1.This Act may be cited as the
Native Hawaiian Health Care
Improvement Reauthorization Act of 2007
.
2.Amendment to the
Native Hawaiian Health Care Improvement ActThe Native Hawaiian Health Care Improvement
Act (42 U.S.C. 11701 et seq.) is amended to read as follows:
1.Short title; table of
contents
(a)This Act may be cited as the Native Hawaiian Health
Care Improvement Act
.
(b)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.
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.
2.
(a)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 Hawai'i 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
Hawai’i;
(8)the constitution
and statutes of the State of Hawai'i—
(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 Hawai'i 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 Hawai'i;
(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 Hawai'i, 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 Hawai'i;
(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 Hawai'i; 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 Hawai'i or the lawful Government of Hawai'i, in violation
of—
(i)treaties between
the Government of Hawai'i 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 Hawai’i, and the Hawaiian Patriotic
League, representing the aboriginal citizens of Hawai'i, 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 Hawai'i 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)between 1897 and
1898, when the total Native Hawaiian population in Hawai’i was less than
40,000, more than 38,000 Native Hawaiians signed petitions (commonly known as
Ku’e Petitions
) protesting annexation by the United States and
requesting restoration of the monarchy;
(18)despite Native
Hawaiian protests, in 1898, the United States—
(A)annexed Hawai'i
through Resolution No. 55 (commonly known as the Newlands
Resolution
) (30 Stat. 750), without the consent of, or compensation to,
the indigenous people of Hawai'i 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;
(19)through the
Newlands Resolution and the Act of April 30, 1900 (commonly known as the
1900 Organic Act
) (31 Stat. 141, chapter 339), the United
States—
(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 Hawai'i;
(20)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.
;
(21)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
;
(22)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;
(23)under the Act
referred to in paragraph (22), 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);
(24)in 1978, the
people of Hawai'i—
(A)amended the
constitution of Hawai'i 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;
(25)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 Hawai’i;
(26)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;
(27)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;
(28)that program is
conducted by the Native Hawaiian Health Care Systems and Papa Ola
Lokahi;
(29)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;
(30)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);
(31)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.);
(32)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);
(33)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);
(34)in addition, the
United States—
(A)has recognized
that Native Hawaiians, as aboriginal, indigenous, native people of Hawai'i, are
a unique population group in Hawai'i and in the continental United States;
and
(B)has so declared
in—
(i)the documents of
the Office of Management and Budget entitled—
(I)Standards
for Maintaining, Collecting, and Presenting Federal Data on Race and
Ethnicity
and dated October 30, 1997; and
(II)Provisional
Guidance on the Implementation of the 1997 Standards for Federal Data on Race
and Ethnicity
and dated December 15, 2000;
(ii)the document
entitled Guidance on Aggregation and Allocation of Data on Race for Use
in Civil Rights Monitoring and Enforcement
(Bulletin 00-02 to the Heads
of Executive Departments and Establishments) and dated March 9, 2000;
(iii)the document
entitled Questions and Answers when Designing Surveys for Information
Collections
(Memorandum for the President’s Management Council) and
dated January 20, 2006;
(iv)Executive order
number 13125 (64 Fed. Reg. 31105; relating to increasing participation of Asian
Americans and Pacific Islanders in Federal programs) (June 7, 1999);
(v)the document
entitled HHS Tribal Consultation Policy
and dated January 2005;
and
(vi)the Department
of Health and Human Services Intradepartment Council on Native American
Affairs, Revised Charter, dated March 7, 2005; and
(35)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 DisparitiesCongress 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)
(i)With respect to all cancer—
(I)as an underlying
cause of death in the State, the cancer mortality rate of Native Hawaiians of
218.3 per 100,000 residents is 50 percent higher than the rate for the total
population of the State of 145.4 per 100,000 residents;
(II)Native Hawaiian
males have the highest cancer mortality rates in the State for cancers of the
lung, colon, and rectum, and for all cancers combined;
(III)Native Hawaiian
females have the highest cancer mortality rates in the State for cancers of the
lung, breast, colon, rectum, pancreas, stomach, ovary, liver, cervix, kidney,
and uterus, and for all cancers combined; and
(IV)for the period
of 1995 through 2000—
- (aa)the cancer
mortality rate for all cancers for Native Hawaiian males of 217 per 100,000
residents was 22 percent higher than the rate for all males in the State of 179
per 100,000 residents; and
- (bb)the cancer
mortality rate for all cancers for Native Hawaiian females of 192 per 100,000
residents was 64 percent higher than the rate for all females in the State of
117 per 100,000 residents.
(ii)With respect to breast cancer—
(I)Native Hawaiians
have the highest mortality rate in the State from breast cancer (30.79 per
100,000 residents), which is 33 percent higher than the rate for Caucasian
Americans (23.07 per 100,000 residents) and 106 percent higher than the rate
for Chinese Americans (14.96 per 100,000 residents); and
(II)nationally,
Native Hawaiians have the third-highest mortality rate as a result of breast
cancer (25.0 per 100,000 residents), behind African Americans (31.4 per 100,000
residents) and Caucasian Americans (27.0 per 100,000 residents).
(iii)Native Hawaiians have the highest mortality rate as a
result of cancer of the cervix in the State (3.65 per 100,000 residents),
followed by Filipino Americans (2.69 per 100,000 residents) and Caucasian
Americans (2.61 per 100,000 residents).
(iv)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 are higher than the rates for
the total population of the State by 48 percent for males and 93 percent for
females.
(v)Native Hawaiian males have the third-highest mortality
rate as a result of prostate cancer in the State (21.48 per 100,000 residents),
with Caucasian Americans having the highest mortality rate as a result of
prostate cancer (23.96 per 100,000 residents).
(B)With
respect to diabetes, in 2004—
(i)Native Hawaiians
had the highest mortality rate as a result of diabetes mellitis (28.9 per
100,000 residents) in the State, which is 119 percent higher than the rate for
all racial groups in the State (13.2 per 100,000 residents);
(ii)the prevalence
of diabetes for Native Hawaiians was 12.7 percent, which is 87 percent higher
than the total prevalence for all residents of the State of 6.8 percent;
and
(iii)a higher
percentage of Native Hawaiians with diabetes experienced diabetic retinopathy,
as compared to other population groups in the State.
(C)With
respect to asthma and lower respiratory disease—
(i)in 2004,
mortality rates for Native Hawaiians (31.6 per 100,000 residents) from chronic
lower respiratory disease were 52 percent higher than rates for the total
population of the State (20.8 per 100,000 residents); and
(ii)in 2005, the
prevalence of current asthma in Native Hawaiian adults was 12.8 percent, which
is 71 percent higher than the prevalence of the total population of the State
of 7.5 percent.
(D)
(i)With respect to heart disease—
(I)in 2004, the
mortality rate for Native Hawaiians as a result of heart disease (305.5 per
100,000 residents) was 86 percent higher than the rate for the total population
of the State (164.3 per 100,000 residents); and
(II)in 2005, the
prevalence for heart attack was 4.4 percent for Native Hawaiians, which is 22
percent higher than the prevalence for the total population of 3.6
percent.
(ii)With respect to cerebrovascular diseases—
(I)the mortality
rate from cerebrovascular diseases for Native Hawaiians (75.6 percent) was 64
percent higher than the rate for the total population of the State (46
percent); and
(II)in 2005, the
prevalence for stroke was 4.9 percent for Native Hawaiians, which is 69 percent
higher than the prevalence for the total population of the State (2.9
percent).
(iii)Other
circulatory diseasesWith respect to other circulatory diseases
(including high blood pressure and atherosclerosis)—
(I)in 2004, the
mortality rate for Native Hawaiians of 20.6 per 100,000 residents was 46
percent higher than the rate for the total population of the State of 14.1 per
100,000 residents; and
(II)in 2005, the
prevalence of high blood pressure for Native Hawaiians was 26.7 percent, which
is 10 percent higher than the prevalence for the total population of the State
of 24.2 percent.
(2)Infectious
disease and illnessWith 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 the incidence for any other
non-Caucasian group in the State.
(3)With
respect to injuries—
(A)the mortality
rate for Native Hawaiians as a result of injuries (32 per 100,000 residents) is
16 percent higher than the rate for the total population of the State (27.5 per
100,000 residents);
(B)32 percent of all
deaths of individuals between the ages of 18 and 24 years 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)With respect to dental health—
(A)Native Hawaiian
children experience significantly higher rates of dental caries and unmet
treatment needs as compared to other children in the continental United States
and other ethnic groups in the State;
(B)the prevalence
rate of dental caries in the primary (baby) teeth of Native Hawaiian children
aged 5 to 9 years of 4.2 per child is more than twice the national average rate
of 1.9 per child in that age range;
(C)81.9 percent of
Native Hawaiian children aged 6 to 8 have 1 or more decayed teeth, as compared
to—
(i)53 percent for
children in that age range in the continental United States; and
(ii)72.7 percent of
other children in that age range in the State; and
(D)21 percent of
Native Hawaiian children aged 5 demonstrate signs of baby bottle tooth decay,
which is generally characterized as severe, progressive dental disease in early
childhood and associated with high rates of dental disorders, as compared to 5
percent for children of that age in the continental United States.
(5)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;
(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); and
(D)except as
provided in the life expectancy calculation for 1920, Native Hawaiians have had
the shortest life expectancy of all major ethnic groups in the United States
since 1910.
(6)Maternal and
child health
(A)With respect to maternal and child health, in
2000—
(i)39 percent of all
deaths of children under the age of 18 years in the State were Native
Hawaiian;
(ii)perinatal
conditions accounted for 38 percent of all Native Hawaiian deaths in that age
group;
(iii)Native Hawaiian
infant mortality rates (9.8 per 1,000 live births) are—
(I)the highest in
the State; and
(II)151 percent
higher than the rate for Caucasian infants (3.9 per 1,000 live births);
and
(iv)Native Hawaiians
have 1 of the highest infant mortality rates in the United States, second only
to the rate for African Americans of 13.6 per 1,000 live births.
(B)With respect to prenatal care—
(i)as of 2005,
Native Hawaiian women have the highest prevalence (20.9 percent) of having had
no prenatal care during the first trimester of pregnancy, as compared to the 5
largest ethnic groups in the State;
(ii)of the mothers
in the State who received no prenatal care in the first trimester, 33 percent
were Native Hawaiian;
(iii)in 2005, 41
percent of mothers with live births who had not completed high school were
Native Hawaiian; 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)With
respect to births, in 2005—
(i)45.2 percent of
live births to Native Hawaiian mothers were nonmarital, putting the affected
infants at higher risk of low birth weight and infant mortality;
(ii)of the 2,934
live births to Native Hawaiian single mothers, 9 percent were low birth weight
(defined as a weight of less than 2,500 grams); and
(iii)43.7 percent of
all low birth-weight infants born to single mothers in the State were Native
Hawaiian.
(D)With respect to births, in 2005—
(i)Native Hawaiians
had the highest rate of births to mothers under the age of 18 years (5.8
percent), as compared to the rate of 2.7 percent for the total population of
the State; and
(ii)nearly 62
percent of all mothers in the State under the age of 19 years were Native
Hawaiian.
(E)With respect to fetal mortality, in 2005—
(i)Native Hawaiians
had the highest number of fetal deaths in the State, as compared to Caucasian,
Japanese, and Filipino residents; and
(ii)(I)17.2 percent of all
fetal deaths in the State were associated with expectant Native Hawaiian
mothers; and
(II)43.5 percent of those Native Hawaiian
mothers were under the age of 25 years.
(7)
(A)With respect to alcohol and drug abuse—
(i)(I)in 2005, Native
Hawaiians had the highest prevalence of smoking of 27.9 percent, which is 64
percent higher than the rate for the total population of the State (17
percent); and
(II)53 percent of Native Hawaiians reported
having smoked at least 100 cigarettes in their lifetime, as compared to 43.3
percent for the total population of the State;
(ii)33 percent of
Native Hawaiians in grade 8 have smoked cigarettes at least once in their
lifetime, as compared to—
(I)22.5 percent for
all youth in the State; and
(II)28.4 percent of
residents of the United States in grade 8;
(iii)Native
Hawaiians have the highest prevalence of binge drinking of 19.9 percent, which
is 21 percent higher than the prevalence for the total population of the State
(16.5 percent);
(iv)the prevalence
of heavy drinking among Native Hawaiians (10.1 percent) is 36 percent higher
than the prevalence for the total population of the State (7.4 percent);
(v)(I)in 2003, 17.2 percent
of Native Hawaiians in grade 6, 45.1 percent of Naive Hawaiians in grade 8,
68.9 percent of Native Hawaiians in grade 10, and 78.1 percent of Native
Hawaiians in grade 12 reported using alcohol at least once in their lifetime,
as compared to 13.2, 36.8, 59.1, and 72.5 percent, respectively, of all
adolescents in the State; and
(II)62.1 percent Native Hawaiians in grade
12 reported being drunk at least once, which is 20 percent higher than the
percentage for all adolescents in the State (51.6 percent);
(vi)on entering
grade 12, 60 percent of Native Hawaiian adolescents reported having used
illicit drugs, including inhalants, at least once in their lifetime, as
compared to—
(I)46.9 percent of
all adolescents in the State; and
(II)52.8 of
adolescents in the United States;
(vii)on entering
grade 12, 58.2 percent of Native Hawaiian adolescents reported having used
marijuana at least once, which is 31 percent higher than the rate of other
adolescents in the State (44.4 percent);
(viii)in 2006,
Native Hawaiians represented 40 percent of the total admissions to substance
abuse treatment programs funded by the State Department of Health; and
(ix)in 2003, Native
Hawaiian adolescents reported the highest prevalence for methamphetamine use in
the State, followed by Caucasian and Filipino adolescents.
(B)With
respect to crime—
(i)during the period
of 1992 to 2002, Native Hawaiian arrests for violent crimes decreased, but the
rate of arrest remained 38.3 percent higher than the rate of the total
population of the State;
(ii)the robbery
arrest rate in 2002 among Native Hawaiian juveniles and adults was 59 percent
higher (6.2 arrests per 100,000 residents) than the rate for the total
population of the State (3.9 arrests per 100,000 residents);
(iii)in 2002—
(I)Native Hawaiian
men comprised between 35 percent and 43 percent of each security class in the
State prison system;
(II)Native Hawaiian
women comprised between 38.1 percent to 50.3 percent of each class of female
prison inmates in the State;
(III)Native
Hawaiians comprised 39.5 percent of the total incarcerated population of the
State; and
(IV)Native Hawaiians
comprised 40 percent of the total sentenced felon population in the State, as
compared to 25 percent for Caucasians, 12 percent for Filipinos, and 5 percent
for Samoans;
(iv)Native Hawaiians
are overrepresented in the State prison population;
(v)of the 2,260
incarcerated Native Hawaiians, 70 percent are between 20 and 40 years of age;
and
(vi)based on
anecdotal information, Native Hawaiians are estimated to comprise between 60
percent and 70 percent of all jail and prison inmates in the State.
(C)With respect to depression and suicide—
(i)(I)in 1999, the prevalence
of depression among Native Hawaiians was 15 percent, as compared to the
national average of approximately 10 percent; and
(II)Native Hawaiian females had a higher
prevalence of depression (16.9 percent) than Native Hawaiian males (11.9
percent);
(ii)in 2000—
(I)Native Hawaiian
adolescents had a significantly higher suicide attempt rate (12.9 percent) than
the rate for other adolescents in the State (9.6 percent); and
(II)39 percent of
all Native Hawaiian adult deaths were due to suicide; and
(iii)in 2006, the
prevalence of obsessive compulsive disorder among Native Hawaiian adolescent
girls was 17.7 percent, as compared to a rate of—
(I)9.2 percent for
Native Hawaiian boys and non-Hawaiian girls; and
(II)a national rate
of 2 percent.
(8)Overweightness
and obesityWith respect to overweightness and obesity—
(A)during the period
of 2000 through 2003, Native Hawaiian males and females had the highest
age-adjusted prevalence rates for obesity (40.5 and 32.5 percent,
respectively), which was—
(i)with respect to
individuals of full Native Hawaiian ancestry, 145 percent higher than the rate
for the total population of the State (16.5 per 100,000); and
(ii)with respect to
individuals with less than 100 percent Native Hawaiian ancestry, 97 percent
higher than the total population of the State; and
(B)for 2005, the
prevalence of obesity among Native Hawaiians was 43.1 percent, which was 119
percent higher than the prevalence for the total population of the State (19.7
percent).
(9)With respect to family and child health—
(A)in 2000, the
prevalence of single-parent families with minor children was highest among
Native Hawaiian households, as compared to all households in the State (15.8
percent and 8.1 percent, respectively);
(B)in 2002,
nonmarital births accounted for 56.8 percent of all live births among Native
Hawaiians, as compared to 34 percent of all live births in the State;
(C)the rate of
confirmed child abuse and neglect among Native Hawaiians has consistently been
3 to 4 times the rates of other major ethnic groups, with a 3-year average of
63.9 cases in 2002, as compared to 12.8 cases for the total population of the
State;
(D)spousal abuse or
abuse of an intimate partner was highest for Native Hawaiians, as compared to
all cases of abuse in the State (4.5 percent and 2.2 percent, respectively);
and
(E)(i)1/2
of uninsured adults in the State have family incomes below 200 percent of the
Federal poverty level; and
(ii)Native Hawaiians residing in the
State and the continental United States have a higher rate of uninsurance than
other ethnic groups in the State and continental United States (14.5 percent
and 9.5 percent, respectively).
(10)Health
professions education and trainingWith respect to health
professions education and training—
(A)in 2003, adult
Native Hawaiians had a higher rate of high school completion, as compared to
the total adult population of the State (49.4 percent and 34.4 percent,
respectively);
(B)Native Hawaiian
physicians make up 4 percent of the total physician workforce in the State;
and
(C)in 2004, Native
Hawaiians comprised—
(i)11.25 percent of
individuals who earned bachelor’s degrees;
(ii)6 percent of
individuals who earned master’s degrees;
(iii)3 percent of
individuals who earned doctorate degrees;
(iv)7.9 percent of
the credited student body at the University of Hawai’i;
(v)0.4 percent of
the instructional faculty at the University of Hawai’i at Manoa; and
(vi)8.4 percent of
the instructional faculty at the University of Hawai’i Community
Colleges.
3.In this Act:
(1)The
term Department means the Department of Health and Human
Services.
(2)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)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)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 medicament service;
(H)a mental health
service, including a service provided by a psychologist or social
worker;
(I)a genetic
counseling service;
(J)a health
administration service, 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 complementary
healing practice, including a practice performed by a traditional Native
Hawaiian healer.
(5)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 systemThe 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; or
(II)the grant each
Native Hawaiian health care system receives from the Secretary under this
Act.
(7)Native hawaiian
health centerThe 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 forceThe 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
organizationThe 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 affairsThe term Office of Hawaiian Affairs
means the governmental entity that—
(A)is established
under article XII, sections 5 and 6, of the Hawai'i State Constitution;
and
(B)charged with the
responsibility to formulate policy relating to the affairs of Native
Hawaiians.
(11)
(A)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 Hawai'i State
Department of Health;
(VI)the Native
Hawaiian Health Task Force;
(VII)the Hawai'i
State Primary Care Association;
(VIII)Ahahui O Na
Kauka, the Native Hawaiian Physicians 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 Hawai'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 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)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)The
term Secretary means the Secretary of Health and Human
Services.
(13)The
term State means the State of Hawaii.
(14)Traditional
native hawaiian healerThe 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.
4.Declaration of
national Native Hawaiian health policy
(a)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 Hawai'i resulting from the unique and historical relationship between
the United States and the indigenous people of Hawaii—
(1)to raise the
health status of Native 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)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)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.
5.Comprehensive
health care master plan for Native Hawaiians
(a)
(1)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)
(A)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
understandingPapa 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)Not later than 18 months after the date of enactment of
the Native Hawaiian Health Care Improvement Reauthorization Act of 2007, 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)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 and consultation with the Native
Hawaiian community.
(b)Authorization
of AppropriationsThere are authorized to be appropriated such
sums as are necessary to carry out subsection (a).
6.Functions of
Papa Ola Lokahi
(a)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)
(1)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)The accounting under paragraph (1)(B) shall include an
identification of—
(A)the amount of
funds expended explicitly for and benefitting 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)Papa
Ola Lokahi shall provide annual recommendations to the Secretary with respect
to the allocation of all amounts made available under this Act.
(2)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 commissionThe 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)Papa Ola Lokahi shall 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)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)
(A)
(i)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 effectsAny 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)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)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)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)
(A)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)Services
described in subparagraph (A) shall be exempt from national accreditation
reviews, including reviews conducted by—
(i)the Joint
Commission on Accreditation of Healthcare Organizations; and
(ii)the Commission
on Accreditation of Rehabilitation Facilities.
7.Native Hawaiian
health care
(a)Comprehensive
Health Promotion, Disease Prevention, and Other Health Services
(1)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 entitiesThe 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 ContractIn 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)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)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)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)A Native Hawaiian health care system that receives funds
under subsection (a) may serve as a Federal loan repayment facility.
(2)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 FundsThe 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 ServicesThe 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)There are authorized to be appropriated such sums as are
necessary to carry out subsection (a) for each of fiscal years 2007 through
2012.
(2)There are authorized to be appropriated such sums as are
necessary to carry out subsection (b) for each of fiscal years 2007 through
2012.
(3)There are authorized to be appropriated such sums as are
necessary to carry out subsection (c) for each of fiscal years 2007 through
2012.
8.Administrative
grant for Papa Ola Lokahi
(a)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 AppropriationsThere are authorized to be appropriated such
sums as are necessary to carry out subsection (a) for each of fiscal years 2007
through 2012.
9.Administration
of grants and contracts
(a)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)The Secretary shall periodically evaluate the performance
of, and compliance with, grants and contracts under this Act.
(c)Administrative
RequirementsThe 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)
(1)Determination
of noncomplianceIf, 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)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)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 lawsEach 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)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)
(1)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)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)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.
10.
(a)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 ProvisionsAny 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.
11.Native Hawaiian
health scholarships and fellowships
(a)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 and fellowship
assistance, counseling, and placement service assistance to students who are
Native Hawaiians.
(b)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)
(1)
(A)The scholarship assistance under subsection (a) shall be
provided in accordance with subparagraphs (B) through (G).
(B)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)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)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)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 servicesThe 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)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 recipientsA scholarship may be provided to a Native
Hawaiian who is enrolled in an appropriate distance learning program offered by
an accredited educational institution.
(2)
(A)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)Assistance under subparagraph (A) may include a
stipend for, or reimbursement for costs associated with, participation in a
program described in that paragraph.
(3)An individual who is a health professional 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 incomeFinancial 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 AppropriationsThere are authorized to be appropriated such
sums as are necessary to carry out subsections (a) and (c)(2) for each of
fiscal years 2007 through 2012.
12.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.
13.Use of Federal
Government facilities and sources of supply
(a)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)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 PropertyThe 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.
14.Demonstration
projects of national significance
(a)Authority and
Areas of Interest
(1)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)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
telehealth 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 Hawai'i
at Hilo;
(ii)a Native
Hawaiian Center of Excellence for Mental Health at the University of Hawai'i 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)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 FundingThe 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.
15.Nothing in this
Act restricts the authority of the State to require licensing of, and issue
licenses to, health practitioners.
16.Compliance with
Budget ActAny 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.
17.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.
.