    ``(D) emergency medical service, including a 
                service provided by a first responder, emergency 
                medical technician, or mobile intensive care 
                technician;
                    ``(E) a transportation service required for 
                adequate patient care;
                    ``(F) a preventive dental service;
                    ``(G) a pharmaceutical and medical service;
                    ``(H) a mental health service, including a service 
                provided by a psychologist or social worker;
                    ``(I) a genetic counseling service;
                    ``(J) a health administration service, including a 
                service provided by a health program administrator;
                    ``(K) a health research service, including a 
                service provided by an individual with an advanced 
                degree in medicine, nursing, psychology, social work, 
                or any other related health program;
                    ``(L) an environmental health service, including a 
                service provided by an epidemiologist, public health 
                official, medical geographer, or medical 
                anthropologist, or an individual specializing in 
                biological, chemical, or environmental health 
                determinants;
                    ``(M) a primary care service that may lead to 
                specialty or tertiary care; and
                    ``(N) a complimentary healing practice, including a 
                practice performed by a traditional Native Hawaiian 
                healer.
            ``(5) Native hawaiian.--The term `Native Hawaiian' means 
        any individual who is Kanaka Maoli (a descendant of the 
        aboriginal people who, prior to 1778, occupied and exercised 
        sovereignty in the area that now constitutes the State), as 
        evidenced by--
                    ``(A) genealogical records;
                    ``(B) kama`aina witness verification from Native 
                Hawaiian Kupuna (elders); or
                    ``(C) birth records of the State or any other State 
                or territory of the United States.
            ``(6) Native hawaiian health care system.--The term `Native 
        Hawaiian health care system' means any of up to 8 entities in 
        the State that--
                    ``(A) is organized under the laws of the State;
                    ``(B) provides or arranges for the provision of 
                health services for Native Hawaiians in the State;
                    ``(C) is a public or nonprofit private entity;
                    ``(D) has Native Hawaiians significantly 
                participating in the planning, management, provision, 
                monitoring, and evaluation of health services;
                    ``(E) addresses the health care needs of an 
                island's Native Hawaiian population; and
                    ``(F) is recognized by Papa Ola Lokahi--
                            ``(i) for the purpose of planning, 
                        conducting, or administering programs, or 
                        portions of programs, authorized by this Act 
                        for the benefit of Native Hawaiians; and
                            ``(ii) as having the qualifications and the 
                        capacity to provide the services and meet the 
                        requirements under--
                                    ``(I) the contract that each Native 
                                Hawaiian health care system enters into 
                                with the Secretary under this Act; and
                                    ``(II) the grant each Native 
                                Hawaiian health care system receives 
                                from the Secretary under this Act.
            ``(7) Native hawaiian health center.--The term `Native 
        Hawaiian Health Center' means any organization that is a 
        primary health care provider that--
                    ``(A) has a governing board composed of 
                individuals, at least 50 percent of whom are Native 
                Hawaiians;
                    ``(B) has demonstrated cultural 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 as having 
                met each of the criteria described in subparagraphs (A) 
                through (C).
            ``(8) Native hawaiian health task force.--The term `Native 
        Hawaiian Health Task Force' means a task force established by 
        the State Council of Hawaiian Homestead Associations to 
        implement health and wellness strategies in Native Hawaiian 
        communities.
            ``(9) Native hawaiian organization.--The term `Native 
        Hawaiian organization' means any organization that--
                    ``(A) serves the interests of Native Hawaiians; and
                    ``(B)(i) is recognized by Papa Ola Lokahi for 
                planning, conducting, or administering programs 
                authorized under this Act for the benefit of Native 
                Hawaiians; and
                    ``(ii) is a public or nonprofit private entity.
            ``(10) Office of hawaiian affairs.--The term `Office of 
        Hawaiian Affairs' means the governmental entity that--
                    ``(A) is established under article XII, sections 5 
                and 6, of the Hawaii State Constitution; and
                    ``(B) charged with the responsibility to formulate 
                policy relating to the affairs of Native Hawaiians.
            ``(11) Papa ola lokahi.--
                    ``(A) In general.--The term `Papa Ola Lokahi' means 
                an organization that--
                            ``(i) is composed of public agencies and 
                        private organizations focusing on improving the 
                        health status of Native Hawaiians; and
                            ``(ii) governed by a board the members of 
                        which may include representation from--
                                    ``(I) E Ola Mau;
                                    ``(II) the Office of Hawaiian 
                                Affairs;
                                    ``(III) Alu Like, Inc.;
                                    ``(IV) the University of Hawaii;
                                    ``(V) the Hawaii State Department 
                                of Health;
                                    ``(VI) the Native Hawaiian Health 
                                Task Force;
                                    ``(VII) the Hawaii State Primary 
                                Care Association;
                                    ``(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 (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 
                                (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 (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 (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 (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) such other Native Hawaiian 
                                health care systems as are 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 shall admit from time to time, 
                                based on satisfactory demonstration of 
                                a record of contribution to the health 
                                and well-being of Native Hawaiians.
                    ``(B) Exclusion.--The term `Papa Ola Lokahi' does 
                not include any organization described in subparagraph 
                (A) for which the Secretary has made a determination 
                that the organization has not developed a mission 
                statement that includes--
                            ``(i) clearly-defined goals and objectives 
                        for the contributions the organization will 
                        make to--
                                    ``(I) Native Hawaiian health care 
                                systems; and
                                    ``(II) the national policy 
                                described in section 4; and
                            ``(ii) an action plan for carrying out 
                        those goals and objectives.
            ``(12) Secretary.--The term `Secretary' means the Secretary 
        of Health and Human Services.
            ``(13) State.--The term `State' means the State of Hawaii.
            ``(14) Traditional native hawaiian 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) the knowledge, skills, and experience of whom 
                are based on demonstrated learning of Native Hawaiian 
                healing practices acquired by--
                            ``(i) direct practical association with 
                        Native Hawaiian elders; and
                            ``(ii) oral traditions transmitted from 
                        generation to generation.

``SEC. 4. DECLARATION OF NATIONAL NATIVE HAWAIIAN HEALTH POLICY.

    ``(a) Declaration.--Congress declares that it is the policy of the 
United States, in fulfillment of special responsibilities and legal 
obligations of the United States to the indigenous people of Hawaii 
resulting from the unique and historical relationship between the 
United States and the indigenous people of Hawaii--
            ``(1) to raise the health status of Native Hawaiians to the 
        highest practicable health level; and
            ``(2) to provide Native Hawaiian health care programs with 
        all resources necessary to effectuate that policy.
    ``(b) Intent of Congress.--It is the intent of Congress that--
            ``(1) health care programs having a demonstrated effect of 
        substantially reducing or eliminating the overrepresentation of 
        Native Hawaiians among those suffering from chronic and acute 
        disease and illness, and addressing the health needs of Native 
        Hawaiians (including perinatal, early child development, and 
        family-based health education needs), shall be established and 
        implemented; and
            ``(2) the United States--
                    ``(A) raise the health status of Native Hawaiians 
                by the year 2010 to at least the levels described in 
                the goals contained within Healthy People 2010 (or 
                successor standards); and
                    ``(B) incorporate within health programs in the 
                United States activities defined and identified by 
                Kanaka Maoli, such as--
                            ``(i) incorporating and supporting the 
                        integration of cultural approaches to health 
                        and well-being, including programs using 
                        traditional practices relating to the 
                        atmosphere (lewa lani), land ('aina), water 
                        (wai), or ocean (kai);
                            ``(ii) increasing the number of Native 
                        Hawaiian health and allied-health providers who 
                        provide care to or have an impact on the health 
                        status of Native Hawaiians;
                            ``(iii) increasing the use of traditional 
                        Native Hawaiian foods in--
                                    ``(I) the diets and dietary 
                                preferences of people, including those 
                                of students; and
                                    ``(II) school feeding programs;
                            ``(iv) identifying and instituting Native 
                        Hawaiian cultural values and practices within 
                        the corporate cultures of organizations and 
                        agencies providing health services to Native 
                        Hawaiians;
                            ``(v) facilitating the provision of Native 
                        Hawaiian healing practices by Native Hawaiian 
                        healers for individuals desiring that 
                        assistance;
                            ``(vi) supporting training and education 
                        activities and programs in traditional Native 
                        Hawaiian healing practices by Native Hawaiian 
                        healers; and
                            ``(vii) demonstrating the integration of 
                        health services for Native Hawaiians, 
                        particularly those that integrate mental, 
                        physical, and dental services in health care.
    ``(c) Report.--The Secretary shall submit to the President, for 
inclusion in each report required to be submitted to Congress under 
section 12, a report on the progress made toward meeting the national 
policy described 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 that is designed--
                    ``(A) to promote comprehensive health promotion and 
                disease prevention services;
                    ``(B) to maintain and improve the health status of 
                Native Hawaiians; and
                    ``(C) to support community-based initiatives that 
                are reflective of holistic approaches to health.
            ``(2) Consultation.--
                    ``(A) In general.--In carrying out this section, 
                Papa Ola Lokahi and the Office of Hawaiian Affairs 
                shall consult with representatives of--
                            ``(i) the Native Hawaiian health care 
                        systems;
                            ``(ii) the Native Hawaiian health centers; 
                        and
                            ``(iii) the Native Hawaiian community.
                    ``(B) Memoranda of understanding.--Papa Ola Lokahi 
                and the Office of Hawaiian Affairs may enter into 
                memoranda of understanding or agreement for the purpose 
                of acquiring joint funding, or for such other purposes 
                as are necessary, to accomplish the objectives of this 
                section.
            ``(3) Health care financing study report.--
                    ``(A) In general.--Not later than 18 months after 
                the date of enactment of the Native Hawaiian Health 
                Care Improvement Reauthorization Act of 2003, Papa Ola 
                Lokahi, in cooperation with the Office of Hawaiian 
                Affairs and other appropriate agencies and 
                organizations in the State (including the Department of 
                Health and the Department of Human Services of the 
                State) and appropriate Federal agencies (including the 
                Centers for Medicare and Medicaid Services), shall 
                submit to Congress a report that describes the impact 
                of Federal and State health care financing mechanisms 
                and policies on the health and well-being of Native 
                Hawaiians.
                    ``(B) Components.--The report shall include--
                            ``(i) information concerning the impact on 
                        Native Hawaiian health and well-being of--
                                    ``(I) cultural competency;
                                    ``(II) risk assessment data;
                                    ``(III) eligibility requirements 
                                and exemptions; and
                                    ``(IV) reimbursement policies and 
                                capitation rates in effect as of the 
                                date of the report for service 
                                providers;
                            ``(ii) such other similar information as 
                        may be important to improving the health status 
                        of Native Hawaiians, as that information 
                        relates to health care financing (including 
                        barriers to health care); and
                            ``(iii) recommendations for submission to 
                        the Secretary, for review in consultation with 
                        the Native Hawaiian community.
    ``(b) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as are necessary to carry out subsection (a).

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

    ``(a) In General.--Papa Ola Lokahi--
            ``(1) shall be responsible for--
                    ``(A) the coordination, implementation, and 
                updating, as appropriate, of the comprehensive health 
                care master plan under section 5;
                    ``(B) the training and education of individuals 
                providing health services;
                    ``(C) the identification of and research (including 
                behavioral, biomedical, epidemiological, and health 
                service research) into the diseases that are most 
                prevalent among Native Hawaiians; and
                    ``(D) the 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 service research;
            ``(2) may receive special project funds (including research 
        endowments under section 736 of the Public Health Service Act 
        (42 U.S.C. 293)) made available for the purpose of--
                    ``(A) research on the health status of Native 
                Hawaiians; or
                    ``(B) addressing the health care needs of Native 
                Hawaiians; and
            ``(3) shall serve as a clearinghouse for--
                    ``(A) the collection and maintenance of data 
                associated with the health status of Native Hawaiians;
                    ``(B) the identification and research into diseases 
                affecting Native Hawaiians;
                    ``(C) the availability of Native Hawaiian project 
                funds, research projects, and 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.
    ``(b) Consultation.--
            ``(1) In general.--The Secretary and the Secretary of each 
        other Federal agency shall--
                    ``(A) consult with Papa Ola Lokahi; and
                    ``(B) provide Papa Ola Lokahi and the Office of 
                Hawaiian Affairs, at least once annually, an accounting 
                of funds and services provided by the Secretary to 
                assist in accomplishing the purposes described in 
                section 4.
            ``(2) Components of accounting.--The accounting under 
        paragraph (1)(B) shall include an identification of--
                    ``(A) the amount of funds expended explicitly for 
                and benefiting Native Hawaiians;
                    ``(B) the number of Native Hawaiians affected by 
                those funds;
                    ``(C) the collaborations between the applicable 
                Federal agency and Native Hawaiian groups and 
                organizations in the expenditure of those funds; and
                    ``(D) the amount of funds used for--
                            ``(i) Federal administrative purposes; and
                            ``(ii) the provision of direct services to 
                        Native Hawaiians.
    ``(c) Fiscal Allocation and Coordination of Programs and 
Services.--
            ``(1) Recommendations.--Papa Ola Lokahi shall provide 
        annual recommendations to the Secretary with respect to the 
        allocation of all amounts made available under this Act.
            ``(2) Coordination.--Papa Ola Lokahi shall, to the maximum 
        extent practicable, coordinate and assist the health care 
        programs and services provided to Native Hawaiians under this 
        Act and other Federal laws.
            ``(3) Representation on commission.--The Secretary, in 
        consultation with Papa Ola Lokahi, shall make recommendations 
        for Native Hawaiian representation on the President's Advisory 
        Commission on Asian Americans and Pacific Islanders.
    ``(d) Technical Support.--Papa Ola Lokahi provide statewide 
infrastructure to provide technical support and coordination of 
training and technical assistance to--
            ``(1) the Native Hawaiian health care systems; and
            ``(2) the Native Hawaiian health centers.
    ``(e) Relationships With Other Agencies.--
            ``(1) Authority.--Papa Ola Lokahi may enter into agreements 
        or memoranda of understanding with relevant institutions, 
        agencies, or organizations that are capable of providing--
                    ``(A) health-related resources or services to 
                Native Hawaiians and the Native Hawaiian health care 
                systems; or
                    ``(B) resources or services for the implementation 
                of the national policy described in section 4.
            ``(2) Health care financing.--
                    ``(A) Federal consultation.--
                            ``(i) In general.--Before adopting any 
                        policy, rule, or regulation that may affect the 
                        provision of services or health insurance 
                        coverage for Native Hawaiians, a Federal agency 
                        that provides health care financing and carries 
                        out health care programs (including the Centers 
                        for Medicare and Medicaid Services) shall 
                        consult with representatives of--
                                    ``(I) the Native Hawaiian 
                                community;
                                    ``(II) Papa Ola Lokahi; and
                                    ``(III) organizations providing 
                                health care services to Native 
                                Hawaiians in the State.
                            ``(ii) Identification of effects.--Any 
                        consultation by a Federal agency under clause 
                        (i) shall include an identification of the 
                        effect of any policy, rule, or regulation 
                        proposed by the Federal agency.
                    ``(B) State consultation.--Before making any change 
                in an existing program or implementing any new program 
                relating to Native Hawaiian health, the State shall 
                engage in meaningful consultation with representatives 
                of--
                            ``(i) the Native Hawaiian community;
                            ``(ii) Papa Ola Lokahi; and
                            ``(iii) organizations providing health care 
                        services to Native Hawaiians in the State.
                    ``(C) Consultation on federal health insurance 
                programs.--
                            ``(i) In general.--The Office of Hawaiian 
                        Affairs, in collaboration with Papa Ola Lokahi, 
                        may develop consultative, contractual, or other 
                        arrangements, including memoranda of 
                        understanding or agreement, with--
                                    ``(I) the Centers for Medicare and 
                                Medicaid Services;
                                    ``(II) the agency of the State that 
                                administers or supervises the 
                                administration of the State plan or 
                                waiver approved under title XVIII, XIX, 
                                or XXI of the Social Security Act (42 
                                U.S.C. 1395 et seq.) for the payment of 
                                all or a part of the health care 
                                services provided to Native Hawaiians 
                                who are eligible for medical assistance 
                                under the State plan or waiver; or
                                    ``(III) any other Federal agency 
                                providing full or partial health 
                                insurance to Native Hawaiians.
                            ``(ii) Contents of arrangements.--An 
                        arrangement under clause (i) may address--
                                    ``(I) appropriate reimbursement for 
                                health care services, including 
                                capitation rates and fee-for-service 
                                rates for Native Hawaiians who are 
                                entitled to or eligible for insurance;
                                    ``(II) the scope of services; or
                                    ``(III) other matters that would 
                                enable Native Hawaiians to maximize 
                                health insurance benefits provided by 
                                Federal and State health insurance 
                                programs.
            ``(3) Traditional healers.--
                    ``(A) In general.--The provision of health services 
                under any program operated by the Department or another 
                Federal agency (including the Department of Veterans 
                Affairs) may include the services of--
                            ``(i) traditional Native Hawaiian healers; 
                        or
                            ``(ii) traditional healers providing 
                        traditional health care practices (as those 
                        terms are defined in section 4 of the Indian 
                        Health Care Improvement Act (25 U.S.C. 1603).
                    ``(B) Exemption.--Services described in 
                subparagraph (A) shall be exempt from national 
                accreditation reviews, including reviews conducted by--
                            ``(i) the Joint Accreditation Commission on 
                        Health Organizations; and
                            ``(ii) the Rehabilitation Accreditation 
                        Commission.

``SEC. 7. NATIVE HAWAIIAN HEALTH CARE.

    ``(a) Comprehensive Health Promotion, Disease Prevention, and Other 
Health Services.--
            ``(1) Grants and contracts.--The Secretary, in consultation 
        with Papa Ola Lokahi, may make grants to, or enter into 
        contracts with 1 or more Native Hawaiian health care systems 
        for the purpose of providing comprehensive health promotion and 
        disease prevention services, as well as other health services, 
        to Native Hawaiians who desire and are committed to bettering 
        their own health.
            ``(2) Limitation on number of entities.--The Secretary may 
        make a grant to, or enter into a contract with, not more than 8 
        Native Hawaiian health care systems under this subsection for 
        any fiscal year.
    ``(b) Planning Grant or Contract.--In addition to grants and 
contracts under subsection (a), the 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, Kaho`lawe, and Ni`ihau in the State.
    ``(c) Health Services To Be Provided.--
            ``(1) In general.--Each recipient of funds under subsection 
        (a) may provide or arrange for--
                    ``(A) outreach services to inform and assist Native 
                Hawaiians in accessing health services;
                    ``(B) education in health promotion and disease 
                prevention for Native Hawaiians that, wherever 
                practicable, is provided by--
                            ``(i) Native Hawaiian health care 
                        practitioners;
                            ``(ii) community outreach workers;
                            ``(iii) counselors;
                            ``(iv) cultural educators; and
                            ``(v) other disease prevention providers;
                    ``(C) services of individuals providing health 
                services;
                    ``(D) collection of data relating to the prevention 
                of diseases and illnesses among Native Hawaiians; and
                    ``(E) support of culturally appropriate activities 
                that enhance 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) that are provided under grants or 
        contracts under subsection (a) may be provided by traditional 
        Native Hawaiian healers, as appropriate.
    ``(d) Federal Tort Claims Act.--An individual who provides a 
medical, dental, or other service referred to in subsection (a)(1) for 
a Native Hawaiian health care system, including a provider of a 
traditional Native Hawaiian healing service, shall be--
            ``(1) treated as if the individual were a member of the 
        Public Health Service; and
            ``(2) subject to section 224 of the Public Health Service 
        Act (42 U.S.C. 233).
    ``(e) Site for Other Federal Payments.--
            ``(1) In general.--A Native Hawaiian health care system 
        that receives funds under subsection (a) may serve as a Federal 
        loan repayment facility.
            ``(2) Remission of payments.--A facility described in 
        paragraph (1) shall be designed to enable health and allied-
        health professionals to remit payments with respect to loans 
        provided to the professionals under any Federal loan program.
    ``(f) Restriction on Use of Grant and Contract Funds.--The 
Secretary shall not make a grant to, or enter into a contract with, an 
entity under subsection (a) unless the entity agrees that amounts 
received under the grant or contract will not, directly or through 
contract, be expended--
            ``(1) for any service other than a service described in 
        subsection (c)(1);
            ``(2) to purchase or improve real property (other than 
        minor remodeling of existing improvements to real property); or
            ``(3) to purchase major medical equipment.
    ``(g) Limitation on Charges for Services.--The Secretary shall not 
make a grant to, or enter into a contract with, an entity under 
subsection (a) unless the entity agrees that, whether health services 
are provided directly or under a contract--
            ``(1) any health service under the grant or contract will 
        be provided without regard to the ability of an individual 
        receiving the health service to pay for the health service; and
            ``(2) the entity will impose for the delivery of such a 
        health service a charge that is--
                    ``(A) made according to a schedule of charges that 
                is made available to the public; and
                    ``(B) adjusted to reflect the income of the 
                individual involved.
    ``(h) Authorization of Appropriations.--
            ``(1) General grants.--There are authorized to be 
        appropriated such sums as are necessary to carry out subsection 
        (a) for each of fiscal years 2004 through 2009.
            ``(2) Planning grants.--There are authorized to be 
        appropriated such sums as are necessary to carry out subsection 
        (b) for each of fiscal years 2004 through 2009.
            ``(3) Health services.--There are authorized to be 
        appropriated such sums as are necessary to carry out subsection 
        (c) for each of fiscal years 2004 through 2009.

``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 under section 5;
            ``(2) training and education for providers of health 
        services;
            ``(3) identification of and research (including behavioral, 
        biomedical, epidemiologic, and health service research) into 
        the diseases that are most prevalent among Native Hawaiians;
            ``(4) a clearinghouse function for--
                    ``(A) the collection and maintenance of data 
                associated with the health status of Native Hawaiians;
                    ``(B) the identification and research into diseases 
                affecting Native Hawaiians; and
                    ``(C) the availability of Native Hawaiian project 
                funds, research projects, and publications;
            ``(5) the establishment and maintenance of an institutional 
        review board for all health-related research involving Native 
        Hawaiians;
            ``(6) the coordination of the health care programs and 
        services provided to Native Hawaiians; and
            ``(7) the administration of special project funds.
    ``(b) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as are necessary to carry out subsection (a) for 
each of fiscal years 2004 through 2009.

``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 the 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 shall not make a 
grant or enter into a contract under this Act with an entity unless the 
entity--
            ``(1) agrees to establish such procedures for fiscal 
        control and fund accounting as the Secretary determines are 
        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 who is 
                fluent in English and the appropriate language to 
                assist in carrying out the plan;
            ``(4) with respect to health services that are covered 
        under a program under title XVIII, XIX, or XXI of the Social 
        Security Act (42 U.S.C. 1395 et seq.) (including any State 
        plan), or under any other Federal health insurance plan--
                    ``(A) if the entity will provide under the grant or 
                contract any of those health services directly--
                            ``(i) has entered into a participation 
                        agreement under each such plan; and
                            ``(ii) is qualified to receive payments 
                        under the plan; and
                    ``(B) if the entity will provide under the grant or 
                contract any of those health services through a 
                contract with an organization--
                            ``(i) ensures that the organization has 
                        entered into a participation agreement under 
                        each such plan; and
                            ``(ii) ensures that the organization is 
                        qualified to receive payments under the plan; 
                        and
            ``(5) agrees to submit to the Secretary and Papa Ola Lokahi 
        an annual report that--
                    ``(A) describes the use and costs of health 
                services provided under the grant or contract 
                (including the average cost of health services per 
                user); and
                    ``(B) provides such other information as the 
                Secretary determines to be appropriate.
    ``(d) Contract Evaluation.--
            ``(1) Determination of noncompliance.--If, as a result of 
        evaluations conducted by the Secretary, the Secretary 
        determines that an entity has not complied with or 
        satisfactorily performed a contract entered into under section 
        7, the Secretary shall, before renewing the contract--
                    ``(A) attempt to resolve the areas of noncompliance 
                or unsatisfactory performance; and
                    ``(B) modify the contract to prevent future 
                occurrences of the 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--
                    ``(A) shall not renew the contract with the entity; 
                and
                    ``(B) may enter into a contract under section 7 
                with another entity referred to in section 7(a)(3) that 
provides services to the same population of Native Hawaiians served by 
the entity the contract with which was 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.--Each contract entered 
        into by the Secretary under this Act shall be in accordance 
        with all Federal contracting laws (including regulations), 
        except that, in the discretion of the Secretary, such a 
        contract may--
                    ``(A) be negotiated without advertising; and
                    ``(B) be exempted from subchapter III of chapter 
                31, United States Code.
            ``(5) Payments.--A payment made under any contract entered 
        into under this Act--
                    ``(A) may be made--
                            ``(i) in advance;
                            ``(ii) by means of reimbursement; or
                            ``(iii) in installments; and
                    ``(B) shall be made on such conditions as the 
                Secretary determines to be necessary to carry out this 
                Act.
    ``(e) Report.--
            ``(1) In general.--For each fiscal year during which an 
        entity receives or expends funds under a grant or contract 
        under this Act, the entity shall submit to the Secretary and to 
        Papa Ola Lokahi an annual report that describes--
                    ``(A) the activities conducted by the entity under 
                the grant or contract;
                    ``(B) the amounts and purposes for which Federal 
                funds were expended; and
                    ``(C) 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--
                    ``(A) the Secretary;
                    ``(B) the Inspector General of the Department of 
                Health and Human Services; and
                    ``(C) 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 to 
carry out this section.

``SEC. 10. ASSIGNMENT OF PERSONNEL.

    ``(a) In General.--The Secretary may enter into an agreement with 
Papa Ola Lokahi or any of the Native Hawaiian health care systems for 
the assignment of personnel of the Department of Health and Human 
Services with relevant expertise for the purpose of--
            ``(1) conducting research; or
            ``(2) providing comprehensive health promotion and disease 
        prevention services and health 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 to Papa 
Ola Lokahi, through a direct grant or a cooperative agreement, funds 
for the purpose of providing scholarship assistance to students who are 
Native Hawaiians.
    ``(b) Priority.--A priority for scholarships under subsection (a) 
may be provided to employees of--
            ``(1) the Native Hawaiian Health Care Systems; and
            ``(2) the Native Hawaiian Health Centers.
    ``(c) Terms and Conditions.--
            ``(1) Scholarship assistance.--
                    ``(A) In general.--The scholarship assistance under 
                subsection (a) shall be provided in accordance with 
                subparagraphs (B) through (G).
                    ``(B) Need.--The provision of scholarships in each 
                type of health profession training shall correspond to 
                the need for each type of health professional to serve 
                the Native Hawaiian community in providing health 
                services, as identified by Papa Ola Lokahi.
                    ``(C) Eligible applicants.--To the maximum extent 
                practicable, the Secretary shall select scholarship 
                recipients from a list of eligible applicants submitted 
                by Papa Ola Lokahi.
                    ``(D) Obligated service requirement.--
                            ``(i) In general.--An obligated service 
                        requirement for each scholarship recipient 
                        (except for a recipient receiving assistance 
                        under paragraph (2)) shall be fulfilled through 
                        service, in order of priority, in--
                                    ``(I) any of the Native Hawaiian 
                                health care systems;
                                    ``(II) any of the Native Hawaiian 
                                health centers;
                                    ``(III) 1 or more health 
                                professions shortage areas, medically 
                                underserved areas, or geographic areas 
                                or facilities similarly designated by 
                                the Public Health Service in the State;
                                    ``(IV) a Native Hawaiian 
                                organization that serves a geographical 
                                area, facility, or organization that 
                                serves a significant Native Hawaiian 
                                population;
                                    ``(V) any public agency or 
                                nonprofit organization providing 
                                services to Native Hawaiians; or
                                    ``(VI) any of the uniformed 
                                services of the United States.
                            ``(ii) Assignment.--The placement service 
                        for a scholarship shall assign each Native 
                        Hawaiian scholarship recipient to 1 or more 
                        appropriate sites for service in accordance 
                        with clause (i).
                    ``(E) Counseling, retention, and support 
                services.--The provision of academic and personal 
                counseling, retention and other support services--
                            ``(i) shall not be limited to scholarship 
                        recipients under this section; and
                            ``(ii) shall be made available to 
                        recipients of other scholarship and financial 
                        aid programs enrolled in appropriate health 
                        professions training programs.
                    ``(F) Financial assistance.--After consultation 
                with Papa Ola Lokahi, financial assistance may be 
                provided to a scholarship recipient during the period 
                that the recipient is fulfilling the service 
                requirement of the recipient in any of--
                            ``(i) the Native Hawaiian health care 
                        systems; or
                            ``(ii) the Native Hawaiians health centers.
                    ``(G) Distance learning recipients.--A scholarship 
                may be provided to a Native Hawaiian who is enrolled in 
                an appropriate distance learning program offered by an 
                accredited educational institution.
            ``(2) Fellowships.--
                    ``(A) In general.--Papa Ola Lokahi may provide 
                financial assistance in the form of a fellowship to a 
                Native Hawaiian health professional who is--
                            ``(i) a Native Hawaiian community health 
                        representative, outreach worker, or health 
                        program administrator in a professional 
                        training program;
                            ``(ii) a Native Hawaiian providing health 
                        services; or
                            ``(iii) a Native Hawaiian enrolled in a 
                        certificated program 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).
                    ``(B) Types of assistance.--Assistance under 
                subparagraph (A) may include a stipend for, or 
                reimbursement for costs associated with, participation 
in a program described in that paragraph.
            ``(3) Rights and benefits.--An individual who is a health 
        profession designated in section 338A of the Public Health 
        Service Act (42 U.S.C. 254l) who receives a scholarship under 
        this subsection while fulfilling a service requirement under 
        that Act shall retain the same rights and benefits as members 
        of the National Health Service Corps during the period of 
        service.
            ``(4) No inclusion of assistance in gross income.--
        Financial assistance provided under this section shall be 
        considered to be qualified scholarships for the purpose of 
        section 117 of the Internal Revenue Code of 1986.
    ``(d) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as are necessary to carry out subsections (a) 
and (c)(2) for each of fiscal years 2004 through 2009.

``SEC. 12. REPORT.

    ``For each fiscal year, the President shall, at the time at which 
the budget of the United States is submitted under section 1105 of 
title 31, United States Code, submit to Congress a report on the 
progress made in meeting the purposes of this Act, including--
            ``(1) a review of programs established or assisted in 
        accordance with this Act; and
            ``(2) an assessment of and recommendations for additional 
        programs or additional assistance necessary to provide, at a 
        minimum, health services to Native Hawaiians, and ensure a 
        health status for Native Hawaiians, that 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 an organization that 
enters into a contract or receives grant under this Act to use in 
carrying out projects or activities under the contract or grant all 
existing facilities under the jurisdiction of the Secretary (including 
all equipment of the facilities), in accordance with such terms and 
conditions as may be agreed on for the use and maintenance of the 
facilities or equipment.
    ``(b) Donation of Property.--The Secretary may donate to an 
organization that enters into a contract or receives grant under this 
Act, for use in carrying out a project or activity under the contract 
or grant, any personal or real property determined to be in excess of 
the needs of the Department or the General Services Administration.
    ``(c) Acquisition of Surplus Property.--The Secretary may acquire 
excess or surplus Federal Government personal or real property for 
donation to an organization under subsection (b) if the Secretary 
determines that the property is appropriate for use by the organization 
for the purpose for which a contract entered into or grant received by 
the organization is authorized under this Act.

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

    ``(a) Authority and Areas of Interest.--
            ``(1) In general.--The Secretary, in consultation with Papa 
        Ola Lokahi, may allocate amounts made available under this Act, 
        or any other Act, to carry out Native Hawaiian demonstration 
        projects of national significance.
            ``(2) Areas of interest.--A demonstration project described 
        in paragraph (1) may relate to such areas of interest as--
                    ``(A) the development of a centralized database and 
                information system relating to the health care status, 
                health care needs, and wellness of Native Hawaiians;
                    ``(B) 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;
                    ``(C) the integration of Western medicine with 
                complementary healing practices, including traditional 
                Native Hawaiian healing practices;
                    ``(D) the use of telewellness and 
                telecommunications in--
                            ``(i) chronic and infectious disease 
                        management; and
                            ``(ii) health promotion and disease 
                        prevention;
                    ``(E) the development of appropriate models of 
                health care for Native Hawaiians and other indigenous 
                people, including--
                            ``(i) the provision of culturally competent 
                        health services;
                            ``(ii) related activities focusing on 
                        wellness concepts;
                            ``(iii) the development of appropriate 
                        kupuna care programs; and
                            ``(iv) the development of financial 
                        mechanisms and collaborative relationships 
                        leading to universal access to health care; and
                    ``(F) the establishment of--
                            ``(i) a Native Hawaiian Center of 
                        Excellence for Nursing at the University of 
                        Hawaii at Hilo;
                            ``(ii) a Native Hawaiian Center of 
                        Excellence for Mental Health at the University 
                        of Hawaii at Manoa;
                            ``(iii) a Native Hawaiian Center of 
                        Excellence for Maternal Health and Nutrition at 
                        the Waimanalo Health Center;
                            ``(iv) a Native Hawaiian Center of 
                        Excellence for Research, Training, Integrated 
                        Medicine at Molokai General Hospital; and
                            ``(v) a Native Hawaiian Center of 
                        Excellence for Complementary Health and Health 
                        Education and Training at the Waianae Coast 
                        Comprehensive Health Center.
            ``(3) Centers of excellence.--Papa Ola Lokahi, and any 
        centers established under paragraph (2)(F), shall be considered 
        to be qualified as Centers of Excellence under sections 485F 
        and 903(b)(2)(A) of the Public Health Service Act (42 U.S.C. 
        287c-32, 299a-1).
    ``(b) Nonreduction in Other Funding.--The allocation of funds for 
demonstration projects under subsection (a) shall not result in any 
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 the respective 
responsibilities of those entities under this Act.

``SEC. 15. RULE OF CONSTRUCTION.

    ``Nothing in this Act restricts the authority of the State to 
require licensing of, and issue licenses to, health practitioners.

``SEC. 16. COMPLIANCE WITH BUDGET ACT.

    ``Any new spending authority described in subparagraph (A) or (B) 
of section 401(c)(2) of the Congressional Budget Act of 1974 (2 U.S.C. 
651(c)(2)) that 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 Acts of appropriation.

``SEC. 17. SEVERABILITY.

    ``If any provision of this Act, or the application of any such 
provision to any person or circumstance, is determined by a court of 
competent jurisdiction to be invalid, the remainder of this Act, and 
the application of the provision to a person or circumstance other than 
that to which the provision is held invalid, shall not be affected by 
that holding.''.




                                                       Calendar No. 796

108th CONGRESS

  2d Session

                                 S. 702

                          [Report No. 108-405]

_______________________________________________________________________

                                 A BILL

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

_______________________________________________________________________

                           November 10, 2004

                       Reported without amendment