[Congressional Record (Bound Edition), Volume 146 (2000), Part 13]
[Senate]
[Pages 19418-19426]
[From the U.S. Government Publishing Office, www.gpo.gov]



              NATIVE HAWAIIAN HEALTH CARE IMPROVEMENT ACT

  Mr. GORTON. Mr. President, I ask unanimous consent that the Senate 
now proceed to the consideration of Calendar No. 765, S. 1929.
  The PRESIDING OFFICER. The clerk will report the bill by title.
  The legislative clerk read as follows:

       A bill (S. 1929) a bill to amend the Native Hawaiian Health 
     Care Improvement Act to revise and extend such Act.

  There being no objection, the Senate proceeded to consider the bill, 
which had been reported from the Committee on Indian Affairs, with an 
amendment to strike all after the enacting clause and insert the part 
printed in italic.

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Native Hawaiian Health Care 
     Improvement Act Reauthorization of 2000''.

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

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

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

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

``Sec. 1. Short title; table of contents.
``Sec. 2. Findings.
``Sec. 3. Definitions.
``Sec. 4. Declaration of national Native Hawaiian health policy.
``Sec. 5. Comprehensive health care master plan for Native Hawaiians.
``Sec. 6. Functions of Papa Ola Lokahi and Office of Hawaiian Affairs.
``Sec. 7. Native Hawaiian health care.
``Sec. 8. Administrative grant for Papa Ola Lokahi.
``Sec. 9. Administration of grants and contracts.
``Sec. 10. Assignment of personnel.
``Sec. 11. Native Hawaiian health scholarships and fellowships.
``Sec. 12. Report.
``Sec. 13. Use of Federal Government facilities and sources of supply.
``Sec. 14. Demonstration projects of national significance.
``Sec. 15. National Bipartisan Commission on Native Hawaiian Health 
              Care Entitlement.
``Sec. 16. Rule of construction.
``Sec. 17. Compliance with Budget Act.
``Sec. 18. Severability.

     ``SEC. 2. FINDINGS.

       ``(a) General Findings.--Congress makes the following 
     findings:
       ``(1) Native Hawaiians begin their story with the Kumulipo 
     which details the creation and inter-relationship of all 
     things, including their evolvement as healthy and well 
     people.
       ``(2) Native Hawaiians are a distinct and unique indigenous 
     peoples with a historical continuity to the original 
     inhabitants of the Hawaiian archipelago within Ke Moananui, 
     the Pacific Ocean, and have a distinct society organized 
     almost 2,000 years ago.
       ``(3) The health and well-being of Native Hawaiians are 
     intrinsically tied to their deep feelings and attachment 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 their 
     ancestral territory, and their cultural identity in 
     accordance with their own spiritual and traditional beliefs, 
     customs, practices, language, and social institutions. In 
     referring to themselves, Native Hawaiians use the term 
     `Kanaka Maoli', a term frequently used in the 19th century to 
     describe the native people of Hawaii.
       ``(7) The constitution and statutes of the State of 
     Hawaii--
       ``(A) acknowledge the distinct land rights of Native 
     Hawaiian people as beneficiaries of the public lands trust; 
     and
       ``(B) reaffirm and protect the unique right of the Native 
     Hawaiian people to practice and perpetuate their cultural and 
     religious customs, beliefs, practices, and language.
       ``(8) At the time of the arrival of the first nonindigenous 
     peoples in Hawaii in 1778, the Native Hawaiian people lived 
     in a highly organized, self-sufficient, subsistence social 
     system based on communal land tenure with a sophisticated 
     language, culture, and religion.
       ``(9) A unified monarchical government of the Hawaiian 
     Islands was established in 1810 under Kamehameha I, the first 
     King of Hawaii.
       ``(10) Throughout the 19th century and until 1893, the 
     United States--
       ``(A) recognized the independence of the Hawaiian Nation;
       ``(B) extended full and complete diplomatic recognition to 
     the Hawaiian Government; and
       ``(C) entered into treaties and conventions with the 
     Hawaiian monarchs to govern commerce and navigation in 1826, 
     1842, 1849, 1875 and 1887.
       ``(11) In 1893, John L. Stevens, the United States Minister 
     assigned to the sovereign and independent Kingdom of Hawaii, 
     conspired with a small group of non-Hawaiian residents of the 
     Kingdom, including citizens of the United States, to 
     overthrow the indigenous and lawful government of Hawaii.
       ``(12) In pursuance of that conspiracy, the United States 
     Minister and the naval representative of the United States 
     caused armed naval

[[Page 19419]]

     forces of the United States to invade the sovereign Hawaiian 
     Nation in support of the overthrow of the indigenous and 
     lawful Government of Hawaii and the United States Minister 
     thereupon extended diplomatic recognition of a provisional 
     government formed by the conspirators without the consent of 
     the native people of Hawaii or the lawful Government of 
     Hawaii in violation of treaties between the 2 nations and of 
     international law.
       ``(13) In a message to Congress on December 18, 1893, then 
     President Grover Cleveland reported fully and accurately on 
     these illegal actions, and acknowledged that by these acts, 
     described by the President as acts of war, the government of 
     a peaceful and friendly people was overthrown, and the 
     President concluded that a `substantial wrong has thus been 
     done which a due regard for our national character as well as 
     the rights of the injured people required that we should 
     endeavor to repair'.
       ``(14) Queen Lili`uokalani, the lawful monarch of Hawaii, 
     and the Hawaiian Patriotic League, representing the 
     aboriginal citizens of Hawaii, promptly petitioned the United 
     States for redress of these wrongs and for restoration of the 
     indigenous government of the Hawaiian nation, but this 
     petition was not acted upon.
       ``(15) The United States has acknowledged the significance 
     of these events and has apologized to Native Hawaiians on 
     behalf of the people of the United States for the overthrow 
     of the Kingdom of Hawaii with the participation of agents and 
     citizens of the United States, and the resulting deprivation 
     of the rights of Native Hawaiians to self-determination in 
     legislation enacted into law in 1993 (Public Law 103-150; 107 
     Stat. 1510).
       ``(16) In 1898, the United States annexed Hawaii through 
     the Newlands Resolution without the consent of or 
     compensation to the indigenous peoples of Hawaii or their 
     sovereign government who were thereby denied the mechanism 
     for expression of their inherent sovereignty through self-
     government and self-determination, their lands and ocean 
     resources.
       ``(17) Through the Newlands Resolution and the 1900 Organic 
     Act, the Congress received 1,750,000 acres of lands formerly 
     owned by the Crown and Government of the Hawaiian Kingdom and 
     exempted the lands from then existing public land laws of the 
     United States by mandating that the revenue and proceeds from 
     these lands be `used solely for the benefit of the 
     inhabitants of the Hawaiian Islands for education and other 
     public purposes', thereby establishing a special trust 
     relationship between the United States and the inhabitants of 
     Hawaii.
       ``(18) In 1921, Congress enacted the Hawaiian Homes 
     Commission Act, 1920, which designated 200,000 acres of the 
     ceded public lands for exclusive homesteading by Native 
     Hawaiians, thereby affirming the trust relationship between 
     the United States and the Native Hawaiians, as expressed by 
     then Secretary of the Interior Franklin K. Lane who was cited 
     in the Committee Report of the Committee on Territories of 
     the House of Representatives as stating, `One thing that 
     impressed me . . . was the fact that the natives of the 
     islands . . . for whom in a sense we are trustees, are 
     falling off rapidly in numbers and many of them are in 
     poverty.'.
       ``(19) In 1938, Congress again acknowledged the unique 
     status of the Native Hawaiian people by including in the Act 
     of June 20, 1938 (52 Stat. 781 et seq.), a provision to lease 
     lands within the extension to Native Hawaiians and to permit 
     fishing in the area `only by native Hawaiian residents of 
     said area or of adjacent villages and by visitors under their 
     guidance'.
       ``(20) Under the Act entitled `An Act to provide for the 
     admission of the State of Hawaii into the Union', approved 
     March 18, 1959 (73 Stat. 4), the United States transferred 
     responsibility for the administration of the Hawaiian Home 
     Lands to the State of Hawaii but reaffirmed the trust 
     relationship which existed between the United States and the 
     Native Hawaiian people by retaining the exclusive power to 
     enforce the trust, including the power to approve land 
     exchanges, and legislative amendments affecting the rights of 
     beneficiaries under such Act.
       ``(21) Under the Act entitled `An Act to provide for the 
     admission of the State of Hawaii into the Union', approved 
     March 18, 1959 (73 Stat. 4), the United States transferred 
     responsibility for administration over portions of the ceded 
     public lands trust not retained by the United States to the 
     State of Hawaii but reaffirmed the trust relationship which 
     existed between the United States and the Native Hawaiian 
     people by retaining the legal responsibility of the State for 
     the betterment of the conditions of Native Hawaiians under 
     section 5(f) of such Act.
       ``(22) In 1978, the people of Hawaii amended their 
     Constitution to establish the Office of Hawaiian Affairs and 
     assigned to that body the authority to accept and hold real 
     and personal property transferred from any source in trust 
     for the Native Hawaiian people, to receive payments from the 
     State of Hawaii due to the Native Hawaiian people in 
     satisfaction of the pro rata share of the proceeds of the 
     Public Land Trust created under section 5 of the Admission 
     Act of 1959 (Public Law 83-3), to act as the lead State 
     agency for matters affecting the Native Hawaiian people, and 
     to formulate policy on affairs relating to the Native 
     Hawaiian people.
       ``(23) The authority of the Congress under the Constitution 
     to legislate in matters affecting the aboriginal or 
     indigenous peoples of the United States includes the 
     authority to legislate in matters affecting the native 
     peoples of Alaska and Hawaii.
       ``(24) The United States has recognized the authority of 
     the Native Hawaiian people to continue to work towards an 
     appropriate form of sovereignty as defined by the Native 
     Hawaiian people themselves in provisions set forth in 
     legislation returning the Hawaiian Island of Kaho`olawe to 
     custodial management by the State of Hawaii in 1994.
       ``(25) In furtherance of the trust responsibility for the 
     betterment of the conditions of Native Hawaiians, the United 
     States has established a program for the provision of 
     comprehensive health promotion and disease prevention 
     services to maintain and improve the health status of the 
     Hawaiian people. This program is conducted by the Native 
     Hawaiian Health Care Systems, the Native Hawaiian Health 
     Scholarship Program and Papa Ola Lokahi. Health initiatives 
     from these and other health institutions and agencies using 
     Federal assistance have been responsible for reducing the 
     century-old morbidity and mortality rates of Native Hawaiian 
     people by providing comprehensive disease prevention, health 
     promotion activities and increasing the number of Native 
     Hawaiians in the health and allied health professions. This 
     has been accomplished through the Native Hawaiian Health Care 
     Act of 1988 (Public Law 100-579) and its reauthorization in 
     section 9168 of Public Law 102-396 (106 Stat. 1948).
       ``(26) This historical and unique legal relationship has 
     been consistently recognized and affirmed by Congress through 
     the enactment of Federal laws which extend to the Native 
     Hawaiian people the same rights and privileges accorded to 
     American Indian, Alaska Native, Eskimo, and Aleut 
     communities, including the Native American Programs Act of 
     1974 (42 U.S.C. 2991 et seq.), the American Indian Religious 
     Freedom Act (42 U.S.C. 1996), the National Museum of the 
     American Indian Act (20 U.S.C. 80q et seq.), and the Native 
     American Graves Protection and Repatriation Act (25 U.S.C. 
     3001 et seq.).
       ``(27) The United States has also recognized and reaffirmed 
     the trust relationship to the Native Hawaiian people through 
     legislation which authorizes the provision of services to 
     Native Hawaiians, specifically, the Older Americans Act of 
     1965 (42 U.S.C. 3001 et seq.), the Developmental Disabilities 
     Assistance and Bill of Rights Act Amendments of 1987, the 
     Veterans' Benefits and Services Act of 1988, the 
     Rehabilitation Act of 1973 (29 U.S.C. 701 et seq.), the 
     Native Hawaiian Health Care Act of 1988 (Public Law 100-579), 
     the Health Professions Reauthorization Act of 1988, the 
     Nursing Shortage Reduction and Education Extension Act of 
     1988, the Handicapped Programs Technical Amendments Act of 
     1988, the Indian Health Care Amendments of 1988, and the 
     Disadvantaged Minority Health Improvement Act of 1990.
       ``(28) The United States has also affirmed the historical 
     and unique legal relationship to the Hawaiian people by 
     authorizing the provision of services to Native Hawaiians to 
     address problems of alcohol and drug abuse under the Anti-
     Drug Abuse Act of 1986 (Public Law 99-570).
       ``(29) Further, the United States has recognized that 
     Native Hawaiians, as aboriginal, indigenous, native peoples 
     of Hawaii, are a unique population group in Hawaii and in the 
     continental United States and has so declared in Office of 
     Management and Budget Circular 15 in 1997 and Presidential 
     Executive Order No. 13125, dated June 7, 1999.
       ``(30) Despite the United States having expressed its 
     commitment to a policy of reconciliation with the Native 
     Hawaiian people for past grievances in Public Law 103-150 
     (107 Stat. 1510) the unmet health needs of the Native 
     Hawaiian people remain severe and their health status 
     continues to be far below that of the general population of 
     the United States.
       ``(b) Unmet Needs and Health Disparities.--Congress finds 
     that the unmet needs and serious health disparities that 
     adversely affect the Native Hawaiian people include the 
     following:
       ``(1) Chronic disease and illness.--
       ``(A) Cancer.--
       ``(i) In general.--With respect to all cancer--

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

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

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

[[Page 19420]]

     African Americans (31.4 out of every 100,000 residents) and 
     Caucasian Americans (27.0 out of every 100,000 residents).

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

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

       ``(ii) Hypertension.--The death rate for Native Hawaiians 
     from hypertension (3.5 out of every 100,000 residents) is 84 
     percent higher than that for the entire State (1.9 out of 
     every 100,000 residents).
       ``(iii) Stroke.--The death rate for Native Hawaiians from 
     stroke (58.3 out of every 100,000 residents) is 13 percent 
     higher than that for the entire State (51.8 out of every 
     100,000 residents).
       ``(2) Infectious disease and illness.--The incidence of 
     AIDS for Native Hawaiians is at least twice as high per 
     100,000 residents (10.5 percent) than that for any other non-
     Caucasian group in the State of Hawaii.
       ``(3) Injuries.--With respect to injuries--
       ``(A) the death rate for Native Hawaiians from injuries 
     (38.8 out of every 100,000 residents) is 45 percent higher 
     than that for the entire State (26.8 out of every 100,000 
     residents);
       ``(B) Native Hawaiian males lose an average of 14 years of 
     productive life lost from injuries as compared to 9.8 years 
     for all other males in Hawaii; and
       ``(C) Native Hawaiian females lose and average of 4 years 
     of productive life lost from injuries but this rate is the 
     highest rate among all females in the State of Hawaii.
       ``(4) Dental health.--With respect to dental health--
       ``(A) Native Hawaiian children exhibit among the highest 
     rates of dental caries in the nation, and the highest in the 
     State of Hawaii as compared to the 5 other major ethnic 
     groups in the State;
       ``(B) the average number of decayed or filled primary teeth 
     for Native Hawaiian children ages 5 through 9 years was 4.3 
     as compared with 3.7 for the entire State of Hawaii and 1.9 
     for the United States; and
       ``(C) the proportion of Native Hawaiian children ages 5 
     through 12 years with unmet treatment needs (defined as 
     having active dental caries requiring treatment) is 40 
     percent as compared with 33 percent for all other races in 
     the State of Hawaii.
       ``(5) Life expectancy.--With respect to life expectancy--
       ``(A) Native Hawaiians have the lowest life expectancy of 
     all population groups in the State of Hawaii;
       ``(B) between 1910 and 1980, the life expectancy of Native 
     Hawaiians from birth has ranged from 5 to 10 years less than 
     that of the overall State population average; and
       ``(C) the most recent tables for 1990 show Native Hawaiian 
     life expectancy at birth (74.27 years) to be about 5 years 
     less than that of the total State population (78.85 years).
       ``(6) Maternal and child health.--
       ``(A) Prenatal care.--With respect to prenatal care--
       ``(i) as of 1996, Native Hawaiian women have the highest 
     prevalence (21 percent) of having had no prenatal care during 
     their first trimester of pregnancy when compared to the 5 
     largest ethnic groups in the State of Hawaii;
       ``(ii) of the mothers in the State of Hawaii who received 
     no prenatal care throughout their pregnancy in 1996, 44 
     percent were Native Hawaiian;
       ``(iii) over 65 percent of the referrals to Healthy Start 
     in fiscal years 1996 and 1997 were Native Hawaiian newborns; 
     and
       ``(iv) in every region of the State of Hawaii, many Native 
     Hawaiian newborns begin life in a potentially hazardous 
     circumstance, far higher than any other racial group.
       ``(B) Births.--With respect to births--
       ``(i) in 1996, 45 percent of the live births to Native 
     Hawaiian mothers were infants born to single mothers which 
     statistics indicate put infants at higher risk of low birth 
     weight and infant mortality;
       ``(ii) in 1996, of the births to Native Hawaiian single 
     mothers, 8 percent were low birth weight (under 2500 grams); 
     and
       ``(iii) of all low birth weight babies born to single 
     mothers in the State of Hawaii, 44 percent were Native 
     Hawaiian.
       ``(C) Teen pregnancies.--With respect to births--
       ``(i) in 1993 and 1994, Native Hawaiians had the highest 
     percentage of teen (individuals who were less than 18 years 
     of age) births (8.1 percent) compared to the rate for all 
     other races in the State of Hawaii (3.6 percent);
       ``(ii) in 1996, nearly 53 percent of all mothers in Hawaii 
     under 18 years of age were Native Hawaiian;
       ``(iii) lower rates of abortion (a third lower than for the 
     statewide population) among Hawaiian women may account in 
     part, for the higher percentage of live births;
       ``(iv) in 1995, of the births to mothers age 14 years and 
     younger in Hawaii, 66 percent were Native Hawaiian; and
       ``(v) in 1996, of the births in this same group, 48 percent 
     were Native Hawaiian.
       ``(D) Fetal mortality.--In 1996, Native Hawaiian fetal 
     mortality rates comprised 15 percent of all fetal deaths for 
     the State of Hawaii. However, for fetal deaths occurring in 
     mothers under the age of 18 years, 32 percent were Native 
     Hawaiian, and for mothers 18 through 24 years of age, 28 
     percent were Native Hawaiians.
       ``(7) Mental health.--
       ``(A) Alcohol and drug abuse.--With respect to alcohol and 
     drug abuse--
       ``(i) Native Hawaiians represent 38 percent of the total 
     admissions to Department of Health, Alcohol, Drugs and Other 
     Drugs, funded substance abuse treatment programs;
       ``(ii) in 1997, the prevalence of cigarette smoking by 
     Native Hawaiians was 28.5 percent, a rate that is 53 percent 
     higher than that for all other races in the State of Hawaii 
     which is 18.6 percent;
       ``(iii) Native Hawaiians have the highest prevalence rates 
     of acute alcohol drinking (31 percent), a rate that is 79 
     percent higher than that for all other races in the State of 
     Hawaii;
       ``(iv) the chronic alcohol drinking rate among Native 
     Hawaiians is 54 percent higher than that for all other races 
     in the State of Hawaii;
       ``(v) in 1991, 40 percent of the Native Hawaiian adults 
     surveyed reported having used marijuana compared with 30 
     percent for all other races in the State of Hawaii; and
       ``(vi) nine percent of the Native Hawaiian adults surveyed 
     reported that they are current users (within the past year) 
     of marijuana, compared with 6 percent for all other races in 
     the State of Hawaii.
       ``(B) Crime.--With respect to crime--
       ``(i) in 1996, of the 5,944 arrests that were made for 
     property crimes in the State of Hawaii, arrests of Native 
     Hawaiians comprised 20 percent of that total;
       ``(ii) Native Hawaiian juveniles comprised a third of all 
     juvenile arrests in 1996;
       ``(iii) In 1996, Native Hawaiians represented 21 percent of 
     the 8,000 adults arrested for violent crimes in the State of 
     Hawaii, and 38 percent of the 4,066 juvenile arrests;
       ``(iv) Native Hawaiians are over-represented in the prison 
     population in Hawaii;
       ``(v) in 1995 and 1996 Native Hawaiians comprised 36.5 
     percent of the sentenced felon prison population in Hawaii, 
     as compared to 20.5 percent for Caucasian Americans, 3.7 
     percent for Japanese Americans, and 6 percent for Chinese 
     Americans;
       ``(vi) in 1995 and 1996 Native Hawaiians made up 45.4 
     percent of the technical violator population, and at the 
     Hawaii Youth Correctional Facility, Native Hawaiians 
     constituted 51.6 percent of all detainees in fiscal year 
     1997; and
       ``(vii) based on anecdotal information from inmates at the 
     Halawa Correction Facilities, Native Hawaiians are estimated 
     to comprise between 60 and 70 percent of all inmates.
       ``(8) Health professions education and training.--With 
     respect to health professions education and training--
       ``(A) Native Hawaiians age 25 years and older have a 
     comparable rate of high school completion, however, the rates 
     of baccalaureate degree achievement amongst Native Hawaiians 
     are less than the norm in the State of Hawaii (6.9 percent 
     and 15.76 percent respectively);
       ``(B) Native Hawaiian physicians make up 4 percent of the 
     total physician workforce in the State of Hawaii; and
       ``(C) in fiscal year 1997, Native Hawaiians comprised 8 
     percent of those individuals who earned Bachelor's Degrees, 
     14 percent of those individuals who earned professional 
     diplomas, 6

[[Page 19421]]

     percent of those individuals who earned Master's Degrees, and 
     less than 1 percent of individuals who earned doctoral 
     degrees at the University of Hawaii.

     ``SEC. 3. DEFINITIONS.

       ``In this Act:
       ``(1) 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) Native hawaiian.--The term `Native Hawaiian' means 
     any individual who is Kanaka Maoli (a descendant of the 
     aboriginal people who, prior to 1778, occupied and exercised 
     sovereignty in the area that now constitutes the State of 
     Hawaii) as evidenced by--
       ``(A) genealogical records,
       ``(B) kama`aina witness verification from Native Hawaiian 
     Kupuna (elders); or
       ``(C) birth records of the State of Hawaii or any State or 
     territory of the United States.
       ``(5) Native hawaiian health care system.--The term `Native 
     Hawaiian health care system' means an entity--
       ``(A) which is organized under the laws of the State of 
     Hawaii;
       ``(B) which provides or arranges for health care services 
     through practitioners licensed by the State of Hawaii, where 
     licensure requirements are applicable;
       ``(C) which is a public or nonprofit private entity;
       ``(D) in which Native Hawaiian health practitioners 
     significantly participate in the planning, management, 
     monitoring, and evaluation of health care services;
       ``(E) which may be composed of as many as 8 Native Hawaiian 
     health care systems as necessary to meet the health care 
     needs of each island's Native Hawaiians; and
       ``(F) which is--
       ``(i) recognized by Papa Ola Lokahi for the purpose of 
     planning, conducting, or administering programs, or portions 
     of programs, authorized by this chapter for the benefit of 
     Native Hawaiians; and
       ``(ii) certified by Papa Ola Lokahi as having the 
     qualifications and the capacity to provide the services and 
     meet the requirements under the contract the Native Hawaiian 
     health care system enters into with the Secretary or the 
     grant the Native Hawaiian health care system receives from 
     the Secretary pursuant to this Act.
       ``(6) Native hawaiian health center.--The term `Native 
     Hawaiian Health Center' means any organization that is a 
     primary care provider and that--
       ``(A) has a governing board that is 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 has having met all 
     the criteria of this paragraph.
       ``(7) 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.
       ``(8) Native hawaiian organization.--The term `Native 
     Hawaiian organization' means any organization--
       ``(A) which serves the interests of Native Hawaiians; and
       ``(B) which is--
       ``(i) recognized by Papa Ola Lokahi for the purpose of 
     planning, conducting, or administering programs (or portions 
     of programs) authorized under this Act for the benefit of 
     Native Hawaiians; and
       ``(ii) a public or nonprofit private entity.
       ``(9) Office of hawaiian affairs.--The terms `Office of 
     Hawaiian Affairs' and `OHA' mean the governmental entity 
     established under Article XII, sections 5 and 6 of the Hawaii 
     State Constitution and charged with the responsibility to 
     formulate policy relating to the affairs of Native Hawaiians.
       ``(10) Papa ola lokahi.--
       ``(A) In general.--The term `Papa Ola Lokahi' means an 
     organization that is composed of public agencies and private 
     organizations focusing on improving the health status of 
     Native Hawaiians. Board members of such organization may 
     include representation from--
       ``(i) E Ola Mau;
       ``(ii) the Office of Hawaiian Affairs of the State of 
     Hawaii;
       ``(iii) Alu Like, Inc.;
       ``(iv) the University of Hawaii;
       ``(v) the Hawaii State Department of Health;
       ``(vi) the Kamehameha Schools, or other Native Hawaiian 
     organization responsible for the administration of the Native 
     Hawaiian Health Scholarship Program;
       ``(vii) the Hawaii State Primary Care Association, or 
     Native Hawaiian Health Centers whose patient populations are 
     predominantly Native Hawaiian;
       ``(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, and which may be composed 
     of as many health care centers as are necessary to meet the 
     health care needs of the Native Hawaiians of those islands;
       ``(x) Ke Ola Mamo, or a health care system serving the 
     island of O`ahu and which may be composed of as many health 
     care centers as are necessary to meet the health care needs 
     of the Native Hawaiians of that island;
       ``(xi) Na Pu`uwai or a health care system serving the 
     islands of Moloka`i or Lana`i, and which may be composed of 
     as many health care centers as are necessary to meet the 
     health care needs of the Native Hawaiians of those islands;
       ``(xii) Hui No Ke Ola Pono, or a health care system serving 
     the island of Maui, and which may be composed of as many 
     health care centers as are necessary to meet the health care 
     needs of the Native Hawaiians of that island;
       ``(xiii) Hui Malama Ola Na `Oiwi, or a health care system 
     serving the island of Hawaii, and which may be composed of as 
     many health care centers as are necessary to meet the health 
     care needs of the Native Hawaiians of that island;
       ``(xiv) other Native Hawaiian health care systems as 
     certified and recognized by Papa Ola Lokahi in accordance 
     with this Act; and
       ``(xv) such other member organizations as the Board of Papa 
     Ola Lokahi will admit from time to time, based upon 
     satisfactory demonstration of a record of contribution to the 
     health and well-being of Native Hawaiians.
       ``(B) Limitation.--Such term does not include any 
     organization described in subparagraph (A) if the Secretary 
     determines that such organization has not developed a mission 
     statement with clearly defined goals and objectives for the 
     contributions the organization will make to the Native 
     Hawaiian health care systems, the national policy as set 
     forth in section 4, and an action plan for carrying out those 
     goals and objectives.
       ``(11) Primary health services.--The term `primary health 
     services' means--
       ``(A) services of physicians, physicians' assistants, nurse 
     practitioners, and other health professionals;
       ``(B) diagnostic laboratory and radiologic services;
       ``(C) preventive health services including perinatal 
     services, well child services, family planning services, 
     nutrition services, home health services, and, generally, all 
     those services associated with enhanced health and wellness.
       ``(D) emergency medical services;
       ``(E) transportation services as required for adequate 
     patient care;
       ``(F) preventive dental services;
       ``(G) pharmaceutical and medicament services;
       ``(H) primary care services that may lead to specialty or 
     tertiary care; and
       ``(I) complimentary healing practices, including those 
     performed by traditional Native Hawaiian healers.
       ``(12) Secretary.--The term `Secretary' means the Secretary 
     of Health and Human Services.
       ``(13) Traditional native hawaiian healer.--The term 
     `traditional Native Hawaiian healer' means a practitioner--
       ``(A) who--
       ``(i) is of Native Hawaiian ancestry; and
       ``(ii) has the knowledge, skills, and experience in direct 
     personal health care of individuals; and
       ``(B) whose knowledge, skills, and experience are based on 
     demonstrated learning of Native Hawaiian healing practices 
     acquired by--
       ``(i) direct practical association with Native Hawaiian 
     elders; and
       ``(ii) oral traditions transmitted from generation to 
     generation.

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

       ``(a) Congress.--Congress hereby declares that it is the 
     policy of the United States in fulfillment of its special 
     responsibilities and legal obligations to the indigenous 
     peoples of Hawaii resulting from the unique and historical 
     relationship between the United States and the indigenous 
     peoples of Hawaii--
       ``(1) to raise the health status of Native Hawaiians to the 
     highest possible health level; and
       ``(2) to provide existing Native Hawaiian health care 
     programs with all resources necessary to effectuate this 
     policy.
       ``(b) Intent of Congress.--It is the intent of the Congress 
     that--
       ``(1) health care programs having a demonstrated effect of 
     substantially reducing or eliminating the over-representation 
     of Native Hawaiians among those suffering from chronic and 
     acute disease and illness and addressing the health needs, 
     including perinatal, early child development, and family-
     based health education, of Native Hawaiians shall be 
     established and implemented; and

[[Page 19422]]

       ``(2) the Nation raise the health status of Native 
     Hawaiians by the year 2010 to at least the levels set forth 
     in the goals contained within Healthy People 2010 or 
     successor standards and to incorporate within health 
     programs, activities defined and identified by Kanaka Maoli 
     which may include--
       ``(A) 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);
       ``(B) increasing the number of health and allied-health 
     care providers who are trained to provide culturally 
     competent care to Native Hawaiians;
       ``(C) increasing the use of traditional Native Hawaiian 
     foods in peoples' diets and dietary preferences including 
     those of students and the use of these traditional foods in 
     school feeding programs;
       ``(D) identifying and instituting Native Hawaiian cultural 
     values and practices within the `corporate cultures' of 
     organizations and agencies providing health services to 
     Native Hawaiians;
       ``(E) facilitating the provision of Native Hawaiian healing 
     practices by Native Hawaiian healers for those clients 
     desiring such assistance; and
       ``(F) supporting training and education activities and 
     programs in traditional Native Hawaiian healing practices by 
     Native Hawaiian healers.
       ``(c) Report.--The Secretary shall submit to the President, 
     for inclusion in each report required to be transmitted to 
     Congress under section 12, a report on the progress made 
     towards meeting the National policy as set forth 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 designed to promote 
     comprehensive health promotion and disease prevention 
     services and to maintain and improve the health status of 
     Native Hawaiians, and to support community-based initiatives 
     that are reflective of holistic approaches to health.
       ``(2) Consultation.--
       ``(A) In general.--Papa Ola Lokahi and the Office of 
     Hawaiian Affairs shall consult with the Native Hawaiian 
     health care systems, Native Hawaiian health centers, and the 
     Native Hawaiian community in carrying out this section.
       ``(B) Memoranda of understanding.--Papa Ola Lokahi and the 
     Office of Hawaiian Affairs may enter into memoranda of 
     understanding or agreement for the purposes of acquiring 
     joint funding and for other issues as may be necessary to 
     accomplish the objectives of this section.
       ``(3) Health care financing study report.--Not later than 
     18 months after the date of enactment of this Act, Papa Ola 
     Lokahi in cooperation with the Office of Hawaiian Affairs and 
     other appropriate agencies of the State of Hawaii, including 
     the Department of Health and the Department of Human Services 
     and the Native Hawaiian health care systems and Native 
     Hawaiian health centers, shall submit to Congress a report 
     detailing the impact of current Federal and State health care 
     financing mechanisms and policies on the health and well-
     being of Native Hawaiians. Such report shall include--
       ``(A) information concerning the impact of cultural 
     competency, risk assessment data, eligibility requirements 
     and exemptions, and reimbursement policies and capitation 
     rates currently in effect for service providers;
       ``(B) any other such information as may be important to 
     improving the health status of Native Hawaiians as such 
     information relates to health care financing including 
     barriers to health care; and
       ``(C) the recommendations for submission to the Secretary 
     for review and consultation with Native Hawaiians.
       ``(b) Authorization of Appropriations.--There are 
     authorized to be appropriated such sums as may be necessary 
     to carry out subsection (a).

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

       ``(a) Responsibility.--Papa Ola Lokahi shall be responsible 
     for the--
       ``(1) coordination, implementation, and updating, as 
     appropriate, of the comprehensive health care master plan 
     developed pursuant to section 5;
       ``(2) training for the persons described in subparagraphs 
     (B) and (C) of section 7(c)(1);
       ``(3) identification of and research into the diseases that 
     are most prevalent among Native Hawaiians, including 
     behavioral, biomedical, epidemiological, and health services;
       ``(4) 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 services studies; and
       ``(5) the maintenance of an action plan outlining the 
     contributions that each member organization of Papa Ola 
     Lokahi will make in carrying out the policy of this Act.
       ``(b) Special Project Funds.--Papa Ola Lokahi may receive 
     special project funds that may be appropriated for the 
     purpose of research on the health status of Native Hawaiians 
     or for the purpose of addressing the health care needs of 
     Native Hawaiians.
       ``(c) Clearinghouse.--
       ``(1) In general.--Papa Ola Lokahi shall serve as a 
     clearinghouse for--
       ``(A) the collection and maintenance of data associated 
     with the health status of Native Hawaiians;
       ``(B) the identification and research into diseases 
     affecting Native Hawaiians;
       ``(C) the availability of Native Hawaiian project funds, 
     research projects and publications;
       ``(D) the collaboration of research in the area of Native 
     Hawaiian health; and
       ``(E) the timely dissemination of information pertinent to 
     the Native Hawaiian health care systems.
       ``(2) Consultation.--The Secretary shall provide Papa Ola 
     Lokahi and the Office of Hawaiian Affairs, at least once 
     annually, an accounting of funds and services provided to 
     States and to nonprofit groups and organizations from the 
     Department for the purposes set forth in section 4. Such 
     accounting shall include--
       ``(A) the amount of funds expended explicitly for and 
     benefiting Native Hawaiians;
       ``(B) the number of Native Hawaiians impacted by these 
     funds;
       ``(C) the identification of collaborations made with Native 
     Hawaiian groups and organizations in the expenditure of these 
     funds; and
       ``(D) the amount of funds used for Federal administrative 
     purposes and for the provision of direct services to Native 
     Hawaiians.
       ``(d) Fiscal Allocation and Coordination of Programs and 
     Services.--
       ``(1) Recommendations.--Papa Ola Lokahi shall provide 
     annual recommendations to the Secretary with respect to the 
     allocation of all amounts appropriated under this Act.
       ``(2) Coordination.--Papa Ola Lokahi shall, to the maximum 
     extent possible, coordinate and assist the health care 
     programs and services provided to Native Hawaiians.
       ``(3) Representation on commission.--The Secretary, in 
     consultation with Papa Ola Lokahi, shall make recommendations 
     for Native Hawaiian representation on the President's 
     Advisory Commission on Asian Americans and Pacific Islanders.
       ``(e) Technical Support.--Papa Ola Lokahi may act as a 
     statewide infrastructure to provide technical support and 
     coordination of training and technical assistance to the 
     Native Hawaiian health care systems and to Native Hawaiian 
     health centers.
       ``(f) 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 
     health-related resources or services to Native Hawaiians and 
     the Native Hawaiian health care systems or of providing 
     resources or services for the implementation of the National 
     policy as set forth in section 4.
       ``(2) Health care financing.--
       ``(A) Federal consultation.--Federal agencies providing 
     health care financing and carrying out health care programs, 
     including the Health Care Financing Administration, shall 
     consult with Native Hawaiians and organizations providing 
     health care services to Native Hawaiians prior to the 
     adoption of any policy or regulation that may impact on the 
     provision of services or health insurance coverage. Such 
     consultation shall include the identification of the impact 
     of any proposed policy, rule, or regulation.
       ``(B) State consultation.--The State of Hawaii shall engage 
     in meaningful consultation with Native Hawaiians and 
     organizations providing health care services to Native 
     Hawaiians in the State of Hawaii prior to making any changes 
     or initiating new programs.
       ``(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 Health Care Financing Administration;
       ``(II) the agency of the State of Hawaii that administers 
     or supervises the administration of the State plan or waiver 
     approved under title XVIII, XIX, or XXI of the Social 
     Security Act 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 or agencies providing full 
     or partial health insurance to Native Hawaiians.

       ``(ii) Contents of arrangements.--Arrangements 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.--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 `traditional Native 
     Hawaiian healers' as defined in this Act or `traditional 
     healers' providing `traditional health care practices' as 
     defined in section 4(r) of Public Law 94-437. Such services 
     shall be exempt from national accreditation reviews, 
     including

[[Page 19423]]

     reviews conducted by the Joint Accreditation Commission on 
     Health Organizations and the Rehabilitation Accreditation 
     Commission.

     ``SEC. 7. NATIVE HAWAIIAN HEALTH CARE.

       ``(a) Comprehensive Health Promotion, Disease Prevention, 
     and Primary Health Services.--
       ``(1) Grants and contracts.--The Secretary, in consultation 
     with Papa Ola Lokahi, may make grants to, or enter into 
     contracts with, any qualified entity for the purpose of 
     providing comprehensive health promotion and disease 
     prevention services, as well as primary health services, to 
     Native Hawaiians who desire and are committed to bettering 
     their own health.
       ``(2) Preference.--In making grants and entering into 
     contracts under this subsection, the Secretary shall give 
     preference to Native Hawaiian health care systems and Native 
     Hawaiian organizations and, to the extent feasible, health 
     promotion and disease prevention services shall be performed 
     through Native Hawaiian health care systems.
       ``(3) Qualified entity.--An entity is a qualified entity 
     for purposes of paragraph (1) if the entity is a Native 
     Hawaiian health care system or a Native Hawaiian Center.
       ``(4) Limitation on number of entities.--The Secretary may 
     make a grant to, or enter into a contract with, not more than 
     8 Native Hawaiian health care systems under this subsection 
     during any fiscal year.
       ``(b) Planning Grant or Contract.--In addition to grants 
     and contracts under subsection (a), the Secretary may make a 
     grant to, or enter into a contract with, Papa Ola Lokahi for 
     the purpose of planning Native Hawaiian health care systems 
     to serve the health needs of Native Hawaiian communities on 
     each of the islands of O`ahu, Moloka`i, Maui, Hawai`i, 
     Lana`i, Kaua`i, and Ni`ihau in the State of Hawaii.
       ``(c) Services To Be Provided.--
       ``(1) In general.--Each recipient of funds under subsection 
     (a) shall ensure that the following services either are 
     provided or arranged for:
       ``(A) Outreach services to inform Native Hawaiians of the 
     availability of health services.
       ``(B) Education in health promotion and disease prevention 
     of the Native Hawaiian population by, wherever possible, 
     Native Hawaiian health care practitioners, community outreach 
     workers, counselors, and cultural educators.
       ``(C) Services of physicians, physicians' assistants, nurse 
     practitioners or other health and allied-health 
     professionals.
       ``(D) Immunizations.
       ``(E) Prevention and control of diabetes, high blood 
     pressure, and otitis media.
       ``(F) Pregnancy and infant care.
       ``(G) Improvement of nutrition.
       ``(H) Identification, treatment, control, and reduction of 
     the incidence of preventable illnesses and conditions endemic 
     to Native Hawaiians.
       ``(I) Collection of data related to the prevention of 
     diseases and illnesses among Native Hawaiians.
       ``(J) Services within the meaning of the terms `health 
     promotion', `disease prevention', and `primary health 
     services', as such terms are defined in section 3, which are 
     not specifically referred to in subsection (a).
       ``(K) Support of culturally appropriate activities 
     enhancing health and wellness including land-based, water-
     based, ocean-based, and spiritually-based projects and 
     programs.
       ``(2) Traditional healers.--The health care services 
     referred to in paragraph (1) which are provided under grants 
     or contracts under subsection (a) may be provided by 
     traditional Native Hawaiian healers.
       ``(d) Federal Tort Claims Act.--Individuals who provide 
     medical, dental, or other services referred to in subsection 
     (a)(1) for Native Hawaiian health care systems, including 
     providers of traditional Native Hawaiian healing services, 
     shall be treated as if such individuals were members of the 
     Public Health Service and shall be covered under the 
     provisions of section 224 of the Public Health Service Act.
       ``(e) Site for Other Federal Payments.--A Native Hawaiian 
     health care system that receives funds under subsection (a) 
     shall provide a designated area and appropriate staff to 
     serve as a Federal loan repayment facility. Such facility 
     shall be designed to enable health and allied-health 
     professionals to remit payments with respect to loans 
     provided to such professionals under any Federal loan 
     program.
       ``(f) Restriction on Use of Grant and Contract Funds.--The 
     Secretary may not make a grant to, or enter into a contract 
     with, an entity under subsection (a) unless the entity agrees 
     that amounts received under such grant or contract will not, 
     directly or through contract, be expended--
       ``(1) for any services other than the services described in 
     subsection (c)(1); or
       ``(2) to purchase or improve real property (other than 
     minor remodeling of existing improvements to real property) 
     or to purchase major medical equipment.
       ``(g) Limitation on Charges for Services.--The Secretary 
     may not make a grant to, or enter into a contract with, an 
     entity under subsection (a) unless the entity agrees that, 
     whether health services are provided directly or through 
     contract--
       ``(1) health services under the grant or contract will be 
     provided without regard to ability to pay for the health 
     services; and
       ``(2) the entity will impose a charge for the delivery of 
     health services, and such charge--
       ``(A) will be made according to a schedule of charges that 
     is made available to the public; and
       ``(B) will be adjusted to reflect the income of the 
     individual involved.
       ``(h) Authorization of Appropriations.--
       ``(1) General grants.--There is authorized to be 
     appropriated such sums as may be necessary for each of fiscal 
     years 2001 through 2011 to carry out subsection (a).
       ``(2) Planning grants.--There is authorized to be 
     appropriated such sums as may be necessary for each of fiscal 
     years 2001 through 2011 to carry out subsection (b).

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

       ``(a) In General.--In addition to any other grant or 
     contract under this Act, the Secretary may make grants to, or 
     enter into contracts with, Papa Ola Lokahi for--
       ``(1) coordination, implementation, and updating (as 
     appropriate) of the comprehensive health care master plan 
     developed pursuant to section 5;
       ``(2) training for the persons described section 7(c)(1);
       ``(3) identification of and research into the diseases that 
     are most prevalent among Native Hawaiians, including 
     behavioral, biomedical, epidemiologic, and health services;
       ``(4) the maintenance of an action plan outlining the 
     contributions that each member organization of Papa Ola 
     Lokahi will make in carrying out the policy of this Act;
       ``(5) a clearinghouse function for--
       ``(A) the collection and maintenance of data associated 
     with the health status of Native Hawaiians;
       ``(B) the identification and research into diseases 
     affecting Native Hawaiians; and
       ``(C) the availability of Native Hawaiian project funds, 
     research projects and publications;
       ``(6) the establishment and maintenance of an institutional 
     review board for all health-related research involving Native 
     Hawaiians;
       ``(7) the coordination of the health care programs and 
     services provided to Native Hawaiians; and
       ``(8) the administration of special project funds.
       ``(b) Authorization of Appropriations.--There is authorized 
     to be appropriated such sums as may be necessary for each of 
     fiscal years 2001 through 2011 to carry out subsection (a).

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

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

[[Page 19424]]

     performance described in paragraph (1) with respect to an 
     entity cannot be resolved and prevented in the future, the 
     Secretary shall not renew the contract with such entity and 
     may enter into a contract under section 7 with another entity 
     referred to in subsection (a)(3) of such section that 
     provides services to the same population of Native Hawaiians 
     which is served by the entity whose contract is not renewed 
     by reason of this paragraph.
       ``(3) Consideration of results.--In determining whether to 
     renew a contract entered into with an entity under this Act, 
     the Secretary shall consider the results of the evaluations 
     conducted under this section.
       ``(4) Application of federal laws.--All contracts entered 
     into by the Secretary under this Act shall be in accordance 
     with all Federal contracting laws and regulations, except 
     that, in the discretion of the Secretary, such contracts may 
     be negotiated without advertising and may be exempted from 
     the provisions of the Act of August 24, 1935 (40 U.S.C. 270a 
     et seq.).
       ``(5) Payments.--Payments made under any contract entered 
     into under this Act may be made in advance, by means of 
     reimbursement, or in installments and shall be made on such 
     conditions as the Secretary deems necessary to carry out the 
     purposes of this Act.
       ``(e) Report.--
       ``(1) In general.--For each fiscal year during which an 
     entity receives or expends funds pursuant to a grant or 
     contract under this Act, such entity shall submit to the 
     Secretary and to Papa Ola Lokahi an annual report--
       ``(A) on the activities conducted by the entity under the 
     grant or contract;
       ``(B) on the amounts and purposes for which Federal funds 
     were expended; and
       ``(C) containing such other information as the Secretary 
     may request.
       ``(2) Audits.--The reports and records of any entity 
     concerning any grant or contract under this Act shall be 
     subject to audit by the Secretary, the Inspector General of 
     the Department of Health and Human Services, and the 
     Comptroller General of the United States.
       ``(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.

     ``SEC. 10. ASSIGNMENT OF PERSONNEL.

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

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

       ``(a) Eligibility.--Subject to the availability of amounts 
     appropriated under subsection (c), the Secretary shall 
     provide funds through a direct grant or a cooperative 
     agreement to Kamehameha Schools or another Native Hawaiian 
     organization or health care organization with experience in 
     the administration of educational scholarships or placement 
     services for the purpose of providing scholarship assistance 
     to students who--
       ``(1) meet the requirements of section 338A of the Public 
     Health Service Act, except for assistance as provided for 
     under subsection (b)(2); and
       ``(2) are Native Hawaiians.
       ``(b) Priority.--A priority for scholarships under 
     subsection (a) may be provided to employees of the Native 
     Hawaiian Health Care Systems and the Native Hawaiian Health 
     Centers.
       ``(c) Terms and Conditions.--
       ``(1) In general.--The scholarship assistance under 
     subsection (a) shall be provided under the same terms and 
     subject to the same conditions, regulations, and rules as 
     apply to scholarship assistance provided under section 338A 
     of the Public Health Service Act (except as provided for in 
     paragraph (2)), except that--
       ``(A) the provision of scholarships in each type of health 
     care profession training shall correspond to the need for 
     each type of health care professional to serve the Native 
     Hawaiian community as identified by Papa Ola Lokahi;
       ``(B) to the maximum extent practicable, the Secretary 
     shall select scholarship recipients from a list of eligible 
     applicants submitted by the Kamehameha Schools or the Native 
     Hawaiian organization administering the program;
       ``(C) the obligated service requirement for each 
     scholarship recipient (except for those receiving assistance 
     under paragraph (2)) shall be fulfilled through service, in 
     order of priority, in--
       ``(i) any one of the Native Hawaiian health care systems or 
     Native Hawaiian health centers;
       ``(ii) health professions shortage areas, medically 
     underserved areas, or geographic areas or facilities 
     similarly designated by the United States Public Health 
     Service in the State of Hawaii; or
       ``(iii) a geographical area, facility, or organization that 
     serves a significant Native Hawaiian population;
       ``(D) the scholarship's placement service shall assign 
     Native Hawaiian scholarship recipients to appropriate sites 
     for service.
       ``(E) the provision of counseling, retention and other 
     support services shall not be limited to scholarship 
     recipients, but shall also include recipients of other 
     scholarship and financial aid programs enrolled in 
     appropriate health professions training programs.
       ``(F) financial assistance may be provided to scholarship 
     recipients in those health professions designated in such 
     section 338A of the Public Health Service Act while they are 
     fulfilling their service requirement in any one of the Native 
     Hawaiian health care systems or community health centers.
       ``(2) Fellowships.--Financial assistance through 
     fellowships may be provided to Native Hawaiian community 
     health representatives, outreach workers, and health program 
     administrators in professional training programs, and to 
     Native Hawaiians in certificated programs 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. Such assistance may include a 
     stipend or reimbursement for costs associated with 
     participation in the program.
       ``(3) Rights and benefits.--Scholarship recipients in 
     health professions designated in section 338A of the Public 
     Health Service Act while fulfilling their service 
     requirements shall have all the same rights and benefits of 
     members of the National Health Service Corps during their 
     period of service.
       ``(4) No inclusion of assistance in gross income.--
     Financial assistance provided under section 11 shall be 
     deemed `Qualified Scholarships' for purposes of the section 
     amended by section 123(a) of Public Law 99-514, as amended.
       ``(d) Authorization of Appropriations.--There is authorized 
     to be appropriated such sums as may be necessary for each of 
     fiscal years 2001 through 2011 for the purpose of funding the 
     scholarship assistance program under subsection (a) and 
     fellowship assistance under subsection (c)(2).

     ``SEC. 12. REPORT.

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

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

       ``(a) In General.--The Secretary shall permit organizations 
     that receive contracts or grants under this Act, in carrying 
     out such contracts or grants, to use existing facilities and 
     all equipment therein or under the jurisdiction of the 
     Secretary under such terms and conditions as may be agreed 
     upon for the use and maintenance of such facilities or 
     equipment.
       ``(b) Donation of Property.--The Secretary may donate to 
     organizations that receive contracts or grants under this Act 
     any personal or real property determined to be in excess of 
     the needs of the Department or the General Services 
     Administration for purposes of carrying out such contracts or 
     grants.
       ``(c) Acquisition of Surplus Property.--The Secretary may 
     acquire excess or surplus Federal Government personal or real 
     property for donation to organizations that receive contracts 
     or grants under this Act if the Secretary determines that the 
     property is appropriate for the use by the organization for 
     the purpose for which a contract or grant is authorized under 
     this Act.

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

       ``(a) Authority and Areas of Interest.--The Secretary, in 
     consultation with Papa Ola Lokahi, may allocate amounts 
     appropriated under this Act, or any other Act, to carry out 
     Native Hawaiian demonstration projects of national 
     significance. The areas of interest of such projects may 
     include--
       ``(1) the development of a centralized database and 
     information system relating to the health care status, health 
     care needs, and wellness of Native Hawaiians;
       ``(2) 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;
       ``(3) the integration of Western medicine with 
     complementary healing practices including traditional Native 
     Hawaiian healing practices;
       ``(4) the use of tele-wellness and telecommunications in 
     chronic disease management and health promotion and disease 
     prevention;
       ``(5) the development of appropriate models of health care 
     for Native Hawaiians and other indigenous peoples including 
     the provision of culturally competent health services, 
     related activities focusing on wellness concepts, the 
     development of appropriate kupuna care programs, and the 
     development of financial mechanisms and collaborative 
     relationships leading to universal access to health care; and
       ``(6) the establishment of a Native Hawaiian Center of 
     Excellence for Nursing at the University of Hawaii at Hilo, a 
     Native Hawaiian Center of Excellence for Mental Health at the 
     University of Hawaii at Manoa, a Native Hawaiian Center of 
     Excellence for Maternal Health and Nutrition at the Waimanalo 
     Health Center, and a Native Hawaiian Center of Excellence for 
     Research, Training, Integrated Medicine at Molokai General 
     Hospital and a Native Hawaiian Center of Excellence for 
     Complimentary

[[Page 19425]]

     Health and Health Education and Training at the Waianae Coast 
     Comprehensive Health Center.
       ``(b) Nonreduction in Other Funding.--The allocation of 
     funds for demonstration projects under subsection (a) shall 
     not result in a reduction in funds required by the Native 
     Hawaiian health care systems, the Native Hawaiian Health 
     Centers, the Native Hawaiian Health Scholarship Program, or 
     Papa Ola Lokahi to carry out their respective 
     responsibilities under this Act.

     ``SEC. 15. NATIONAL BIPARTISAN COMMISSION ON NATIVE HAWAIIAN 
                   HEALTH CARE ENTITLEMENT.

       ``(a) Establishment.--There is hereby established a 
     National Bipartisan Native Hawaiian Health Care Entitlement 
     Commission (referred to in this Act as the `Commission').
       ``(b) Membership.--The Commission shall be composed of 21 
     members to be appointed as follows:
       ``(1) Congressional members.--
       ``(A) Appointment.--Eight members of the Commission shall 
     be members of Congress, of which--
       ``(i) two members shall be from the House of 
     Representatives and shall be appointed by the Majority 
     Leader;
       ``(ii) two members shall be from the House of 
     Representatives and shall be appointed by the Minority 
     Leader;
       ``(iii) two members shall be from the Senate and shall be 
     appointed by the Majority Leader; and
       ``(iv) two members shall be from the Senate and shall be 
     appointed by the Minority Leader.
       ``(B) Relevant committee membership.--The members of the 
     Commission appointed under subparagraph (A) shall each be 
     members of the committees of Congress that consider 
     legislation affecting the provision of health care to Native 
     Hawaiians and other Native Americans.
       ``(C) Chairperson.--The members of the Commission appointed 
     under subparagraph (A) shall elect the chairperson and vice-
     chairperson of the Commission.
       ``(2) Hawaiian health members.--Eleven members of the 
     Commission shall be appointed by Hawaiian health entities, of 
     which--
       ``(A) five members shall be appointed by the Native 
     Hawaiian Health Care Systems;
       ``(B) one member shall be appointed by the Hawaii State 
     Primary Care Association;
       ``(C) one member shall be appointed by Papa Ola Lokahi;
       ``(D) one member shall be appointed by the Native Hawaiian 
     Health Task Force;
       ``(E) one member shall be appointed by the Office of 
     Hawaiian Affairs; and
       ``(F) two members shall be appointed by the Association of 
     Hawaiian Civic Clubs and shall represent Native Hawaiian 
     populations residing in the continental United States.
       ``(3) Secretarial members.--Two members of the Commission 
     shall be appointed by the Secretary and shall possess 
     knowledge of Native Hawaiian health concerns and wellness.
       ``(c) Terms.--
       ``(1) In general.--The members of the Commission shall 
     serve for the life of the Commission.
       ``(2) Initial appointment of members.--The members of the 
     Commission shall be appointed under subsection (b)(1) not 
     later than 90 days after the date of enactment of this Act, 
     and the remaining members of the Commission shall be 
     appointed not later than 60 days after the date on which the 
     members are appointed under such subsection (b)(1).
       ``(3) Vacancies.--A vacancy in the membership of the 
     Commission shall be filled in the manner in which the 
     original appointment was made.
       ``(d) Duties of the Commission.--The Commission shall carry 
     out the following duties and functions:
       ``(1) Review and analyze the recommendations of the report 
     of the study committee established under paragraph (3).
       ``(2) Make recommendations to Congress for the provision of 
     health services to Native Hawaiian individuals as an 
     entitlement, giving due regard to the effects of a program on 
     existing health care delivery systems for Native Hawaiians 
     and the effect of such programs on self-determination and the 
     reconciliation of their relationship with the United States.
       ``(3) Establish a study committee to be composed of at 
     least 10 members from the Commission, including 4 members of 
     the members appointed under subsection (b)(1), 5 of the 
     members appointed under subsection (b)(2), and 1 of the 
     members appointed by the Secretary under subsection (b)(3), 
     which shall--
       ``(A) to the extent necessary to carry out its duties, 
     collect, compile, qualify, and analyze data necessary to 
     understand the extent of Native Hawaiian needs with regard to 
     the provision of health services, including holding hearings 
     and soliciting the views of Native Hawaiians and Native 
     Hawaiian organizations, and which may include authorizing and 
     funding feasibility studies of various models for all Native 
     Hawaiian beneficiaries and their families, including those 
     that live in the continental United States;
       ``(B) make recommendations to the Commission for 
     legislation that will provide for the culturally-competent 
     and appropriate provision of health services for Native 
     Hawaiians as an entitlement, which shall, at a minimum, 
     address issues of eligibility and benefits to be provided, 
     including recommendations regarding from whom such health 
     services are to be provided and the cost and mechanisms for 
     funding of the health services to be provided;
       ``(C) determine the effect of the enactment of such 
     recommendations on the existing system of delivery of health 
     services for Native Hawaiians;
       ``(D) determine the effect of a health service entitlement 
     program for Native Hawaiian individuals on their self-
     determination and the reconciliation of their relationship 
     with the United States;
       ``(E) not later than 12 months after the date of the 
     appointment of all members of the Commission, make a written 
     report of its findings and recommendations to the Commission, 
     which report shall include a statement of the minority and 
     majority position of the committee and which shall be 
     disseminated, at a minimum, to Native Hawaiian organizations 
     and agencies and health organizations referred to in 
     subsection (b)(2) for comment to the Commission; and
       ``(F) report regularly to the full Commission regarding the 
     findings and recommendations developed by the committee in 
     the course of carrying out its duties under this section.
       ``(4) Not later than 18 months after the date of the 
     appointment of all members of the Commission, submit a 
     written report to Congress containing a recommendation of 
     policies and legislation to implement a policy that would 
     establish a health care system for Native Hawaiians, grounded 
     in their culture, and based on the delivery of health 
     services as an entitlement, together with a determination of 
     the implications of such an entitlement system on existing 
     health care delivery systems for Native Hawaiians and their 
     self-determination and the reconciliation of their 
     relationship with the United States.
       ``(e) Administrative Provisions.--
       ``(1) Compensation and expenses.--
       ``(A) Congressional members.--Each member of the Commission 
     appointed under subsection (b)(1) shall not receive any 
     additional compensation, allowances, or benefits by reason of 
     their service on the Commission. Such members shall receive 
     travel expenses and per diem in lieu of subsistence in 
     accordance with sections 5702 and 5703 of title 5, United 
     States Code.
       ``(B) Other members.--The members of the Commission 
     appointed under paragraphs (2) and (3) of subsection (b) 
     shall, while serving on the business of the Commission 
     (including travel time), receive compensation at the per diem 
     equivalent of the rate provided for individuals under level 
     IV of the Executive Schedule under section 5315 of title 5, 
     United States Code, and while serving away from their home or 
     regular place of business, be allowed travel expenses, as 
     authorized by the chairperson of the Commission.
       ``(C) Other personnel.--For purposes of compensation (other 
     than compensation of the members of the Commission) and 
     employment benefits, rights, and privileges, all personnel of 
     the Commission shall be treated as if they were employees of 
     the Senate.
       ``(2) Meetings and quorum.--
       ``(A) Meetings.--The Commission shall meet at the call of 
     the chairperson.
       ``(B) Quorum.--A quorum of the Commission shall consist of 
     not less than 12 members, of which--
       ``(i) not less than 4 of such members shall be appointees 
     under subsection (b)(1);
       ``(ii) not less than 7 of such members shall be appointees 
     under subsection (b)(2); and
       ``(iii) not less than 1 of such members shall be an 
     appointee under subsection (b)(3).
       ``(3) Director and staff.--
       ``(A) Executive director.--The members of the Commission 
     shall appoint an executive director of the Commission. The 
     executive director shall be paid the rate of basic pay equal 
     to that under level V of the Executive Schedule under section 
     5316 of title 5, United States Code.
       ``(B) Staff.--With the approval of the Commission, the 
     executive director may appoint such personnel as the 
     executive director deems appropriate.
       ``(C) Applicability of civil service laws.--The staff of 
     the Commission shall be appointed without regard to the 
     provisions of title 5, United States Code, governing 
     appointments in the competitive service, and shall be paid 
     without regard to the provisions of chapter 51 and subchapter 
     III of chapter 53 of such title (relating to classification 
     and General Schedule pay rates).
       ``(D) Experts and consultants.--With the approval of the 
     Commission, the executive director may procure temporary and 
     intermittent services under section 3109(b) of title 5, 
     United States Code.
       ``(E) Facilities.--The Administrator of the General 
     Services Administration shall locate suitable office space 
     for the operations of the Commission in Washington, D.C. and 
     in the State of Hawaii. The Washington, D.C. facilities shall 
     serve as the headquarters of the Commission while the Hawaii 
     office shall serve a liaison function. Both such offices 
     shall include all necessary equipment and incidentals 
     required for the proper functioning of the Commission.
       ``(f) Powers.--
       ``(1) Hearings and other activities.--For purposes of 
     carrying out its duties, the Commission may hold such 
     hearings and undertake such other activities as the 
     Commission determines to be necessary to carry out its 
     duties, except that at least 8 hearings shall be held on each 
     of the Hawaiian Islands and 3 hearings in the continental 
     United States in areas where a significant population of 
     Native Hawaiians reside. Such hearings shall be held to 
     solicit the views of Native Hawaiians regarding the delivery 
     of health care services to such individuals. To constitute a 
     hearing under this paragraph,

[[Page 19426]]

     at least 4 members of the Commission, including at least 1 
     member of Congress, must be present. Hearings held by the 
     study committee established under subsection (d)(3) may be 
     counted towards the number of hearings required under this 
     paragraph.
       ``(2) Studies by the general accounting office.--Upon the 
     request of the Commission, the Comptroller General shall 
     conduct such studies or investigations as the Commission 
     determines to be necessary to carry out its duties.
       ``(3) Cost estimates.--
       ``(A) In general.--The Director of the Congressional Budget 
     Office or the Chief Actuary of the Health Care Financing 
     Administration, or both, shall provide to the Commission, 
     upon the request of the Commission, such cost estimates as 
     the Commission determines to be necessary to carry out its 
     duties.
       ``(B) Reimbursements.--The Commission shall reimburse the 
     Director of the Congressional Budget Office for expenses 
     relating to the employment in the office of the Director of 
     such additional staff as may be necessary for the Director to 
     comply with requests by the Commission under subparagraph 
     (A).
       ``(4) Detail of federal employees.--Upon the request of the 
     Commission, the head of any Federal agency is authorized to 
     detail, without reimbursement, any of the personnel of such 
     agency to the Commission to assist the Commission in carrying 
     out its duties. Any such detail shall not interrupt or 
     otherwise affect the civil service status or privileges of 
     the Federal employees.
       ``(5) Technical assistance.--Upon the request of the 
     Commission, the head of any Federal agency shall provide such 
     technical assistance to the Commission as the Commission 
     determines to be necessary to carry out its duties.
       ``(6) Use of mails.--The Commission may use the United 
     States mails in the same manner and under the same conditions 
     as Federal agencies and shall, for purposes of the frank, be 
     considered a commission of Congress as described in section 
     3215 of title 39, United States Code.
       ``(7) Obtaining information.--The Commission may secure 
     directly from any Federal agency information necessary to 
     enable the Commission to carry out its duties, if the 
     information may be disclosed under section 552 of title 5, 
     United States Code. Upon request of the chairperson of the 
     Commission, the head of such agency shall furnish such 
     information to the Commission.
       ``(8) Support services.--Upon the request of the 
     Commission, the Administrator of General Services shall 
     provide to the Commission on a reimbursable basis such 
     administrative support services as the Commission may 
     request.
       ``(9) Printing.--For purposes of costs relating to printing 
     and binding, including the cost of personnel detailed from 
     the Government Printing Office, the Commission shall be 
     deemed to be a committee of Congress.
       ``(g) Authorization of Appropriations.--There is authorized 
     to be appropriated such sums as may be necessary to carry out 
     this section. The amount appropriated under this subsection 
     shall not result in a reduction in any other appropriation 
     for health care or health services for Native Hawaiians.

     ``SEC. 16. RULE OF CONSTRUCTION.

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

     ``SEC. 17. COMPLIANCE WITH BUDGET ACT.

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

     ``SEC. 18. SEVERABILITY.

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

  Mr. GORTON. Mr. President, I ask unanimous consent the committee 
substitute be agreed to, the bill be read a third time and passed, the 
motion to reconsider be laid upon the table, and any statements 
relating to the bill be printed in the Record.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The committee amendment in the nature of a substitute was agreed to.
  The bill (S. 1929), as amended, was read the third time and passed.

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