[Congressional Record Volume 151, Number 7 (Monday, January 31, 2005)]
[Senate]
[Pages S659-S668]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. INOUYE:
  S. 215. A bill to amend the Native Hawaiian Health Care Improvement 
Act to revise and extend that Act; to the Committee on Indian Affairs.
  Mr. INOUYE. Mr. President, I rise today to introduce a bill to 
reauthorize the Native Hawaiian Health Care Improvement Act. Senator 
Akaka joins me in sponsoring this measure.
  The Native Hawaiian Health Care Improvement Act was enacted into law 
in 1988, and has been reauthorized every 4 years since that time.
  The Act provides authority for range of programs and services 
designed to improve the health care status of the Native people of 
Hawaii.
  With the enactment of the Native Hawaiian Health Care Improvement Act 
and the establishment of Native Hawaiian health care systems on most of 
the islands that make up the State of Hawaii, we have witnessed 
significant improvements in the health status of Native Hawaiians, but 
as the findings of unmet needs and health disparities set forth in this 
bill make clear, we still have a long way to go.
  For instance, Native Hawaiians have the highest cancer mortality 
rates in the State of Hawaii--rates that are 21 percent higher than the 
rate for the total State male population and 64 percent higher than the 
rate for the total State female population. Nationally, Native 
Hawaiians have the third highest mortality rate as a result of breast 
cancer.
  With respect to diabetes, in 2000, Native Hawaiians had the highest 
mortality rate associated with diabetes in the State--a rate which is 
138 percent higher than the statewide rate for all racial groups.
  When it comes to heart disease, the mortality rate of Native 
Hawaiians associated with heart disease is 68 percent higher than the 
rate for the entire State, and the mortality rate for hypertension is 
84 percent higher than that for the entire State.
  These statistics on the health status of Native Hawaiians are but a 
small part of the long list of data that makes clear that our objective 
of assuring that the Native people of Hawaii attain some parity of good 
health comparable to that of the larger U.S. population has not yet 
been achieved.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                 S. 215

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Native Hawaiian Health Care 
     Improvement Reauthorization Act of 2005''.

     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 S661]]


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

     ``SEC. 2. FINDINGS.

       ``(a) General Findings.--Congress finds that--
       ``(1) Native Hawaiians begin their story with the Kumulipo, 
     which details the creation and interrelationship of all 
     things, including the evolvement of Native Hawaiians as 
     healthy and well people;
       ``(2) Native Hawaiians--
       ``(A) are a distinct and unique indigenous people with a 
     historical continuity to the original inhabitants of the 
     Hawaiian archipelago within Ke Moananui, the Pacific Ocean; 
     and
       ``(B) have a distinct society that was first organized 
     almost 2,000 years ago;
       ``(3) the health and well-being of Native Hawaiians are 
     intrinsically tied to the deep feelings and attachment of 
     Native Hawaiians to their lands and seas;
       ``(4) the long-range economic and social changes in Hawaii 
     over the 19th and early 20th centuries have been devastating 
     to the health and well-being of Native Hawaiians;
       ``(5) Native Hawaiians have never directly relinquished to 
     the United States their claims to their inherent sovereignty 
     as a people or over their national territory, either through 
     their monarchy or through a plebiscite or referendum;
       ``(6) the Native Hawaiian people are determined to 
     preserve, develop, and transmit to future generations, in 
     accordance with their own spiritual and traditional beliefs, 
     their customs, practices, language, social institutions, 
     ancestral territory, and cultural identity;
       ``(7) in referring to themselves, Native Hawaiians use the 
     term `Kanaka Maoli', a term frequently used in the 19th 
     century to describe the native people of Hawaii;
       ``(8) the constitution and statutes of the State of 
     Hawaii--
       ``(A) acknowledge the distinct land rights of Native 
     Hawaiian people as beneficiaries of the public lands trust; 
     and
       ``(B) reaffirm and protect the unique right of the Native 
     Hawaiian people to practice and perpetuate their cultural and 
     religious customs, beliefs, practices, and language;
       ``(9) at the time of the arrival of the first nonindigenous 
     people in Hawaii in 1778, the Native Hawaiian people lived in 
     a highly organized, self-sufficient, subsistence social 
     system based on communal land tenure with a sophisticated 
     language, culture, and religion;
       ``(10) a unified monarchical government of the Hawaiian 
     Islands was established in 1810 under Kamehameha I, the first 
     King of Hawaii;
       ``(11) throughout the 19th century until 1893, the United 
     States--
       ``(A) recognized the independence of the Hawaiian Nation;
       ``(B) extended full and complete diplomatic recognition to 
     the Hawaiian Government; and
       ``(C) entered into treaties and conventions with the 
     Hawaiian monarchs to govern commerce and navigation in 1826, 
     1842, 1849, 1875, and 1887;
       ``(12) in 1893, John L. Stevens, the United States Minister 
     assigned to the sovereign and independent Kingdom of Hawaii, 
     conspired with a small group of non-Hawaiian residents of the 
     Kingdom, including citizens of the United States, to 
     overthrow the indigenous and lawful government of Hawaii;
       ``(13) in pursuance of that conspiracy--
       ``(A) the United States Minister and the naval 
     representative of the United States caused armed forces of 
     the United States Navy to invade the sovereign Hawaiian 
     Nation in support of the overthrow of the indigenous and 
     lawful Government of Hawaii; and
       ``(B) after that overthrow, the United States Minister 
     extended diplomatic recognition of a provisional government 
     formed by the conspirators without the consent of the native 
     people of Hawaii or the lawful Government of Hawaii, in 
     violation of--
       ``(i) treaties between the Government of Hawaii and the 
     United States; and
       ``(ii) international law;
       ``(14) in a message to Congress on December 18, 1893, 
     President Grover Cleveland--
       ``(A) reported fully and accurately on those illegal 
     actions;
       ``(B) acknowledged that by those acts, described by the 
     President as acts of war, the government of a peaceful and 
     friendly people was overthrown; and
       ``(C) concluded that a `substantial wrong has thus been 
     done which a due regard for our national character as well as 
     the rights of the injured people required that we should 
     endeavor to repair';
       ``(15) Queen Lili`uokalani, the lawful monarch of Hawaii, 
     and the Hawaiian Patriotic League, representing the 
     aboriginal citizens of Hawaii, promptly petitioned the United 
     States for redress of those wrongs and restoration of the 
     indigenous government of the Hawaiian nation, but no action 
     was taken on that petition;
       ``(16) in 1993, Congress enacted Public Law 103-150 (107 
     Stat. 1510), in which Congress--
       ``(A) acknowledged the significance of those events; and
       ``(B) apologized to Native Hawaiians on behalf of the 
     people of the United States for the overthrow of the Kingdom 
     of Hawaii with the participation of agents and citizens of 
     the United States, and the resulting deprivation of the 
     rights of Native Hawaiians to self-determination;
       ``(17) in 1898, the United States--
       ``(A) annexed Hawaii through Resolution No. 55 (commonly 
     known as the `Newlands Resolution') (30 Stat. 750), without 
     the consent of, or compensation to, the indigenous people of 
     Hawaii or the sovereign government of those people; and
       ``(B) denied those people the mechanism for expression of 
     their inherent sovereignty through self-government and self-
     determination of their lands and ocean resources;
       ``(18) through the Newlands Resolution and the Act of April 
     30, 1900 (commonly known as the `1900 Organic Act') (31 Stat. 
     141, chapter 339), Congress--
       ``(A) received 1,750,000 acres of land formerly owned by 
     the Crown and Government of the Hawaiian Kingdom; and
       ``(B) exempted the land from then-existing public land laws 
     of the United States by mandating that the revenue and 
     proceeds from that land be `used solely for the benefit of 
     the inhabitants of the Hawaiian Islands for education and 
     other public purposes', thereby establishing a special trust 
     relationship between the United States and the inhabitants of 
     Hawaii;
       ``(19) in 1921, Congress enacted the Hawaiian Homes 
     Commission Act, 1920 (42 Stat. 108, chapter 42), which--
       ``(A) designated 200,000 acres of the ceded public land for 
     exclusive homesteading by Native Hawaiians; and
       ``(B) affirmed the trust relationship between the United 
     States and Native Hawaiians, as expressed by Secretary of the 
     Interior Franklin K. Lane, who was cited in the Committee 
     Report of the Committee on Territories of the House of 
     Representatives as stating, `One thing that impressed me . . 
     . was the fact that the natives of the islands . . . for whom 
     in a sense we are trustees, are falling off rapidly in 
     numbers and many of them are in poverty.';
       ``(20) in 1938, Congress again acknowledged the unique 
     status of the Native Hawaiian people by including in the Act 
     of June 20, 1938 (52 Stat. 781), a provision--
       ``(A) to lease land within the extension to Native 
     Hawaiians; and
       ``(B) to permit fishing in the area `only by native 
     Hawaiian residents of said area or of adjacent villages and 
     by visitors under their guidance';
       ``(21) under the Act of March 18, 1959 (48 U.S.C. prec. 491 
     note; 73 Stat. 4), the United States--
       ``(A) transferred responsibility for the administration of 
     the Hawaiian home lands to the State; but
       ``(B) reaffirmed the trust relationship that existed 
     between the United States and the Native Hawaiian people by 
     retaining the exclusive power to enforce the trust, including 
     the power to approve land exchanges and 
     legislative amendments affecting the rights of 
     beneficiaries under that Act;
       ``(22) under the Act referred to in paragraph (21), the 
     United States--
       ``(A) transferred responsibility for administration over 
     portions of the ceded public lands trust not retained by the 
     United States to the State; but
       ``(B) reaffirmed the trust relationship that existed 
     between the United States and the Native Hawaiian people by 
     retaining the legal responsibility of the State for the 
     betterment of the conditions of Native Hawaiians under 
     section 5(f) of that Act (73 Stat. 6);
       ``(23) in 1978, the people of Hawaii--
       ``(A) amended the constitution of Hawaii to establish the 
     Office of Hawaiian Affairs; and
       ``(B) assigned to that Office the authority--
       ``(i) to accept and hold in trust for the Native Hawaiian 
     people real and personal property transferred from any 
     source;
       ``(ii) to receive payments from the State owed to the 
     Native Hawaiian people in satisfaction of the pro rata share 
     of the proceeds of the public land trust established by 
     section 5(f) of the Act of March 18, 1959 (48 U.S.C. prec. 
     491 note; 73 Stat. 6);
       ``(iii) to act as the lead State agency for matters 
     affecting the Native Hawaiian people; and
       ``(iv) to formulate policy on affairs relating to the 
     Native Hawaiian people;
       ``(24) the authority of Congress under the Constitution to 
     legislate in matters affecting the aboriginal or indigenous 
     people of the United States includes the authority to 
     legislate in matters affecting the native people of Alaska 
     and Hawaii;
       ``(25) the United States has recognized the authority of 
     the Native Hawaiian people to continue to work toward an 
     appropriate form of sovereignty, as defined by the Native 
     Hawaiian people in provisions set forth in legislation 
     returning the Hawaiian Island of

[[Page S662]]

     Kaho`olawe to custodial management by the State in 1994;
       ``(26) in furtherance of the trust responsibility for the 
     betterment of the conditions of Native Hawaiians, the United 
     States has established a program for the provision of 
     comprehensive health promotion and disease prevention 
     services to maintain and improve the health status of the 
     Hawaiian people;
       ``(27) that program is conducted by the Native Hawaiian 
     Health Care Systems and Papa Ola Lokahi;
       ``(28) health initiatives implemented by those and other 
     health institutions and agencies using Federal assistance 
     have been responsible for reducing the century-old morbidity 
     and mortality rates of Native Hawaiian people by--
       ``(A) providing comprehensive disease prevention;
       ``(B) providing health promotion activities; and
       ``(C) increasing the number of Native Hawaiians in the 
     health and allied health professions;
       ``(29) those accomplishments have been achieved through 
     implementation of--
       ``(A) the Native Hawaiian Health Care Act of 1988 (Public 
     Law 100-579); and
       ``(B) the reauthorization of that Act under section 9168 of 
     the Department of Defense Appropriations Act, 1993 (Public 
     Law 102-396; 106 Stat. 1948);
       ``(30) the historical and unique legal relationship between 
     the United States and Native Hawaiians has been consistently 
     recognized and affirmed by Congress through the enactment of 
     more than 160 Federal laws that extend to the Native Hawaiian 
     people the same rights and privileges accorded to American 
     Indian, Alaska Native, Eskimo, and Aleut communities, 
     including--
       ``(A) the Native American Programs Act of 1974 (42 U.S.C. 
     2991 et seq.);
       ``(B) the American Indian Religious Freedom Act (42 U.S.C. 
     1996);
       ``(C) the National Museum of the American Indian Act (20 
     U.S.C. 80q et seq.); and
       ``(D) the Native American Graves Protection and 
     Repatriation Act (25 U.S.C. 3001 et seq.);
       ``(31) the United States has recognized and reaffirmed the 
     trust relationship to the Native Hawaiian people through 
     legislation that authorizes the provision of services to 
     Native Hawaiians, specifically--
       ``(A) the Older Americans Act of 1965 (42 U.S.C. 3001 et 
     seq.);
       ``(B) the Developmental Disabilities Assistance and Bill of 
     Rights Act Amendments of 1987 (42 U.S.C. 6000 et seq.);
       ``(C) the Veterans' Benefits and Services Act of 1988 
     (Public Law 100-322);
       ``(D) the Rehabilitation Act of 1973 (29 U.S.C. 701 et 
     seq.);
       ``(E) the Native Hawaiian Health Care Act of 1988 (42 
     U.S.C. 11701 et seq.);
       ``(F) the Health Professions Reauthorization Act of 1988 
     (Public Law 100-607; 102 Stat. 3122);
       ``(G) the Nursing Shortage Reduction and Education 
     Extension Act of 1988 (Public Law 100-607; 102 Stat. 3153);
       ``(H) the Handicapped Programs Technical Amendments Act of 
     1988 (Public Law 100-630);
       ``(I) the Indian Health Care Amendments of 1988 (Public Law 
     100-713); and
       ``(J) the Disadvantaged Minority Health Improvement Act of 
     1990 (Public Law 101-527);
       ``(32) the United States has affirmed that historical and 
     unique legal relationship to the Hawaiian people by 
     authorizing the provision of services to Native Hawaiians to 
     address problems of alcohol and drug abuse under the Anti-
     Drug Abuse Act of 1986 (21 U.S.C. 801 note; Public Law 99-
     570);
       ``(33) in addition, the United States--
       ``(A) has recognized that Native Hawaiians, as aboriginal, 
     indigenous, native people of Hawaii, are a unique population 
     group in Hawaii and in the continental United States; and
       ``(B) has so declared in Office of Management and Budget 
     Circular 15 in 1997 and Presidential Executive Order No. 
     13125, dated June 7, 1999; and
       ``(34) despite the United States having expressed in Public 
     Law 103-150 (107 Stat. 1510) its commitment to a policy of 
     reconciliation with the Native Hawaiian people for past 
     grievances--
       ``(A) the unmet health needs of the Native Hawaiian people 
     remain severe; and
       ``(B) the health status of the Native Hawaiian people 
     continues to be far below that of the general population of 
     the United States.
       ``(b) Finding of Unmet Needs and Health Disparities.--
     Congress finds that the unmet needs and serious health 
     disparities that adversely affect the Native Hawaiian people 
     include the following:
       ``(1) Chronic disease and illness.--
       ``(A) Cancer.--
       ``(i) In general.--With respect to all cancer--

       ``(I) Native Hawaiians have the highest cancer mortality 
     rates in the State (216.8 out of every 100,000 male residents 
     and 191.6 out of every 100,000 female residents), rates that 
     are 21 percent higher than the rate for the total State male 
     population (179.0 out of every 100,000 residents) and 64 
     percent higher than the rate for the total State female 
     population (117.0 per 100,000);
       ``(II) Native Hawaiian males have the highest cancer 
     mortality rates in the State for cancers of the lung, colon, 
     rectum, and colorectum, and for all cancers combined;
       ``(III) Native Hawaiian females have the highest cancer 
     mortality rates in the State for cancers of the lung, liver, 
     pancreas, breast, corpus uteri, stomach, colon, and rectum, 
     and for all cancers combined;
       ``(IV) Native Hawaiian males have 8.7 years of productive 
     life lost as a result of cancer in the State, the highest 
     years of productive life lost in that State, as compared with 
     6.4 years for all males; and
       ``(V) Native Hawaiian females have 8.2 years of productive 
     life lost as a result of cancer in the State as compared with 
     6.4 years for all females in the State.

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

       ``(I) Native Hawaiians have the highest mortality rate in 
     the State from breast cancer (30.79 out of every 100,000 
     residents), a rate that is 33 percent higher than that for 
     Caucasian Americans (23.07 out of every 100,000 residents) 
     and 106 percent higher than that for Chinese Americans (14.96 
     out of every 100,000 residents); and
       ``(II) nationally, Native Hawaiians have the third highest 
     mortality rate as a result of breast cancer (25.0 out of 
     every 100,000 residents), behind African Americans (31.4 out 
     of every 100,000 residents) and Caucasian Americans (27.0 out 
     of every 100,000 residents).

       ``(iii) Cancer of the cervix.--Native Hawaiians have the 
     highest mortality rate as a result of cancer of the cervix in 
     the State (3.65 out of every 100,000 residents), followed by 
     Filipino Americans (2.69 out of every 100,000 residents) and 
     Caucasian Americans (2.61 out of every 100,000 residents).
       ``(iv) Lung cancer.--Native Hawaiian males and females have 
     the highest mortality rates as a result of lung cancer in the 
     State, at 74.79 per 100,000 for males and 47.84 per 100,000 
     females, which rates are higher than the rates for the total 
     State population by 48 percent for males and 93 percent for 
     females.
       ``(v) Prostate cancer.--Native Hawaiian males have the 
     third highest mortality rate as a result of prostate cancer 
     in the State (21.48 out of every 100,000 residents), with 
     Caucasian Americans having the highest mortality rate as a 
     result of prostate cancer (23.96 out of every 100,000 
     residents).
       ``(B) Diabetes.--With respect to diabetes, in 2000--
       ``(i) Native Hawaiians had the highest mortality rate as a 
     result of diabetes mellitis (38.8 out of every 100,000 
     residents) in the State, which rate is 138 percent higher 
     than the statewide rate for all racial groups (16.3 out of 
     every 100,000 residents); and
       ``(ii) full-blood Hawaiians had a mortality as a result of 
     diabetes mellitis of 93.3 out of every 100,000 residents, 
     which is 518 percent higher than the rate for the statewide 
     population of all other racial groups.
       ``(C) Asthma.--With respect to asthma--
       ``(i) in 1990, Native Hawaiians comprised 44 percent of all 
     asthma cases in the State for those 18 years of age and 
     younger, and 35 percent of all asthma cases reported; and
       ``(ii) in 1999, the Native Hawaiian prevalence rate for 
     asthma was 129.6 out of every 1,000 residents, which was 69 
     percent higher than the rate for all others combined in the 
     State (76.7 out of every 1,000 residents).
       ``(D) Circulatory diseases.--
       ``(i) Heart disease.--With respect to heart disease--

       ``(I) the mortality rate for Native Hawaiians as a result 
     of heart disease (372.3 out of every 100,000 residents) is 68 
     percent higher than the rate for the entire State (221.9 out 
     of every 100,000 residents); and
       ``(II) Native Hawaiian males have the greatest years of 
     productive life lost in the State, because Native Hawaiian 
     males lose an average of 15.5 years and Native Hawaiian 
     females lose an average of 8.2 years as a result of heart 
     disease, as compared with 7.5 years for all males, and 6.4 
     years for all females, in the State.
       ``(ii) Hypertension.--With respect to hypertension--

       ``(I) the mortality rate for Native Hawaiians as a result 
     of hypertension (3.5 out of every 100,000 residents) is 84 
     percent higher than that for the entire State (1.9 out of 
     every 100,000 residents);
       ``(II) Native Hawaiians have substantially higher 
     prevalence rates of hypertension than--

       ``(aa) those observed statewide; and
       ``(bb) those of any other ethnic group in Hawaii; and

       ``(III) the prevalence rate of hypertension for Native 
     Hawaiians is 37.9 percent, 11 percent higher than that for 
     all others in the State (34.1 percent).

       ``(iii) Stroke.--The mortality rate for Native Hawaiians as 
     a result of stroke (72.0 out of every 100,000 residents) is 
     20 percent higher than that for the entire State (60 out of 
     every 100,000 residents).
       ``(2) Infectious disease and illness.--With respect to 
     infectious disease and illness--
       ``(A) in 1998, Native Hawaiians comprised 20 percent of all 
     deaths resulting from infectious diseases in the State for 
     all ages; and
       ``(B) the incidence of acquired immune deficiency syndrome 
     for Native Hawaiians is at least twice as high per 100,000 
     residents (10.5 percent) than that for any other non-
     Caucasian group in the State.
       ``(3) Injuries.--With respect to injuries--
       ``(A) the mortality rate for Native Hawaiians as a result 
     of injuries (32.0 out of every 100,000 residents) is 16 
     percent higher than that for the entire State (27.5 out of 
     every 100,000 residents);

[[Page S663]]

       ``(B) 32 percent of all deaths of individuals between the 
     ages of 18 and 24 years of age resulting from injuries were 
     Native Hawaiian; and
       ``(C) the 2 primary causes of Native Hawaiian deaths in 
     that age group were motor vehicle accidents (30 percent) and 
     intentional self-harm (39 percent).
       ``(4) Dental health.--With respect to dental health--
       ``(A) Native Hawaiian children exhibit among the highest 
     rates of dental caries in the United States, and the highest 
     in the State as compared with the 5 other major ethnic groups 
     in the State;
       ``(B) the average number of decayed or filled primary teeth 
     for Native Hawaiian children aged 5 through 9 years was 4.3, 
     as compared with 3.7 for all children in the State and 1.9 
     for all children in the United States; and
       ``(C) the proportion of Native Hawaiian children aged 5 
     through 12 years with unmet dental treatment needs (defined 
     as having active dental caries requiring treatment) is 40 
     percent, as compared with 33 percent for all other racial 
     groups in the State.
       ``(5) Life expectancy.--With respect to life expectancy--
       ``(A) Native Hawaiians have the lowest life expectancy of 
     all population groups in the State;
       ``(B) between 1910 and 1980, the life expectancy of Native 
     Hawaiians from birth has ranged from 5 to 10 years less than 
     that of the overall State population average; and
       ``(C) the most recent tables for 1990 show Native Hawaiian 
     life expectancy at birth (74.27 years) to be approximately 5 
     years less than that of the total State population (78.85 
     years).
       ``(6) Maternal and child health.--
       ``(A) In general.--With respect to maternal and child 
     health, for 2000--
       ``(i) 39 percent of all deaths of children under the age of 
     18 years in the State were Native Hawaiian; and
       ``(ii) perinatal conditions accounted for 38 percent of all 
     Native Hawaiian deaths in that age group.
       ``(B) Prenatal care.--With respect to prenatal care--
       ``(i) as of 1998, Native Hawaiian women have the highest 
     prevalence (24 percent) of having had no prenatal care during 
     the first trimester of pregnancy, as compared with the 5 
     largest ethnic groups in the State;
       ``(ii) of the mothers in the State who received no prenatal 
     care throughout their pregnancies in 1996, 44 percent were 
     Native Hawaiian;
       ``(iii) more than 65 percent of the referrals to Healthy 
     Start in fiscal years 1996 and 1997 were Native Hawaiian 
     newborns; and
       ``(iv) in every region of the State, many Native Hawaiian 
     newborns begin life in a potentially hazardous circumstance, 
     far higher than any other racial group.
       ``(C) Births.--With respect to births--
       ``(i) in 1996, 45 percent of the live births to Native 
     Hawaiian mothers were infants born to single mothers, a 
     circumstance which statistics indicate puts infants at higher 
     risk of low birth weight and infant mortality;
       ``(ii) in 1996, of the births to Native Hawaiian single 
     mothers, 8 percent were low birth weight (defined as a weight 
     of less than 2,500 grams); and
       ``(iii) of all low birth weight infants born to single 
     mothers in the State, 44 percent were Native Hawaiian.
       ``(D) Teen pregnancies.--With respect to births--
       ``(i) in 1993 and 1994, Native Hawaiians had the highest 
     percentage of teen (individuals who were less than 18 years 
     of age) births (8.1 percent), as compared with the rate for 
     all other racial groups in the State (3.6 percent);
       ``(ii) in 1998, nearly 49 percent of all mothers in the 
     State under 19 years of age were Native Hawaiian;
       ``(iii) in 1998, Native Hawaiians comprised 31 percent 
     (1,425) of all live births to mothers with medical risk 
     factors in the State (4,559); and
       ``(iv) lower rates of abortion (approximately 33 percent 
     lower than for the statewide population) among Hawaiian women 
     may account, in part, for that higher percentage of live 
     births.
       ``(E) Fetal mortality.--With respect to fetal mortality--
       ``(i) in 2000, Native Hawaiians had the highest number of 
     fetal deaths in the State; and
       ``(ii)(I) 21 percent of all fetal deaths in the State were 
     associated with expectant Native Hawaiian mothers; and
       ``(II) 37 percent of those Native Hawaiian mothers were 
     under the age of 25 years.
       ``(7) Mental health.--
       ``(A) Alcohol and drug abuse.--With respect to alcohol and 
     drug abuse--
       ``(i) Native Hawaiians represent 38 percent of the total 
     admissions to substance abuse treatment programs funded by 
     the Department of Health, Alcohol, Drugs and Other Drugs of 
     the State;
       ``(ii) in 2000, the prevalence of cigarette smoking by 
     Native Hawaiians was 31.0 percent, a rate that is 57 percent 
     higher than that for the total population in the State, which 
     is 19.7 percent;
       ``(iii) Native Hawaiians have the highest prevalence rate 
     of acute alcohol drinking (19.6 percent), a rate that is 40 
     percent higher than that for the total population in the 
     State;
       ``(iv) the chronic alcohol drinking rate among Native 
     Hawaiians is 54 percent higher than that for all other racial 
     groups in the State;
       ``(v) in 1991, 40 percent of Native Hawaiian adults 
     surveyed reported having used marijuana, as compared with 30 
     percent for all other racial groups in the State; and
       ``(vi) 9 percent of the Native Hawaiian adults surveyed 
     reported that they use or have used marijuana within the year 
     preceding the survey, as compared with 6 percent for all 
     other racial groups in the State.
       ``(B) Crime.--With respect to crime--
       ``(i) in 1998, of the 7,789 arrests that were made for 
     property crimes in the State, arrests of Native Hawaiians 
     comprised 23 percent;
       ``(ii) Native Hawaiians comprised 40 percent of juvenile 
     arrests in 1998, the largest percentage of all juvenile 
     arrests in that year;
       ``(iii) in the period of 1996 through 1998, the 
     overrepresentation of Native Hawaiian juvenile arrests for 
     index crimes and Part II offenses increased by 6 percent and 
     2 percent, respectively;
       ``(iv) in 1998, Native Hawaiians represented 22 percent of 
     the 2,423 adults arrested for drug-related offenses in the 
     State;
       ``(v) Native Hawaiians are overrepresented in the prison 
     population in the State;
       ``(vi) of the 2,260 incarcerated Native Hawaiians, 70 
     percent are between 20 and 40 years of age;
       ``(vii) in 1995 and 1996, Native Hawaiians comprised 36.5 
     percent of the sentenced felon prison population in Hawaii, 
     as compared with 20.5 percent for Caucasian Americans, 3.7 
     percent for Japanese Americans, and 6 percent for Chinese 
     Americans;
       ``(viii) in 2002, Native Hawaiians comprised 40 percent of 
     the total sentenced felon population in the State, as 
     compared with 25 percent for Caucasian Americans, 12 percent 
     for Filipino Americans, 6 percent for Japanese Americans, and 
     5 percent for Samoans; and
       ``(ix) based on anecdotal information from inmates at the 
     Halawa Correction Facilities, Native Hawaiians are estimated 
     to comprise between 60 and 70 percent of all inmates in the 
     State.
       ``(8) Obesity.--Native Hawaiians have the highest 
     prevalence rate of overweightness and obesity (69.4 percent), 
     a rate that is 38 percent higher than that for the total 
     State population (50.2 percent).
       ``(9) Health professions education and training.--With 
     respect to health professions education and training--
       ``(A)(i) Native Hawaiians who are at least 25 years of age 
     have a comparable rate of high school completion as compared 
     with all people in the State who are at least 25 years of 
     age; but
       ``(ii) the rate of baccalaureate degree achievement among 
     Native Hawaiians is 6.9 percent, which is less than the 
     average in the State (15.76 percent);
       ``(B) Native Hawaiian physicians make up 4 percent of the 
     total physician workforce in the State; and
       ``(C)(i) in fiscal year 1999, Native Hawaiians comprised--
       ``(I) 9 percent of those individuals who earned Bachelor's 
     degrees;
       ``(II) 15 percent of those individuals who earned 2-year 
     diplomas; and
       ``(III) 6 percent of those individuals who earned Master's 
     degrees; and
       ``(ii) in 1997, Native Hawaiians comprised less than 1 
     percent of individuals who earned doctoral degrees at the 
     University of Hawaii.

     ``SEC. 3. DEFINITIONS.

       ``In this Act:
       ``(1) Department.--The term `Department' means the 
     Department of Health and Human Services.
       ``(2) Disease prevention.--The term `disease prevention' 
     includes--
       ``(A) immunizations;
       ``(B) control of high blood pressure;
       ``(C) control of sexually transmittable diseases;
       ``(D) prevention and control of chronic diseases;
       ``(E) control of toxic agents;
       ``(F) occupational safety and health;
       ``(G) injury prevention;
       ``(H) fluoridation of water;
       ``(I) control of infectious agents; and
       ``(J) provision of mental health care.
       ``(3) Health promotion.--The term `health promotion' 
     includes--
       ``(A) pregnancy and infant care, including prevention of 
     fetal alcohol syndrome;
       ``(B) cessation of tobacco smoking;
       ``(C) reduction in the misuse of alcohol and harmful 
     illicit drugs;
       ``(D) improvement of nutrition;
       ``(E) improvement in physical fitness;
       ``(F) family planning;
       ``(G) control of stress;
       ``(H) reduction of major behavioral risk factors and 
     promotion of healthy lifestyle practices; and
       ``(I) integration of cultural approaches to health and 
     well-being (including traditional practices relating to the 
     atmosphere (lewa lani), land (`aina), water (wai), and ocean 
     (kai)).
       ``(4) Health service.--The term `health service' means--
       ``(A) service provided by a physician, physician's 
     assistant, nurse practitioner, nurse, dentist, or other 
     health professional;
       ``(B) a diagnostic laboratory or radiologic service;
       ``(C) a preventive health service (including a perinatal 
     service, well child service, family planning service, 
     nutrition service, home health service, sports medicine and 
     athletic training service, and, generally, any service 
     associated with enhanced health and wellness);

[[Page S664]]

       ``(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) Native hawaiian.--The term `Native Hawaiian' means 
     any individual who is Kanaka Maoli (a descendant of the 
     aboriginal people who, prior to 1778, occupied and exercised 
     sovereignty in the area that now constitutes the State), as 
     evidenced by--
       ``(A) genealogical records;
       ``(B) kama`aina witness verification from Native Hawaiian 
     Kupuna (elders); or
       ``(C) birth records of the State or any other State or 
     territory of the United States.
       ``(6) Native hawaiian health care system.--The term `Native 
     Hawaiian health care system' means any of up to 8 entities in 
     the State that--
       ``(A) is organized under the laws of the State;
       ``(B) provides or arranges for the provision of health 
     services for Native Hawaiians in the State;
       ``(C) is a public or nonprofit private entity;
       ``(D) has Native Hawaiians significantly participating in 
     the planning, management, provision, monitoring, and 
     evaluation of health services;
       ``(E) addresses the health care needs of an island's Native 
     Hawaiian population; and
       ``(F) is recognized by Papa Ola Lokahi--
       ``(i) for the purpose of planning, conducting, or 
     administering programs, or portions of programs, authorized 
     by this Act for the benefit of Native Hawaiians; and
       ``(ii) as having the qualifications and the capacity to 
     provide the services and meet the requirements under--

       ``(I) the contract that each Native Hawaiian health care 
     system enters into with the Secretary under this Act; or
       ``(II) the grant each Native Hawaiian health care system 
     receives from the Secretary under this Act.

       ``(7) Native hawaiian health center.--The term `Native 
     Hawaiian Health Center' means any organization that is a 
     primary health care provider that--
       ``(A) has a governing board composed of individuals, at 
     least 50 percent of whom are Native Hawaiians;
       ``(B) has demonstrated cultural competency in a 
     predominantly Native Hawaiian community;
       ``(C) serves a patient population that--
       ``(i) is made up of individuals at least 50 percent of whom 
     are Native Hawaiian; or
       ``(ii) has not less than 2,500 Native Hawaiians as annual 
     users of services; and
       ``(D) is recognized by Papa Ola Lokahi as having met each 
     of the criteria described in subparagraphs (A) through (C).
       ``(8) Native hawaiian health task force.--The term `Native 
     Hawaiian Health Task Force' means a task force established by 
     the State Council of Hawaiian Homestead Associations to 
     implement health and wellness strategies in Native Hawaiian 
     communities.
       ``(9) Native hawaiian organization.--The term `Native 
     Hawaiian organization' means any organization that--
       ``(A) serves the interests of Native Hawaiians; and
       ``(B)(i) is recognized by Papa Ola Lokahi for planning, 
     conducting, or administering programs authorized under this 
     Act for the benefit of Native Hawaiians; and
       ``(ii) is a public or nonprofit private entity.
       ``(10) Office of hawaiian affairs.--The term `Office of 
     Hawaiian Affairs' means the governmental entity that--
       ``(A) is established under article XII, sections 5 and 6, 
     of the Hawaii State Constitution; and
       ``(B) charged with the responsibility to formulate policy 
     relating to the affairs of Native Hawaiians.
       ``(11) Papa ola lokahi.--
       ``(A) In general.--The term `Papa Ola Lokahi' means an 
     organization that--
       ``(i) is composed of public agencies and private 
     organizations focusing on improving the health status of 
     Native Hawaiians; and
       ``(ii) governed by a board the members of which may include 
     representation from--

       ``(I) E Ola Mau;
       ``(II) the Office of Hawaiian Affairs;
       ``(III) Alu Like, Inc.;
       ``(IV) the University of Hawaii;
       ``(V) the Hawaii State Department of Health;
       ``(VI) the Native Hawaiian Health Task Force;
       ``(VII) the Hawaii State Primary Care Association;
       ``(VIII) Ahahui O Na Kauka, the Native Hawaiian Physicians 
     Association;
       ``(IX) Ho`ola Lahui Hawaii, or a health care system serving 
     the islands of Kaua`i or Ni`ihau (which may be composed of as 
     many health care centers as are necessary to meet the health 
     care needs of the Native Hawaiians of those islands);
       ``(X) Ke Ola Mamo, or a health care system serving the 
     island of O`ahu (which may be composed of as many health care 
     centers as are necessary to meet the health care needs of the 
     Native Hawaiians of that island);
       ``(XI) Na Pu`uwai or a health care system serving the 
     islands of Moloka`i or Lana`i (which may be composed of as 
     many health care centers as are necessary to meet the health 
     care needs of the Native Hawaiians of those islands);
       ``(XII) Hui No Ke Ola Pono, or a health care system serving 
     the island of Maui (which may be composed of as many health 
     care centers as are necessary to meet the health care needs 
     of the Native Hawaiians of that island);
       ``(XIII) Hui Malama Ola Na `Oiwi, or a health care system 
     serving the island of Hawaii (which may be composed of as 
     many health care centers as are necessary to meet the 
     health care needs of the Native Hawaiians of that island);

       ``(XIV) such other Native Hawaiian health care systems as 
     are certified and recognized by Papa Ola Lokahi in accordance 
     with this Act; and
       ``(XV) such other member organizations as the Board of Papa 
     Ola Lokahi shall admit from time to time, based on 
     satisfactory demonstration of a record of contribution to the 
     health and well-being of Native Hawaiians.

       ``(B) Exclusion.--The term `Papa Ola Lokahi' does not 
     include any organization described in subparagraph (A) for 
     which the Secretary has made a determination that the 
     organization has not developed a mission statement that 
     includes--
       ``(i) clearly-defined goals and objectives for the 
     contributions the organization will make to--

       ``(I) Native Hawaiian health care systems; and
       ``(II) the national policy described in section 4; and

       ``(ii) an action plan for carrying out those goals and 
     objectives.
       ``(12) Secretary.--The term `Secretary' means the Secretary 
     of Health and Human Services.
       ``(13) State.--The term `State' means the State of Hawaii.
       ``(14) Traditional native hawaiian healer.--The term 
     `traditional Native Hawaiian healer' means a practitioner--
       ``(A) who--
       ``(i) is of Native Hawaiian ancestry; and
       ``(ii) has the knowledge, skills, and experience in direct 
     personal health care of individuals; and
       ``(B) the knowledge, skills, and experience of whom are 
     based on demonstrated learning of Native Hawaiian healing 
     practices acquired by--
       ``(i) direct practical association with Native Hawaiian 
     elders; and
       ``(ii) oral traditions transmitted from generation to 
     generation.

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

       ``(a) Declaration.--Congress declares that it is the policy 
     of the United States, in fulfillment of special 
     responsibilities and legal obligations of the United States 
     to the indigenous people of Hawaii resulting from the unique 
     and historical relationship between the United States and the 
     indigenous people of Hawaii--
       ``(1) to raise the health status of Native Hawaiians to the 
     highest practicable health level; and
       ``(2) to provide Native Hawaiian health care programs with 
     all resources necessary to effectuate that policy.
       ``(b) Intent of Congress.--It is the intent of Congress 
     that--
       ``(1) health care programs having a demonstrated effect of 
     substantially reducing or eliminating the overrepresentation 
     of Native Hawaiians among those suffering from chronic and 
     acute disease and illness, and addressing the health needs of 
     Native Hawaiians (including perinatal, early child 
     development, and family-based health education needs), shall 
     be established and implemented; and
       ``(2) the United States--
       ``(A) raise the health status of Native Hawaiians by the 
     year 2010 to at least the levels described in the goals 
     contained within Healthy People 2010 (or successor 
     standards); and
       ``(B) incorporate within health programs in the United 
     States activities defined and identified by Kanaka Maoli, 
     such as--
       ``(i) incorporating and supporting the integration of 
     cultural approaches to health and well-being, including 
     programs using traditional practices relating to the 
     atmosphere (lewa lani), land ('aina), water (wai), or ocean 
     (kai);
       ``(ii) increasing the number of Native Hawaiian health and 
     allied-health providers who provide care to or have an impact 
     on the health status of Native Hawaiians;
       ``(iii) increasing the use of traditional Native Hawaiian 
     foods in--

       ``(I) the diets and dietary preferences of people, 
     including those of students; and
       ``(II) school feeding programs;

[[Page S665]]

       ``(iv) identifying and instituting Native Hawaiian cultural 
     values and practices within the corporate cultures of 
     organizations and agencies providing health services to 
     Native Hawaiians;
       ``(v) facilitating the provision of Native Hawaiian healing 
     practices by Native Hawaiian healers for individuals desiring 
     that assistance;
       ``(vi) supporting training and education activities and 
     programs in traditional Native Hawaiian healing practices by 
     Native Hawaiian healers; and
       ``(vii) demonstrating the integration of health services 
     for Native Hawaiians, particularly those that integrate 
     mental, physical, and dental services in health care.
       ``(c) Report.--The Secretary shall submit to the President, 
     for inclusion in each report required to be submitted to 
     Congress under section 12, a report on the progress made 
     toward meeting the national policy described in this section.

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

       ``(a) Development.--
       ``(1) In general.--The Secretary may make a grant to, or 
     enter into a contract with, Papa Ola Lokahi for the purpose 
     of coordinating, implementing, and updating a Native Hawaiian 
     comprehensive health care master plan that is designed--
       ``(A) to promote comprehensive health promotion and disease 
     prevention services;
       ``(B) to maintain and improve the health status of Native 
     Hawaiians; and
       ``(C) to support community-based initiatives that are 
     reflective of holistic approaches to health.
       ``(2) Consultation.--
       ``(A) In general.--In carrying out this section, Papa Ola 
     Lokahi and the Office of Hawaiian Affairs shall consult with 
     representatives of--
       ``(i) the Native Hawaiian health care systems;
       ``(ii) the Native Hawaiian health centers; and
       ``(iii) the Native Hawaiian community.
       ``(B) Memoranda of understanding.--Papa Ola Lokahi and the 
     Office of Hawaiian Affairs may enter into memoranda of 
     understanding or agreement for the purpose of acquiring joint 
     funding, or for such other purposes as are necessary, to 
     accomplish the objectives of this section.
       ``(3) Health care financing study report.--
       ``(A) In general.--Not later than 18 months after the date 
     of enactment of the Native Hawaiian Health Care Improvement 
     Reauthorization Act of 2005, Papa Ola Lokahi, in cooperation 
     with the Office of Hawaiian Affairs and other appropriate 
     agencies and organizations in the State (including the 
     Department of Health and the Department of Human Services of 
     the State) and appropriate Federal agencies (including the 
     Centers for Medicare and Medicaid Services), shall submit to 
     Congress a report that describes the impact of Federal and 
     State health care financing mechanisms and policies on the 
     health and well-being of Native Hawaiians.
       ``(B) Components.--The report shall include--
       ``(i) information concerning the impact on Native Hawaiian 
     health and well-being of--

       ``(I) cultural competency;
       ``(II) risk assessment data;
       ``(III) eligibility requirements and exemptions; and
       ``(IV) reimbursement policies and capitation rates in 
     effect as of the date of the report for service providers;

       ``(ii) such other similar information as may be important 
     to improving the health status of Native Hawaiians, as that 
     information relates to health care financing (including 
     barriers to health care); and
       ``(iii) recommendations for submission to the Secretary, 
     for review and consultation with the Native Hawaiian 
     community.
       ``(b) Authorization of Appropriations.--There are 
     authorized to be appropriated such sums as are necessary to 
     carry out subsection (a).

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

       ``(a) In General.--Papa Ola Lokahi--
       ``(1) shall be responsible for--
       ``(A) the coordination, implementation, and updating, as 
     appropriate, of the comprehensive health care master plan 
     under section 5;
       ``(B) the training and education of individuals providing 
     health services;
       ``(C) the identification of and research (including 
     behavioral, biomedical, epidemiological, and health service 
     research) into the diseases that are most prevalent among 
     Native Hawaiians; and
       ``(D) the development and maintenance of an institutional 
     review board for all research projects involving all aspects 
     of Native Hawaiian health, including behavioral, biomedical, 
     epidemiological, and health service research;
       ``(2) may receive special project funds (including research 
     endowments under section 736 of the Public Health Service Act 
     (42 U.S.C. 293)) made available for the purpose of--
       ``(A) research on the health status of Native Hawaiians; or
       ``(B) addressing the health care needs of Native Hawaiians; 
     and
       ``(3) shall serve as a clearinghouse for--
       ``(A) the collection and maintenance of data associated 
     with the health status of Native Hawaiians;
       ``(B) the identification and research into diseases 
     affecting Native Hawaiians;
       ``(C) the availability of Native Hawaiian project funds, 
     research projects, and publications;
       ``(D) the collaboration of research in the area of Native 
     Hawaiian health; and
       ``(E) the timely dissemination of information pertinent to 
     the Native Hawaiian health care systems.
       ``(b) Consultation.--
       ``(1) In general.--The Secretary and the Secretary of each 
     other Federal agency shall--
       ``(A) consult with Papa Ola Lokahi; and
       ``(B) provide Papa Ola Lokahi and the Office of Hawaiian 
     Affairs, at least once annually, an accounting of funds and 
     services provided by the Secretary to assist in accomplishing 
     the purposes described in section 4.
       ``(2) Components of accounting.--The accounting under 
     paragraph (1)(B) shall include an identification of--
       ``(A) the amount of funds expended explicitly for and 
     benefiting Native Hawaiians;
       ``(B) the number of Native Hawaiians affected by those 
     funds;
       ``(C) the collaborations between the applicable Federal 
     agency and Native Hawaiian groups and organizations in the 
     expenditure of those funds; and
       ``(D) the amount of funds used for--
       ``(i) Federal administrative purposes; and
       ``(ii) the provision of direct services to Native 
     Hawaiians.
       ``(c) Fiscal Allocation and Coordination of Programs and 
     Services.--
       ``(1) Recommendations.--Papa Ola Lokahi shall provide 
     annual recommendations to the Secretary with respect to the 
     allocation of all amounts made available under this Act.
       ``(2) Coordination.--Papa Ola Lokahi shall, to the maximum 
     extent practicable, coordinate and assist the health care 
     programs and services provided to Native Hawaiians under this 
     Act and other Federal laws.
       ``(3) Representation on commission.--The Secretary, in 
     consultation with Papa Ola Lokahi, shall make recommendations 
     for Native Hawaiian representation on the President's 
     Advisory Commission on Asian Americans and Pacific Islanders.
       ``(d) Technical Support.--Papa Ola Lokahi 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) Authority.--Papa Ola Lokahi may enter into agreements 
     or memoranda of understanding with relevant institutions, 
     agencies, or organizations that are capable of providing--
       ``(A) health-related resources or services to Native 
     Hawaiians and the Native Hawaiian health care systems; or
       ``(B) resources or services for the implementation of the 
     national policy described in section 4.
       ``(2) Health care financing.--
       ``(A) Federal consultation.--
       ``(i) In general.--Before adopting any policy, rule, or 
     regulation that may affect the provision of services or 
     health insurance coverage for Native Hawaiians, a Federal 
     agency that provides health care financing and carries out 
     health care programs (including the Centers for Medicare and 
     Medicaid Services) shall consult with representatives of--

       ``(I) the Native Hawaiian community;
       ``(II) Papa Ola Lokahi; and
       ``(III) organizations providing health care services to 
     Native Hawaiians in the State.

       ``(ii) Identification of effects.--Any consultation by a 
     Federal agency under clause (i) shall include an 
     identification of the effect of any policy, rule, or 
     regulation proposed by the Federal agency.
       ``(B) State consultation.--Before making any change in an 
     existing program or implementing any new program relating to 
     Native Hawaiian health, the State shall engage in meaningful 
     consultation with representatives of--
       ``(i) the Native Hawaiian community;
       ``(ii) Papa Ola Lokahi; and
       ``(iii) organizations providing health care services to 
     Native Hawaiians in the State.
       ``(C) Consultation on federal health insurance programs.--
       ``(i) In general.--The Office of Hawaiian Affairs, in 
     collaboration with Papa Ola Lokahi, may develop consultative, 
     contractual, or other arrangements, including memoranda of 
     understanding or agreement, with--

       ``(I) the Centers for Medicare and Medicaid Services;
       ``(II) the agency of the State that administers or 
     supervises the administration of the State plan or waiver 
     approved under title XVIII, XIX, or XXI of the Social 
     Security Act (42 U.S.C. 1395 et seq.) for the payment of all 
     or a part of the health care services provided to Native 
     Hawaiians who are eligible for medical assistance under the 
     State plan or waiver; or
       ``(III) any other Federal agency providing full or partial 
     health insurance to Native Hawaiians.

       ``(ii) Contents of arrangements.--An arrangement under 
     clause (i) may address--

       ``(I) appropriate reimbursement for health care services, 
     including capitation rates and fee-for-service rates for 
     Native Hawaiians who are entitled to or eligible for 
     insurance;
       ``(II) the scope of services; or

[[Page S666]]

       ``(III) other matters that would enable Native Hawaiians to 
     maximize health insurance benefits provided by Federal and 
     State health insurance programs.

       ``(3) Traditional healers.--
       ``(A) In general.--The provision of health services under 
     any program operated by the Department or another Federal 
     agency (including the Department of Veterans Affairs) may 
     include the services of--
       ``(i) traditional Native Hawaiian healers; or
       ``(ii) traditional healers providing traditional health 
     care practices (as those terms are defined in section 4 of 
     the Indian Health Care Improvement Act (25 U.S.C. 1603).
       ``(B) Exemption.--Services described in subparagraph (A) 
     shall be exempt from national accreditation reviews, 
     including reviews conducted by--
       ``(i) the Joint Commission on Accreditation of Healthcare 
     Organizations; and
       ``(ii) the Commission on Accreditation of Rehabilitation 
     Facilities.

     ``SEC. 7. NATIVE HAWAIIAN HEALTH CARE.

       ``(a) Comprehensive Health Promotion, Disease Prevention, 
     and Other Health Services.--
       ``(1) Grants and contracts.--The Secretary, in consultation 
     with Papa Ola Lokahi, may make grants to, or enter into 
     contracts with 1 or more Native Hawaiian health care systems 
     for the purpose of providing comprehensive health promotion 
     and disease prevention services, as well as other health 
     services, to Native Hawaiians who desire and are committed to 
     bettering their own health.
       ``(2) Limitation on number of entities.--The Secretary may 
     make a grant to, or enter into a contract with, not more than 
     8 Native Hawaiian health care systems under this subsection 
     for any fiscal year.
       ``(b) Planning Grant or Contract.--In addition to grants 
     and contracts under subsection (a), the Secretary may make a 
     grant to, or enter into a contract with, Papa Ola Lokahi for 
     the purpose of planning Native Hawaiian health care systems 
     to serve the health needs of Native Hawaiian communities on 
     each of the islands of O`ahu, Moloka`i, Maui, Hawai`i, 
     Lana`i, Kaua`i, Kaho`lawe, and Ni`ihau in the State.
       ``(c) Health Services To Be Provided.--
       ``(1) In general.--Each recipient of funds under subsection 
     (a) may provide or arrange for--
       ``(A) outreach services to inform and assist Native 
     Hawaiians in accessing health services;
       ``(B) education in health promotion and disease prevention 
     for Native Hawaiians that, wherever practicable, is provided 
     by--
       ``(i) Native Hawaiian health care practitioners;
       ``(ii) community outreach workers;
       ``(iii) counselors;
       ``(iv) cultural educators; and
       ``(v) other disease prevention providers;
       ``(C) services of individuals providing health services;
       ``(D) collection of data relating to the prevention of 
     diseases and illnesses among Native Hawaiians; and
       ``(E) support of culturally appropriate activities that 
     enhance health and wellness, including land-based, water-
     based, ocean-based, and spiritually-based projects and 
     programs.
       ``(2) Traditional healers.--The health care services 
     referred to in paragraph (1) that are provided under grants 
     or contracts under subsection (a) may be provided by 
     traditional Native Hawaiian healers, as appropriate.
       ``(d) Federal Tort Claims Act.--An individual who provides 
     a medical, dental, or other service referred to in subsection 
     (a)(1) for a Native Hawaiian health care system, including a 
     provider of a traditional Native Hawaiian healing service, 
     shall be--
       ``(1) treated as if the individual were a member of the 
     Public Health Service; and
       ``(2) subject to section 224 of the Public Health Service 
     Act (42 U.S.C. 233).
       ``(e) Site for Other Federal Payments.--
       ``(1) In general.--A Native Hawaiian health care system 
     that receives funds under subsection (a) may serve as a 
     Federal loan repayment facility.
       ``(2) Remission of payments.--A facility described in 
     paragraph (1) shall be designed to enable health and allied-
     health professionals to remit payments with respect to loans 
     provided to the professionals under any Federal loan program.
       ``(f) Restriction on Use of Grant and Contract Funds.--The 
     Secretary shall not make a grant to, or enter into a contract 
     with, an entity under subsection (a) unless the entity agrees 
     that amounts received under the grant or contract will not, 
     directly or through contract, be expended--
       ``(1) for any service other than a service described in 
     subsection (c)(1);
       ``(2) to purchase or improve real property (other than 
     minor remodeling of existing improvements to real property); 
     or
       ``(3) to purchase major medical equipment.
       ``(g) Limitation on Charges for Services.--The Secretary 
     shall not make a grant to, or enter into a contract with, an 
     entity under subsection (a) unless the entity agrees that, 
     whether health services are provided directly or under a 
     contract--
       ``(1) any health service under the grant or contract will 
     be provided without regard to the ability of an individual 
     receiving the health service to pay for the health service; 
     and
       ``(2) the entity will impose for the delivery of such a 
     health service a charge that is--
       ``(A) made according to a schedule of charges that is made 
     available to the public; and
       ``(B) adjusted to reflect the income of the individual 
     involved.
       ``(h) Authorization of Appropriations.--
       ``(1) General grants.--There are authorized to be 
     appropriated such sums as are necessary to carry out 
     subsection (a) for each of fiscal years 2006 through 2011.
       ``(2) Planning grants.--There are authorized to be 
     appropriated such sums as are necessary to carry out 
     subsection (b) for each of fiscal years 2006 through 2011.
       ``(3) Health services.--There are authorized to be 
     appropriated such sums as are necessary to carry out 
     subsection (c) for each of fiscal years 2006 through 2011.

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

       ``(a) In General.--In addition to any other grant or 
     contract under this Act, the Secretary may make grants to, or 
     enter into contracts with, Papa Ola Lokahi for--
       ``(1) coordination, implementation, and updating (as 
     appropriate) of the comprehensive health care master plan 
     developed under section 5;
       ``(2) training and education for providers of health 
     services;
       ``(3) identification of and research (including behavioral, 
     biomedical, epidemiologic, and health service research) into 
     the diseases that are most prevalent among Native Hawaiians;
       ``(4) a clearinghouse function for--
       ``(A) the collection and maintenance of data associated 
     with the health status of Native Hawaiians;
       ``(B) the identification and research into diseases 
     affecting Native Hawaiians; and
       ``(C) the availability of Native Hawaiian project funds, 
     research projects, and publications;
       ``(5) the establishment and maintenance of an institutional 
     review board for all health-related research involving Native 
     Hawaiians;
       ``(6) the coordination of the health care programs and 
     services provided to Native Hawaiians; and
       ``(7) the administration of special project funds.
       ``(b) Authorization of Appropriations.--There are 
     authorized to be appropriated such sums as are necessary to 
     carry out subsection (a) for each of fiscal years 2006 
     through 2011.

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

       ``(a) Terms and Conditions.--The Secretary shall include in 
     any grant made or contract entered into under this Act such 
     terms and conditions as the Secretary considers necessary or 
     appropriate to ensure that the objectives of the grant or 
     contract are achieved.
       ``(b) Periodic Review.--The Secretary shall periodically 
     evaluate the performance of, and compliance with, grants and 
     contracts under this Act.
       ``(c) Administrative Requirements.--The Secretary shall not 
     make a grant or enter into a contract under this Act with an 
     entity unless the entity--
       ``(1) agrees to establish such procedures for fiscal 
     control and fund accounting as the Secretary determines are 
     necessary to ensure proper disbursement and accounting with 
     respect to the grant or contract;
       ``(2) agrees to ensure the confidentiality of records 
     maintained on individuals receiving health services under the 
     grant or contract;
       ``(3) with respect to providing health services to any 
     population of Native Hawaiians, a substantial portion of 
     which has a limited ability to speak the English language--
       ``(A) has developed and has the ability to carry out a 
     reasonable plan to provide health services under the grant or 
     contract through individuals who are able to communicate with 
     the population involved in the language and cultural context 
     that is most appropriate; and
       ``(B) has designated at least 1 individual who is fluent in 
     English and the appropriate language to assist in carrying 
     out the plan;
       ``(4) with respect to health services that are covered 
     under a program under title XVIII, XIX, or XXI of the Social 
     Security Act (42 U.S.C. 1395 et seq.) (including any State 
     plan), or under any other Federal health insurance plan--
       ``(A) if the entity will provide under the grant or 
     contract any of those health services directly--
       ``(i) has entered into a participation agreement under each 
     such plan; and
       ``(ii) is qualified to receive payments under the plan; and
       ``(B) if the entity will provide under the grant or 
     contract any of those health services through a contract with 
     an organization--
       ``(i) ensures that the organization has entered into a 
     participation agreement under each such plan; and
       ``(ii) ensures that the organization is qualified to 
     receive payments under the plan; and
       ``(5) agrees to submit to the Secretary and Papa Ola Lokahi 
     an annual report that--
       ``(A) describes the use and costs of health services 
     provided under the grant or contract (including the average 
     cost of health services per user); and
       ``(B) provides such other information as the Secretary 
     determines to be appropriate.
       ``(d) Contract Evaluation.--
       ``(1) Determination of noncompliance.--If, as a result of 
     evaluations conducted by the

[[Page S667]]

     Secretary, the Secretary determines that an entity has not 
     complied with or satisfactorily performed a contract entered 
     into under section 7, the Secretary shall, before renewing 
     the contract--
       ``(A) attempt to resolve the areas of noncompliance or 
     unsatisfactory performance; and
       ``(B) modify the contract to prevent future occurrences of 
     the noncompliance or unsatisfactory performance.
       ``(2) Nonrenewal.--If the Secretary determines that the 
     noncompliance or unsatisfactory performance described in 
     paragraph (1) with respect to an entity cannot be resolved 
     and prevented in the future, the Secretary--
       ``(A) shall not renew the contract with the entity; and
       ``(B) may enter into a contract under section 7 with 
     another entity referred to in section 7(a)(3) that provides 
     services to the same population of Native Hawaiians served 
     by the entity the contract with which was not renewed by 
     reason of this paragraph.
       ``(3) Consideration of results.--In determining whether to 
     renew a contract entered into with an entity under this Act, 
     the Secretary shall consider the results of the evaluations 
     conducted under this section.
       ``(4) Application of federal laws.--Each contract entered 
     into by the Secretary under this Act shall be in accordance 
     with all Federal contracting laws (including regulations), 
     except that, in the discretion of the Secretary, such a 
     contract may--
       ``(A) be negotiated without advertising; and
       ``(B) be exempted from subchapter III of chapter 31, United 
     States Code.
       ``(5) Payments.--A payment made under any contract entered 
     into under this Act--
       ``(A) may be made--
       ``(i) in advance;
       ``(ii) by means of reimbursement; or
       ``(iii) in installments; and
       ``(B) shall be made on such conditions as the Secretary 
     determines to be necessary to carry out this Act.
       ``(e) Report.--
       ``(1) In general.--For each fiscal year during which an 
     entity receives or expends funds under a grant or contract 
     under this Act, the entity shall submit to the Secretary and 
     to Papa Ola Lokahi an annual report that describes--
       ``(A) the activities conducted by the entity under the 
     grant or contract;
       ``(B) the amounts and purposes for which Federal funds were 
     expended; and
       ``(C) such other information as the Secretary may request.
       ``(2) Audits.--The reports and records of any entity 
     concerning any grant or contract under this Act shall be 
     subject to audit by--
       ``(A) the Secretary;
       ``(B) the Inspector General of the Department of Health and 
     Human Services; and
       ``(C) the Comptroller General of the United States.
       ``(f) Annual Private Audit.--The Secretary shall allow as a 
     cost of any grant made or contract entered into under this 
     Act the cost of an annual private audit conducted by a 
     certified public accountant to carry out this section.

     ``SEC. 10. ASSIGNMENT OF PERSONNEL.

       ``(a) In General.--The Secretary may enter into an 
     agreement with Papa Ola Lokahi or any of the Native Hawaiian 
     health care systems for the assignment of personnel of the 
     Department of Health and Human Services with relevant 
     expertise for the purpose of--
       ``(1) conducting research; or
       ``(2) providing comprehensive health promotion and disease 
     prevention services and health services to Native Hawaiians.
       ``(b) Applicable Federal Personnel Provisions.--Any 
     assignment of personnel made by the Secretary under any 
     agreement entered into under subsection (a) shall be treated 
     as an assignment of Federal personnel to a local government 
     that is made in accordance with subchapter VI of chapter 33 
     of title 5, United States Code.

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

       ``(a) Eligibility.--Subject to the availability of amounts 
     appropriated under subsection (c), the Secretary shall 
     provide to Papa Ola Lokahi, through a direct grant or a 
     cooperative agreement, funds for the purpose of providing 
     scholarship and fellowship assistance, counseling, and 
     placement service assistance to students who are Native 
     Hawaiians.
       ``(b) Priority.--A priority for scholarships under 
     subsection (a) may be provided to employees of--
       ``(1) the Native Hawaiian Health Care Systems; and
       ``(2) the Native Hawaiian Health Centers.
       ``(c) Terms and Conditions.--
       ``(1) Scholarship assistance.--
       ``(A) In general.--The scholarship assistance under 
     subsection (a) shall be provided in accordance with 
     subparagraphs (B) through (G).
       ``(B) Need.--The provision of scholarships in each type of 
     health profession training shall correspond to the need for 
     each type of health professional to serve the Native Hawaiian 
     community in providing health services, as identified by Papa 
     Ola Lokahi.
       ``(C) Eligible applicants.--To the maximum extent 
     practicable, the Secretary shall select scholarship 
     recipients from a list of eligible applicants submitted by 
     Papa Ola Lokahi.
       ``(D) Obligated service requirement.--
       ``(i) In general.--An obligated service requirement for 
     each scholarship recipient (except for a recipient receiving 
     assistance under paragraph (2)) shall be fulfilled through 
     service, in order of priority, in--

       ``(I) any of the Native Hawaiian health care systems;
       ``(II) any of the Native Hawaiian health centers;
       ``(III) 1 or more health professions shortage areas, 
     medically underserved areas, or geographic areas or 
     facilities similarly designated by the Public Health Service 
     in the State;
       ``(IV) a Native Hawaiian organization that serves a 
     geographical area, facility, or organization that serves a 
     significant Native Hawaiian population;
       ``(V) any public agency or nonprofit organization providing 
     services to Native Hawaiians; or
       ``(VI) any of the uniformed services of the United States.

       ``(ii) Assignment.--The placement service for a scholarship 
     shall assign each Native Hawaiian scholarship recipient to 1 
     or more appropriate sites for service in accordance with 
     clause (i).
       ``(E) Counseling, retention, and support services.--The 
     provision of academic and personal counseling, retention and 
     other support services--
       ``(i) shall not be limited to scholarship recipients under 
     this section; and
       ``(ii) shall be made available to recipients of other 
     scholarship and financial aid programs enrolled in 
     appropriate health professions training programs.
       ``(F) Financial assistance.--After consultation with Papa 
     Ola Lokahi, financial assistance may be provided to a 
     scholarship recipient during the period that the recipient is 
     fulfilling the service requirement of the recipient in any 
     of--
       ``(i) the Native Hawaiian health care systems; or
       ``(ii) the Native Hawaiians health centers.
       ``(G) Distance learning recipients.--A scholarship may be 
     provided to a Native Hawaiian who is enrolled in an 
     appropriate distance learning program offered by an 
     accredited educational institution.
       ``(2) Fellowships.--
       ``(A) In general.--Papa Ola Lokahi may provide financial 
     assistance in the form of a fellowship to a Native Hawaiian 
     health professional who is--
       ``(i) a Native Hawaiian community health representative, 
     outreach worker, or health program administrator in a 
     professional training program;
       ``(ii) a Native Hawaiian providing health services; or
       ``(iii) a Native Hawaiian enrolled in a certificated 
     program provided by traditional Native Hawaiian healers in 
     any of the traditional Native Hawaiian healing practices 
     (including lomi-lomi, la`au lapa`au, and ho`oponopono).
       ``(B) Types of assistance.--Assistance under subparagraph 
     (A) may include a stipend for, or reimbursement for costs 
     associated with, participation in a program described in that 
     paragraph.
       ``(3) Rights and benefits.--An individual who is a health 
     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 income.--
     Financial assistance provided under this section shall be 
     considered to be qualified scholarships for the purpose of 
     section 117 of the Internal Revenue Code of 1986.
       ``(d) Authorization of Appropriations.--There are 
     authorized to be appropriated such sums as are necessary to 
     carry out subsections (a) and (c)(2) for each of fiscal years 
     2006 through 2011.

     ``SEC. 12. REPORT.

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

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

       ``(a) In General.--The Secretary shall permit an 
     organization that enters into a contract or receives grant 
     under this Act to use in carrying out projects or activities 
     under the contract or grant all existing facilities under the 
     jurisdiction of the Secretary (including all equipment of the 
     facilities), in accordance with such terms and conditions as 
     may be agreed on for the use and maintenance of the 
     facilities or equipment.
       ``(b) Donation of Property.--The Secretary may donate to an 
     organization that enters into a contract or receives grant 
     under this Act, for use in carrying out a project or activity 
     under the contract or grant, any personal or real property 
     determined to be in excess of the needs of the Department or 
     the General Services Administration.

[[Page S668]]

       ``(c) Acquisition of Surplus Property.--The Secretary may 
     acquire excess or surplus Federal Government personal or real 
     property for donation to an organization under subsection (b) 
     if the Secretary determines that the property is appropriate 
     for use by the organization for the purpose for which a 
     contract entered into or grant received by the organization 
     is authorized under this Act.

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

       ``(a) Authority and Areas of Interest.--
       ``(1) In general.--The Secretary, in consultation with Papa 
     Ola Lokahi, may allocate amounts made available under this 
     Act, or any other Act, to carry out Native Hawaiian 
     demonstration projects of national significance.
       ``(2) Areas of interest.--A demonstration project described 
     in paragraph (1) may relate to such areas of interest as--
       ``(A) the development of a centralized database and 
     information system relating to the health care status, health 
     care needs, and wellness of Native Hawaiians;
       ``(B) the education of health professionals, and other 
     individuals in institutions of higher learning, in health and 
     allied health programs in healing practices, including Native 
     Hawaiian healing practices;
       ``(C) the integration of Western medicine with 
     complementary healing practices, including traditional Native 
     Hawaiian healing practices;
       ``(D) the use of 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 Hawaii at Hilo;
       ``(ii) a Native Hawaiian Center of Excellence for Mental 
     Health at the University of Hawaii at Manoa;
       ``(iii) a Native Hawaiian Center of Excellence for Maternal 
     Health and Nutrition at the Waimanalo Health Center;
       ``(iv) a Native Hawaiian Center of Excellence for Research, 
     Training, Integrated Medicine at Molokai General Hospital; 
     and
       ``(v) a Native Hawaiian Center of Excellence for 
     Complementary Health and Health Education and Training at the 
     Waianae Coast Comprehensive Health Center.
       ``(3) Centers of excellence.--Papa Ola Lokahi, and any 
     centers established under paragraph (2)(F), shall be 
     considered to be qualified as Centers of Excellence under 
     sections 485F and 903(b)(2)(A) of the Public Health Service 
     Act (42 U.S.C. 287c-32, 299a-1).
       ``(b) Nonreduction in Other Funding.--The allocation of 
     funds for demonstration projects under subsection (a) shall 
     not result in any reduction in funds required by the Native 
     Hawaiian health care systems, the Native Hawaiian Health 
     Centers, the Native Hawaiian Health Scholarship Program, or 
     Papa Ola Lokahi to carry out the respective responsibilities 
     of those entities under this Act.

     ``SEC. 15. RULE OF CONSTRUCTION.

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

     ``SEC. 16. COMPLIANCE WITH BUDGET ACT.

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

     ``SEC. 17. SEVERABILITY.

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