[Congressional Record Volume 155, Number 1 (Tuesday, January 6, 2009)]
[Senate]
[Pages S74-S83]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. INOUYE:
  S. 76. 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, again, 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 several times throughout the years.

[[Page S75]]

  The Act provides authority for a 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 22 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 2004 native Hawaiians had the highest 
mortality rate associated with diabetes in the State--a rate which is 
119 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 86 percent higher than the 
rate for the entire State and the mortality rate for hypertension is 46 
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 date 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.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                 S. 76

       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 2009''.

     SEC. 2. AMENDMENT TO THE NATIVE HAWAIIAN HEALTH CARE 
                   IMPROVEMENT ACT.

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

     ``SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

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

``Sec. 1. Short title; table of contents.
``Sec. 2. Findings.
``Sec. 3. Definitions.
``Sec. 4. Declaration of national Native Hawaiian health policy.
``Sec. 5. Comprehensive health care master plan for Native Hawaiians.
``Sec. 6. Functions of Papa Ola Lokahi.
``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) In General.--Congress finds that--
       ``(1) Native Hawaiians begin their story with the Kumulipo, 
     which details the creation and interrelationship of all 
     things, including the evolvement of Native Hawaiians as 
     healthy and well people;
       ``(2) Native Hawaiians--
       ``(A) are a distinct and unique indigenous people with a 
     historical continuity to the original inhabitants of the 
     Hawaiian archipelago within Ke Moananui, the Pacific Ocean; 
     and
       ``(B) have a distinct society that was first organized 
     almost 2,000 years ago;
       ``(3) the health and well-being of Native Hawaiians are 
     intrinsically tied to the deep feelings and attachment of 
     Native Hawaiians to their lands and seas;
       ``(4) the long-range economic and social changes in Hawai'i 
     over the 19th and early 20th centuries have been devastating 
     to the health and well-being of Native Hawaiians;
       ``(5) Native Hawaiians have never directly relinquished to 
     the United States their claims to their inherent sovereignty 
     as a people or over their national territory, either through 
     their monarchy or through a plebiscite or referendum;
       ``(6) the Native Hawaiian people are determined to 
     preserve, develop, and transmit to future generations, in 
     accordance with their own spiritual and traditional beliefs, 
     their customs, practices, language, social institutions, 
     ancestral territory, and cultural identity;
       ``(7) in referring to themselves, Native Hawaiians use the 
     term `Kanaka Maoli', a term frequently used in the 19th 
     century to describe the native people of Hawai'i;
       ``(8) the constitution and statutes of the State of 
     Hawai'i--
       ``(A) acknowledge the distinct land rights of Native 
     Hawaiian people as beneficiaries of the public lands trust; 
     and
       ``(B) reaffirm and protect the unique right of the Native 
     Hawaiian people to practice and perpetuate their cultural and 
     religious customs, beliefs, practices, and language;
       ``(9) at the time of the arrival of the first nonindigenous 
     people in Hawai'i in 1778, the Native Hawaiian people lived 
     in a highly organized, self-sufficient, subsistence social 
     system based on communal land tenure with a sophisticated 
     language, culture, and religion;
       ``(10) a unified monarchical government of the Hawaiian 
     Islands was established in 1810 under Kamehameha I, the first 
     King of Hawai'i;
       ``(11) throughout the 19th century until 1893, the United 
     States--
       ``(A) recognized the independence of the Hawaiian Nation;
       ``(B) extended full and complete diplomatic recognition to 
     the Hawaiian Government; and
       ``(C) entered into treaties and conventions with the 
     Hawaiian monarchs to govern commerce and navigation in 1826, 
     1842, 1849, 1875, and 1887;
       ``(12) in 1893, John L. Stevens, the United States Minister 
     assigned to the sovereign and independent Kingdom of Hawai'i, 
     conspired with a small group of non-Hawaiian residents of the 
     Kingdom, including citizens of the United States, to 
     overthrow the indigenous and lawful government of Hawai'i;
       ``(13) in pursuance of that conspiracy--
       ``(A) the United States Minister and the naval 
     representative of the United States caused armed forces of 
     the United States Navy to invade the sovereign Hawaiian 
     Nation in support of the overthrow of the indigenous and 
     lawful Government of Hawai'i; and
       ``(B) after that overthrow, the United States Minister 
     extended diplomatic recognition of a provisional government 
     formed by the conspirators without the consent of the native 
     people of Hawai'i or the lawful Government of Hawai'i, in 
     violation of--
       ``(i) treaties between the Government of Hawai'i and the 
     United States; and
       ``(ii) international law;
       ``(14) in a message to Congress on December 18, 1893, 
     President Grover Cleveland--
       ``(A) reported fully and accurately on those illegal 
     actions;
       ``(B) acknowledged that by those acts, described by the 
     President as acts of war, the government of a peaceful and 
     friendly people was overthrown; and
       ``(C) concluded that a `substantial wrong has thus been 
     done which a due regard for our national character as well as 
     the rights of the injured people required that we should 
     endeavor to repair';
       ``(15) Queen Lili`uokalani, the lawful monarch of Hawai'i, 
     and the Hawaiian Patriotic League, representing the 
     aboriginal citizens of Hawai'i, promptly petitioned the 
     United States for redress of those wrongs and restoration of 
     the indigenous government of the Hawaiian nation, but no 
     action was taken on that petition;
       ``(16) in 1993, Congress enacted Public Law 103-150 (107 
     Stat. 1510), in which Congress--
       ``(A) acknowledged the significance of those events; and
       ``(B) apologized to Native Hawaiians on behalf of the 
     people of the United States for the overthrow of the Kingdom 
     of Hawai'i with the participation of agents and citizens of 
     the United States, and the resulting deprivation of the 
     rights of Native Hawaiians to self-determination;
       ``(17) between 1897 and 1898, when the total Native 
     Hawaiian population in Hawai'i was less than 40,000, more 
     than 38,000 Native Hawaiians signed petitions (commonly known 
     as `Ku'e Petitions') protesting annexation by the United 
     States and requesting restoration of the monarchy;
       ``(18) despite Native Hawaiian protests, in 1898, the 
     United States--
       ``(A) annexed Hawai'i through Resolution No. 55 (commonly 
     known as the `Newlands Resolution') (30 Stat. 750), without 
     the consent of, or compensation to, the indigenous people of 
     Hawai'i or the sovereign government of those people; and
       ``(B) denied those people the mechanism for expression of 
     their inherent sovereignty through self-government and self-
     determination of their lands and ocean resources;
       ``(19) through the Newlands Resolution and the Act of April 
     30, 1900 (commonly known as the `1900 Organic Act') (31 Stat. 
     141, chapter 339), the United States--
       ``(A) received 1,750,000 acres of land formerly owned by 
     the Crown and Government of the Hawaiian Kingdom; and
       ``(B) exempted the land from then-existing public land laws 
     of the United States by mandating that the revenue and 
     proceeds from that land be `used solely for the benefit of 
     the inhabitants of the Hawaiian Islands for education and 
     other public purposes', thereby establishing a special trust 
     relationship between the United States and the inhabitants of 
     Hawai'i;

[[Page S76]]

       ``(20) in 1921, Congress enacted the Hawaiian Homes 
     Commission Act, 1920 (42 Stat. 108, chapter 42), which--
       ``(A) designated 200,000 acres of the ceded public land for 
     exclusive homesteading by Native Hawaiians; and
       ``(B) affirmed the trust relationship between the United 
     States and Native Hawaiians, as expressed by Secretary of the 
     Interior Franklin K. Lane, who was cited in the Committee 
     Report of the Committee on Territories of the House of 
     Representatives as stating, `One thing that impressed me . . 
     . was the fact that the natives of the islands . . . for whom 
     in a sense we are trustees, are falling off rapidly in 
     numbers and many of them are in poverty.';
       ``(21) in 1938, Congress again acknowledged the unique 
     status of the Native Hawaiian people by including in the Act 
     of June 20, 1938 (52 Stat. 781), a provision--
       ``(A) to lease land within the extension to Native 
     Hawaiians; and
       ``(B) to permit fishing in the area `only by native 
     Hawaiian residents of said area or of adjacent villages and 
     by visitors under their guidance';
       ``(22) under the Act of March 18, 1959 (48 U.S.C. prec. 491 
     note; 73 Stat. 4), the United States--
       ``(A) transferred responsibility for the administration of 
     the Hawaiian home lands to the State; but
       ``(B) reaffirmed the trust relationship that existed 
     between the United States and the Native Hawaiian people by 
     retaining the exclusive power to enforce the trust, including 
     the power to approve land exchanges and legislative 
     amendments affecting the rights of beneficiaries under that 
     Act;
       ``(23) under the Act referred to in paragraph (22), the 
     United States--
       ``(A) transferred responsibility for administration over 
     portions of the ceded public lands trust not retained by the 
     United States to the State; but
       ``(B) reaffirmed the trust relationship that existed 
     between the United States and the Native Hawaiian people by 
     retaining the legal responsibility of the State for the 
     betterment of the conditions of Native Hawaiians under 
     section 5(f) of that Act (73 Stat. 6);
       ``(24) in 1978, the people of Hawai'i--
       ``(A) amended the constitution of Hawai'i to establish the 
     Office of Hawaiian Affairs; and
       ``(B) assigned to that Office the authority--
       ``(i) to accept and hold in trust for the Native Hawaiian 
     people real and personal property transferred from any 
     source;
       ``(ii) to receive payments from the State owed to the 
     Native Hawaiian people in satisfaction of the pro rata share 
     of the proceeds of the public land trust established by 
     section 5(f) of the Act of March 18, 1959 (48 U.S.C. prec. 
     491 note; 73 Stat. 6);
       ``(iii) to act as the lead State agency for matters 
     affecting the Native Hawaiian people; and
       ``(iv) to formulate policy on affairs relating to the 
     Native Hawaiian people;
       ``(25) the authority of Congress under the Constitution to 
     legislate in matters affecting the aboriginal or indigenous 
     people of the United States includes the authority to 
     legislate in matters affecting the native people of Alaska 
     and Hawai'i;
       ``(26) the United States has recognized the authority of 
     the Native Hawaiian people to continue to work toward an 
     appropriate form of sovereignty, as defined by the Native 
     Hawaiian people in provisions set forth in legislation 
     returning the Hawaiian Island of Kaho`olawe to custodial 
     management by the State in 1994;
       ``(27) in furtherance of the trust responsibility for the 
     betterment of the conditions of Native Hawaiians, the United 
     States has established a program for the provision of 
     comprehensive health promotion and disease prevention 
     services to maintain and improve the health status of the 
     Hawaiian people;
       ``(28) that program is conducted by the Native Hawaiian 
     Health Care Systems and Papa Ola Lokahi;
       ``(29) health initiatives implemented by those and other 
     health institutions and agencies using Federal assistance 
     have been responsible for reducing the century-old morbidity 
     and mortality rates of Native Hawaiian people by--
       ``(A) providing comprehensive disease prevention;
       ``(B) providing health promotion activities; and
       ``(C) increasing the number of Native Hawaiians in the 
     health and allied health professions;
       ``(30) those accomplishments have been achieved through 
     implementation of--
       ``(A) the Native Hawaiian Health Care Act of 1988 (Public 
     Law 100-579); and
       ``(B) the reauthorization of that Act under section 9168 of 
     the Department of Defense Appropriations Act, 1993 (Public 
     Law 102-396; 106 Stat. 1948);
       ``(31) the historical and unique legal relationship between 
     the United States and Native Hawaiians has been consistently 
     recognized and affirmed by Congress through the enactment of 
     more than 160 Federal laws that extend to the Native Hawaiian 
     people the same rights and privileges accorded to American 
     Indian, Alaska Native, Eskimo, and Aleut communities, 
     including--
       ``(A) the Native American Programs Act of 1974 (42 U.S.C. 
     2991 et seq.);
       ``(B) the American Indian Religious Freedom Act (42 U.S.C. 
     1996);
       ``(C) the National Museum of the American Indian Act (20 
     U.S.C. 80q et seq.); and
       ``(D) the Native American Graves Protection and 
     Repatriation Act (25 U.S.C. 3001 et seq.);
       ``(32) the United States has recognized and reaffirmed the 
     trust relationship to the Native Hawaiian people through 
     legislation that authorizes the provision of services to 
     Native Hawaiians, specifically--
       ``(A) the Older Americans Act of 1965 (42 U.S.C. 3001 et 
     seq.);
       ``(B) the Developmental Disabilities Assistance and Bill of 
     Rights Act Amendments of 1987 (42 U.S.C. 6000 et seq.);
       ``(C) the Veterans' Benefits and Services Act of 1988 
     (Public Law 100-322);
       ``(D) the Rehabilitation Act of 1973 (29 U.S.C. 701 et 
     seq.);
       ``(E) the Native Hawaiian Health Care Act of 1988 (42 
     U.S.C. 11701 et seq.);
       ``(F) the Health Professions Reauthorization Act of 1988 
     (Public Law 100-607; 102 Stat. 3122);
       ``(G) the Nursing Shortage Reduction and Education 
     Extension Act of 1988 (Public Law 100-607; 102 Stat. 3153);
       ``(H) the Handicapped Programs Technical Amendments Act of 
     1988 (Public Law 100-630);
       ``(I) the Indian Health Care Amendments of 1988 (Public Law 
     100-713); and
       ``(J) the Disadvantaged Minority Health Improvement Act of 
     1990 (Public Law 101-527);
       ``(33) the United States has affirmed that historical and 
     unique legal relationship to the Hawaiian people by 
     authorizing the provision of services to Native Hawaiians to 
     address problems of alcohol and drug abuse under the Anti-
     Drug Abuse Act of 1986 (21 U.S.C. 801 note; Public Law 99-
     570);
       ``(34) in addition, the United States--
       ``(A) has recognized that Native Hawaiians, as aboriginal, 
     indigenous, native people of Hawai'i, are a unique population 
     group in Hawai'i and in the continental United States; and
       ``(B) has so declared in--
       ``(i) the documents of the Office of Management and Budget 
     entitled--

       ``(I) `Standards for Maintaining, Collecting, and 
     Presenting Federal Data on Race and Ethnicity' and dated 
     October 30, 1997; and
       ``(II) `Provisional Guidance on the Implementation of the 
     1997 Standards for Federal Data on Race and Ethnicity' and 
     dated December 15, 2000;

       ``(ii) the document entitled `Guidance on Aggregation and 
     Allocation of Data on Race for Use in Civil Rights Monitoring 
     and Enforcement' (Bulletin 00-02 to the Heads of Executive 
     Departments and Establishments) and dated March 9, 2000;
       ``(iii) the document entitled `Questions and Answers when 
     Designing Surveys for Information Collections' (Memorandum 
     for the President's Management Council) and dated January 20, 
     2006;
       ``(iv) Executive order number 13125 (64 Fed. Reg. 31105; 
     relating to increasing participation of Asian Americans and 
     Pacific Islanders in Federal programs) (June 7, 1999);
       ``(v) the document entitled `HHS Tribal Consultation 
     Policy' and dated January 2005; and
       ``(vi) the Department of Health and Human Services 
     Intradepartment Council on Native American Affairs, Revised 
     Charter, dated March 7, 2005; and
       ``(35) despite the United States having expressed in Public 
     Law 103-150 (107 Stat. 1510) its commitment to a policy of 
     reconciliation with the Native Hawaiian people for past 
     grievances--
       ``(A) the unmet health needs of the Native Hawaiian people 
     remain severe; and
       ``(B) the health status of the Native Hawaiian people 
     continues to be far below that of the general population of 
     the United States.
       ``(b) Finding of Unmet Needs and Health 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) as an underlying cause of death in the State, the 
     cancer mortality rate of Native Hawaiians of 218.3 per 
     100,000 residents is 50 percent higher than the rate for the 
     total population of the State of 145.4 per 100,000 residents;
       ``(II) Native Hawaiian males have the highest cancer 
     mortality rates in the State for cancers of the lung, colon, 
     and rectum, and for all cancers combined;
       ``(III) Native Hawaiian females have the highest cancer 
     mortality rates in the State for cancers of the lung, breast, 
     colon, rectum, pancreas, stomach, ovary, liver, cervix, 
     kidney, and uterus, and for all cancers combined; and
       ``(IV) for the period of 1995 through 2000--

       ``(aa) the cancer mortality rate for all cancers for Native 
     Hawaiian males of 217 per 100,000 residents was 22 percent 
     higher than the rate for all males in the State of 179 per 
     100,000 residents; and
       ``(bb) the cancer mortality rate for all cancers for Native 
     Hawaiian females of 192 per 100,000 residents was 64 percent 
     higher than the rate for all females in the State of 117 per 
     100,000 residents.
       ``(ii) Breast cancer.--With respect to breast cancer--

[[Page S77]]

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

       ``(iii) Cancer of the cervix.--Native Hawaiians have the 
     highest mortality rate as a result of cancer of the cervix in 
     the State (3.65 per 100,000 residents), followed by Filipino 
     Americans (2.69 per 100,000 residents) and Caucasian 
     Americans (2.61 per 100,000 residents).
       ``(iv) 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 are higher than the rates for the total 
     population of the State 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 per 100,000 residents), with Caucasian 
     Americans having the highest mortality rate as a result of 
     prostate cancer (23.96 per 100,000 residents).
       ``(B) Diabetes.--With respect to diabetes, in 2004--
       ``(i) Native Hawaiians had the highest mortality rate as a 
     result of diabetes mellitis (28.9 per 100,000 residents) in 
     the State, which is 119 percent higher than the rate for all 
     racial groups in the State (13.2 per 100,000 residents);
       ``(ii) the prevalence of diabetes for Native Hawaiians was 
     12.7 percent, which is 87 percent higher than the total 
     prevalence for all residents of the State of 6.8 percent; and
       ``(iii) a higher percentage of Native Hawaiians with 
     diabetes experienced diabetic retinopathy, as compared to 
     other population groups in the State.
       ``(C) Asthma.--With respect to asthma and lower respiratory 
     disease--
       ``(i) in 2004, mortality rates for Native Hawaiians (31.6 
     per 100,000 residents) from chronic lower respiratory disease 
     were 52 percent higher than rates for the total population of 
     the State (20.8 per 100,000 residents); and
       ``(ii) in 2005, the prevalence of current asthma in Native 
     Hawaiian adults was 12.8 percent, which is 71 percent higher 
     than the prevalence of the total population of the State of 
     7.5 percent.
       ``(D) Circulatory diseases.--
       ``(i) Heart disease.--With respect to heart disease--

       ``(I) in 2004, the mortality rate for Native Hawaiians as a 
     result of heart disease (305.5 per 100,000 residents) was 86 
     percent higher than the rate for the total population of the 
     State (164.3 per 100,000 residents); and
       ``(II) in 2005, the prevalence for heart attack was 4.4 
     percent for Native Hawaiians, which is 22 percent higher than 
     the prevalence for the total population of 3.6 percent.

       ``(ii) Cerebrovascular diseases.--With respect to 
     cerebrovascular diseases--

       ``(I) the mortality rate from cerebrovascular diseases for 
     Native Hawaiians (75.6 percent) was 64 percent higher than 
     the rate for the total population of the State (46 percent); 
     and
       ``(II) in 2005, the prevalence for stroke was 4.9 percent 
     for Native Hawaiians, which is 69 percent higher than the 
     prevalence for the total population of the State (2.9 
     percent).

       ``(iii) Other circulatory diseases.--With respect to other 
     circulatory diseases (including high blood pressure and 
     atherosclerosis)--

       ``(I) in 2004, the mortality rate for Native Hawaiians of 
     20.6 per 100,000 residents was 46 percent higher than the 
     rate for the total population of the State of 14.1 per 
     100,000 residents; and
       ``(II) in 2005, the prevalence of high blood pressure for 
     Native Hawaiians was 26.7 percent, which is 10 percent higher 
     than the prevalence for the total population of the State of 
     24.2 percent.

       ``(2) Infectious disease and 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 the incidence 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 per 100,000 residents) is 16 percent higher 
     than the rate for the total population of the State (27.5 per 
     100,000 residents);
       ``(B) 32 percent of all deaths of individuals between the 
     ages of 18 and 24 years resulting from injuries were Native 
     Hawaiian; and
       ``(C) the 2 primary causes of Native Hawaiian deaths in 
     that age group were motor vehicle accidents (30 percent) and 
     intentional self-harm (39 percent).
       ``(4) Dental health.--With respect to dental health--
       ``(A) Native Hawaiian children experience significantly 
     higher rates of dental caries and unmet treatment needs as 
     compared to other children in the continental United States 
     and other ethnic groups in the State;
       ``(B) the prevalence rate of dental caries in the primary 
     (baby) teeth of Native Hawaiian children aged 5 to 9 years of 
     4.2 per child is more than twice the national average rate of 
     1.9 per child in that age range;
       ``(C) 81.9 percent of Native Hawaiian children aged 6 to 8 
     have 1 or more decayed teeth, as compared to--
       ``(i) 53 percent for children in that age range in the 
     continental United States; and
       ``(ii) 72.7 percent of other children in that age range in 
     the State; and
       ``(D) 21 percent of Native Hawaiian children aged 5 
     demonstrate signs of baby bottle tooth decay, which is 
     generally characterized as severe, progressive dental disease 
     in early childhood and associated with high rates of dental 
     disorders, as compared to 5 percent for children of that age 
     in the continental United States.
       ``(5) 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;
       ``(C) the most recent tables for 1990 show Native Hawaiian 
     life expectancy at birth (74.27 years) to be approximately 5 
     years less than that of the total State population (78.85 
     years); and
       ``(D) except as provided in the life expectancy calculation 
     for 1920, Native Hawaiians have had the shortest life 
     expectancy of all major ethnic groups in the United States 
     since 1910.
       ``(6) Maternal and child health.--
       ``(A) In general.--With respect to maternal and child 
     health, in 2000--
       ``(i) 39 percent of all deaths of children under the age of 
     18 years in the State were Native Hawaiian;
       ``(ii) perinatal conditions accounted for 38 percent of all 
     Native Hawaiian deaths in that age group;
       ``(iii) Native Hawaiian infant mortality rates (9.8 per 
     1,000 live births) are--

       ``(I) the highest in the State; and

       ``(II) 151 percent higher than the rate for Caucasian 
     infants (3.9 per 1,000 live births); and

       ``(iv) Native Hawaiians have 1 of the highest infant 
     mortality rates in the United States, second only to the rate 
     for African Americans of 13.6 per 1,000 live births.
       ``(B) Prenatal care.--With respect to prenatal care--
       ``(i) as of 2005, Native Hawaiian women have the highest 
     prevalence (20.9 percent) of having had no prenatal care 
     during the first trimester of pregnancy, as compared to the 5 
     largest ethnic groups in the State;
       ``(ii) of the mothers in the State who received no prenatal 
     care in the first trimester, 33 percent were Native Hawaiian;
       ``(iii) in 2005, 41 percent of mothers with live births who 
     had not completed high school were Native Hawaiian; and
       ``(iv) in every region of the State, many Native Hawaiian 
     newborns begin life in a potentially hazardous circumstance, 
     far higher than any other racial group.
       ``(C) Births.--With respect to births, in 2005--
       ``(i) 45.2 percent of live births to Native Hawaiian 
     mothers were nonmarital, putting the affected infants at 
     higher risk of low birth weight and infant mortality;
       ``(ii) of the 2,934 live births to Native Hawaiian single 
     mothers, 9 percent were low birth weight (defined as a weight 
     of less than 2,500 grams); and
       ``(iii) 43.7 percent of all low birth-weight infants born 
     to single mothers in the State were Native Hawaiian.
       ``(D) Teen pregnancies.--With respect to births, in 2005--
       ``(i) Native Hawaiians had the highest rate of births to 
     mothers under the age of 18 years (5.8 percent), as compared 
     to the rate of 2.7 percent for the total population of the 
     State; and
       ``(ii) nearly 62 percent of all mothers in the State under 
     the age of 19 years were Native Hawaiian.
       ``(E) Fetal mortality.--With respect to fetal mortality, in 
     2005--
       ``(i) Native Hawaiians had the highest number of fetal 
     deaths in the State, as compared to Caucasian, Japanese, and 
     Filipino residents; and
       ``(ii)(I) 17.2 percent of all fetal deaths in the State 
     were associated with expectant Native Hawaiian mothers; and
       ``(II) 43.5 percent of those Native Hawaiian mothers were 
     under the age of 25 years.
       ``(7) Behavioral health.--
       ``(A) Alcohol and drug abuse.--With respect to alcohol and 
     drug abuse--
       ``(i)(I) in 2005, Native Hawaiians had the highest 
     prevalence of smoking of 27.9 percent, which is 64 percent 
     higher than the rate for the total population of the State 
     (17 percent); and
       ``(II) 53 percent of Native Hawaiians reported having 
     smoked at least 100 cigarettes in their lifetime, as compared 
     to 43.3 percent for the total population of the State;
       ``(ii) 33 percent of Native Hawaiians in grade 8 have 
     smoked cigarettes at least once in their lifetime, as 
     compared to--

       ``(I) 22.5 percent for all youth in the State; and
       ``(II) 28.4 percent of residents of the United States in 
     grade 8;

       ``(iii) Native Hawaiians have the highest prevalence of 
     binge drinking of 19.9 percent,

[[Page S78]]

     which is 21 percent higher than the prevalence for the total 
     population of the State (16.5 percent);
       ``(iv) the prevalence of heavy drinking among Native 
     Hawaiians (10.1 percent) is 36 percent higher than the 
     prevalence for the total population of the State (7.4 
     percent);
       ``(v)(I) in 2003, 17.2 percent of Native Hawaiians in grade 
     6, 45.1 percent of Naive Hawaiians in grade 8, 68.9 percent 
     of Native Hawaiians in grade 10, and 78.1 percent of Native 
     Hawaiians in grade 12 reported using alcohol at least once in 
     their lifetime, as compared to 13.2, 36.8, 59.1, and 72.5 
     percent, respectively, of all adolescents in the State; and
       ``(II) 62.1 percent Native Hawaiians in grade 12 reported 
     being drunk at least once, which is 20 percent higher than 
     the percentage for all adolescents in the State (51.6 
     percent);
       ``(vi) on entering grade 12, 60 percent of Native Hawaiian 
     adolescents reported having used illicit drugs, including 
     inhalants, at least once in their lifetime, as compared to--

       ``(I) 46.9 percent of all adolescents in the State; and
       ``(II) 52.8 of adolescents in the United States;

       ``(vii) on entering grade 12, 58.2 percent of Native 
     Hawaiian adolescents reported having used marijuana at least 
     once, which is 31 percent higher than the rate of other 
     adolescents in the State (44.4 percent);
       ``(viii) in 2006, Native Hawaiians represented 40 percent 
     of the total admissions to substance abuse treatment programs 
     funded by the State Department of Health; and
       ``(ix) in 2003, Native Hawaiian adolescents reported the 
     highest prevalence for methamphetamine use in the State, 
     followed by Caucasian and Filipino adolescents.
       ``(B) Crime.--With respect to crime--
       ``(i) during the period of 1992 to 2002, Native Hawaiian 
     arrests for violent crimes decreased, but the rate of arrest 
     remained 38.3 percent higher than the rate of the total 
     population of the State;
       ``(ii) the robbery arrest rate in 2002 among Native 
     Hawaiian juveniles and adults was 59 percent higher (6.2 
     arrests per 100,000 residents) than the rate for the total 
     population of the State (3.9 arrests per 100,000 residents);
       ``(iii) in 2002--

       ``(I) Native Hawaiian men comprised between 35 percent and 
     43 percent of each security class in the State prison system;
       ``(II) Native Hawaiian women comprised between 38.1 percent 
     to 50.3 percent of each class of female prison inmates in the 
     State;
       ``(III) Native Hawaiians comprised 39.5 percent of the 
     total incarcerated population of the State; and
       ``(IV) Native Hawaiians comprised 40 percent of the total 
     sentenced felon population in the State, as compared to 25 
     percent for Caucasians, 12 percent for Filipinos, and 5 
     percent for Samoans;

       ``(iv) Native Hawaiians are overrepresented in the State 
     prison population;
       ``(v) of the 2,260 incarcerated Native Hawaiians, 70 
     percent are between 20 and 40 years of age; and
       ``(vi) based on anecdotal information, Native Hawaiians are 
     estimated to comprise between 60 percent and 70 percent of 
     all jail and prison inmates in the State.
       ``(C) Depression and suicide.--With respect to depression 
     and suicide--
       ``(i)(I) in 1999, the prevalence of depression among Native 
     Hawaiians was 15 percent, as compared to the national average 
     of approximately 10 percent; and
       ``(II) Native Hawaiian females had a higher prevalence of 
     depression (16.9 percent) than Native Hawaiian males (11.9 
     percent);
       ``(ii) in 2000--

       ``(I) Native Hawaiian adolescents had a significantly 
     higher suicide attempt rate (12.9 percent) than the rate for 
     other adolescents in the State (9.6 percent); and
       ``(II) 39 percent of all Native Hawaiian adult deaths were 
     due to suicide; and

       ``(iii) in 2006, the prevalence of obsessive compulsive 
     disorder among Native Hawaiian adolescent girls was 17.7 
     percent, as compared to a rate of--

       ``(I) 9.2 percent for Native Hawaiian boys and non-Hawaiian 
     girls; and
       ``(II) a national rate of 2 percent.

       ``(8) Overweightness and obesity.--With respect to 
     overweightness and obesity--
       ``(A) during the period of 2000 through 2003, Native 
     Hawaiian males and females had the highest age-adjusted 
     prevalence rates for obesity (40.5 and 32.5 percent, 
     respectively), which was--
       ``(i) with respect to individuals of full Native Hawaiian 
     ancestry, 145 percent higher than the rate for the total 
     population of the State (16.5 per 100,000); and
       ``(ii) with respect to individuals with less than 100 
     percent Native Hawaiian ancestry, 97 percent higher than the 
     total population of the State; and
       ``(B) for 2005, the prevalence of obesity among Native 
     Hawaiians was 43.1 percent, which was 119 percent higher than 
     the prevalence for the total population of the State (19.7 
     percent).
       ``(9) Family and child health.--With respect to family and 
     child health--
       ``(A) in 2000, the prevalence of single-parent families 
     with minor children was highest among Native Hawaiian 
     households, as compared to all households in the State (15.8 
     percent and 8.1 percent, respectively);
       ``(B) in 2002, nonmarital births accounted for 56.8 percent 
     of all live births among Native Hawaiians, as compared to 34 
     percent of all live births in the State;
       ``(C) the rate of confirmed child abuse and neglect among 
     Native Hawaiians has consistently been 3 to 4 times the rates 
     of other major ethnic groups, with a 3-year average of 63.9 
     cases in 2002, as compared to 12.8 cases for the total 
     population of the State;
       ``(D) spousal abuse or abuse of an intimate partner was 
     highest for Native Hawaiians, as compared to all cases of 
     abuse in the State (4.5 percent and 2.2 percent, 
     respectively); and
       ``(E)(i) \1/2\ of uninsured adults in the State have family 
     incomes below 200 percent of the Federal poverty level; and
       ``(ii) Native Hawaiians residing in the State and the 
     continental United States have a higher rate of uninsurance 
     than other ethnic groups in the State and continental United 
     States (14.5 percent and 9.5 percent, respectively).
       ``(10) Health professions education and training.--With 
     respect to health professions education and training--
       ``(A) in 2003, adult Native Hawaiians had a higher rate of 
     high school completion, as compared to the total adult 
     population of the State (49.4 percent and 34.4 percent, 
     respectively);
       ``(B) Native Hawaiian physicians make up 4 percent of the 
     total physician workforce in the State; and
       ``(C) in 2004, Native Hawaiians comprised--
       ``(i) 11.25 percent of individuals who earned bachelor's 
     degrees;
       ``(ii) 6 percent of individuals who earned master's 
     degrees;
       ``(iii) 3 percent of individuals who earned doctorate 
     degrees;
       ``(iv) 7.9 percent of the credited student body at the 
     University of Hawai'i;
       ``(v) 0.4 percent of the instructional faculty at the 
     University of Hawai'i at Manoa; and
       ``(vi) 8.4 percent of the instructional faculty at the 
     University of Hawai'i Community Colleges.

     ``SEC. 3. DEFINITIONS.

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

[[Page S79]]

       ``(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 Hawai'i 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 Hawai'i State Department of Health;
       ``(VI) the Native Hawaiian Health Task Force;
       ``(VII) the Hawai'i State Primary Care Association;
       ``(VIII) Ahahui O Na Kauka, the Native Hawaiian Physicians 
     Association;
       ``(IX) Ho`ola Lahui Hawaii, or a health care system serving 
     the islands of Kaua`i or Ni`ihau (which may be composed of as 
     many health care centers as are necessary to meet the health 
     care needs of the Native Hawaiians of those islands);
       ``(X) Ke Ola Mamo, or a health care system serving the 
     island of O`ahu (which may be composed of as many health care 
     centers as are necessary to meet the health care needs of the 
     Native Hawaiians of that island);
       ``(XI) Na Pu`uwai or a health care system serving the 
     islands of Moloka`i or Lana`i (which may be composed of as 
     many health care centers as are necessary to meet the health 
     care needs of the Native Hawaiians of those islands);
       ``(XII) Hui No Ke Ola Pono, or a health care system serving 
     the island of Maui (which may be composed of as many health 
     care centers as are necessary to meet the health care needs 
     of the Native Hawaiians of that island);
       ``(XIII) Hui Malama Ola Na `Oiwi, or a health care system 
     serving the island of Hawai'i (which may be composed of as 
     many health care centers as are necessary to meet the health 
     care needs of the Native Hawaiians of that island);
       ``(XIV) such other Native Hawaiian health care systems as 
     are certified and recognized by Papa Ola Lokahi in accordance 
     with this Act; and
       ``(XV) such other member organizations as the Board of Papa 
     Ola Lokahi shall admit from time to time, based on 
     satisfactory demonstration of a record of contribution to the 
     health and well-being of Native Hawaiians.

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

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

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

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

       ``(a) Development.--
       ``(1) In general.--The Secretary may make a grant to, or 
     enter into a contract with, Papa Ola Lokahi for the purpose 
     of coordinating, implementing, and updating a Native Hawaiian 
     comprehensive health care master plan that is designed--

[[Page S80]]

       ``(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 2009, 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.

       ``(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 
     benefitting Native Hawaiians;
       ``(B) the number of Native Hawaiians affected by those 
     funds;
       ``(C) the collaborations between the applicable Federal 
     agency and Native Hawaiian groups and organizations in the 
     expenditure of those funds; and
       ``(D) the amount of funds used for--
       ``(i) Federal administrative purposes; and
       ``(ii) the provision of direct services to Native 
     Hawaiians.
       ``(c) Fiscal Allocation and Coordination of Programs and 
     Services.--
       ``(1) 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
       ``(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

[[Page S81]]

     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 2009 through 2014.
       ``(2) Planning grants.--There are authorized to be 
     appropriated such sums as are necessary to carry out 
     subsection (b) for each of fiscal years 2009 through 2014.
       ``(3) Health services.--There are authorized to be 
     appropriated such sums as are necessary to carry out 
     subsection (c) for each of fiscal years 2009 through 2014.

     ``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 2009 
     through 2014.

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

       ``(a) Terms and Conditions.--The Secretary shall include in 
     any grant made or contract entered into under this Act such 
     terms and conditions as the Secretary considers necessary or 
     appropriate to ensure that the objectives of the grant or 
     contract are achieved.
       ``(b) Periodic Review.--The Secretary shall periodically 
     evaluate the performance of, and compliance with, grants and 
     contracts under this Act.
       ``(c) Administrative Requirements.--The Secretary shall not 
     make a grant or enter into a contract under this Act with an 
     entity unless the entity--
       ``(1) agrees to establish such procedures for fiscal 
     control and fund accounting as the Secretary determines are 
     necessary to ensure proper disbursement and accounting with 
     respect to the grant or contract;
       ``(2) agrees to ensure the confidentiality of records 
     maintained on individuals receiving health services under the 
     grant or contract;
       ``(3) with respect to providing health services to any 
     population of Native Hawaiians, a substantial portion of 
     which has a limited ability to speak the English language--
       ``(A) has developed and has the ability to carry out a 
     reasonable plan to provide health services under the grant or 
     contract through individuals who are able to communicate with 
     the population involved in the language and cultural context 
     that is most appropriate; and
       ``(B) has designated at least 1 individual who is fluent in 
     English and the appropriate language to assist in carrying 
     out the plan;
       ``(4) with respect to health services that are covered 
     under a program under title XVIII, XIX, or XXI of the Social 
     Security Act (42 U.S.C. 1395 et seq.) (including any State 
     plan), or under any other Federal health insurance plan--
       ``(A) if the entity will provide under the grant or 
     contract any of those health services directly--
       ``(i) has entered into a participation agreement under each 
     such plan; and
       ``(ii) is qualified to receive payments under the plan; and
       ``(B) if the entity will provide under the grant or 
     contract any of those health services through a contract with 
     an organization--
       ``(i) ensures that the organization has entered into a 
     participation agreement under each such plan; and
       ``(ii) ensures that the organization is qualified to 
     receive payments under the plan; and
       ``(5) agrees to submit to the Secretary and Papa Ola Lokahi 
     an annual report that--
       ``(A) describes the use and costs of health services 
     provided under the grant or contract (including the average 
     cost of health services per user); and
       ``(B) provides such other information as the Secretary 
     determines to be appropriate.
       ``(d) Contract Evaluation.--
       ``(1) Determination of noncompliance.--If, as a result of 
     evaluations conducted by the Secretary, the Secretary 
     determines that an entity has not complied with or 
     satisfactorily performed a contract entered into under 
     section 7, the Secretary shall, before renewing the 
     contract--
       ``(A) attempt to resolve the areas of noncompliance or 
     unsatisfactory performance; and
       ``(B) modify the contract to prevent future occurrences of 
     the noncompliance or unsatisfactory performance.
       ``(2) Nonrenewal.--If the Secretary determines that the 
     noncompliance or unsatisfactory performance described in 
     paragraph (1) with respect to an entity cannot be resolved 
     and prevented in the future, the Secretary--
       ``(A) shall not renew the contract with the entity; and
       ``(B) may enter into a contract under section 7 with 
     another entity referred to in section 7(a)(3) that provides 
     services to the same population of Native Hawaiians served by 
     the entity the contract with which was not renewed by reason 
     of this paragraph.
       ``(3) Consideration of results.--In determining whether to 
     renew a contract entered into with an entity under this Act, 
     the Secretary shall consider the results of the evaluations 
     conducted under this section.
       ``(4) Application of federal laws.--Each contract entered 
     into by the Secretary under

[[Page S82]]

     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 
     2009 through 2014.

     ``SEC. 12. REPORT.

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

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

       ``(a) In General.--The Secretary shall permit an 
     organization that enters into a contract or receives grant 
     under this Act to use in carrying out projects or activities 
     under the contract or grant all existing facilities under the 
     jurisdiction of the Secretary (including all equipment of the 
     facilities), in accordance with such terms and conditions as 
     may be agreed on for the use and maintenance of the 
     facilities or equipment.
       ``(b) Donation of Property.--The Secretary may donate to an 
     organization that enters into a contract or receives grant 
     under this Act, for use in carrying out a project or activity 
     under the contract or grant, any personal or real property 
     determined to be in excess of the needs of the Department or 
     the General Services Administration.
       ``(c) Acquisition of Surplus Property.--The Secretary may 
     acquire excess or surplus Federal Government personal or real 
     property for donation to an organization under subsection (b) 
     if the Secretary determines that the property is appropriate 
     for use by the organization for the purpose for which a 
     contract entered into or grant received by the organization 
     is authorized under this Act.

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

       ``(a) Authority and Areas of Interest.--
       ``(1) In general.--The Secretary, in consultation with Papa 
     Ola Lokahi, may allocate amounts made available under this 
     Act, or any other Act, to carry out Native Hawaiian 
     demonstration projects of national significance.
       ``(2) Areas of interest.--A demonstration project described 
     in paragraph (1) may relate to such areas of interest as--
       ``(A) the development of a centralized database and 
     information system relating to the health care status, health 
     care needs, and wellness of Native Hawaiians;
       ``(B) the education of health professionals, and other 
     individuals in institutions of higher learning, in health and 
     allied health programs in healing practices, including Native 
     Hawaiian healing practices;

[[Page S83]]

       ``(C) the integration of Western medicine with 
     complementary healing practices, including traditional Native 
     Hawaiian healing practices;
       ``(D) the use of telehealth and telecommunications in--
       ``(i) chronic and infectious disease management; and
       ``(ii) health promotion and disease prevention;
       ``(E) the development of appropriate models of health care 
     for Native Hawaiians and other indigenous people, including--
       ``(i) the provision of culturally competent health 
     services;
       ``(ii) related activities focusing on wellness concepts;
       ``(iii) the development of appropriate kupuna care 
     programs; and
       ``(iv) the development of financial mechanisms and 
     collaborative relationships leading to universal access to 
     health care; and
       ``(F) the establishment of--
       ``(i) a Native Hawaiian Center of Excellence for Nursing at 
     the University of Hawai'i at Hilo;
       ``(ii) a Native Hawaiian Center of Excellence for Mental 
     Health at the University of Hawai'i at Manoa;
       ``(iii) a Native Hawaiian Center of Excellence for Maternal 
     Health and Nutrition at the Waimanalo Health Center;
       ``(iv) a Native Hawaiian Center of Excellence for Research, 
     Training, Integrated Medicine at Molokai General Hospital; 
     and
       ``(v) a Native Hawaiian Center of Excellence for 
     Complementary Health and Health Education and Training at the 
     Waianae Coast Comprehensive Health Center.
       ``(3) 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.''.
                                 ______