[Congressional Record Volume 145, Number 162 (Tuesday, November 16, 1999)]
[Senate]
[Pages S14620-S14628]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. INOUYE (for himself and Mr. Akaka):
  S. 1929. A bill to amend the Native Hawaiian Health Care Improvement 
Act to revise and extend such Act; to the Committee on Indian Affairs.


  Native Hawaiian Health Care Improvement Act Reauthorization of 1999

  Mr. INOUYE. Mr. President, I rise today to introduce a bill to 
reauthorize and extend the provisions of the Native Hawaiian Health 
Care Act. I am joined in the sponsorship of this measure by my esteemed 
colleague, Senator Daniel Akaka.
  Although the act was enacted into law in 1988, appropriations to 
implement these critically-needed health care programs and services 
were not forthcoming for several years. As a result, the Native 
Hawaiian Health care Systems are still struggling to address the 
overwhelming need for health care services that are designed to improve 
the health status of the native people of Hawaii.
  Native Hawaiians have the highest cancer mortality rates in the State 
of Hawaii, as well as the highest years of productive life lost from 
cancer. Native Hawaiians also have the highest mortality rates in the 
State of Hawaii from diabetes mellitus--130 percent higher than the 
statewide rate for all other races. The death rate from heart disease 
is 66 percent higher amongst Native Hawaiians than for the entire State 
of Hawaii. The Native Hawaiian mortality rate associated with 
hypertension is 84 percent higher than that for the rest of the State. 
These are just a few of the health status indicators at which the 
health care programs and services authorized by the Native Hawaiian 
Health Care Improvement Act are targeted.
  Through the training of Native Hawaiian health care professionals, 
and the assignment of physicians, nurses, allied health professionals, 
and traditional healers to serve the needs of the Native Hawaiian 
community, we anticipate that the objectives established by the Surgeon 
General--the Healthy People 2010 goals--as well as kanaka maoli health 
objectives--will be attained. But to do so will require a sustained 
effort and a continuity of authorization and support for health care 
services provided to our most needy population.
  Mr. President, I ask unanimous consent that the text of this measure 
be printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1829

       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 Act Reauthorization of 1999''.

     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:


[[Page S14621]]


``Sec. 1. Short title; table of contents.
``Sec. 2. Findings.
``Sec. 3. Definitions.
``Sec. 4. Declaration of policy.
``Sec. 5. Comprehensive health care master plan for Native Hawaiians.
``Sec. 6. Functions of Papa Ola Lokahi.
``Sec. 7. Native Hawaiian Health Care Systems.
``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. Demonstration projects of national significance.
``Sec. 14. National Bipartisan Commission on Native Hawaiian Health 
              Care Entitlement.
``Sec. 15. Rule of construction.
``Sec. 16. Compliance with Budget Act.
``Sec. 17. Severability.

     ``SEC. 2. FINDINGS.

       ``(a) General Findings.--Congress makes the following 
     findings:
       ``(1) Native Hawaiians begin their story with the Kumulipo 
     which details the creation and inter-relationship of all 
     things, including their evolvement as healthy and well 
     people.
       ``(2) Native Hawaiians are a distinct and unique indigenous 
     people with a historical continuity to the original 
     inhabitants of the Hawaiian archipelago and have a distinct 
     society organized almost 2,000 years ago.
       ``(3) Native Hawaiians have never directly relinquished to 
     the United States their claims to their inherent sovereignty 
     as a people or over their national lands, either through 
     their monarchy or through a plebiscite or referendum.
       ``(4) The health and well-being of Native Hawaiians are 
     intrinsically tied to their deep feelings and attachment to 
     their lands and seas.
       ``(5) The long-range economic and social changes in Hawaii 
     over the 19th and early 20th centuries have been devastating 
     to the health and well-being of Native Hawaiians.
       ``(6) The Native Hawaiian people are determined to 
     preserve, develop and transmit to future generations their 
     ancestral territory, and their cultural identity in 
     accordance with their own spiritual and traditional beliefs, 
     customs, practices, language, and social institutions. In 
     referring to themselves, Native Hawaiians use the term 
     ``Kanaka Maoli'', a term frequently used in the 19th century 
     to describe the native people of Hawaii.
       ``(7) The constitution and statutes of the State of 
     Hawaii--
       ``(A) acknowledge the distinct land rights of Native 
     Hawaiian people as beneficiaries of the public lands trust; 
     and
       ``(B) reaffirm and protect the unique right of the Native 
     Hawaiian people to practice and perpetuate their cultural and 
     religious customs, beliefs, practices, and language.
       ``(8) At the time of the arrival of the first nonindigenous 
     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.
       ``(9) A unified monarchical government of the Hawaiian 
     Islands was established in 1810 under Kamehameha I, the first 
     King of Hawaii.
       ``(10) Throughout the 19th century and until 1893, the 
     United States--
       ``(A) recognized the independence of the Hawaiian Nation;
       ``(B) extended full and complete diplomatic recognition to 
     the Hawaiian Government; and
       ``(C) entered into treaties and conventions with the 
     Hawaiian monarchs to govern commerce and navigation in 1826, 
     1842, 1849, 1875 and 1887.
       ``(11) In 1893, John L. Stevens, the United States Minister 
     assigned to the sovereign and independent Kingdom of Hawaii, 
     conspired with a small group of non-Hawaiian residents of the 
     Kingdom, including citizens of the United States, to 
     overthrow the indigenous and lawful government of Hawaii.
       ``(12) In pursuance of that conspiracy, the United States 
     Minister and the naval representative of the United States 
     caused armed naval forces of the United States to invade the 
     sovereign Hawaiian Nation in support of the overthrow of the 
     indigenous and lawful Government of Hawaii and the United 
     States Minister thereupon extended diplomatic recognition of 
     a provisional government formed by the conspirators without 
     the consent of the native people of Hawaii or the lawful 
     Government of Hawaii in violation of treaties between the 2 
     nations and of international law.
       ``(13) In a message to Congress on December 18, 1893, then 
     President Grover Cleveland reported fully and accurately on 
     these illegal actions, and acknowledged that by these acts, 
     described by the President as acts of war, the government of 
     a peaceful and friendly people was overthrown, and the 
     President concluded that a ``substantial wrong has thus been 
     done which a due regard for our national character as well as 
     the rights of the injured people required that we should 
     endeavor to repair''.
       ``(14) Queen Lili`uokalani, the lawful monarch of Hawaii, 
     and the Hawaiian Patriotic League, representing the 
     aboriginal citizens of Hawaii, promptly petitioned the United 
     States for redress of these wrongs and for restoration of the 
     indigenous government of the Hawaiian nation, but this 
     petition was not acted upon.
       ``(15) Further, the United States has acknowledged the 
     significance of these events and has apologized to Native 
     Hawaiians on behalf of the people of the United States for 
     the overthrow of the Kingdom of Hawaii with the participation 
     of agents and citizens of the United States, and the 
     resulting deprivation of the rights of Native Hawaiians to 
     self-determination in legislation in 1993 (Public Law 103-
     150; 107 Stat. 1510).
       ``(16) In 1898, the United States annexed Hawaii through 
     the Newlands Resolution without the consent of or 
     compensation to the indigenous people of Hawaii or their 
     sovereign government who were thereby denied the mechanism 
     for expression of their inherent sovereignty through self-
     government and self- determination, their lands and ocean 
     resources.
       ``(17) Through the Newlands Resolution and the 1900 Organic 
     Act, the Congress received 1,750,000 acres of lands formerly 
     owned by the Crown and Government of the Hawaiian Kingdom and 
     exempted the lands from then existing public land laws of the 
     United States by mandating that the revenue and proceeds from 
     these lands be ``used solely for the benefit of the 
     inhabitants of the Hawaiian Islands for education and other 
     public purposes'', thereby establishing a special trust 
     relationship between the United States and the inhabitants of 
     Hawaii.
       ``(18) In 1921, Congress enacted the Hawaiian Homes 
     Commission Act, 1920 which designated 200,000 acres of the 
     ceded public lands for exclusive homesteading by Native 
     Hawaiians, thereby affirming the trust relationship between 
     the United States and the Native Hawaiians, as expressed by 
     then Secretary of the Interior Franklin K. Lane who was cited 
     in the Committee Report of the Committee on Territories of 
     the House of Representatives as stating, ``One thing that 
     impressed me . . . was the fact that the natives of the 
     islands . . . for whom in a sense we are trustees, are 
     falling off rapidly in numbers and many of them are in 
     poverty.''.
       ``(19) In 1938, Congress again acknowledged the unique 
     status of the Native Hawaiian people by including in the Act 
     of June 20, 1938 (52 Stat. 781 et seq.), a provision to lease 
     lands within the extension to Native Hawaiians and to permit 
     fishing in the area ``only by native Hawaiian residents of 
     said area or of adjacent villages and by visitors under their 
     guidance''.
       ``(20) Under the Act entitled ``An Act to provide for the 
     admission of the State of Hawaii into the Union'', approved 
     March 18, 1959 (73 Stat. 4), the United States transferred 
     responsibility for the administration of the Hawaiian Home 
     Lands to the State of Hawaii but reaffirmed the trust 
     relationship which existed between the United States and the 
     Native Hawaiian people by retaining the exclusive power to 
     enforce the trust, including the power to approve land 
     exchanges, and legislative amendments affecting the rights of 
     beneficiaries under such Act.
       ``(21) Under the Act entitled ``An Act to provide for the 
     admission of the State of Hawaii into the Union'', approved 
     March 18, 1959 (73 Stat. 4), the United States transferred 
     responsibility for administration over portions of the ceded 
     public lands trust not retained by the United States to the 
     State of Hawaii but reaffirmed the trust relationship which 
     existed between the United States and the Native Hawaiian 
     people by retaining the legal responsibility of the State for 
     the betterment of the conditions of Native Hawaiians under 
     section 5(f) of such Act.
       ``(22) The authority of the Congress under the Constitution 
     to legislate in matters affecting the aboriginal or 
     indigenous peoples of the United States includes the 
     authority to legislate in matters affecting the native 
     peoples of Alaska and Hawaii.
       ``(23) Further, the United States has recognized the 
     authority of the Native Hawaiian people to continue to work 
     towards an appropriate form of sovereignty as defined by the 
     Native Hawaiian people themselves in provisions set forth in 
     legislation returning the Hawaiian Island of Kaho`olawe to 
     custodial management by the State of Hawaii in 1994.
       ``(24) In furtherance of the trust responsibility for the 
     betterment of the conditions of Native Hawaiians, the United 
     States has established a program for the provision of 
     comprehensive health promotion and disease prevention 
     services to maintain and improve the health status of the 
     Hawaiian people. This program is conducted by the Native 
     Hawaiian Health Care Systems, the Native Hawaiian Health 
     Scholarship Program and Papa Ola Lokahi. Health initiatives 
     from these and other health institutions and agencies using 
     Federal assistance have begun to lower the century-old 
     morbidity and mortality rates of Native Hawaiian people by 
     providing comprehensive disease prevention, health promotion 
     activities and increasing the number of Native Hawaiians in 
     the health and allied health professions. This has been 
     accomplished through the Native Hawaiian Health Care Act of 
     1988 (Public Law 100-579) and its reauthorization in section 
     9168 of Public Law 102-396 (106 Stat. 1948).
       ``(25) This historical and unique legal relationship has 
     been consistently recognized and affirmed by Congress through 
     the enactment of Federal laws which extend to the Native 
     Hawaiian people the same rights and privileges accorded to 
     American Indian,

[[Page S14622]]

     Alaska Native, Eskimo, and Aleut communities, including the 
     Native American Programs Act of 1974 (42 U.S.C. 2991 et 
     seq.), the American Indian Religious Freedom Act (42 U.S.C. 
     1996), the National Museum of the American Indian Act (20 
     U.S.C. 80q et seq.), and the Native American Graves 
     Protection and Repatriation Act (25 U.S.C. 3001 et seq.).
       ``(26) The United States has also recognized and reaffirmed 
     the trust relationship to the Native Hawaiian people through 
     legislation which authorizes the provision of services to 
     Native Hawaiians, specifically, the Older Americans Act of 
     1965 (42 U.S.C. 3001 et seq.), the Developmental Disabilities 
     Assistance and Bill of Rights Act Amendments of 1987, the 
     Veterans` Benefits and Services Act of 1988, the 
     Rehabilitation Act of 1973 (29 U.S.C. 701 et seq.), the 
     Native Hawaiian Health Care Act of 1988 (Public Law 100-579), 
     the Health Professions Reauthorization Act of 1988, the 
     Nursing Shortage Reduction and Education Extension Act of 
     1988, the Handicapped Programs Technical Amendments Act of 
     1988, the Indian Health Care Amendments of 1988, and the 
     Disadvantaged Minority Health Improvement Act of 1990.
       ``(27) The United States has also affirmed the historical 
     and unique legal relationship to the Hawaiian people by 
     authorizing the provision of services to Native Hawaiians to 
     address problems of alcohol and drug abuse under the Anti-
     Drug Abuse Act of 1986 (Public Law 99-570).
       ``(28) Further, the United States has recognized that 
     Native Hawaiians, as aboriginal, indigenous, native peoples 
     of Hawaii, are a unique population group in Hawaii and in the 
     continental United States and has so declared in Office of 
     Management and Budget Circular 15 in 1997 and Presidential 
     Executive Order No. 13125, dated June 7, 1999.
       ``(29) Despite the United States having expressed its 
     commitment to a policy of reconciliation with the Native 
     Hawaiian people for past grievances in Public Law 103-150 
     (107 Stat. 1510) the unmet health needs of the Native 
     Hawaiian people remain severe and their health status 
     continues to be far below that of the general population of 
     the United States.
       ``(b) Unmet Needs and Health Disparities.--Congress finds 
     that the unmet needs and serious health disparities that 
     adversely affect the Native Hawaiian people include the 
     following:
       ``(1) Chronic disease and illness.--
       ``(A) Cancer.--
       ``(i) In general.--With respect to all cancer--

       ``(I) Native Hawaiians have the highest cancer mortality 
     rates in the State of Hawaii (231.0 out of every 100,000 
     residents), 45 percent higher than that for the total State 
     population (159.7 out of every 100,000 residents);
       ``(II) Native Hawaiian males have the highest cancer 
     mortality rates in the State of Hawaii for cancers of the 
     lung, liver and pancreas and for all cancers combined;
       ``(III) Native Hawaiian females ranked highest in the State 
     of Hawaii for cancers of the lung, liver, pancreas, breast, 
     cervix uteri, corpus uteri, stomach, and rectum, and for all 
     cancers combined;
       ``(IV) Native Hawaiian males have the highest years of 
     productive life lost from cancer in the State of Hawaii with 
     8.7 years compared to 6.4 years for other males; and
       ``(V) Native Hawaiian females have 8.2 years of productive 
     life lost from cancer in the State of Hawaii as compared to 
     6.4 years for other females in the State of Hawaii;

       ``(ii) Breast cancer.--With respect to breast cancer--

       ``(I) Native Hawaiians have the highest mortality rates in 
     the State of Hawaii from breast cancer (37.96 out of every 
     100,000 residents), which is 25 percent higher than that for 
     Caucasian Americans (30.25 out of every 100,000 residents) 
     and 106 percent higher than that for Chinese Americans (18.39 
     out of every 100,000 residents); and
       ``(II) nationally, Native Hawaiians have the third highest 
     mortality rates due to breast cancer (25.0 out of every 
     100,000 residents) following African Americans (31.4 out of 
     every 100,000 residents) and Caucasian Americans (27.0 out of 
     every 100,000 residents).

       ``(iii) Cancer of the cervix.--Native Hawaiians have the 
     highest mortality rates from cancer of the cervix in the 
     State of Hawaii (3.82 out of every 100,000 residents) 
     followed by Filipino Americans (3.33 out of every 100,000 
     residents) and Caucasian Americans (2.61 out of every 100,000 
     residents).
       ``(iv) Lung cancer.--Native Hawaiians have the highest 
     mortality rates from lung cancer in the State of Hawaii 
     (90.70 out of every 100,000 residents), which is 61 percent 
     higher than Caucasian Americans, who rank second and 161 
     percent higher than Japanese Americans, who rank third.
       ``(v) Prostate cancer.--Native Hawaiian males have the 
     second highest mortality rates due to prostate cancer in the 
     State of Hawaii (25.86 out of every 100,000 residents) with 
     Caucasian Americans having the highest mortality rate from 
     prostate cancer (30.55 out of every 100,000 residents).
       ``(B) Diabetes.--With respect to diabetes, for the years 
     1989 through 1991--
       ``(i) Native Hawaiians had the highest mortality rate due 
     to diabetes mellitis (34.7 out of every 100,000 residents) in 
     the State of Hawaii which is 130 percent higher than the 
     statewide rate for all other races (15.1 out of every 100,000 
     residents);
       ``(ii) full-blood Hawaiians had a mortality rate of 93.3 
     out of every 100,000 residents, which is 518 percent higher 
     than the rate for the statewide population of all other 
     races; and
       ``(iii) Native Hawaiians who are less than full-blood had a 
     mortality rate of 27.1 out of every 100,000 residents, which 
     is 79 percent higher than the rate for the statewide 
     population of all other races.
       ``(C) Asthma.--With respect to asthma--
       ``(i) in 1990, Native Hawaiians comprised 44 percent of all 
     asthma cases in the State of Hawaii for those 18 years of age 
     and younger, and 35 percent of all asthma cases reported; and
       ``(ii) in 1992, the Native Hawaiian rate for asthma was 
     81.7 out of every 1000 residents, which was 73 percent higher 
     than the rate for the total statewide population of 47.3 out 
     of every 1000 residents.
       ``(D) Circulatory diseases.--
       ``(i) Heart Disease.--With respect to heart disease--

       ``(I) the death rate for Native Hawaiians from heart 
     disease (333.4 out of every 100,000 residents) is 66 percent 
     higher than for the entire State of Hawaii (201.1 out of 
     every 100,000 residents); and
       ``(II) Native Hawaiian males have the greatest years of 
     productive life lost in the State of Hawaii where Native 
     Hawaiian males lose an average of 15.5 years and Native 
     Hawaiian females lose an average of 8.2 years due to heart 
     disease, as compared to 7.5 years for all males in the State 
     of Hawaii and 6.4 years for all females.

       ``(ii) Hypertension.--The death rate for Native Hawaiians 
     from hypertension (3.5 out of every 100,000 residents) is 84 
     percent higher than that for the entire State (1.9 out of 
     every 100,000 residents).
       ``(iii) Stroke.--The death rate for Native Hawaiians from 
     stroke (58.3 out of every 100,000 residents) is 13 percent 
     higher than that for the entire State (51.8 out of every 
     100,000 residents).
       ``(2) Infectious disease and illness.--The incidence of 
     AIDS for Native Hawaiians is at least twice as high per 
     100,000 residents (10.5 percent) than that for any other non-
     Caucasian group in the State of Hawaii.
       ``(3) Accidents.--With respect to accidents--
       ``(A) the death rate for Native Hawaiians from accidents 
     (38.8 out of every 100,000 residents) is 45 percent higher 
     than that for the entire State (26.8 out of every 100,000 
     residents);
       ``(B) Native Hawaiian males lose an average of 14 years of 
     productive life lost from accidents as compared to 9.8 years 
     for all other males in Hawaii; and
       ``(C) Native Hawaiian females lose and average of 4 years 
     of productive life lost from accidents but this rate is the 
     highest rate among all females in the State of Hawaii.
       ``(4) Dental health.--With respect to dental health--
       ``(A) Native Hawaiian children exhibit among the highest 
     rates of dental caries in the nation, and the highest in the 
     State of Hawaii as compared to the 5 other major ethnic 
     groups in the State;
       ``(B) the average number of decayed or filled primary teeth 
     for Native Hawaiian children ages 5 through 9 years was 4.3 
     as compared with 3.7 for the entire State of Hawaii and 1.9 
     for the United States; and
       ``(C) the proportion of Native Hawaiian children ages 5 
     through 12 years with unmet treatment needs (defined as 
     having active dental caries requiring treatment) is 40 
     percent as compared with 33 percent for all other races in 
     the State of Hawaii.
       ``(5) Life expectancy.--With respect to life expectancy--
       ``(A) Native Hawaiians have the lowest life expectancy of 
     all population groups in the State of Hawaii;
       ``(B) between 1910 and 1980, the life expectancy of Native 
     Hawaiians from birth has ranged from 5 to 10 years less than 
     that of the overall State population average; and
       ``(C) the most recent tables for 1990 show Native Hawaiian 
     life expectancy at birth (74.27 years) to be about 5 years 
     less than that of the total State population (78.85 years).
       ``(6) Maternal and child health.--
       ``(A) Prenatal care.--With respect to prenatal care--
       ``(i) as of 1996, Native Hawaiian women have the highest 
     prevalence (21 percent) of having had no prenatal care during 
     their first trimester of pregnancy when compared to the 5 
     largest ethnic groups in the State of Hawaii;
       ``(ii) of the mothers in the State of Hawaii who received 
     no prenatal care throughout their pregnancy in 1996, 44 
     percent were Native Hawaiian;
       ``(iii) over 65 percent of the referrals to Healthy Start 
     in fiscal years 1996 and 1997 were Native Hawaiian newborns; 
     and
       ``(iv) in every region of the State of Hawaii, many Native 
     Hawaiian newborns begin life in a potentially hazardous 
     circumstance, far higher than any other racial group.
       ``(B) Births.--With respect to births--
       ``(i) in 1996, 45 percent of the live births to Native 
     Hawaiian mothers were infants born to single mothers which 
     statistics indicate put infants at higher risk of low birth 
     weight and infant mortality;
       ``(ii) in 1996, of the births to Native Hawaiian single 
     mothers, 8 percent were low birth weight (under 2500 grams); 
     and
       ``(iii) of all low birth weight babies born to single 
     mothers in the State of Hawaii, 44 percent were Native 
     Hawaiian.
       ``(C) Teen pregnancies.--With respect to births--
       ``(i) in 1993 and 1994, Native Hawaiians had the highest 
     percentage of teen (individuals

[[Page S14623]]

     who were less than 18 years or age) births (8.1 percent) 
     compared to the rate for all other races in the State of 
     Hawaii (3.6 percent);
       ``(ii) in 1996, nearly 53 percent of all mothers in Hawaii 
     under 18 years of age were Native Hawaiian;
       ``(iii) lower rates of abortion (a third lower than for the 
     statewide population) among Hawaiian women may account in 
     part, for the higher percentage of live births;
       ``(iv) in 1995, of the births to mothers age 14 years and 
     younger in Hawaii, 66 percent were Native Hawaiian; and
       ``(v) in 1996, of the births in this same group, 48 percent 
     were Native Hawaiian.
       ``(D) Fetal mortality.--In 1996, Native Hawaiian fetal 
     mortality rates comprised 15 percent of all fetal deaths for 
     the State of Hawaii. However, for fetal deaths occurring in 
     mothers under the age of 18 years, 32 percent were Native 
     Hawaiian, and for mothers 18 through 24 years of age, 28 
     percent were Native Hawaiians.
       ``(7) Mental health.--
       ``(A) Alcohol and drug abuse.--With respect to alcohol and 
     drug abuse--
       ``(i) Native Hawaiians represent 38 percent of the total 
     admissions to Department of Health, Alcohol, Drugs and Other 
     Drugs, funded substance abuse treatment programs;
       ``(ii) in 1997, the prevalence of smoking by Native 
     Hawaiians was 28.5 percent, a rate that is 53 percent higher 
     than that for all other races in the State of Hawaii which is 
     18.6 percent;
       ``(iii) Native Hawaiians have the highest prevalence rates 
     of acute drinking (31 percent), a rate that is 79 percent 
     higher than that for all other races in the State of Hawaii;
       ``(iv) the chronic drinking rate among Native Hawaiians is 
     54 percent higher than that for all other races in the State 
     of Hawaii;
       ``(v) in 1991, 40 percent of the Native Hawaiian adults 
     surveyed reported having used marijuana compared with 30 
     percent for all other races in the State of Hawaii; and
       ``(vi) nine percent of the Native Hawaiian adults surveyed 
     reported that they are current users (within the past year) 
     of marijuana, compared with 6 percent for all other races in 
     the State of Hawaii.
       ``(B) Crime.--With respect to crime--
       ``(i) in 1996, of the 5,944 arrests that were made for 
     property crimes in the State of Hawaii, arrests of Native 
     Hawaiians comprised 20 percent of that total;
       ``(ii) Native Hawaiian juveniles comprised a third of all 
     juvenile arrests in 1996;
       ``(iii) In 1996, Native Hawaiians represented 21 percent of 
     the 8,000 adults arrested for violent crimes in the State of 
     Hawaii, and 38 percent of the 4,066 juvenile arrests;
       ``(iv) Native Hawaiians are over-represented in the prison 
     population in Hawaii;
       ``(v) in 1995 and 1996 Native Hawaiians comprised 36.5 
     percent of the sentenced felon prison population in Hawaii, 
     as compared to 20.5 percent for Caucasian Americans, 3.7 
     percent for Japanese Americans, and 6 percent for Chinese 
     Americans;
       ``(vi) in 1995 and 1996 Native Hawaiians made up 45.4 
     percent of the technical violator population, and at the 
     Hawaii Youth Correctional Facility, Native Hawaiians 
     constituted 51.6 percent of all detainees in fiscal year 
     1997; and
       ``(vii) based on anecdotal information from inmates at the 
     Halawa Correction Facilities, Native Hawaiians are estimated 
     to comprise between 60 and 70 percent of all inmates.
       ``(8) Health professions education and training.--With 
     respect to health professions education and training--
       ``(A) Native Hawaiians age 25 years and older have a 
     comparable rate of high school completion, however, the rates 
     of baccalaureate degree achievement amongst Native Hawaiians 
     are less than the norm in the State of Hawaii (6.9 percent 
     and 15.76 percent respectively);
       ``(B) Native Hawaiian physicians make up 4 percent of the 
     total physician workforce in the State of Hawaii; and
       ``(C) in fiscal year 1997, Native Hawaiians comprised 8 
     percent of those individuals who earned Bachelor's Degrees, 
     14 percent of those individuals who earned professional 
     diplomas, 6 percent of those individuals who earned Master's 
     Degrees, and less than 1 percent of individuals who earned 
     doctoral degrees at the University of Hawaii.

     ``SEC. 3. DEFINITIONS.

       ``In this Act:
       ``(1) Disease prevention.--The term `disease prevention' 
     includes--
       ``(A) immunizations;
       ``(B) control of high blood pressure;
       ``(C) control of sexually transmittable diseases;
       ``(D) prevention and control of diabetes;
       ``(E) control of toxic agents;
       ``(F) occupational safety and health;
       ``(G) accident prevention;
       ``(H) fluoridation of water;

       ``(I) control of infectious agents; and

       ``(J) provision of mental health care.
       ``(2) Health promotion.--The term `health promotion' 
     includes--
       ``(A) pregnancy and infant care, including prevention of 
     fetal alcohol syndrome;
       ``(B) cessation of tobacco smoking;
       ``(C) reduction in the misuse of alcohol and drugs;
       ``(D) improvement of nutrition;
       ``(E) improvement in physical fitness;
       ``(F) family planning;
       ``(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 
     land (`aina), water (wai), and ocean (kai).

       ``(3) Native hawaiian.--The term `Native Hawaiian' means 
     any individual who is Kanaka Maoli (a descendant of the 
     aboriginal people who, prior to 1778, occupied and exercised 
     sovereignty in the area that now constitutes the State of 
     Hawaii) as evidenced by--
       ``(A) genealogical records,
       ``(B) Kupuna (elders) or Kama`aina (long-term community 
     residents) verification; or
       ``(C) birth records of the State of Hawaii.
       ``(4) Native hawaiian health care system.--The term `Native 
     Hawaiian health care system' means an entity--
       ``(A) which is organized under the laws of the State of 
     Hawaii;
       ``(B) which provides or arranges for health care services 
     through practitioners licensed by the State of Hawaii, where 
     licensure requirements are applicable;
       ``(C) which is a public or nonprofit private entity;
       ``(D) in which Native Hawaiian health practitioners 
     significantly participate in the planning, management, 
     monitoring, and evaluation of health care services;
       ``(E) which may be composed of as many as 8 Native Hawaiian 
     health care systems as necessary to meet the health care 
     needs of each island's Native Hawaiians; and
       ``(F) which is--
       ``(i) recognized by Papa Ola Lokahi for the purpose of 
     planning, conducting, or administering programs, or portions 
     of programs, authorized by this chapter for the benefit of 
     Native Hawaiians; and
       ``(ii) certified by Papa Ola Lokahi as having the 
     qualifications and the capacity to provide the services and 
     meet the requirements under the contract the Native Hawaiian 
     health care system enters into with the Secretary or the 
     grant the Native Hawaiian health care system receives from 
     the Secretary pursuant to this Act.
       ``(5) Native hawaiian organization.--The term `Native 
     Hawaiian organization' means any organization--
       ``(A) which serves the interests of Native Hawaiians; and
       ``(B) which is--
       ``(i) recognized by Papa Ola Lokahi for the purpose of 
     planning, conducting, or administering programs (or portions 
     of programs) authorized under this Act for the benefit of 
     Native Hawaiians; and
       ``(ii) a public or nonprofit private entity.
       ``(6) Papa ola lokahi.--
       ``(A) In general.--The term `Papa Ola Lokahi' means an 
     organization that is composed of public agencies and private 
     organizations focusing on improving the health status of 
     Native Hawaiians. Board members of such organization may 
     include representation from--
       ``(i) E Ola Mau;
       ``(ii) the Office of Hawaiian Affairs of the State of 
     Hawaii;
       ``(iii) Alu Like Inc.;
       ``(iv) the University of Hawaii;
       ``(v) the Hawaii State Department of Health;
       ``(vi) the Kamehameha Schools Bishop Estate, or other 
     Native Hawaiian organization responsible for the 
     administration of the Native Hawaiian Health Scholarship 
     Program;
       ``(vii) the Hawaii State Primary Care Association, or other 
     organizations responsible for the placement of scholars from 
     the Native Hawaiian Health Scholarship Program;
       ``(viii) Ahahui O Na Kauka, the Native Hawaiian Physicians 
     Association;
       ``(ix) Ho`ola Lahui Hawaii, or a health care system serving 
     Kaua`i or Ni`ihau, and which may be composed of as many 
     health care centers as are necessary to meet the health care 
     needs of the Native Hawaiians of those islands;
       ``(x) Ke Ola Mamo, or a health care system serving the 
     island of O`ahu and which may be composed of as many health 
     care centers as are necessary to meet the health care needs 
     of the Native Hawaiians of that island;
       ``(xi) Na Pu`uwai or a health care system serving Moloka`i 
     or Lana`i, and which may be composed of as many health care 
     centers as are necessary to meet the health care needs of the 
     Native Hawaiians of those islands;
       ``(xii) Hui No Ke Ola Pono, or a health care system serving 
     the island of Maui, and which may be composed of as many 
     health care centers as are necessary to meet the health care 
     needs of the Native Hawaiians of that island;
       ``(xiii) Hui Malama Ola Ha `Oiwi, or a health care system 
     serving the island of Hawaii, and which may be composed of as 
     many health care centers as are necessary to meet the health 
     care needs of the Native Hawaiians of that island;
       ``(xiv) other Native Hawaiian health care systems as 
     certified and recognized by Papa Ola Lokahi in accordance 
     with this Act; and
       ``(xv) such other member organizations as the Board of Papa 
     Ola Lokahi may admit from time to time, based upon 
     satisfactory demonstration of a record of contribution to the 
     health and well-being of Native Hawaiians.
       ``(B) Limitation.--Such term does not include any 
     organization described in subparagraph (A) if the Secretary 
     determines that such organization has not developed a mission 
     statement with clearly defined goals and objectives for the 
     contributions the organization will make to the Native 
     Hawaiian health care systems, and an action plan for carrying 
     out those goals and objectives.

[[Page S14624]]

       ``(7) Primary health services.--The term `primary health 
     services' means--
       ``(A) services of physicians, physicians' assistants, nurse 
     practitioners, and other health professionals;
       ``(B) diagnostic laboratory and radiologic services;
       ``(C) preventive health services including perinatal 
     services, well child services, family planning services, 
     nutrition services, home health services, and, generally, all 
     those services associated with enhanced health and wellness.
       ``(D) emergency medical services;
       ``(E) transportation services as required for adequate 
     patient care;
       ``(F) preventive dental services; and
       ``(G) pharmaceutical and nutraceutical services.
       ``(8) Secretary.--The term `Secretary' means the Secretary 
     of Health and Human Services.
       ``(9) Traditional native hawaiian healer.--The term 
     `traditional Native Hawaiian healer' means a practitioner--
       ``(A) who--
       ``(i) is of Native Hawaiian ancestry; and
       ``(ii) has the knowledge, skills, and experience in direct 
     personal health care of individuals; and
       ``(B) whose knowledge, skills, and experience are based on 
     demonstrated learning of Native Hawaiian healing practices 
     acquired by--
       ``(i) direct practical association with Native Hawaiian 
     elders; and
       ``(ii) oral traditions transmitted from generation to 
     generation.

     ``SEC. 4. DECLARATION OF POLICY.

       ``(a) Congress.--Congress hereby declares that it is the 
     policy of the United States in fulfillment of its special 
     responsibilities and legal obligations to the indigenous 
     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 possible health level; and
       ``(2) to provide existing Native Hawaiian health care 
     programs with all resources necessary to effectuate this 
     policy.
       ``(b) Intent of Congress.--
       ``(1) In general.--It is the intent of the Congress that--
       ``(A) health care programs having a demonstrated effect of 
     substantially reducing or eliminating the over-representation 
     of Native Hawaiians among those suffering from chronic and 
     acute disease and illness and addressing the health needs of 
     Native Hawaiians shall be established and implemented; and
       ``(B) the Nation meet the Healthy People 2010 and Kanaka 
     Maoli health objectives described in paragraph (2) by the 
     year 2010.
       ``(2) Healthy people and kanaka maoli health objectives.--
     The Healthy People 2010 and Kanaka Maoli health objectives 
     described in this paragraph are the following:
       ``(A) Chronic disease and illness.--
       ``(i) Cardiovascular disease.--With respect to 
     cardiovascular disease--

       ``(I) to increase to 75 percent the proportion of females 
     who are aware that cardiovascular disease (heart disease and 
     stroke) is the leading cause of death for all females.
       ``(II) to increase to at least 95 percent the proportion of 
     adults who have had their blood pressure measured within the 
     preceding 2 years and can state whether their blood pressure 
     was normal or high; and
       ``(III) to increase to at least 75 percent the proportion 
     of adults who have had their blood cholesterol checked within 
     the preceding 5 years.

       ``(ii) Diabetes.--With respect to diabetes--

       ``(I) to increase to 80 percent the proportion of persons 
     with diabetes whose condition has been diagnosed;
       ``(II) to increase to at least 20 percent the proportion of 
     patients with diabetes who annually obtain lipid assessment 
     (total cholesterol, LDL cholesterol, HDL cholesterol, 
     triglyceride); and
       ``(III) to increase to 52 percent the proportion of persons 
     with diabetes who have received formal diabetes education.

       ``(iii) Cancer.--With respect to cancer--

       ``(I) to increase to at least 95 percent the proportion of 
     women age 18 and older who have ever received a Pap test and 
     to at least 85 percent those who have received a Pap test 
     within the preceding 3 years; and
       ``(II) to increase to at least 40 percent the proportion of 
     women age 40 and older who have received a breast examination 
     and a mammogram within the preceding 2 years.

       ``(iv) Dental health.--With respect to dental health--

       ``(I) to reduce untreated cavities in the primary and 
     permanent teeth (mixed dentition) so that the proportion of 
     children with decayed teeth not filled is not more than 12 
     percent among children ages 2 through 4, 22 percent among 
     children ages 6 through 8, and 15 percent among adolescents 
     ages 8 through 15;
       ``(II) to increase to at least 70 percent the proportion of 
     children ages 8 through 14 who have received protective 
     sealants in permanent molar teeth; and
       ``(III) to increase to at least 70 percent the proportion 
     of adults age 18 and older using the oral health care system 
     each year.

       ``(v) Mental health.--With respect to mental health--

       ``(I) to incorporate or support land(`aina)-based, 
     water(wai)-based, or the ocean(kai)-based programs within the 
     context of mental health activities; and
       ``(II) to reduce the anger and frustration levels within 
     `ohana focusing on building positive relationships and 
     striving for balance in living (lokahi) and achieving a sense 
     of contentment (pono).

       ``(vi) Asthma.--With respect to asthma--

       ``(I) to increase to at least 40 percent the proportion of 
     people with asthma who receive formal patient education, 
     including information about community and self-help 
     resources, as an integral part of the management of their 
     condition;
       ``(II) to increase to at least 75 percent the proportion of 
     patients who receive counseling from health care providers on 
     how to recognize early signs of worsening asthma and how to 
     respond appropriately; and
       ``(III) to increase to at least 75 percent the proportion 
     of primary care providers who are trained to provide 
     culturally competent care to ethnic minorities (Native 
     Hawaiians) seeking health care for chronic obstructive 
     pulmonary disease.

       ``(B) Infectious disease and illness.--
       ``(i) Immunizations.--With respect to immunizations--

       ``(I) to reduce indigenous cases of vaccine-preventable 
     disease;
       ``(II) to achieve immunization coverage of at least 90 
     percent among children between 19 and 35 months of age; and
       ``(III) to increase to 90 percent the rate of immunization 
     coverage among adults 65 years of age or older, and 60 
     percent for high-risk adults between 18 and 64 years of age.

       ``(ii) Sexually transmitted diseases, hiv; aids.--To 
     increase the number of HIV-infected adolescents and adults in 
     care who receive treatment consistent with current public 
     health treatment guidelines.
       ``(C) Wellness.--
       ``(i) Exercise.--With respect to exercise--

       ``(I) to increase to 85 percent the proportion of people 
     ages 18 and older who engage in any leisure time physical 
     activity; and
       ``(II) to increase to at least 30 percent the proportion of 
     people ages 18 and older who engage regularly, preferably 
     daily, in sustained physical activity for at least 30 minutes 
     per day.

       ``(ii) Nutrition.--With respect to nutrition--

       ``(I) to increase to at least 60 percent the prevalence of 
     healthy weight (defined as body mass index equal to or 
     greater than 19.0 and less than 25.0) among all people age 20 
     and older;
       ``(II) to increase to at least 75 percent the proportion of 
     people age 2 and older who meet the dietary guidelines' 
     minimum average daily goal of at least 5 servings of 
     vegetables and fruits; and
       ``(III) to increase the use of traditional Native Hawaiian 
     foods in all peoples' diets and dietary preferences.

       ``(iii) Lifestyle.--With respect to lifestyle--

       ``(I) to reduce cigarette smoking among pregnant women to a 
     prevalence of not more than 2 percent;
       ``(II) to reduce the prevalence of respiratory disease, 
     cardiovascular disease, and cancer resulting from exposure to 
     tobacco smoke;
       ``(III) to increase to at least 70 percent the proportion 
     of all pregnancies among women between the ages of 15 and 44 
     that are planned (intended); and
       ``(IV) to reduce deaths caused by unintentional injuries to 
     not more than 25.9 per 100,000.

       ``(iv) Culture.--With respect to culture--

       ``(I) to develop and implement cultural values within the 
     context of the corporate cultures of the Native Hawaiian 
     health care systems, the Native Hawaiian Health Scholarship 
     Program, and Papa Ola Lokahi; and
       ``(II) to facilitate the provision of Native Hawaiian 
     healing practices by Native Hawaiian healers for those 
     clients desiring such assistance.

       ``(D) Access.--With respect to access--
       ``(i) to increase the proportion of patients who have 
     coverage for clinical preventive services as part of their 
     health insurance; and
       ``(ii) to reduce to not more than 7 percent the proportion 
     of individuals and families who report that they did not 
     obtain all the health care that they needed.
       ``(E) Health professions training and education.--With 
     respect to health professions training and education--
       ``(i) to increase the proportion of all degrees in the 
     health professions and allied and associated health 
     professions fields awarded to members of underrepresented 
     racial and ethnic minority groups; and
       ``(ii) to support training activities and programs in 
     traditional Native Hawaiian healing practices by Native 
     Hawaiian healers.
       ``(c) Report.--The Secretary shall submit to the President, 
     for inclusion in each report required to be transmitted to 
     Congress under section 11, a report on the progress made in 
     each toward meeting each of the objectives described in 
     subsection (b)(2).

     ``SEC. 5. COMPREHENSIVE HEALTH CARE MASTER PLAN FOR NATIVE 
                   HAWAIIANS.

       ``(a) Development.--
       ``(1) in general.--The Secretary may make a grant to, or 
     enter into a contract with, Papa Ola Lokahi for the purpose 
     of coordinating, implementing and updating a Native Hawaiian 
     comprehensive health care master plan designed to promote 
     comprehensive health promotion and disease prevention 
     services and to maintain and improve the health status of 
     Native Hawaiians, and to support community-based initiatives 
     that

[[Page S14625]]

     are reflective of holistic approaches to health.
       ``(2) Collaboration.--The Papa Ola Lokahi shall collaborate 
     with the Office of Hawaiian Affairs in carrying out this 
     section.
       ``(b) Authorization of Appropriations.--There are 
     authorized to be appropriated such sums as may be necessary 
     to carry out subsection (a).

     ``SEC. 6. FUNCTIONS OF PAPA OLA LOKAHI.

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

     ``SEC. 7. NATIVE HAWAIIAN HEALTH CARE SYSTEMS.

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

     ``SEC. 8. ADMINISTRATIVE GRANT FOR PAPA OLA LOKAHI.

       ``(a) In General.--In addition to any other grant or 
     contract under this Act, the Secretary may make grants to, or 
     enter into contracts with, Papa Ola Lokahi for--
       ``(1) coordination, implementation, and updating (as 
     appropriate) of the comprehensive health care master plan 
     developed pursuant to section 5;
       ``(2) training for the persons described in subparagraphs 
     (B) and (C) of section 7(c)(1);

[[Page S14626]]

       ``(3) identification of and research into the diseases that 
     are most prevalent among Native Hawaiians, including 
     behavioral, biomedical, epidemiological, and health services;
       ``(4) the development of an action plan outlining the 
     contributions that each member organization of Papa Ola 
     Lokahi will make in carrying out the policy of this Act;
       ``(5) a clearinghouse function for--
       ``(A) the collection and maintenance of data associated 
     with the health status of Native Hawaiians;
       ``(B) the identification and research into diseases 
     affecting Native Hawaiians; and
       ``(C) the availability of Native Hawaiian project funds, 
     research projects and publications;
       ``(6) the 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 is authorized 
     to be appropriated such sums as may be necessary for each of 
     fiscal years 2000 through 2010 to carry out subsection (a).

     ``SEC. 9. ADMINISTRATION OF GRANTS AND CONTRACTS.

       ``(a) Terms and Conditions.--The Secretary shall include in 
     any grant made or contract entered into under this Act such 
     terms and conditions as the Secretary considers necessary or 
     appropriate to ensure that the objectives of such grant or 
     contract are achieved.
       ``(b) Periodic Review.--The Secretary shall periodically 
     evaluate the performance of, and compliance with, grants and 
     contracts under this Act.
       ``(c) Administrative Requirements.--The Secretary may not 
     make a grant or enter into a contract under this Act with an 
     entity unless the entity--
       ``(1) agrees to establish such procedures for fiscal 
     control and fund accounting as may be necessary to ensure 
     proper disbursement and accounting with respect to the grant 
     or contract;
       ``(2) agrees to ensure the confidentiality of records 
     maintained on individuals receiving health services under the 
     grant or contract;
       ``(3) with respect to providing health services to any 
     population of Native Hawaiians, a substantial portion of 
     which has a limited ability to speak the English language--
       ``(A) has developed and has the ability to carry out a 
     reasonable plan to provide health services under the grant or 
     contract through individuals who are able to communicate with 
     the population involved in the language and cultural context 
     that is most appropriate; and
       ``(B) has designated at least 1 individual, fluent in both 
     English and the appropriate language, to assist in carrying 
     out the plan;
       ``(4) with respect to health services that are covered in 
     the plan of the State of Hawaii approved under title XIX of 
     the Social Security Act--
       ``(A) if the entity will provide under the grant or 
     contract any such health services directly--
       ``(i) the entity has entered into a participation agreement 
     under such plans; and
       ``(ii) the entity is qualified to receive payments under 
     such plan; and
       ``(B) if the entity will provide under the grant or 
     contract any such health services through a contract with an 
     organization--
       ``(i) the organization has entered into a participation 
     agreement under such plan; and
       ``(ii) the organization is qualified to receive payments 
     under such plan; and
       ``(5) agrees to submit to the Secretary and to Papa Ola 
     Lokahi an annual report that describes the use and costs of 
     health services provided under the grant or contract 
     (including the average cost of health services per user) and 
     that provides such other information as the Secretary 
     determines to be appropriate.
       ``(d) Contract Evaluation.--
       ``(1) Determination of noncompliance.--If, as a result of 
     evaluations conducted by the Secretary, the Secretary 
     determines that an entity has not complied with or 
     satisfactorily performed a contract entered into under 
     section 7, the Secretary shall, prior to renewing such 
     contract, attempt to resolve the areas of noncompliance or 
     unsatisfactory performance and modify such contract to 
     prevent future occurrences of such noncompliance or 
     unsatisfactory performance.
       ``(2) Nonrenewal.--If the Secretary determines that the 
     noncompliance or unsatisfactory performance described in 
     paragraph (1) with respect to an entity cannot be resolved 
     and prevented in the future, the Secretary shall not renew 
     the contract with such entity and may enter into a contract 
     under section 7 with another entity referred to in subsection 
     (a)(3) of such section that provides services to the same 
     population of Native Hawaiians which is served by the entity 
     whose contract is not renewed by reason of this paragraph.
       ``(3) Consideration of results.--In determining whether to 
     renew a contract entered into with an entity under this Act, 
     the Secretary shall consider the results of the evaluations 
     conducted under this section.
       ``(4) Application of federal laws.--All contracts entered 
     into by the Secretary under this Act shall be in accordance 
     with all Federal contracting laws and regulations, except 
     that, in the discretion of the Secretary, such contracts may 
     be negotiated without advertising and may be exempted from 
     the provisions of the Act of August 24, 1935 (40 U.S.C. 270a 
     et seq.).
       ``(5) Payments.--Payments made under any contract entered 
     into under this Act may be made in advance, by means of 
     reimbursement, or in installments and shall be made on such 
     conditions as the Secretary deems necessary to carry out the 
     purposes of this Act.
       ``(e) Limitation on Use of Funds for Administrative 
     Expenses.--Except with respect to grants and contracts under 
     section 8, the Secretary may not make a grant to, or enter 
     into a contract with, an entity under this Act unless the 
     entity agrees that the entity will not expend more than 15 
     percent of the amounts received pursuant to this Act for the 
     purpose of administering the grant or contract.
       ``(f) Report.--
       ``(1) In general.--For each fiscal year during which an 
     entity receives or expends funds pursuant to a grant or 
     contract under this Act, such entity shall submit to the 
     Secretary and to Papa Ola Lokahi an annual report--
       ``(A) on the activities conducted by the entity under the 
     grant or contract;
       ``(B) on the amounts and purposes for which Federal funds 
     were expended; and
       ``(C) containing such other information as the Secretary 
     may request.
       ``(2) Audits.--The reports and records of any entity 
     concerning any grant or contract under this Act shall be 
     subject to audit by the Secretary, the Inspector General of 
     the Department of Health and Human Services, and the 
     Comptroller General of the United States.
       ``(g) Annual Private Audit.--The Secretary shall allow as a 
     cost of any grant made or contract entered into under this 
     Act the cost of an annual private audit conducted by a 
     certified public accountant.

     ``SEC. 10. ASSIGNMENT OF PERSONNEL.

       ``(a) In General.--The Secretary may enter into an 
     agreement with any entity under which the Secretary may 
     assign personnel of the Department of Health and Human 
     Services with expertise identified by such entity to such 
     entity on detail for the purposes of providing comprehensive 
     health promotion and disease prevention services to Native 
     Hawaiians.
       ``(b) Applicable Federal Personnel Provisions.--Any 
     assignment of personnel made by the Secretary under any 
     agreement entered into under subsection (a) shall be treated 
     as an assignment of Federal personnel to a local government 
     that is made in accordance with subchapter VI of chapter 33 
     of title 5, United States Code.

     ``SEC. 11. NATIVE HAWAIIAN HEALTH SCHOLARSHIPS AND 
                   FELLOWSHIPS.

       ``(a) Eligibility.--Subject to the availability of amounts 
     appropriated under subsection (c), the Secretary shall 
     provide funds through a direct grant or a cooperative 
     agreement to Kamehameha Schools Bishop Estate or another 
     Native Hawaiian organization or health care organization with 
     experience in the administration of educational scholarships 
     or placement services for the purpose of providing 
     scholarship assistance to students who--
       ``(1) meet the requirements of section 338A of the Public 
     Health Service Act, except for assistance as provided for 
     under subsection (b)(2); and
       ``(2) are Native Hawaiians.
       ``(b) Terms and Conditions.--
       ``(1) In general.--The scholarship assistance under 
     subsection (a) shall be provided under the same terms and 
     subject to the same conditions, regulations, and rules as 
     apply to scholarship assistance provided under section 338A 
     of the Public Health Service Act (except as provided for in 
     paragraph (2)), except that--
       ``(A) the provision of scholarships in each type of health 
     care profession training shall correspond to the need for 
     each type of health care professional to serve the Native 
     Hawaiian health care systems identified by Papa Ola Lokahi;
       ``(B) to the maximum extent practicable, the Secretary 
     shall select scholarship recipients from a list of eligible 
     applicants submitted by the Kamehameha Schools Bishop Estate 
     or the Native Hawaiian organization administering the 
     program;
       ``(C) the obligated service requirement for each 
     scholarship recipient (except for those receiving assistance 
     under paragraph (2)) shall be fulfilled through service, in 
     order of priority, in--
       ``(i) any one of the Native Hawaiian health care systems; 
     or
       ``(ii) health professions shortage areas, medically 
     underserved areas, or geographic areas or facilities 
     similarly designated by the United States Public Health 
     Service in the State of Hawaii;
       ``(D) the provision of counseling, retention and other 
     support services shall not be limited to scholarship 
     recipients, but shall also include recipients of other 
     scholarship and financial aid programs enrolled in 
     appropriate health professions training programs.
       ``(E) financial assistance may be provided to scholarship 
     recipients in those health professions designated in such 
     section 338A while they are fulfilling their service 
     requirement in any one of the Native Hawaiian health care 
     systems or community health centers.
       ``(2) Fellowships.--Financial assistance through 
     fellowships may be provided to Native Hawaiian applicants 
     accepted and participating in a certificated program provided 
     by a traditional Native Hawaiian healer in

[[Page S14627]]

     traditional Native Hawaiian healing practices including lomi-
     lomi, la`au lapa`au, and ho`oponopono. Such assistance may 
     include a stipend or reimbursement for costs associated with 
     participation in the program.
       ``(3) Rights and benefits.--Scholarship recipients in 
     health professions designated in section 338A of the Public 
     Health Service Act while fulfilling their service 
     requirements shall have all the same rights and benefits of 
     members of the National Health Service Corps during their 
     period of service.
       ``(4) No inclusion of assistance in gross income.--
     Financial assistance provided to scholarship recipients for 
     tuition, books and other school-related expenditures under 
     this section shall not be included in gross income for 
     purposes of the Internal Revenue Code of 1986.
       ``(c) Authorization of Appropriations.--There is authorized 
     to be appropriated such sums as may be necessary for each of 
     fiscal years 2000 through 2010 for the purpose of funding the 
     scholarship assistance program under subsection (a).

     ``SEC. 12. REPORT.

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

     ``SEC. 13. DEMONSTRATION PROJECTS OF NATIONAL SIGNIFICANCE.

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

     ``SEC. 14. NATIONAL BIPARTISAN COMMISSION ON NATIVE HAWAIIAN 
                   HEALTH CARE ENTITLEMENT.

       ``(a) Establishment.--There is hereby established a 
     National Bipartisan Native Hawaiian Health Care Entitlement 
     Commission (referred to in this Act as the `Commission').
       ``(b) Membership.--The Commission shall be composed of 21 
     members to be appointed as follows:
       ``(1) Congressional members.--
       ``(A) Appointment.--Eight members of the Commission shall 
     be members of Congress, of which--
       ``(i) two members shall be from the House of 
     Representatives and shall be appointed by the Majority 
     Leader;
       ``(ii) two members shall be from the House of 
     Representatives and shall be appointed by the Minority 
     Leader;
       ``(iii) two members shall be from the Senate and shall be 
     appointed by the Majority Leader; and
       ``(iv) two members shall be from the Senate and shall be 
     appointed by the Minority Leader.
       ``(B) Relevant committee membership.--The members of the 
     Commission appointed under subparagraph (A) shall each be 
     members of the committees of Congress that consider 
     legislation affecting the provision of health care to Native 
     Hawaiians and other Native American.
       ``(C) Chairperson.--The members of the Commission appointed 
     under subparagraph (A) shall elect the chairperson and vice-
     chairperson of the Commission.
       ``(2) Hawaiian health members.--Eleven members of the 
     Commission shall be appointed by Hawaiian health entities, of 
     which--
       ``(A) five members shall be appointed by the Native 
     Hawaiian Health Care Systems;
       ``(B) one member shall be appointed by the Hawaii State 
     Primary Care Association;
       ``(C) one member shall be appointed by Papa Ola Lokahi;
       ``(D) one member shall be appointed by the State Council of 
     Hawaiian Homestead Associations;
       ``(E) one member shall be appointed by the Office of 
     Hawaiian Affairs; and
       ``(F) two members shall be appointed by the Association of 
     Hawaiian Civic Clubs and shall represent Native Hawaiian 
     populations on the United States continent.
       ``(3) Secretarial members.--Two members of the Commission 
     shall be appointed by the Secretary and shall possess 
     knowledge of the health concerns and wellness issues facing 
     Native Hawaiians.
       ``(c) Terms.--
       ``(1) In general.--The members of the Commission shall 
     serve for the life of the Commission.
       ``(2) Initial appointment of members.--The members of the 
     Commission shall be appointed under subsection (b)(1) not 
     later than 90 days after the date of enactment of this Act, 
     and the remaining members of the Commission shall be 
     appointed not later than 60 days after the date on which the 
     members are appointed under such subsection (b)(1).
       ``(3) Vacancies.--A vacancy in the membership of the 
     Commission shall be filled in the manner in which the 
     original appointment was made.
       ``(d) Duties of the Commission.--The Commission shall carry 
     out the following duties and functions:
       ``(1) Review and analyze the recommendations of the report 
     of the study committee established under paragraph (3).
       ``(2) Make recommendations to Congress for the provision of 
     health services to Native Hawaiian individuals as an 
     entitlement, giving due regard to the effects of a program on 
     existing health care delivery systems for Native Hawaiians 
     and the effect of such programs on self-determination and 
     their reconciliation.
       ``(3) Establish a study committee to be composed of at 
     least 10 members from the Commission, including 4 members of 
     the members appointed under subsection (b)(1), 5 of the 
     members appointed under subsection (b)(2), and 1 of the 
     members appointed by the Secretary under subsection (b)(3), 
     which shall--
       ``(A) to the extent necessary to carry out its duties, 
     collect and compile data necessary to understand the extent 
     of Native Hawaiian needs with regards to the provision of 
     health services, including holding hearings and soliciting 
     the views of Native Hawaiians and Native Hawaiian 
     organizations, and which may include authorizing and funding 
     feasibility studies of various models for all Native Hawaiian 
     beneficiaries and their families, including those that live 
     on the United States continent;
       ``(B) make recommendations to the Commission for 
     legislation that will provide for the culturally-competent 
     and appropriate provision of health services for Native 
     Hawaiians as an entitlement, which shall, at a minimum, 
     address issues of eligibility and benefits to be provided, 
     including recommendations regarding from whom such health 
     services are to be provided and the cost and mechanisms for 
     funding of the health services to be provided;
       ``(C) determine the effect of the enactment of such 
     recommendations on the existing system of delivery of health 
     services for Native Hawaiians;
       ``(D) determine the effect of a health service entitlement 
     program for Native Hawaiian individuals on their self-
     determination and the reconciliation of their relationship 
     with the United States;
       ``(E) not later than 12 months after the date of the 
     appointment of all members of the Commission, make a written 
     report of its findings and recommendations to the Commission, 
     which report shall include a statement of the minority and 
     majority position of the committee and which shall be 
     disseminated, at a minimum, to Native Hawaiian organizations 
     and agencies and health organizations referred to in 
     subsection (b)(2) for comment to the Commission; and
       ``(F) report regularly to the full Commission regarding the 
     findings and recommendations developed by the committee in 
     the course of carrying out its duties under this section.
       ``(4) Not later than 18 months after the date of the 
     appointment of all members of the Commission, submit a 
     written report to Congress containing a recommendation of 
     policies and legislation to implement a policy that would 
     establish a health care system for Native Hawaiians, grounded 
     in their culture, and based on the delivery of health 
     services as an entitlement, together with a determination of 
     the implications of such an entitlement system on existing 
     health care delivery systems for Native Hawaiians and their 
     self-determination and the reconciliation of their 
     relationship with the United States.
       ``(e) Administrative Provisions.--
       ``(1) Compensation and expenses.--

[[Page S14628]]

       ``(A) Congressional members.--Each member of the Commission 
     appointed under subsection (b)(1) shall not receive any 
     additional compensation, allowances, or benefits by reason of 
     their service on the Commission. Such members shall receive 
     travel expenses and per diem in lieu of subsistence in 
     accordance with sections 5702 and 5703 of title 5, United 
     States Code.
       ``(B) Other members.--The members of the Commission 
     appointed under paragraphs (2) and (3) of subsection (b) 
     shall, while serving on the business of the Commission 
     (including travel time), receive compensation at the per diem 
     equivalent of the rate provided for individuals under level 
     IV of the Executive Schedule under section 5315 of title 5, 
     United States Code, and while serving away from their home or 
     regular place of business, be allowed travel expenses, as 
     authorized by the chairperson of the Commission.
       ``(C) other personnel.--For purposes of compensation (other 
     than compensation of the members of the Commission) and 
     employment benefits, rights, and privileges, all personnel of 
     the Commission shall be treated as if they were employees of 
     the Senate.
       ``(2) Meetings and quorum.--
       ``(A) Meetings.--The Commission shall meet at the call of 
     the chairperson.
       ``(B) Quorum.--A quorum of the Commission shall consist of 
     not less than 12 members, of which--
       ``(i) not less than 4 of such members shall be appointees 
     under subsection (b)(1)l;
       ``(ii) not less than 7 of such members shall be appointees 
     under subsection (b)(2); and
       ``(iii) not less than 1 of such members shall be an 
     appointee under subsection (b)(3).
       ``(3) Director and staff.--
       ``(A) Executive director.--The members of the Commission 
     shall appoint an executive director of the Commission. The 
     executive director shall be paid the rate of basic pay equal 
     to that under level V of the Executive Schedule under section 
     5316 of title 5, United States Code.
       ``(B) Staff.--With the approval of the Commission, the 
     executive director may appoint such personnel as the 
     executive director deems appropriate.
       ``(C) Applicability of civil service laws.--The staff of 
     the Commission shall be appointed without regard to the 
     provisions of title 5, United States Code, governing 
     appointments in the competitive service, and shall be paid 
     without regard to the provisions of chapter 51 and subchapter 
     III of chapter 53 of such title (relating to classification 
     and General Schedule pay rates).
       ``(D) Experts and consultants.--With the approval of the 
     Commission, the executive director may procure temporary and 
     intermittent services under section 3109(b) of title 5, 
     United States Code.
       ``(E) Facilities.--The Administrator of the General 
     Services Administration shall locate suitable office space 
     for the operations of the Commission in the State of Hawaii. 
     The facilities shall serve as the headquarters of the 
     Commission and shall include all necessary equipment and 
     incidentals required for the proper functioning of the 
     Commission.
       ``(f) Powers.--
       ``(1) Hearings and other activities.--For purposes of 
     carrying out its duties, the Commission may hold such 
     hearings and undertake such other activities as the 
     Commission determines to be necessary to carry out its 
     duties, except that at least 8 hearings shall be held on each 
     of the Hawaiian Islands and 3 hearings in the continental 
     United States in areas where large numbers of Native 
     Hawaiians are present. Such hearings shall be held to solicit 
     the views of Native Hawaiians regarding the delivery of 
     health care services to such individuals. To constitute a 
     hearing under this paragraph, at least 4 members of the 
     Commission, including at least 1 member of Congress, must be 
     present. Hearings held by the study committee established 
     under subsection (d)(3) may be counted towards the number of 
     hearings required under this paragraph.
       ``(2) Studies by the general accounting office.--Upon the 
     request of the Commission, the Comptroller General shall 
     conduct such studies or investigations as the Commission 
     determines to be necessary to carry out its duties.
       ``(3) Cost estimates.--
       ``(A) In general.--The Director of the Congressional Budget 
     Office or the Chief Actuary of the Health Care Financing 
     Administration, or both, shall provide to the Commission, 
     upon the request of the Commission, such cost estimates as 
     the Commission determines to be necessary to carry out its 
     duties.
       ``(B) Reimbursements.--The Commission shall reimburse the 
     Director of the Congressional Budget Office for expenses 
     relating to the employment in the office of the Director of 
     such additional staff as may be necessary for the Director to 
     comply with requests by the Commission under subparagraph 
     (A).
       ``(4) Detail of federal employees.--Upon the request of the 
     Commission, the head of any Federal agency is authorized to 
     detail, without reimbursement, any of the personnel of such 
     agency to the Commission to assist the Commission in carrying 
     out its duties. Any such detail shall not interrupt or 
     otherwise affect the civil service status or privileges of 
     the Federal employees.
       ``(5) Technical assistance.--Upon the request of the 
     Commission, the head of any Federal agency shall provide such 
     technical assistance to the Commission as the Commission 
     determines to be necessary to carry out its duties.
       ``(6) Use of mails.--The Commission may use the United 
     States mails in the same manner and under the same conditions 
     as Federal agencies and shall, for purposes of the frank, be 
     considered a commission of Congress as described in section 
     3215 of title 39, United States Code.
       ``(7) Obtaining information.--The Commission may secure 
     directly from any Federal agency information necessary to 
     enable the Commission to carry out its duties, if the 
     information may be disclosed under section 552 of title 5, 
     United States Code. Upon request of the chairperson of the 
     Commission, the head of such agency shall furnish such 
     information to the Commission.
       ``(8) Support services.--Upon the request of the 
     Commission, the Administrator of General Services shall 
     provide to the Commission on a reimbursable basis such 
     administrative support services as the Commission may 
     request.
       ``(9) Printing.--For purposes of costs relating to printing 
     and binding, including the cost of personnel detailed from 
     the Government Printing Office, the Commission shall be 
     deemed to be a committee of Congress.
       ``(g) Authorization of Appropriations.--There is authorized 
     to be appropriated $1,500,000 to carry out this section. The 
     amount appropriated under this subsection shall not result in 
     a reduction in any other appropriation for health care or 
     health services for Native Hawaiians.

     ``SEC. 15. RULE OF CONSTRUCTION.

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

     ``SEC. 16. COMPLIANCE WITH BUDGET ACT.

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

     ``SEC. 17. SEVERABILITY.

       ``If any provision of this Act, or the application of any 
     such provision to any person or circumstances is held to be 
     invalid, the remainder of this Act, and the application of 
     such provision or amendment to persons or circumstances other 
     than those to which it is held invalid, shall not be affected 
     thereby.''.
                                 ______