[Senate Report 106-389]
[From the U.S. Government Publishing Office]
Calendar No. 765
106th Congress Report
SENATE
2d Session 106-389
======================================================================
AMENDING THE NATIVE HAWAIIAN HEALTH CARE IMPROVEMENT ACT TO REVISE AND
EXTEND SUCH ACT
_______
August 25, 2000.--Ordered to be printed
Filed under authority of the order of the Senate of July 26, 2000
_______
Mr. Campbell, from the Committee on Indian Affairs, submitted the
following
R E P O R T
[To accompany S. 1929]
The Committee on Indian Affairs, to which was referred the
bill (S. 1929) to amend the Native Hawaiian Health Care
Improvement Act to revise and extend such Act, having
considered the same, reports favorably thereon with an
amendment in the nature of a substitute, and recommends that
the bill (as amended) do pass.
Purpose
The purpose of S. 1929, a bill to provide for the
reauthorization of the Native Hawaiian Health Care Improvement
Act, is to improve the health status of Native Hawaiians
through the continuation of a comprehensive health promotion
and disease prevention effort that involves health education in
Native Hawaiian communities, and the provision of primary care
health care services using traditional Native Hawaiian healers
and health care providers trained in Western medicine. In areas
where there is an underutilization of existing health care
delivery systems that have the capacity to provide culturally-
relevant health care services, S. 1929 provides authority for
the Secretary of the Department of Health and Human Services to
enter into contracts with Native Hawaiian health care systems
to provide health care referral services to Native Hawaiian
patients. S. 1929 is intended to assure the continuity of the
health care programs that are provided to Native Hawaiians
under the authority of Public Law 100-579.
As enacted in 1988, the Native Hawaiian Health Care
Improvement Act is premised upon the findings and
recommendations of the Native Hawaiian Health Research
Consortium report to the Secretary of the Department of Health
and Human Services of December, 1985. That report clearly
indicates that the underutilization of existing health care
services by Native Hawaiians can be traced to the absence of
culturally-relevant services, in which traditional Native
Hawaiian concepts of healing are lacking, as well as to a
general perception in the Native Hawaiian community that health
care services which are fundamentally based on concepts of
Western medicine, will not effect the healing or cure of
diseases and illnesses afflicting Native Hawaiian people.
Historical Background
The islands that now compose the State of Hawaii were
governed by a monarchy of Native Hawaiians until 1893. The
Native Hawaiian government was recognized as an independent
sovereign nation by foreign governments, and treaty
relationships were established with the United States (Treaty
of Friendship, Commerce, and Navigation of 1849; Treaty of
Commercial Reciprocity, January 30, 1875.) As a result of
expanded trade with the United States, western influence in the
islands increased, and in 1893, the government of Queen
Liliuokalani was overthrown in an insurrection engineered by a
group of western businessmen in an effort to secure the
annexation of Hawaii to the United States. The United States
minister in Hawaii ordered one company of marines and two
companies of sailors to be landed, and the minister then
recognized a new provisional government even before Queen
Liliuokalani's lines of defense had surrendered. Although the
provisional government sought immediate annexation by the
United States, President Grover Cleveland refused to submit a
treaty of annexation to the Senate, finding that the
provisional government lacked the popular support of the Native
Hawaiian population and that the government would not have been
established but for the lawless and unauthorized military
intervention of the United States. Upon the inauguration of
William McKinley as the new President of the United States in
1897, however, the western businessmen that sought annexation
were able to change the official U.S. position, and in 1898,
Hawaii became a territory of the United States.
During the first two decades of the twentieth century, the
already depressed economic conditions of Native Hawaiians
deteriorated further, and in 1920, the United States Congress
legislated directly for the benefit of Native Hawaiians by
enacting the Hawaiian Homes Commission Act, and establishing a
land base for Native Hawaiians to provide a permanent homeland
and to encourage agricultural pursuits. The Act placed
approximately 200,000 acres under the jurisdiction of the
Hawaiian Homes Commission, a branch of the territorial
government established for the purpose of ``rehabilitating''
persons of at least fifty percent Native Hawaiian ancestry
through a return to pastoral life. The Act also authorized the
Commission to undertake ``activities having to do with the
economic and social welfare of the homesteaders.''
Hawaii was admitted to statehood in 1959, and the
Admissions Act transferred the title to the lands administered
by the Hawaiian Homes Commission from the Federal government to
the State of Hawaii. The Admissions Act requires the State to
hold the lands ``as a public trust * * * for the betterment of
the conditions of Native Hawaiians * * * and their use for any
other object shall constitute a breach of trust for which suit
may be brought by the United States.
Background
Language contained in the 1984 Supplemental Appropriations
Act, Public Law 98-396, directed the Department of Health and
Human Services to conduct a comprehensive study of the health
care needs of Native Hawaiians. The study was conducted under
the aegis of Region IX of the Department by a consortium of
health care providers and professionals from the State of
Hawaii in a predominantly volunteer effort, organized by Alu
Like, Inc., a Native Hawaiian organization. An island-wide
conference was held in November of 1985 in Honolulu to provide
an opportunity for members of the Native Hawaiian community to
review the study's findings. Recommended changes were
incorporated in the final report of the Native Hawaiian Health
Research Consortium, and the study was formally submitted to
the Department of Health and Human Services in December of
1985. The Department submitted the report to the Congress on
July 21, 1986, and the report was referred to the Select
Committee on Indian Affairs.
Because the Consortium report's findings as to the health
status of Native Hawaiians was compared only to other
populations within the State of Hawaii, the Select Committee
requested that the Office of Technology Assessment (OTA), an
independent agency of the Congress, undertake an analysis of
Native Hawaiian health statistics as they compared to national
data in other United States populations. Using the same
population projection model that was employed in OTA's April
1986 report on Indian Health Care to American Indian and Alaska
Native populations, and based on additional information
provided by the Department of Health and the Office of Hawaiian
Affairs of the State of Hawaii, the Office of Technology
Assessment report contains the following findings:
The Native Hawaiian population living in Hawaii consists of
two groups, Hawaiians and part-Hawaiians, who are distinctly
different in both age distributions and mortality rates.
Hawaiians comprise less than five percent of the total Native
Hawaiian population and are much older than the young and
growing part-Hawaiian populations.
Overall, Native Hawaiians have a death rate that is thirty-
four percent higher than the death rate for the United States
all races, but this composite masks the great differences that
exist between Hawaiians and part-Hawaiians. Hawaiians have a
death rate that is 146 percent higher than the U.S. all races
rate. Part-Hawaiians also have a higher death rate, but only 17
percent greater. A comparison of age-adjusted death rates for
Hawaiians and part-Hawaiians reveals that Hawaiians die at a
rate 110 percent higher than part-Hawaiians, and this pattern
persists for all except one of the 13 leading causes of death
that are common to both groups.
As in the case of the U.S. all races population, Hawaiian
and part-Hawaiian males have higher death rates than their
female counterparts. However, when Hawaiian and part-Hawaiian
males and females are compared to their U.S. all races
counterparts, females are found to have more excess deaths than
males. Most of these excess deaths are accounted for by
diseases of the heart and cancers, with lesser contributions
from cerebrovascular disease and diabetes mellitus.
Diseases of the heart and cancers account for more than
half of all deaths in the U.S. all races population, and this
pattern is also found in both the Hawaiian and part-Hawaiian
populations, whether grouped by both sexes or by male or
female. However, Hawaiians and part-Hawaiians have
significantly higher death rates than their U.S. all races
counterparts, with the exception of part-Hawaiian males, for
whom the death rate from all causes is approximately equal to
that of U.S. all races males.
One disease that is particularly pervasive is diabetes
mellitus, for which even part-Hawaiian males have a death rate
128 percent higher than the rate for U.S. all races males.
Overall, native Hawaiians die from diabetes at a rate that is
222 percent higher than for the U.S. all races. When compared
to their U.S. all races counterparts, deaths from diabetes
mellitus range from 630 percent higher for Hawaiian females and
538 percent higher for Hawaiian males, to 127 percent higher
for part-Hawaiian females and 128 percent higher for part-
Hawaiian males.''
There is thus little doubt that the health status of Native
Hawaiians is far below that of other U.S. population groups,
and that in a number of areas, the evidence in compelling that
Native Hawaiians constitute a population group for whom the
mortality rate associated with certain diseases exceed that for
other U.S. populations in alarming proportions.
Native Hawaiians premise the high mortality rates and the
incidence of disease that far exceed that of other populations
in the United States upon the breakdown of the Hawaiian culture
and belief systems, including traditional healing practices,
that was brought about by western settlement, and the influx of
western diseases to which the native people of the Hawaiian
Islands lacked immune systems. Further, Native Hawaiians
predicate the high incidence of mental illness and emotional
disorders in the Native Hawaiian population as evidence of the
cultural isolation and alienation of the native peoples, in a
statewide population in which they now constitute only 20
percent. Settlement from both the east and the west have not
only brought new diseases which decimated the Native Hawaiian
population, but which devalued the customs and traditions of
Native Hawaiians, and which eventually resulted in Native
Hawaiians being prohibited from speaking their native tongue in
school, and in many instances, at all.
In 1998, Papa Ola Lokahi updated the health care statistics
from the original E Ola Mau report. In addition, on an annual
basis, Papa Ola Lokahi extrapolates the data on Native
Hawaiians gathered yearly by the Hawaii State Department of
Health from the Department's behavioral risk assessment and
health surveillance survey. The findings from those assessments
revealed that--
With respect to cancer, Native Hawaiians have the highest
cancer mortality rates in the State of Hawaii (231 out of every
100,000 residents), 45 percent higher than that for the total
State population. Native Hawaiian males have the higher cancer
mortality rates in the State of Hawaii for cancers of the lung,
liver and pancreas and for all cancers combined, and the
highest years of productive life lost from cancer in the State
of Hawaii. 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.
With respect to breast cancer, Native Hawaiians have the
highest mortality rates in the State of Hawaii, and nationally,
Native Hawaiians have the third highest mortality rates due to
breast cancer.
Native Hawaiians have the highest mortality rates from
cancer of the cervix and lung cancer in the State of Hawaii,
and Native Hawaiian males have the second highest mortality
rates due to prostate cancer in the State.
For the years 1989 through 1991, Native Hawaiians had the
highest mortality rate due to diabetes mellitus in the State of
Hawaii, with full-blood Hawaiians having a mortality rate that
is 518 percent higher than the rate for the statewide
population of all other races, and Native Hawaiians who are
less than full-blood having a mortality rate that is 79 percent
higher than the rate for the statewide population of all other
races.
In 1990, Native Hawaiians represented 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
in 1992, the Native Hawaiian rate for asthma was 73 percent
higher than the rate for the total statewide population.
With respect to heart disease, the death rate for Native
Hawaiians from heart disease is 66 percent higher than for the
entire State of Hawaii, and Native Hawaiian males have the
greatest years of productive life lost in the State of Hawaii.
The death rate for Native Hawaiians from hypertension is 84
percent higher than that for the entire State, and the death
rate from stroke for Native Hawaiians is 13 percent higher than
for the entire State.
Native Hawaiians have the lowest life expectancy of all
population groups in the State of Hawaii. Between 1910 and
1980, the life expectancy of Native Hawaiians from birth has a
range from 5 to 10 years less than that of the overall State
population average, and the most recent data for 1990 indicates
that Native Hawaiian life expectancy at birth is approximately
5 years less than that of the total State population.
With respect to prenatal care, as of 1996, Native Hawaiian
women have the highest prevalence of having had no prenatal
care during their first trimester of pregnancy, representing 44
percent of all such women statewide. Over 65 percent of the
referrals to Healthy Start in fiscal year 1996 and 1997 were
Native Hawaiian newborns, and in every region of the State of
Hawaii, many Native Hawaiian newborns begin life in a
potentially hazardous circumstance.
In 1996, 45 percent of the live births to Native Hawaiians
mothers were infants born to single mothers. Statistics
indicated that infants born to single mothers have a higher
risk of low birth weight and infant mortality. Of all low birth
weight babies born to single mothers in the State of Hawaii, 44
percent were Native Hawaiians.
In 1996, Native Hawaiian fetal mortality rates comprised 15
percent of all fetal deaths for the State of Hawaii. Thirty-two
percent of all fetal deaths occurring in mothers under the age
of 18 years were Native Hawaiians, and for mothers 18 through
24 years, 28 percent were Native Hawaiians.
These and other health status statistics contained in the
findings section of S. 1929 make clear that the health care
challenges that the Native Hawaiian health care systems were
established to address require reauthorization of the Native
Hawaiian Health Care Improvement Act.
Native Hawaiian Health Care Master Plan and Native Hawaiian Health Care
Systems
The concepts embodied in S. 1929 are the result of the
Committee's work with Native Hawaiian health care professionals
and others who are dedicated to improving the health status of
Native Hawaiians. It is based on the beliefs of those with whom
the Committee has consulted, that to insure that Native
Hawaiians are able to achieve the healthful harmony of the self
(body, mind and spirit) or lokahi, with others and all of
nature, and to assure that Native Hawaiians are able to
function effectively as citizens and leaders in their own
homeland, there must be a restoration of cultural traditions,
an integration of traditional healing methods in the health
care delivery system, and a collective effort to restore to the
Native Hawaiian, a sense of self esteem and self worth, both
for his or her culture, as well as for the individual.
E Ola Mau, a group of Native Hawaiian health care
professionals, proposed that this effort begin with the
development of a health care master plan, based on a bio-
psycho-socio-cultural-political model that would be aimed at
identifying significant events and factors related to specific
health care needs and issues. E Ola Mau proposed that this
master plan be implemented at every societal level (individual,
household, community, county and state) in the Hawaiian
Islands. It is their goal to have this Native Hawaiian way of
dealing with health, eventually become an institutional part of
the State's health policy for both Native Hawaiian and Non-
Hawaiians.
After much debate and careful consideration in the Native
Hawaiian community and amongst those concerned with the health
status of Native Hawaiians, a consensus wasreached that Papa
Ola Lokahi, the Native Hawaiian Health Board, should be the mechanism
through which Native Hawaiian health care systems were to be developed,
coordinated, administered, monitored, and continually revised to meet
the changing health care needs of the Native Hawaiian population. Papa
Ola Lokahi is currently composed of five organizations: (1) the Office
of Hawaiian Affairs, an agency of the State which was established
pursuant to the authority of amendments make to the Constitution of the
State of Hawaii in 1978 to assure the well-being and interests of
Native Hawaiians; (2) E Ola Mau, a nonprofit organization of Native
Hawaiian professionals dedicated to insuring that Native Hawaiians
achieve a healthful harmony of self (body, mind and spirit) with others
and all of nature, and become productive citizens and leaders in their
homeland; (3) Alu Like, a Federally-funded Native Hawaiian agency that
promotes vocational training and the founding of community-based
organizations that promote health, education and economic development
for Native Hawaiians; (4) the University of Hawaii; and (5) the Office
of Hawaiian Health within the State Department of Health.
Papa Ola Lokahi has assumed the primary responsibility of
overseeing the development and maintenance of a Native Hawaiian
Comprehensive Health Care Master Plan, and is the entity
responsible for certifying to the Secretary the qualifications
and capabilities of Native Hawaiian organizations that petition
the Secretary to carry out, pursuant to contracts with the
Secretary, the provisions of the Act.
Public Law 100-579 authorized Papa Ola Lokahi, the Native
Hawaiian Health Board, to--
(1) designate a chairman and vice-chairman from among
its member organizations and such other officers as may
be deemed necessary to carry out its responsibilities
under the Act;
(2) adopt bylaws and such other internal regulations
or procedures as may be deemed necessary to carry out
its responsibilities under the Act;
(3) certify to the Secretary that a Native Hawaiian
organization meets the definition of ``Native Hawaiian
organization'' as set forth in the Act;
(4) certify to the Secretary that a Native Hawaiian
organization has the qualifications and capacity to
provide the services or perform contract requirements
pursuant to a contract with the Secretary;
(5) oversee the development of a comprehensive native
Hawaiian health care master plan;
(6) assure the conduct of health status and health
care needs assessments of Native Hawaiian communities
desiring to participate in Native Hawaiian health care
program; and
(7) coordinate the activities and functions of all
Native Hawaiian organizations operating health care
programs pursuant to contracts with the Secretary.
Public Law 100-579 envisions a comprehensive health care
system that is community-based, building upon the Native
Hawaiian 'ohana system (The 'ohana system is based upon the
fundamental unit of societal interaction for Native Hawaiians
in which a family or an organization is led by a haku, the
recognized leader, whose function is to coordinate and
facilitate the expertise and resources of the various
households or affiliated organizations in order to accomplish a
task or resolve a problem. The households or affiliated
organizations are in turn led by po'o, the head of the
household or designated leader of the organization.) and
incorporating traditional healing (la'au lapa'au) practices
with western medical services to provide a health care system
that will be culturally consistent and responsive to the needs
of Native Hawaiian communities.
As enacted, Public Law 100-579 authorized the establishment
of Native Hawaiian Healing Centers on each of the islands
comprising the State of Hawaii, upon the acceptance of and in
consultation with the Native Hawaiian communities on those
islands, and wherever possible, using existing health care
facilities and health care providers now serving the Native
Hawaiian communities on those islands. These centers were
intended to lead and coordinate the development and
implementation of a statewide Native Hawaiian health care
system, which would include: (1) a research and monitoring
staff, state-certified neighborhood counselors, outreach
workers and health educators, traditional Native Hawaiian
healers, and Native Hawaiian cultural educators; (2) primary
health care providers; (3) primary health care facilities,
using existing health care facilities where practicable and
acceptable to the local Native Hawaiian community; (4)
participation by the State Department of Health Office of
Hawaiian Health in the provision of disease prevention and
health promotion programs, as well as a multi-disciplinary
approach to Native Hawaiian health care which would include
nursing, dental hygiene, nutrition education, maternal and
infant child care education; and (5) other Federal, State,
county, community and private organizations and agencies that
could provide services which meet the health care needs of
their respective communities.
The development of the master plan by Papa Ola Lokahi was
intended to include: (1) work with Native Hawaiian communities
which support the establishment of a Native Hawaiian Health
Center; (2) conducting a community health needs assessment
survey for participating communities; (3) facilitating the
development, establishment, and effectivefunctioning of such
Centers on the islands of O'ahu, Moloka'i, Maui, Hawai'i, Lana'i,
Kaua'i and Ni'ihau; and (4) coordinating the work of relevant agencies
and organizations to provide participating communities with: (a) direct
health care services and health education, including maternal and child
health care and mental health care; (b) instruction in the Native
Hawaiian language, cultural beliefs and traditions with an emphasis on
health concepts and practices; (c) training and education of health
care providers and educators and cultural educators in health promotion
and disease prevention; (d) basic and applied research and monitoring
of Native Hawaiian health care approaches to validate outcomes and
create standards of quality care; (e) development of health care
services, training and education that would have a Native Hawaiian
perspective as its primary focus; (f) development of Native Hawaiian
community health counselors, outreach workers, educators, and community
health aide training programs; (g) preventive-oriented health care
services in medical, dental, nutrition, mental health, and in other
designated areas as needs assessments may identify as necessary; (h)
data collection related to prevention of diseases and illnesses among
Native Hawaiians; (i) medical and general health-related research into
the diseases that are most prevalent among Native Hawaiians; (j) mental
health research in areas of mental health problems that are most
prevalent in the Native Hawaiian population; (k) ongoing health
planning for further development of the Native Hawaiian health care
system; and (l) the provision of health care referral services when
certain health care services are not available within the Native
Hawaiian Health Center.
Following enactment of the Native Hawaiian Health Care Act,
the Papa Ola Lokahi Board became incorporated and began working
with health care providers on each island toward the
development of a master plan and an island-specific plan for
the provision of primary health care and health care referral
services. Those involved in the planning effort ultimately
determined that the health care needs of Native Hawaiians would
be better served by the establishment of five Native Hawaiian
health care systems which could be composed of as many health
care centers as might be necessary to serve the health care
needs of Native Hawaiians on each island.
Accordingly, Papa Ola Lokahi certified to the Secretary
that five health care systems qualified as Native Hawaiian
organizations for purposes of entering into contracts with the
Secretary, and plans for the provision of primary health care
services or health care referral services were submitted to the
Secretary in 1990. The first contract awards were made in
October of 1991, and the health care systems are now engaged
not only in the implementation of the plans approved by the
Secretary, but the provision of health care services. The plans
for each health care system vary according to the availability
of and access to existing health care resources on each island
and the need for primary health care services. Currently, all
five Native Hawaiian health care systems have become
incorporated as 501(c)(3) non-profit health care organizations.
In general, the capacity to provide critical care exists
only on the island of O'ahu, and thus, it has long been the
pattern that if a patient requires hospitalization and complex
surgery or treatment, the patient would be referred to a health
care provider on the island of O'ahu. However, it is not
uncommon that treatment requiring advanced medical technology
must be secured in the mainland United States.
The Native Hawaiian Health Care Improvement Act provides
authority for the provision of health promotion, disease
prevention, and primary health services to Native Hawaiians who
reside in the State of Hawai'i. Federal planning funds first
became available in July of 1990. However, Papa Ola Lokahi
incorporated in Federal 1989 and was able to initiate its
organizing activities in July 1989 with funds provided by the
Hawai'i State legislature. Between July 1989 and December 1990,
informational meetings and organizational activities took place
throughout the state, resulting in the establishment or
recognition of the five Native Hawaiian health care systems
which would take the responsibility for providing services: (1)
Ho'ola Lahui Hawai'i for Kaua'i and Ni'ihau; (2) Ke Ola Mamo
for O'ahu; (3) Na Pu'uwai for Moloka'i and Lana'i; (4) Hui No
Ke Ola Pono for Maui; and (5) Hui Malama Ola Na 'Oiwi for
Hawai'i. Papa Ola Lokahi provided planning funds and technical
assistance to these five health care systems, who then
developed their service plans from January through June 1991,
applied for funding under the Native Hawaiian Health Care Act
in July 1991, and were awarded service grants in October of
1991.
The basic set of services that all five health care systems
must provide include: (1) outreach services to inform Native
Hawaiians of the availability of health services; (2) education
in health promotion and disease prevention of the Native
Hawaiian population by Native Hawaiian health care
practitioners, community outreach workers, counselors, and
cultural educators, whenever possible; (3) services of
physicians, physicians' assistants, nurse practitioners or,
other health professionals; (4) immunizations; (5) prevention
and control of diabetes, high blood pressure, and otitis media;
(6) pregnancy and infant care; and (7) improvement of
nutrition.
In the initial stages, because the five health care systems
needed to gain experience in managing health services and
because of limited funds, each health care system concentrated
on outreach, health assessments, case management, and disease
prevention and health promotion activities, with the ultimate
objective of providing the full range of health and medical
services that are available through a typical primary care
health center, and working with traditional healers so that
their services will also be more readily available to Native
Hawaiians.
Now that the five island-wide Native Hawaiian health care
systems are established and engaged in the provision of health
care services, Papa Ola Lokahi's role is to provide technical
and training support to the five health care systems to develop
a statewide, cooperative Native Hawaiian health system, develop
research activities and capacities within the five health care
systems, and evaluate how well the objectives of the Native
Hawaiian Health Care Act are being met.
To serve the health care needs of Native Hawaiians on the
islands of Kaua'i and Ni'ihau, Ho'ola Lahui Hawai'i (to
preserve the Hawaiian Race) is a nonprofit organization
dedicated to elevating the health status and overall living
conditions of the Native Hawaiian. Ho'ola Lahui Hawai'i has
established offices in Waimea and Anahola which serve as a base
from which outreach is provided to the East and West sides of
Kaua'i. Service to the island of Ni'ihau is provided through
the office in Waimea. Ho'ola Lahui Hawai'i is working with
existing health and health-related organizations in an effort
to assure access to services for Native Hawaiians that were for
some reason or another inaccessible or unacceptable. Ho'ola
Lahui Hawai'i is organized around the concept of lokahi (unity
in all aspects of life) in which they seek to maintain a
balance of body, mind, and soul. As a community-based
organization which works from the ground level up, the concern
of Ho'ola Lahui Hawai'i for the Native Hawaiian grows out of a
shared history, for those involved in Ho'ola Lahui Hawai'i are
Native Hawaiian.
At this time, Ho'ola Lahui Hawai'i provides health
education and teaching on cancer, diabetes, hypertension, high
cholesterol, gout, hygiene, and diet/exercise. Ho'ola Lahui
Hawai'i also conducts monitoring on blood pressure, blood
sugar, weight, and diet. Ho'ola Lahui Hawai'i offers
information and referral to outside agencies through case
management. In addition, Ho'ola Lahui Hawai'i is sponsoring the
traditional Native Hawaiian diet regimen on the island of
Kaua'i. Ho'ola Lahui Hawai'i completed one diet project in
Waimea in conjunction with the State Department of Health and
started another in Kapa'a in May of 1992.
Traditional healing is also an area Ho'ola Lahui Hawai'i
addresses with sponsorship of a statewide la'au lapa'u
(training in traditional medicine) in the spring of 1992 in
conjunction with E Ola Mau and Ka Wai Ola'o Kalani. In
addition, Ho'ola Lahui Hawai'i offers lomi lomi (traditional
massage therapy). Ho'ola Lahui Hawai'i intends to expand its
services to include health education and teaching on sexually-
transmitted diseases, family planning, maternal and infant
care, and alcohol/substance abuse. Ho'ola Lahui Hawai'i's plans
include establishing a health education component in
kindergarten, elementary, and high schools, tailored to the
physical and psychological needs of the particular age group.
Ke Ola Mamo is committed to improving the health status of
Native Hawaiians on the island of O'ahu through the development
of a system of culturally-competent services that use rather
than duplicate the existing health care service delivery
system. Through outreach referral and case consultation, Ke Ola
Mamo's goal is the empowerment of Native Hawaiian families and
individuals to access appropriate health care services; the
development of partnerships with existing health care services
in a collaborative effort to improve access to health care; and
working with Native Hawaiian communities and neighborhoods to
assist them in meeting their health care needs.
In 1986, there were 137,481 Native Hawaiians living on the
island of O'ahu, who comprise approximately two-thirds of the
total Native Hawaiian population in the entire State of
Hawai'i. The Native Hawaiian population living on O'ahu can be
roughly divided into three equal groups by geographic location;
those living on the leeward coast, including Pearl City; those
living on the windward and north coasts; and those living in
the urban Honolulu complex. There are estimated to be at least
twenty distinct communities and neighborhoods where Native
Hawaiian families reside. As a start, Ke Ola Mamo has selected
four of these communities to develop service delivery projects.
Three projects involve rural communities: the Waimanalo
community, the Wai'anae community, and the Ko'olauloa
community. A fourth project is being proposed as a community
education and planning process for the urban Honolulu
communities with future service implementation proposals.
The goal of Na Pu'uwai is to raise the health status of the
Native Hawaiian residents of the island of Moloka'i, including
Kalaupapa, and the island of Lana'i to the highest possible
level and to encourage the maximum participation of Native
Hawaiians to achieve this goal. The strategy of the program is
two-fold: (1) to develop a personalized schedule of recommended
health care activities, referred to as a ``personalized health
care plan'' for each client; and (2) to use case management
methodologies as a behavioral intervention to assure client
adherence to their ``personalized health care plan.''
To implement this strategy, the program: (1) conducts
screening and enrollment for those who are self-referred,
provider-referred, or recruited by staff; (2) conducts a health
risk appraisal on each enrollee to assess current health
maintenance status; (3) develops a personalized health care
plan with each client, based on recommended primary, secondary,
and tertiary health maintenance guidelines and the client's
concerns and needs; (4) coordinates and provides health
promotion and disease prevention programs and health screening;
(5) provides clinic-based primary health care services; (6)
provides multi-disciplinary case management services as
appropriate, to enrolled participants; and (7) reassesses
client status as dictated in the case management plan
andconducts ongoing followup on all clients, case management and non-
case management.
Na' Pu'uwai's service delivery plan provides for (1) direct
outpatient care services of a physician and nurse; (2) case
management services of a social worker and multi-disciplinary
case management team; (3) direct health education and health
screening services; and (4) patient followup and outreach
services.
Hui No Ke Ola Pono (an association to strengthen and
perpetuate life) is Maui's Native Hawaiian Health Care System,
providing services that are culturally relevant to Native
Hawaiians of Maui, including identification, treatment,
control, and reduction of the incidence of preventable
illnesses and conditions frequently occurring in the Native
Hawaiian population. The services provided by Hui No Ke Ola
Pono include health promotion and disease prevention; referrals
for immunizations; improvement of nutrition; referrals for
pregnancy and infant care; prevention and control of diabetes,
high blood pressure and middle ear infections; community
outreach services; referrals to physician and nursing services;
and education on traditional practitioner services.
In addition, traditional Hawaiian healers provide the
following services: ho'oponopono (family or group counseling);
la'au lapa'au (traditional Hawaiian herbal medicine); and lomi
lomi (Hawaiian massage therapy).
Hui Malama Ola Na 'Oiwi (caring for our people) is the
Native Hawaiian health care system for Native Hawaiians on the
Island of Hawai'i. The program mission of Hui Malama Ola Na
'Oiwi is to assist Native Hawaiians in restoring a high quality
health care system by creating and developing a non-threatening
healing environment inclusive of traditional health assistance
and to provide an facilitate a process of awareness and
addressing the health needs, both physical and spiritual, of
Native Hawaiians.
Hui Malama's objectives are to (1) promote physical,
emotional, and spiritual health and well-being of Native
Hawaiians on the island of Hawaii; (2) assist and promote
personal responsibility among Native Hawaiians toward making
sound, informed decisions which would decrease unhealthy
behaviors and reduce morbidity and mortality rates; (3) support
and advocate the use of health care services that come from the
traditions of the Native Hawaiian culture and of western
science; and (4) work toward the establishment of primary
health care centers in appropriate locations where quality
primary care can be provided and where primary care services
are not currently available.
The death rates of Native Hawaiians exceed the death rates
for all races in the United States caused by diseases of the
heart, cancer, strokes, and diabetes. Achieving good health for
Native Hawaiians appears difficult, but these diseases can be
controlled through early detection, proper diet and treatment,
regular exercise, etc.
Hui Malama Ola Na 'Oiwi provides the following services:
(1) Outreach--enrolling participants in the program, assessing
their health risk factors, assisting in securing medical
insurance where needed, assisting in access to a physician,
providing transportation to and from the physician for those
who are unable to do so, and making home visits when necessary;
(2) Health promotion and disease prevention--providing
education regarding the prevention and control of diabetes,
high blood pressure (hypertension), misuse of tobacco, alcohol
and other harmful drugs, sexually transmitted diseases, stress,
cancer, the importance of sound nutrition habits, regular
exercise, and proper material and infant care practices; (3)
Primary health services--Hui Malama Ola Na 'Oiwi assists
patients in securing access to the primary health care services
of a physician, a physician's assistant, or a nurse
practitioner where a doctor may not be available.
Through the work of the five Native Hawaiian health care
systems, on an annual basis, 20,000 Native Hawaiians continue
to benefit from the range of health care services provided by
the systems.
Native Hawaiian Health Care Professions Scholarships
The Native Hawaiian Health Care Improvement Act also
provides authority for the provision of scholarships to Native
Hawaiians who are seeking higher education opportunities in the
health care professions. The Native Hawaiian Health Scholarship
Program is administered by the Kamehameha Schools Bishop
Estate, and has awarded 92 scholarships since 1991. These
scholarships include: 10 bachelors of nursing, 2 clinical
psychology doctoral programs, 2 dentists, 7 dental hygienists,
one osteopathic physician, 29 allopathic physicians, 6 masters
public health, 12 masters in social work, one nurse midwife, 3
nurse practitioners, 4 doctors of psychology, and 5 registered
nurses. Nineteen of the scholarship recipients have completed
their studies and their service payback requirements and are
practicing in the Native Hawaiian community. Seventeen are
enrolled in advanced studies, three have completed their
training and are awaiting placement for the service payback
requirement, three have enrolled and completed their
scholarships, thirteen are in residency programs, and 24 have
completed their studies and are currently providing services to
the Native Hawaiian community.
Reauthorization Process
In order to assure the maximum involvement of Native
Hawaiians in thedevelopment of a bill to reauthorize the Native
Hawaiian Health Care Improvement Act, from December of 1997 through
January of 1998, eight island 'aha's (island-wide conferences) were
held involving more than 1,200 individuals in and effort to identify
the principal Native Hawaiian health and wellness issues and concerns.
In March of 1998, a statewide Native Hawaiian Health and Wellness
Summit, Ka 'Uhane Lokahi, was held on the island of O'ahu, bringing
together more than 600 people to identify potential health and wellness
issues and concerns. In January of 1999, a Native Hawaiian Health Forum
was convened to discuss major health care trends and strategies for
health care and wellness developed by the indigenous peoples of North
America and Aotearoa.
In March of 1999, the Executive Directors of the Native
Hawaiian health care systems, the members of the Papa Ola
Lokahi Board, and the Director of the Native Hawaiian Health
Scholarship Program met to review the Act and to incorporate
recommendations from the 'aha's, the summit, and the health
forum for inclusion in a bill to reauthorize the Native
Hawaiian Health care Improvement Act. Thereafter, a series of
public meetings were held to discuss and review a draft
reauthorization bill and based upon the comments received, the
bill was further refined and then circulated in the Native
Hawaiian community. A final draft of the bill, incorporating
and responding to recommendations received from the Native
Hawaiian community, was submitted to the Congress.
Summary of Major Provisions
S. 1929 extends the existing program authorities of the Act
and authorizes appropriations in such sums as may be necessary
through fiscal year 2011. The bill contains extensive findings
on the current health status of Native Hawaiians including the
incidence and mortality rates associated with various forms of
cancer, diabetes, asthma, circulatory diseases, infectious
disease and illness, and injuries, as well as statistics on
life expectancy, maternal and child health, births, teen
pregnancies, fetal mortality, mental health, and health
professions education and training.
The bill further refines the role of Papa Ola Lokahi and
the Native Hawaiian health care systems, providing authority
for the establishment of additional health care systems to
serve the islands of Lana's and Ni'ihau, for a total number of
health care systems not to exceed eight.
In addition to those organizations that originally
comprised the Board of Papa Ola Lokahi, S. 1929 adds the five
Native Hawaiian health care systems to the Papa Board as well
as the Kamehameha Schools, and the Native State Primary Care
Association which represents the community health centers, or
other organizations responsible for the placement of scholars
from the Native Hawaiian Scholarship Program, the Native
Hawaiian Physicians Association, and such other member
organizations as the Papa Ola Lokahi Board will admit based
upon a satisfactory demonstration of a record of contribution
to the health and well-being of Native Hawaiians.
The 1992 amendments to the Act adopted the relevant health
objectives of the U.S. Surgeon General's Healthy People 2000
objectives as goals to be met by the Native Hawaiian health
care systems. S. 1929 establishes new objectives to be met by
the Native Hawaiian health care systems, drawing upon the
objectives established in the U.S. Surgeon General's Healthy
People 2010 objectives.
S. 1929 proposes that the providers of health care
services, including the providers of traditional Native
Hawaiian healing services, who provide services under the
auspices of the Native Hawaiian health care systems shall be
treated as members of the Public Health Service for purposes of
Federal Tort Claims Act coverage.
The bill also provides authorization for Papa Ola Lokahi to
carry out Native Hawaiian demonstration projects of national
significance in areas such as the education of health
professionals, the integration of Western medicine with
complementary health practices including traditional Native
Hawaiian healing practices, the use of tele-wellness and
telecommunications in chronic disease management and health
promotion and disease prevention, the development of an
appropriate model of health care of Native Hawaiians and other
indigenous people, the development of a centralized data base
and information system relating to the health care status,
health care needs, and wellness of Native Hawaiians, and 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, a
Native Hawaiian Center of Excellence for Research, Training,
and Integrated Medicine at Molokai General Hospital, and a
Native Hawaiian Center of Excellence for Complementary Health
and Health Education and Training at the Waianae Coast
Comprehensive Health Center.
S. 1929 also provides authorization for the establishment
for a 21-member National Bipartisan Native Hawaiian Health Care
Entitlement Commission which would in turn be authorized to
establish a 10-member study committee to collect and compile
data necessary to understand the extend of Native Hawaiian
needs with regard to the provision of health services, and to
make recommendations to the Commission for legislation that
would provide for the culturally-competent and appropriate
provision of health services for Native Hawaiians as an
entitlement.
The Provision of Federal Programs to Native Hawaiians
In the exercise of the plenary power vested in the Congress
in Article I, section 8, clause 3 of the United States
Constitution, the Congress has exercised its authority to
address the conditions of the aboriginal, indigenous, native
people of the United States, including the aboriginal,
indigenous, native people of the states of Alaska and Hawaii.
Numerous federal laws have been enacted to address the
conditions of American Indians, Alaska Natives and Native
Hawaiians.
One hundred and sixty Federal laws have been enacted to
address the conditions of Native Hawaiians. Those laws are set
forth as an appendix to this report (Appendix A).
Section-by-Section Analysis
Section 1. Short title
The title of the Act is the Native Hawaiian Health Care
Improvement Act Reauthorization of 1999.
Section 2. Findings
Section (a) sets forth Congress' findings which are as
follows:
Subsection (a)(1): Congress finds that 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.
Subsection (a)(2): Congress finds that Native Hawaiians are
a distinct and unique indigenous people with 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.
Subsection (a)(3): Congress finds that the health and well-
being of the Native Hawaiians are connected to their feelings
and attachment to their lands and sea.
Subsection (a)(4): Congress finds that the economic and
social changes in Hawai'i over the 19th and early 20th
centuries have been devastating to the health and well being of
Native Hawaiians.
Subsection (a)(5): Congress finds that 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.
Subsection (a)(6): Congress finds that Native Hawaiians are
determined to preserve and transit to future generations their
ancestral territory, and cultural identity.
Subsection (a)(7): Congress finds that the constitution and
statutes of the State of Hawai'i acknowledge land rights of
Native Hawaiian people as beneficiaries of public lands trust
and protect the right of Native Hawaiian people to practice
their cultural and religious practices.
Subsection (a)(8): Congress finds that in 1778 at the time
of first contact between non-indigenous people and Native
Hawaiians, that Native Hawaiians were a highly organized, self-
sufficient, subsistence social system based on communal land
tenure. Native Hawaiians also had developed a sophisticated
language, culture, and religion.
Subsection (a)(9): Congress finds that a unified monarchial
government of the Hawaiian Islands was established in 1810
under Kamehameha I, the first King of Hawai'i.
Subsection (a)(10): Congress finds that throughout the 19th
century and until 1893, the United States recognized the
independence of the Hawaiian Nation; extended full diplomatic
recognition to the Hawaiian Government; and entered into
treaties and conventions with the Hawaiian monarchs to govern
commerce and navigation in 1826, 1842, 1849, and 1875 and 1887.
Subsection (a)(11): Congress finds that in 1892, the United
States Minister, which was assigned to the sovereign and
independent Kingdom of Hawai'i, conspired with a small group of
non-Hawaiian residents of the Kingdom along with some residents
of the United States to overthrow the indigenous and lawful
government of Hawai'i.
Subsection (a)(12): Congress finds that the United States
Minister and the United States representative caused its armed
naval forces of the United States to invade the sovereignty of
the Hawaiian Nation in support of the overthrow of the
indigenous and lawful Government of Hawai'i. In addition,
United States Minister extended diplomatic recognition of a
provisional government formed by the conspirators without the
consent of the native people of Hawai'i or the lawful
Government of Hawai'i in violation of treaties between the two
nations and of international law.
Subsection (a)(13): Congress finds that on December 18,
1893, President Grover Cleveland reported fully on the
conspiracy actions and described them as acts of war which the
United States should endeavor to repair.
Subsection (a)(14): Congress finds that Queen
Lili'uokalani, the lawful monarch of Hawai'i, and the Hawaiian
Patriotic League, representing the aboriginal citizens of
Hawai'i, promptly petitioned the United States for redress of
the wrongs and for restoration of the indigenous government of
the Hawaiian nation, but the United States did not act upon the
petition.
Subsection (a)(15): Congress finds that in 1993 the United
States enacted Public Law 103-150 which acknowledges the
overthrow of the Kingdom of Hawai'i through the participation
of agents and citizens of the United States and apologizes to
native Hawaiians for the resulting deprivation of their right
to self-determination.
Subsection (a)(16): Congress finds that in 1898, the United
States annexed Hawai'i through the Newlands Resolution without
the consent of or compensation to the indigenous people of
Hawai'i 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.
Subsection (a)(17): Congress finds that 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 Hawai'i.
Subsection (a)(18): Congress finds that it enacted the
Hawaiian Homes Commission Act, 1920, which designated
approximately 200,000 acres of ceded public lands for Native
Hawaiian homesteads was in response to the sharp decline in the
Native Hawaiian population and reaffirms the trust relationship
between the United States and Native Hawaiians.
Subsection (a)(19): Congress finds that in 1938 they again
acknowledged the unique status of the Native Hawaiian people by
including the Act of June 20, 1938, 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''.
Subsection (a)(20): Congress finds that under the Act
entitled ``An Act to provide for the admission of the State of
Hawai'i into the Union'', approved March 18, 1959 the United
States transferred responsibility for administration of the
Hawaiian Home Lands to the State of Hawai'i 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.
Subsection (a)(21): Congress finds that under the Act
entitled ``An Act to provide for the admission of the State of
Hawai'i into the Union'', approved March 18, 1959, 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 Hawai'i but reaffirmed the trust
relationship which existed between the United States and the
native Hawaiian people by retaining legal responsibility of the
State for the betterment of the conditions of the Native
Hawaiians under that Act.
Subsection (a)(22): Congress finds that in 1978 the people
of Hawai'i 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 in trust for Native
Hawaiian people and to receive payments from the state. The
Office of Hawaiian affairs is 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.
Subsection (a)(23): Congress finds that it has the
authority under the Constitution to legislate in matters
affecting the aboriginal or indigenous peoples of the United
States, including the authority to legislate in matters
affecting native peoples of Alaska and Hawai'i.
Subsection (a)(24): Congress finds that it has recognized
the authority of the Native Hawaiian people 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'olawae to
custodial management by the State of Hawai'i in 1994.
Subsection (a)(25): Congress finds that the United States
furthered the trust responsibility to better the conditions of
Native Hawaiians by establishing programs to provide
comprehensive health promotion and disease prevention services
to maintain and improve the health status of the Native
Hawaiian people. Federal assistance and health initiatives
conducted by the Native Hawaiian Health Care Systems, the
Native Hawaiian Health Scholarship Program, Papa Ola Lokahi,
and other health institutions, accomplished through the Native
Hawaiian Health Care Act of 1988 and its reauthorization, have
been responsible for reducing the century-old morbidity and
mortality rates of native Hawaiians.
Subsection (a)(26): Congress finds that the United States
has recognized and confirmed its special relationship with
Native Hawaiians through theinclusion of Native Hawaiians in
laws affecting Native Americans. These acts include the Native American
Programs Act of 1974, the American Indian Religious Freedom Act, the
National Museum of the American Indian Act, and the Native American
Graves Protection and Repatriation Act.
Subsection (a)(27): Congress finds that the United States
has also recognized its special political relationship with
Native Hawaiians through the inclusion of Native Hawaiians
under the following legislation: the Older Americans Act of
1965, 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, the
Native Hawaiian Health Care Act of 1988, 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.
Subsection (a)(28): Congress finds that the United States
has again affirmed the historical and unique relationship to
the Native 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).
Subsection (a)(29): Congress finds that the United States
has recognized that Native Hawaiians, as aboriginal,
indigenous, native people of Hawai'i, are a distinctive
population group in Hawai'i and in the continental United
States as has been articulated in Office of Management and
Budget Circular 15 in 1997 and Presidential Executive Order No.
13125, dated June 7, 1999.
Subsection (a)(30): Congress finds that despite the United
States' repeated expression of its commitment to a policy of
reconciliation with the Native Hawaiian people for past
grievances, the unmet health needs of the Native Hawaiian
people remain severe and their health status continues to be
below that of the general United States population.
Subsection (2)(b) describes the unmet needs and health
disparities that adversely affect Native Hawaiians.
Subsection (b)(1) discusses chronic diseases and illnesses
affecting Native Hawaiians. It includes the following:
(A) Cancer. Native Hawaiian women have the highest cancer
mortality rates in the State (including breast, lung, and
cervix cancer) which is 45 percent higher than that for the
total State population. Native Hawaiian males have the highest
cancer mortality rates in the State for cancers of the lung,
liver and pancreas and for all cancers combined (including the
second highest mortality rates due to prostate cancer in the
State). Native Hawaiian females ranked highest in the State for
cancers of the lung, liver, pancreas, breast, cervix uteri,
corpus uteri, stomach, and rectum, and for all cancers
combined. Native Hawaiian males have the highest years of
productive life lost from cancer in the State, and Native
Hawaiian females have 8.2 years of productive life lost from
cancer in the State.
(B) Diabetes. With respect to diabetes, for the years 1989
through 1991, Native Hawaiians had the highest mortality rate
due to diabetes mellitis in the State which is 130 percent
higher than the statewide rate for all other races, with full-
blood Hawaiians having 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. 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. In 1990, Native Hawaiians comprised 44 percent
of all asthma cases in the State for those 18 years of age and
younger, and 35 percent of all asthma cases reported, and in
1992 the Native Hawaiian rate for asthma was 81.7 out of every
1,000 residents, which was 73 percent higher than the rate for
the total statewide population.
(D) Circulatory diseases. The death rate for Native
Hawaiians from heart disease is 66 percent higher than for the
entire State. The death rate for Native Hawaiians from
hypertension is 84 percent higher than that for the entire
State. The death rate for Native Hawaiians from stroke is 13
percent higher than that for the entire State.
Subsection (b)(2) describes infectious diseases and
illnesses affecting Native Hawaiians. The incidence of AIDS for
Native Hawaiians is at least twice as high per 100,000
residents than that for any other non-Caucasian group in the
State.
Subsection (b)(3) describes that the death rate for Native
Hawaiians from accidents is 45 percent higher than that for the
entire State, with Native Hawaiian males losing an average of
14 years of productive life lost from accidents and Native
Hawaiian females losing an average of 4 years of productive
life lost from accidents.
Subsection (b)(4) describes that Native Hawaiian children
exhibit among the highest rates of dental caries in the nation
and State. The average number ofdecayed 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. 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.
Subsection (b)(5) describes that Native Hawaiians have the
lowest life expectancy of all population groups in the State of
Hawai'i. The most recent tables for 1990 show Native Hawaiian
life expectancy at birth to be about 5 years less than that of
the total State population.
Subsection (b)(6) describes the statistics for Native
Hawaiian maternal and child health. Since 1996, Native Hawaiian
women have the highest prevalence of having had no prenatal
care during their first trimester of pregnancy, and of mothers
in the State who received no prenatal care throughout their
pregnancy in 1996, 44 percent were Native Hawaiian. In 1996, of
the births to Native Hawaiian single mothers, 8 percent were
low birth weight and of all low birth weight babies born to
single mothers in the State, 44 percent were Native Hawaiian.
In 1993 and 1994 Native Hawaiians had the highest percentage of
teen births compared to the rate for all other races in the
State, and for births to mothers age 14 years and younger in
Hawai'i, Native Hawaiians comprised 66% in 1995 and 48 percent
in 1996.
Subsection (b)(7) describes the level of alcohol and drug
abuse. Native Hawaiians represent 38 percent of the total
admissions to substance abuse treatment programs in the
Department of Health, Alcohol, Drugs and Other Drugs. In 1997,
the prevalence of smoking by Native Hawaiians was 28.5 percent,
a rate that is 53 percent higher than that for all other races
in the State. Native Hawaiians have the highest prevalence
rates of acute drinking, a rate that is 79 percent higher than
that for all other races in the State. The chronic drinking
rate among Native Hawaiians is 54 percent higher than that for
all other races in the State. In 1991, 40 percent of the Native
Hawaiian adults surveyed reported having used marijuana and
nine percent of the Native Hawaiian adults surveyed reported
that they are current users (within the past year) of
marijuana. In 1996, with respect to crime, 5,944 arrests were
made for property crimes in the State with Native Hawaiian
arrests comprising 20 percent of that total, with Native
Hawaiian juveniles comprised a third of all juvenile arrests.
In 1996, Native Hawaiians represented 21 percent of the 8,000
adults arrested for violent crimes in the State of Hawai'i, and
38 percent of the 4,066 juvenile arrests. In 1995 and 1996
Native Hawaiians comprised 36.5 percent of the sentenced felon
prison population in Hawai'i, comprised 45.4 percent of the
technical violator population, and constituted 51.6 percent of
all detainees at the Hawai'i Youth Correctional Facility in
1997.
Subsection (b)(8) describes that with respect to health
professions education and training, Native Hawaiians age 25
years and older have a comparable rate of high school
completion, but the rates of baccalaureate degree achievement
amongst Native Hawaiians are less than the norm in the State.
Native Hawaiian physicians make up 4 percent of the total
physician workforce in the State. Native Hawaiians comprise 8
percent of individuals who earned Bachelor's Degrees, 14
percent of individuals who earned professional diplomas, 6
percent of individuals who earned Master's Degrees, and less
than 1 percent of individuals who earned doctoral degrees at
the University of Hawai'i.
Section 3. Definitions
This section sets forth the definitions of terms used in
the Act.
Section 3(1) defines ``Department'' to mean the Department
of Health and Human Services.
Section 3(2) provides that for purposes of the Act, the
term ``disease prevention'' includes immunizations, control of
high blood pressure, control of sexually transmittable
diseases, the prevention and control of chronic diseases,
control of toxic agents, occupational safety and health, injury
prevention, fluoridation of water, control of infectious
agents, and provision of mental health care.
Section 3(3) provides that for the purposes of the Act, the
term ``health promotion'' includes pregnancy and infant care,
including prevention of fetal alcohol syndrome, cessation of
tobacco smoking, reduction in the misuse of alcohol and harmful
illicit drugs, improvement of nutrition, improvement in
physical fitness, family planning, control of stress, reduction
of major behavioral risk factors, and promotion of healthy
lifestyle practices, and integration of cultural approaches to
health and well-being.
Section 3(4) provides that for purposes of the Act, the
term ``Native Hawaiian'' means any individual who is a
descendant of the aboriginal people who, prior to 1778,
occupied and exercised sovereignty in the area that now
constitutes the State of Hawai'i as evidenced by genealogical
records, or kama'aina (long-term community residents) witness
verification by Native Hawaiian kupuna (elders), or birth
records of the State of Hawai'i or any state or territory of
the United States.
Section 3(5) provides that for purposes of the Act, the
term ``Native Hawaiian health care system'' means an entity
which
(A) is organized under the laws of the State of
Hawai'i;
(B) which provides or arranges for health care
services through practitionerslicensed by the State of
Hawai'i 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 eight Native Hawaiian
health care systems; and
(F) which Papa Ola Lokahi recognizes for the purpose
of planning, conducting, or administering programs (or
portions of programs) under the authority of the Act
for the benefit of Native Hawaiians and which is
certified by Papa Ola Lokahi as having the
qualifications and the capacity to provide the services
and meet the requirements under the contract or the
grant the Native Hawaiian health care system enters
into with or receives from the Secretary under the Act.
Section 3(6) provides that for purposes of the Act, the
term ``Native Hawaiian Health Center'' means an organization
which provides primary care and which Papa Ola Lokahi has
recognized has met the following criteria: a governing board
that is fifty-percent (50%) or more Native Hawaiians; has
demonstrated cultural competency in a predominantly Native
Hawaiian community; has a patient population that is either
fifty-percent Native Hawaiian or number not less than 2,500
Native Hawaiian clients annually.
Section 3(7) provides that for purposes of the Act,
``Native Hawaiian Health Task Force'' means a task force the
State Council of Hawaiian Homestead Association establishes
that implements health and wellness strategies in Native
Hawaiian communities in Hawai'i.
Section 3(8) provides that for purposes of the Act,
``Native Hawaiian organization'' means a public or nonprofit
organization that serves Native Hawaiian interests which Papa
Ola Lokahi has recognized for planning, conducting, or
administering programs (or portions of programs) authorized
under this Act.
Section 3(9) provides that for purposes of the Act,
``Office of Hawaiian Affairs'' and ``OHA'' means the
governmental entity established under the Hawai'i State
Constitution which is charged with the responsibility to
formulate policy relating to Native Hawaiian affairs.
Section 3(10) provides that for purposes of the Act, the
term ``Papa Ola Lokahi'' means an organization composed of
public agencies and private organizations focusing on improving
the health status of Native Hawaiians. Board members may
include representatives from the following: E Ola Mau; the
Office of Hawaiian Affairs; Alu Like, Inc.; the University of
Hawai'i; the Hawai'i State Department of Health; the Kamehameha
Schools (or other Native Hawaiian organization that administers
the Native Hawaiian health scholarship program); the Hawai'i
State Primary Care Association or Native Hawaiian health
scholarship program); the Hawai'i State Primary Care
Association or Native Hawaiian Health Centers whose patient
populations are predominantly Native Hawaiian; 'Ahahui O Na
Kauka (the Native Hawaiian Physicians Association); Ho'ola
Lahui Hawai'i or a health care system serving the islands of
Kaua'i or Ni'ihau; Ke Ola Mamo, or a health care system serving
the island of O'ahu; Na Pu'uwai or a health care system serving
the islands of Moloka'i and Lana'i; Hui No Ke Ola Pono, or a
health care system serving the island of Maui; Hui Malama Ola
Na 'Oiwi or a health care system serving the island of Hawai'i;
other native Hawaiian health care systems that Papa Ola Lokahi
certifies and recognizes; and such other member organizations
as the Board of Papa Ola Lokahi may admit from time to time,
based upon a satisfactory demonstration of a record of
contribution to the health and well-being of Native Hawaiians,
but with the proviso that organizations will not be part of
Papa Ola Lokahi if the Secretary determines that an
organization has not developed a mission statement with clearly
defined goals and objectives for the contributions the
organization will make to the Native Hawaiian health care
systems and an action plan for carrying out those goals and
objectives.
Section 3(11) provides that for purposes of the Act, the
term ``primary health services'' means: the services of
physicians, physicians' assistants, nurse practitioners, and
other health care professionals; diagnostic laboratory and
radiologic services; preventive health services, including
perinatal services, well child services, and family planning
services, nutrition services, home health services, and other
wellness services; emergency medical services; transportation
services as required for adequate patient care; preventive
dental services; and pharmaceutical and medicament services;
primary care services which may lead to specialty and/or
tertiary care; and complementary healing practices, including
those performed by traditional Native Hawaiian healers.
Section 3(12) provides that for purposes of the Act, the
term ``Secretary'' means the Secretary of the U.S. Department
of Health and Human Services.
Section 3(13) provides that for purposes of the Act, the
term ``traditional Native Hawaiian healer'' means a
practitioner who is of Hawaiian ancestry and has the knowledge,
skills, and experience in direct personal health care of
individuals, and whose knowledge, skills, and experience are
based on demonstrated learning of Native Hawaiian healing
practices acquired by direct practical association with Native
Hawaiian elders andoral traditions passed from generation to
generation.
Section 4. Declaration of National Native Hawaiian Health Policy
This section establishes the policy of the Act.
Section 4 (a) and (b) establish that it is the United
States' policy, in fulfilling its special responsibilities and
legal obligations to the indigenous people of Hawai'i which
results from the unique and historical relationship between the
United States and the government of the indigenous people of
Hawai'i, to raise the health status of Native Hawaiians to the
highest possible level and to provide existing Native Hawaiian
health care programs with the resources necessary to effectuate
this policy. Section 4 also expresses Congress' intent to raise
Native Hawaiians' health status by 2010 to at least the
standards contained within Healthy People 2010 or successor
standards, and to incorporate the following activities within
health programs: integration of cultural approaches to health
and well-being; increasing the number of health and allied-
health care providers who can provide culturally competent
care; increasing the use of traditional Native Hawaiian foods
in peoples' diets and dietary preferences including those of
students and the use of traditional foods in school feeding
programs; identifying and instituting Native Hawaiian cultural
values and practices within the ``corporate cultures'' of
organizations and agencies providing health services to Native
Hawaiians; facilitating the provision of Native Hawaiian
healing practices by Native Hawaiian healers for those clients
desiring such assistance; and supporting training and education
activities and programs in traditional Native Hawaiian healing
practices by Native Hawaiian healers.
Section 4(c) directs the Secretary of Health and Human
Services to include in his report to the Congress, as required
under section 12, a report on the progress made towards meeting
the national policy of the Act.
Section 5. Comprehensive Health Care Master Plan for Native Hawaiians
Section 5(a)(1) authorizes the Secretary to make a grant or
enter into a contract with Papa Ola Lokahi for the purpose of
coordinating, implementing, and updating the Native Hawaiian
comprehensive health care master plan which is designed to
promote comprehensive health promotion and disease prevention
services and to maintain and improve the Native Hawaiians'
health status.
Section 5(a)(2) is amended to require Papa Ola Lokahi and
the Office of Hawaiian Affairs to consult with the Native
Hawaiian health care systems, the Native Hawaiian health care
centers, and the Native Hawaiian community in carrying out
section 5, and authorizes Papa Ola Lokahi and the Office of
Hawaiian Affairs to enter into memoranda of understanding or
agreement to acquire joint funding and for other issues to
accomplish the objectives of this section
Section 5(a)(3) requires that within eighteen months of the
Act's promulgation, that Papa Ola Lokahi cooperate with the
Office of Hawaiian Affairs and other appropriate agencies of
the State of Hawai'i, and prepare and submit a report to
Congress detailing the impact of current Federal and State
health care financing mechanisms and policies on the health and
well-being of Native Hawaiians. The study is to include the
impact of cultural competency, risk assessment data,
eligibility requirements and exemptions, reimbursement policies
and capitation rates currently in effect for service providers,
and any other information that may be important to improving
the health status of Native Hawaiians as it relates to health
care financing, including barriers to health care. These
recommendations will also be submitted to the Secretary for
review and consultation with Native Hawaiians.
Section 5(b) authorizes the appropriation of such sums as
may be necessary to carry out subsection (a).
Section 6. Functions of Papa Ola Lokahi and Office of Hawaiian Affairs
This section sets forth the functions of Papa Ola Lokahi
and is amended to include the Office of Hawaiian Affairs.
Section 6(a) makes Papa Ola Lokahi responsible for the
following:
(1) coordinating, implementing, and updating the
comprehensive health care master plan developed
pursuant to the authority contained in section 5;
(2) training of Native Hawaiian health care
practitioners, community outreach workers, and
counselor and cultural educators who will be involved
in providing health promotion and disease prevention
education;
(3) identifying and researching the diseases that are
most prevalent among Native Hawaiians, including
behavioral, biomedical, epidemiological, and health
services;
(4) developing and maintaining an institutional
review board for all research projects involving all
aspects of Native Hawaiian health; and
(5) maintaining an action plan outlining the
contributions that each member ofPapa Ola Lokahi will
make in carrying out the Act's policy.
Section 6(b) authorizes Papa Ola Lokahi to receive special
project funds that may be appropriated for the purpose of
conducting research on the health status of Native Hawaiians or
for the purpose of addressing the health care needs of Native
Hawaiians.
Section 6(c)(1) authorizes Papa Ola Lokahi to serve as a
clearinghouse for the collection and maintenance of data
associated with the health status of Native Hawaiians; the
identification and research into diseases affecting Native
Hawaiians; the availability of Native Hawaiian project funds,
research projects and publications; the collaboration of
research in Native Hawaiian health; and the timely
dissemination of information pertinent to the Native Hawaiian
health care systems.
Section 6(c)(2) requires the Secretary to provide Papa Ola
Lokahi and the Office of Hawaiian Affairs with at least one
annual accounting of funds and services that the Department of
Health and Human Services provided to states and non-profit
groups and organizations in carrying out the Act's policy. This
accounting will include, but not be limited to, the following:
the amount of funds expended explicitly for and benefiting
Native Hawaiians; the number of Native Hawaiians impacted by
these funds; the identification of collaborations made with
Native Hawaiian groups and organizations in the expenditure of
these funds; and the amount of funds used for federal
administrative purposes and for the provision of direct
services to Native Hawaiians.
Section 6(d)(1) requires that Papa Ola Lokahi provide
annual recommendations to the Secretary regarding the
allocation of all amounts appropriated under this Act.
Section 6(d)(2) requires Papa Ola Lokahi, to the extent
possible, to coordinate and assist the health care programs and
services to Native Hawaiians.
Section 6(d)(3) requires the Secretary to consult with Papa
Ola Lokahi and make recommendations for Native Hawaiian
representation on the President's Advisory Commission on Asian
Americans and Pacific Islanders.
Section 6(e) authorizes Papa Ola Lokahi to act as a
statewide infrastructure to provide technical support and
coordination of training and technical assistance to the Native
Hawaiian health care systems and the Native Hawaiian health
care centers.
Section 6(f)(1) authorizes Papa Ola Lokahi to enter into
agreements or memoranda of understanding with relevant
institutions, agencies, or organizations that are capable of
providing health-related resources or services to the Native
Hawaiians and the Native Hawaiian health care systems or
providing resources or services to implement the national
policy of this Act as set forth in section 4.
Section 6(f)(2) addresses health care financing as follows:
Subsection (A) requires federal agencies that provide
health care financing and health care programs to consult with
Native Hawaiians and with organizations providing Native
Hawaiian health care services before adopting any policy or
regulation that may impact on the provision of services or
health insurance coverage. The consultation is to include but
not be limited to the identification of the impact of proposed
policies, rules, or regulations.
Subsection (B) requires that the State of Hawai'i engage in
meaningful consultation with Native Hawaiians and organizations
providing Native Hawaiian health care services before making
changes or initiating new programs.
Subsection (C) authorizes the Office of Hawaiian Affairs,
in collaboration with Papa Ola Lokahi, to develop consultative,
contractual, or other arrangements including memoranda of
understanding or agreement with the following: the Health Care
Financing Administration; the agency of the State of Hawai'i
that administers or supervises the administration of the State
plan or waiver approved under title XVIII, XIX, or XII of the
Social Security Act for payment of all or part of the health
care services to Native Hawaiians who are eligible for medical
assistance under such a State plan or waiver; or any other
Federal agency or agencies providing Native Hawaiians with full
or partial health insurance. Such arrangements may include
appropriate reimbursement for health care services including
capitation and fee for service rates for Native Hawaiians who
are entitled to or eligible for insurance; the scope of
services provided, or other mattes which enable Native
Hawaiians to maximize health insurance benefits provided by
Federal and State health insurance programs.
Section 6(f)(3) provides that the provision of health care
services by the department and other federal agencies may
include the services of traditional ``Native Hawaiian healers''
and ``traditional healers'' providing ``traditional health care
practices'' as defined in section 4(r) of Public Law 94-437.
Such services are exempt from national accreditation reviews,
including reviews conducted by the Joint Accreditation
Commission on Health Organizations and the Rehabilitation
Accreditation Commission.
Section 7. Native Hawaiian health care systems
This section addresses the authority of the Secretary to
enter into contracts and grants with Native Hawaiian healthcare
systems for the provision of health care services and health care
referral services to Native Hawaiians and the responsibilities of the
Native Hawaiian health care systems.
Section 7(a) authorizes the Secretary of Health and Human
Services to consult with Papa Ola Lokahi and make grants to or
enter into contracts with any qualified entity for the purpose
of providing comprehensive health promotion, disease prevention
services, and primary health care services provide to Native
Hawaiians. The Secretary may enter into up to eight grants or
contracts with preference given to Native Hawaiian health care
systems and Native Hawaiian organizations. To the extent
feasible, health promotion and disease prevention services
shall be performed through Native Hawaiian health care systems.
A ``qualified entity'' for purposes of subsection 7(a) means a
Native Hawaiian health care system or a Native Hawaiian Health
Care Center.
Section 7(b) authorizes the Secretary to also make a grant
to, or enter into a contract with, Papa Ola Lokahi for purposes
of planning Native Hawaiian health care systems to serve the
health needs of Native Hawaiian communities on the islands of
O'ahu, Moloka'i, Maui, Hawai'i, Lana'i, Kaua'i, and Ni'ihau in
the State of Hawai'i.
Section 7(c) specifies that each Native Hawaiian health
care system will ensure that the following services are
provided or arranged: outreach services to inform Native
Hawaiians of the availability of health services; health
promotion and disease prevention education of Native Hawaiians
by, wherever possible, Native Hawaiian health care
practitioners, community outreach workers, counselors, and
cultural educators; services of physicians, physicians'
assistants, nurse practitioners, and other health
professionals; immunizations; prevention and control of
diabetes, high blood pressure, and otitis media; pregnancy and
infant care; improvement of nutrition, identification,
treatment, control and reduction of the incidences of
preventable illnesses and conditions endemic to Native
Hawaiians; collection of data related to the prevention of
diseases and illnesses among Native Hawaiians; services within
the meaning of the terms ``health promotion'', ``disease
prevention'', and ``primary health services''; and support of
culturally appropriate activities that enhance health and
wellness including land-based, ocean-based, water-based, and
spiritual-based projects and programs. Any of these services
may be provided by traditional Native Hawaiian healers.
Section 7(d) provides that individuals who provide medical,
dental, or other services under subsection (a)(1) for Native
Hawaiian health care systems shall be treated as if they were
members of the Public Health Service and shall be covered under
the provisions of section 224 of the Public Health Service Act.
Section 7(e) requires that a Native Hawaiian health care
system that receives funds under subsection 7(a) provide a
designation area and appropriate staff to serve as a Federal
loan repayment facility. This facility must be designed to
enable health and allied-health professionals to remit payments
to loans provided to such professionals under any Federal loan
program.
Section 7(f) specifies that the Secretary may not make a
grant or enter into a contract as authorizes under subsection
7(a) unless the qualified entity agrees that the grant or
contract amount will not, directly or through contract, be
expended for: services other than services described in section
(c)(1); the purchase or improvement of real property (other
than minor remodeling of existing improvements to real
property); or the purchase of major medical equipment.
Section 7(g) provides that the Secretary may not make a
grant or enter into a contract with any qualified entity under
subsection 7(a) unless the qualified entity agrees that,
whether health services are provided directly or through
contract, health services under the grant or contract will be
provided without regard to ability to pay for the health
services and the entity will impose a change for the delivery
of health services which will be made according to a schedule
of charges that is made publically available and will be
adjusted to reflect the income of the individual involved.
Section 7(h) authorizes the appropriation of sums as may be
necessary to carry out activities under subsections 7(a) and
7(b) for fiscal years 2001 and 2011.
Section 8. Administrative grant for Papa Ola Lokahi
This section authorizes the Secretary to make a grant or
enter into a contract with Papa Ola Lokahi for its
administrative functions.
Section 8(a) authorizes the Secretary to make grants to or
enter into contracts with Papa Ola Lokahi for: the
coordination, implementation, and appropriate updating of the
comprehensive health care master plan developed under the
authority of section 5; training for persons described in
section 7(c)(1); identification of and research into the
diseases that are most prevalent among Native Hawaiians,
including behavioral, biomedical, epidemiological and health
services; the maintenance of an action plan outlining the
contributions that each member organization of Papa Ola Lokahi
will make in carrying out the Act's policy; a clearinghouse
function for the collection and maintenance of data associated
with the health status of Native Hawaiians, the identification
of research into diseases affecting Native Hawaiians, and the
availability of Native Hawaiian project funds, research
projects, and publications; the establishment and maintenance
of an institutional review board for all health-related
research involving Native Hawaiians; the coordination of the
health care programs and services provided toNative Hawaiians;
and the administration of special project funds.
Section 8(b) authorizes the appropriation of sums as may be
necessary to carry out the activities in subsection 8(a) for
each of fiscal years 2001 through 2011.
Section 9. Administration of grants and contracts
This section sets forth the terms and conditions under
which the Secretary makes grants or enter into contracts.
Section 9(a) specifies that within any grants made or
contracts entered that the Secretary include terms and
conditions the Secretary considers necessary or appropriate to
ensure that the grant or contract objectives are achieved.
Section 9(b) requires that the Secretary periodically
evaluate the performance of and compliance with grants and
contracts under this Act.
Section 9(c) prohibits the Secretary from making any grant
or entering into any contract 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 health services provided to any
Native Hawaiian population, which substantial portion
has a limited ability to speak the English language,
develops 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 that population in the language and in
the most appropriate cultural context, and has
designated at least one individual, fluent in both
English and the appropriate language, to assist in
carrying out the plan;
(4) with respect to health services 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 if the entity will
provide under the grant or contract any such health
services directly, has entered into a participation
agreement under such plans and the entity is qualified
to receive payments under such plan. Also, if the
entity will provide under the grant or contract any
such health services through a contract with an
organization, the organization has entered into a
participation agreement under such plan, and the
organization is qualified to receive payments under
such plan; and
(5) agrees to submit an annual report to the
Secretary and to Papa Ola Lokahi 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 the Secretary determines to be appropriate.
Section 9(d) addresses the Secretary's evaluation of
contracts entered into by the Secretary.
Subsection (1) provides that when the Secretary's
evaluation reveals that an entity has not complied with or
satisfactorily performed a contract entered into under section
7, that before the contract is renewed the Secretary must
attempt to resolve the areas of noncompliance or unsatisfactory
performance and modify the contract to prevent future
noncompliance or unsatisfactory performance.
Subsection (2) provides that if the Secretary determines
that the noncompliance or unsatisfactory performance cannot be
resolved and prevented in the future, the Secretary shall not
renew that entity's contract and is authorized to enter into a
new section 7 contract with a qualified entity, as defined in
section 7(a)(3), that provides services to the same population
of Native Hawaiians that was served by the entity whose
contract was not renewed.
Subsection (3) specifies that in determining whether to
renew an entity's contract under the Act the Secretary shall
consider the results of the evaluations undertaken under the
authority of this section.
Subsection (4) specifies that the contracts the Secretary
enters under this Act must be in accordance with all Federal
contracting laws and regulations, but that the Secretary has
the discretion to negotiate contracts without advertising and
may be exempt from the provisions of the Act of August 24, 1935
(40 U.S.C. 270a et seq.).
Subsection (5) specifies that payments made under any
contract entered into under this Act may be made in advance, by
means of reimbursement or installments, and shall be made on
such conditions as the Secretary deems necessary to carry out
the purposes of this Act.
Subsection (9)(e) provides that for each fiscal year during
which any entity receives or expends funds pursuant to a grant
or contract under the Act, such entity is to submit anannual
report to the Secretary and to Papa Ola Lokahi on the entity's
activities under the grant or contract, the amounts and purposes for
which Federal funds were expended, and such other information as the
Secretary may request. 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.
Section 9(f) provides that 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 by a certified public
accountant.
Section 10. Assignment of personnel
This section addresses the assignment of personnel by the
Secretary.
Section 10(a) specifies that where the Secretary may make
assignments of Department of Health and Human Services
personnel, the Secretary may enter into an agreement with any
entity to such personnel with the expertise the entity
identifies, to provide comprehensive health promotion and
disease prevention services to Native Hawaiians.
Section 10(b) specifies that under the authority of
subsection 10(a) is to 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 of the United States
Code.
Section 11. Native Hawaiian health scholarships and fellowships
Section 11(a) specifies that, subject to the availability
of funds appropriated under the authority of subsection 11(c),
the Secretary is to provide funds through a direct grant to or
a cooperative agreement with the Kamehamedha Schools as another
Native Hawaiian organization or health care organization with
experience in administering education scholarship or placement
services for the purpose of providing scholarship assistance to
Native Hawaiian students who meet the requirements of section
338A of the Public Health Service Act, except for assistance
provided for under section 11(b)(2) of this Act.
Section 11(b) specifies employees of the Native Hawaiian
Health Care Systems and the Native Hawaiian Health Centers may
be given priority for scholarships.
Section 11(c)(1) specifies that subsection 11(a) is to be
provided under the same terms and subject to the same
conditions, regulations, and rules that apply to scholarship
assistance provided under section 338A of the Public Health
Service Act, except as follows:
Subsection (A) specifies that 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 Papa Ola
Lokahi identifies.
Subsection (B) specifies that to the maximum extent
practicable, the Secretary is to select scholarship recipients
from a list of eligible applicants submitted by the Kamehameha
Schools (or the Native Hawaiian organization administering the
program).
Subsection (C) specifies that the obligated service
requirement for each scholarship recipient is to be fulfilled
through service in the following order of priority: in any one
of the Native Hawaiian health care systems or Native Hawaiian
health centers; 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 Hawai'i; or a geographical area, facility, or
organization that serves a significant Native Hawaiian
population.
Subsection (D) specifies that the scholarship program's
placement services shall assign scholarship recipients to
appropriate sites for service.
Subsection (E) specifies that counseling, retention, and
other support services will be available to any scholarship
recipient and other scholarship and financial aid programs
recipient enrolled in appropriate health professions training
programs.
Subsection (F) specifies that financial assistance may be
provided to scholarship recipients in the health professions,
designated in 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.
Section 11(c)(2) specifies that the financial aid through
fellowships may be provided to Native Hawaiian community health
representatives, outreach workers, health program
administrators in professional training programs, and Native
Hawaiians in certificated programs provided by traditional
Native Hawaiian healers using traditional Native Hawaiian
healing practices. The financial assistance may include a
stipend and/orreimbursement for costs associated with
participating in the program.
Section 11(c)(3) specifies that scholarship recipients in
health professions designated in section 338A of the Public
Health Service Act shall have the same rights and benefits as
members of the National Health Service Corps while fulfilling
their service requirements.
Section 11(c)(4) provides that the financial assistance
provided under section 11 of this Act shall be deemed
``Qualified Scholarships'' for purposes of section 117, title
26, United States Code.
Section 11(d) authorizes the appropriation of such sums as
may be necessary for the purpose of funding the scholarship
assistance under subsection (a) and fellowship assistance under
subsection (c)(2) for fiscal years 2001 through 2011.
Section 12. Report
This section provides that at the time the budget is
submitted under section 1105 of title 31 of the United States
Code, the President is to transmit a report to Congress for
each fiscal year on the progress made in meeting the Act's
objectives, including a review of programs established or
assisted pursuant to the Act and an assessment and
recommendations of additional programs or assistance necessary
to provide health services to Native Hawaiians and to ensure a
health status for Native Hawaiians which are on par with the
general population's health services and health status.
Section 13. Use of Federal Government facilities and sources of supply
This section authorizes organizations that receive grants
or contracts to have access to federal property and supplies.
Section 13(a) authorizes the Secretary to allow
organizations, in carrying out their grants or contracts
authorized under the Act, to use existing facilities and
equipment therein or under the Secretary's jurisdiction, under
such terms and conditions as may be agreed upon for their use
and maintenance.
Section 13(b) authorizes the Secretary to donate any
personal or real property determined to be in excess of the
needs of the Department or the General Services Administration
to organizations that receive contracts or grants for purposes
of carrying out such contract or grants.
Section 13(c) authorizes the Secretary to acquire excess or
surplus Federal government real and personal property for
donation to organizations that receive grants or contracts
under this Act, provided that the Secretary determines that the
organization's property use is appropriate for the purpose
which a contract or grant is authorized under this Act.
Section 14. Demonstration projects of national significance
This section authorizes demonstration projects to improve
the health status of Native Hawaiians.
Section 14(a) authorizes the Secretary to consult with Papa
Ola Lokahi and allocate appropriated amounts under this or any
other Act to carry out Native Hawaiian demonstration projects
of national significance. The project areas of interest may
include the following:
(1) the development of a centralized database and
information system relating to Native Hawaiian health
care status, health care needs, and wellness;
(2) the education of health professionals, and other
individuals in higher learning institutions, 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 Native
Hawaiian health care and other indigenous people,
including the provision of culturally competent health
services, related activities focusing on wellness
concepts, the development of appropriate kupuna care
programs, and the development of financial mechanisms
and collaborative relationships leading to universal
access to health care; and
(6) the establishment of Native Hawaiian Centers of
Excellence for Nursing at the University of Hawai'i at
Hilo; for Mental Health at the University of Hawai'i at
Manoa; for Maternal Health and Nutrition at the
Waimanalo Health Center; and for Research, Training,
Integrated Medicine at Moloka'i General Hospital; and
for Complimentary Health and Health Education and
Training at the Waianae Coast Comprehensive Health
Center.
Section 14(b) specifies that funds allocated for
demonstration projects under subsection 14(a) shall not result
in a reduction on funds required by the Native Hawaiianhealth
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.
Section 15. National Bipartisan Commission on Native Hawaiian health
care entitlement
This section authorizes the establishment of a commission
for the purpose of examining and making recommendations to the
Congress as to whether the provision of health care services to
Native Hawaiians should be an entitlement program.
Section 15(a) establishes a National bipartisan Native
Hawaiian Health Care Entitlement Commission (the
``Commission'').
Section 15(b) specifies that the Commission will be
comprised of twenty-one (21) members who are appointed as
follows:
(1) The Majority and Minority Leaders of the House of
Representatives and of the Senate will each appoint two
members. These congressional commission members must also be
members of congressional committees that consider legislation
affecting the provision of health care to Native Hawaiians and
other Native Americans. Commission members appointed under this
subsection will elect the Commission's chairperson and vice-
chairperson.
(2) The Native Hawaiian health care systems will appoint
five embers, and the Hawai'i State Primary Care Association,
Papa Ola Lokahi, Native Hawaiian Health Task Force, and the
Office of Hawaiian Affairs will each appoint one member. The
Association of Hawaiian Civic Clubs shall appoint two members
who will represent Native Hawaiian populations residing in the
continental United States.
(3) The Secretary shall appoint two members who possess
knowledge of Native Hawaiian health concerns and wellness.
Section 15(c) provides that Commission members shall serve
for the life of the Commission. Initial Commission members are
to be appointed not later than 90 days after the Act's
enactment, with the remaining Commission members appointed not
later than 60 days after the members are appointed under
subsection 15(b)(1). This section also specifies that vacancies
will be filled in the manner which original appointments were
made.
Section 15(d) specifies that the Commission's duties and
functions are as follows:
(1) reviewing and analyzing the recommendations of
the report of the study committee establishes under
subsection 15(d)(3).
(2) making 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 composed of at least
ten Commission members, with four appointed under
subsection (b)(1), five members appointed under
subsection (b)(2), and one member the Secretary
appointed under subsection 15(b)(3). The study
committee will conduct the following activities:
(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 living 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 to 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) within twelve months after the
appointment of the Commission members, make a
written report of its findings and
recommendations to the Commission which shall
include statements from the minority and
majoritypositions of the committee and which
will be disseminated to Native Hawaiian organizations, agencies, and
health organizations referred to in subsection 15(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) specifies that not later than eighteen months
after the appointment of the Commission members, 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.
Section 15(e)(1) specifies that Commission members
appointed under subsection 15(b)(1) will not receive any
additional compensation, allowances, or benefits for serving on
the Commission, but may receive travel expenses and per diem in
lieu of subsistence in accordance with sections 5702 and 5703
of title 5, United States Code. Commission members appointed
under subsections 15 (b)(2) and (b)(3) may receive compensation
while performing Commission business 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 home or regular place of
business, be allowed travel expenses as the Commission
chairperson authorizes. for purposes of compensation (except
for Commission members), and for employment benefits, rights,
and privileges, Commission personnel will be treated as if they
were Senate employees.
Section 15(e)(2) specifies that the Commission chairperson
shall call Commission meetings. This subsection further
specifies that a quorum must consist of not less than twelve
members, with not less than four members appointed under
subsection 15(b)(1), with not less than seven members appointed
under subsection 15(b)(2), and with not less than one (1)
member appointed under subsection 15(b)(3).
Section 15(e)(3) authorizes Commission members to appoint
an executive director who shall be paid the rate of basic pay
equal to level V of the Executive Schedule under section 5316
of title 5, United States Code. The executive director, with
the Commission's approval, may appoint such personnel as the
executive director deems appropriate. The Commission staff
shall be appointed without regard to title 5 provision of the
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).
This subsection also specifies that the executive director,
with the Commission's approval, may procure temporary and
intermittent services under section 3109(b) of title 5, United
States Code. This subsection further authorizes the General
Services Administration Administrator to locate suitable office
space for Commission headquarters in Washington, DC and a
Commission liaison office in the State of Hawai'i. Both offices
shall include all necessary equipment and incidentals required
for the Commission's proper functioning.
Section 15(f)(1) authorizes the Commission to hold
hearings and to undertake other activities the Commission
determines to be necessary to carry out its duties, except that
at least eight hearings shall be held on each of the Hawaiian
Islands and three 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 Native Hawaiians. At least four Commission members,
including at least one congressional member, must be present to
constitute a hearing. Study committee hearings, authorized
under subsection 15(d)(3) may be counted towards the number of
hearings this paragraph requires.
Section 15(f)(2) authorizes the Comptroller General, at
the Commission's request, to conduct such studies or
investigations as the Commission determines to be necessary to
carry out its duties.
Section 15(f)(3) specifies that, upon the Commission's
request, the Director of the Congressional Budget Office and/or
the Chief Actuary of the Health Care Financing Administration
shall provide cost estimates the Commission determines to be
necessary to carry outs its duties. 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
subsection 15(f)(3)(A).
Section 15(f)(4) specifies that, at the Commission's
request, the head of any Federal agency may detail its
personnel to the Commission, without reimbursement, to assist
in carrying out the Commission's duties. Such detail will not
interrupt or otherwise affect the civil service status or
privileges of the Federal employees.
Section 15(f)(5) specifies that, at the Commission's
request, 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.
Section 15(f)(6) authorizes the Commission to 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.
Section 15(f)(7) authorizes the Commission to 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 Commission chairperson,
the head of such agency shall furnish such information to the
Commission.
Section 15(f)(8) authorizes the Administrator of General
Services, at the Commission's request, to provide the
Commission with administrative support services which are
provided on a reimbursable basis.
Section 15(f)(9) specifies that the Commission shall be
treated as a congressional committee for purposes of costs
relating to printing and binding (including the cost of
personnel detailed from the Government Printing Office).
Section 15(g) authorizes appropriations of such sums as may
be necessary to carry out this section. This appropriated
amount shall not result in a reduction in any other
appropriation for health care or health services for Native
Hawaiians.
Section 16. Rule of construction
This section specifies that nothing in this Act will be
construed to restrict the authority of the State of Hawaii to
license health practitioners.
Section 17. Compliance with Budget Act
This section provides that any new spending authority
described in sections 401(c)(2) (A) or (B) of the Congressional
Budget At of 1974 which is provided under the authority of this
Act is to be effective for any fiscal year only to the extent
or in such amounts as are provided in appropriation Acts.
Section 18. Severability
This section provides that if any provision of the Act or
the application of any provision of the Act to any person or
circumstances is held to be invalid, the remainder of the Act,
and the application of a provision or amendment to persons or
circumstances other than those to which it is held invalid,
will be unaffected.
Legislative History
S. 1929 was introduced on November 16, 1999, by Senator
Inouye for himself and Senator Akaka, and was referred to the
Committee on Indian Affairs. Hearings on S. 1929 were held on
the islands of Moloka'i and Kaua'i on January 18, 2000, on the
island of Maui on January 19, 2000, at Hilo, Hawaii on January
20, 2000, on the island of O'ahu on January 21, 2000, and at
Kona, Hawaii and on the island of Lana'i on March 16, 2000.
Committee Recommendation and Tabulation of Vote
The Committee on Indian Affairs, on May 3, 2000, in an open
business meeting, by a unanimous vote, recommended that the
Senate pass an amendment in the nature of a substitute to S.
1929, a bill to reauthorize and amend the Native Hawaiian
Health Care Act.
Cost and Budgetary Considerations
The cost estimate of the Congressional Budget Office on S.
1929 is set forth below.
CONGRESSIONAL BUDGET OFFICE COST ESTIMATE
S. 1929--Native Hawaiian Health Care Improvement Act Reauthorization of
1999
Summary: S. 1929 would reauthorize the Native Hawaiian
Health Care Improvement Act. It would amend the act to reflect
how current programs are operated and to treat the Native
Hawaiian health systems in a manner similar to health centers
authorized under the Public Health Service Act. In addition, it
would create a Commission to advise the Congress whether the
provision of health care services to Native Hawaiians should be
an entitlement program. It also would require Federal agencies
to consult with Native Hawaiians and organizations providing
health care services to Native Hawaiians before adopting any
policy or regulation which may impact their health services or
health insurance coverage.
The act is administered through the Health Resources and
Services Administration. Assuming the appropriation of the
necessary amounts, CBO estimates that implementing S. 1929
would cost $1 million in 2001 and a total of $19 million from
2001 through 2005. (That total assumes that the annual
appropriation level is not adjusted to reflect anticipated
inflation. If such adjustments are made, the five-year outlay
total would be $20 million.) The legislation would not affect
direct spending or receipts; therefore, pay-as-you-go
procedures would not apply.
S. 1929 contains no private-sector mandates as defined in
the Unfunded Mandates Reform Act (UMRA). It does contain an
intergovernmental mandate, but CBO estimates that the costs of
the mandate would be minimal and would not exceed the threshold
established in UMRA ($55 million in 2000, adjusted annually for
inflation).
Estimated Cost to the Federal Government: The estimated
budgetary impact of S. 1929 is shown in the following table.
The costs of this legislation fall within budget function 550
(health).
----------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
-----------------------------------------------------
2000 2001 2002 2003 2004 2005
----------------------------------------------------------------------------------------------------------------
SPENDING SUBJECT TO APPROPRIATIONS
Spending Under Current Law:
Budget Authority\1\................................... 5 5 0 0 0 0
Estimated Outlays..................................... 5 5 2 (\2\) 0 0
Proposed Changes:
Estimated Authorization Level......................... 0 2 5 5 5 5
Estimated Outlays..................................... 0 1 3 5 5 5
Spending Under S. 1929:
Estimated Authorization Level\1\...................... 5 7 5 5 5 5
Estimated Outlays..................................... 5 6 5 5 5 5
----------------------------------------------------------------------------------------------------------------
\1\The 2000 level is the amount appropriated for that year for activities conducted under the Native Hawaiian
Health Care Improvement Act.
\2\Less than $500,000.
Basis of Estimate: For this cost estimate, CBO assumes that
the bill will be enacted by or near the start of fiscal year
2001, that the necessary amounts will be appropriated each
year, and that outlays will follow historical spending rates
for the authorized activities.
Current programs in the act were authorized at such sums as
necessary through 2001. S. 1929 would reauthorize the
administrative grant for Papa Ola Lokahi, extending it through
2010. It also would reauthorize the Native Hawaiian health
systems and the scholarship assistance programs, extending
their authorization through 2011. Because these activities are
currently authorized through 2001, this provision would not
affect spending until 2002.
S. 1929 would amend the requirements for Native Hawaiian
health systems to remove differences in treatment between them
and health centers which perform similar functions, but are
authorized under the Public Health Service Act. It would remove
the requirement that health systems provide matching funds to
receive the full amount of the cost of providing health
services under a grant or contract. Providers of services in
health systems could be treated as if they were members of the
Public Health Service and covered under section 224 of the
Public Health Service Act, which provides for defense and
payment of claims in certain malpractice and negligence suits.
In addition, it would enable health systems, like health
centers, to receive and use surplus buildings and equipment
owned by the federal government. CBO estimates these provisions
would have a negligible impact on federal spending.
S. 1929 would create a commission composed of members of
the Congress, individuals appointed by Hawaiian health
entities, and individuals appointed by the Secretary of the
Department of Health and Human Services. The initial members
would be appointed within 90 days after enactment. Not later
than 18 months after the last members was appointed, the
commission would submit a written report to the Congress
containing a recommendation of policies and legislation to
establish a health care system for native Hawaiians based on
the delivery of health care services as an entitlement. The
bill would authorize $1.5 million in appropriations to carry
out this section.
S. 1929 would require federal agencies providing health
care financing and carrying out health care programs to consult
with Native Hawaiians and organizations providing health care
services to Native Hawaiians prior to adopting any policy or
regulation which may impact the provision of health services or
health insurance coverage for Native Hawaiians. The
consultation would include, but not be limited to, the
identification of the impact of proposed policies, rules, or
regulations. Depending on how the consultation would be
defined, this provision could have budgetary implications.
Should the consultation require a significant amount of work
and time, it would delay the promulgation of rules and
regulations affecting federal payment for programs such as
Medicare and Medicaid. CBO cannot estimate the budgetary impact
of this provision since it would depend on the rule or
regulation being considered and the time necessary to perform
the consultation.
Pay-as-you-go considerations: None.
Estimated impact on state, local, and tribal governments:
The bill would require the state of Hawaii to consult with
Native Hawaiians and health care organizations that provide
services to Native Hawaiians before making policy changes or
initiating new programs. That requirement would be an
intergovernmental mandate as defined in UMRA, but CBO estimates
that the costs of the mandate would be minimal and would not
exceed the threshold established in UMRA ($55 million in 2000,
adjusted annually for inflation).
Estimated impact on the private sector: The bill contains
no private-sector mandates as defined in UMRA.
Estimate prepared by: Federal Costs: Cyndi Dudzinski;
Impact on State, Local, and Tribal Governments: Leo Lex; and
Impact on the Private Sector: Jennifer Bullard.
Estimate approved by: Pete H. Fontaine, Deputy Assistant
Director for Budget Analysis.
Executive Communications
The Committee received no communications from the Executive
branch of government of S. 1929.
Regulatory and Paperwork Impact
Paragraph 11(b) of rule XXVI of the Standing Rules of the
Senate requires each report accompanying a bill to evaluate the
regulatory and paperwork impact that would be incurred in
carrying out the bill. The Committee believes that the
amendment in the nature of a substitute to S. 1929 will have a
minimal impact on regulatory or paperwork requirements.
Changes in Existing Law
UNITED STATES CODE ANNOTATED
TITLE 42--THE PUBLIC HEALTH AND WELFARE
CHAPTER 122--NATIVE HAWAIIAN HEALTH CARE
Sec. 11701. Findings
[The Congress finds that:] (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.
[(1)] (2) Native Hawaiians [comprise] are a distinct
and unique indigenous people with a historical
continuity to the original inhabitants of the Hawaiian
archipelago [whose society was organized as a Nation
prior to the arrival of the first nonindigenous people
in 1778.] 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 lands,
either through their monarchy or through a plebiscite
or referendum.
[(2)] (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.
[(3)] (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.
[(4)] (8) At the time of the arrival of the first
nonindigenous people in Hawaii in 1778, the Native
Hawaiian people lived in a highly organized, self-
sufficient, subsistence social system based on communal
land tenure with a sophisticated language, culture, and
religion.
[(5)] (9) A unified monarchical government of the
Hawaiian Islands was established in 1810 under
Kamehameha I, the first King of Hawaii.
[(6)] (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.
[(7)] (11) In [the year] 1893, John L. Stevens, the
United States Minister assigned to the sovereign and
independent Kingdom of Hawaii, [John L. Stevens,]
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.
[(8)] (12) In pursuance of that conspiracy, the
United States Minister and the naval representative of
the United States caused armed naval forces of the
United States to invade the sovereign Hawaiian Nation
in support of the indigenous andlawful 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 two nations
of international law.
[(9)] (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''.
[(10)] (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).
[(11)] (16) In 1898, the United States annexed Hawaii
through the Newlands Resolution without the consent of
or compensation to the indigenous people of Hawaii or
their sovereign government who were thereby denied the
mechanism for expression of their inherent sovereignty
through self-government and self-determination, their
lands and ocean resources.
[(12)] (17) Through the Newlands Resolution and the
1900 Organic Act, the United States Congress received
[1.75 million] 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.
[(13)] (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 United States House of
Representatives Committee on Territories as stating,
``One thing that impressed me . . . was the fact that
the natives of the islands [who are wards, I should
say, and] for whom in a sense we are trustees, are
falling off rapidly in number and many of them are in
poverty.''.
[(14)] (19) In 1938, [the United States] 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''.
[(15)] (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 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.
[(16)] (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 Hawaiian
people by retaining the legal responsibility of the
State for the betterment of the conditions of Native
Hawaiians under section 5(f) [of 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,
6).] 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.
[(17)] (23) The authority of the Congress under the
United States 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) Further, the United States has recognized the
authority of the Native Hawaiian people to continue to
work towards an appropriate form of sovereignty as
defined by the Native Hawaiian people themselves in
provisions set forth in legislation returning the
Hawaiian Island of Kaho'olawe to custodial management
by the State of Hawaii in 1994.
[(18)] (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 begun to lower the century-old
morbidity and mortality rates of Native Hawaiian people
by providing comprehensive disease prevention, health
promotion activities and increasing the number of
Native Hawaiians in the health and allied health
professions. This has been accomplished through the
Native Hawaiian Health Care Improvement Act of 1988
(Public Law 100-579) and its reauthorization in section
9168 of Public Law 102-396 (106 Stat. 1948).
[(19)] (26) This historical and unique legal
relationship has been consistently recognized and
affirmed by the Congress through the enactment of
Federal laws which extend to the 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.A.
Sec. 2991 et seq.); the American Indian Religious
Freedom Act (42 U.S.C.A. Sec. 1996); the National
Museum of the American Indian Act (20 U.S.C.A. Sec. 80q
et seq.); and the Native American Graves Protection and
Repatriation Act (25 U.S.C.A. Sec. 3001 et seq.).
[(20)] (27) The United States has also recognized and
reaffirmed the trust relationship to the Hawaiian
people through legislation which authorizes the
provision of services to Native Hawaiians,
specifically, the Older Americans Act of 1965 (42
U.S.C.A. Sec. 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.A. Sec. 701 et seq.), the Native Hawaiian Health
Care Act of 1988, 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.
[(21)] (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
people 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.
[(22)] (30) Despite [such services,] 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 [are]
remain severe and [the] their health status [of Native
Hawaiians] continues to be far below that of the
general population of the United States.
(b) Unmet Needs and Health Disparities.--Congress finds
that the unmet needs and serious health disparities that
adversely affect the Native Hawaiian people include the
following:
(1) Chronic disease and illness.--
(A) Cancer.--
(i) In general.--With respect to all
cancer--
(I) Native Hawaiians have the
highest cancer mortality rates
in the State of Hawaii (231.0
out of every 100,000
residents), 45 percent higher
than that for the total State
population (159.7 out of every
100,000 residents);
(II) Native Hawaiian males
have the highest cancer
mortality rates in the State of
Hawaii for cancers of the lung,
liver and pancreas and for all
cancers combined;
(III) Native Hawaiian females
ranked highest in the State of
Hawaii for cancers of the lung,
liver, pancreas, breast, cervix
uteri, corpus uteri, stomach,
and rectum, and for all cancers
combined;
(IV) Native Hawaiian males
have the highest years of
productive life lost from
cancer in the State of Hawaii
with 8.7 years compared to 6.4
years for other males; and
(V) Native Hawaiian females
have 8.2 years of productive
life lost from cancer in the
State of Hawaii as compared to
6.4 years for other females in
the State of Hawaii;
(ii) Breast cancer.--With respect to
breast cancer--
(I) Native Hawaiians have the
highest mortality rates in the
State of Hawaii from breast
cancer (37.96 out of every
100,000 residents), which is 25
percent higher than that for
Caucasian Americans (30.25 out
of every 100,000 residents) and
106 percent higher than that
for Chinese Americans (18.39
out of every 100,000
residents); and
(II) nationally, Native
Hawaiians have the third
highest mortality rates due to
breast cancer (25.0 out of
every 100,000 residents)
following African Americans
(31.4 out of every 100,000
residents) and Caucasian
Americans (27.0 out of every
100,000 residents).
(iii) Cancer of the cervix.--Native
Hawaiians have the highest mortality
rates from cancer of the cervix in the
State of Hawaii (3.82 out of every
100,000 residents) followed by Filipino
Americans (3.33 out of every 100,000
residents) and Caucasian Americans
(2.61 out of every 100,000 residents).
(iv) Lung cancer.--Native Hawaiians
have the highest mortality rates from
lung cancer in the State of Hawaii
(90.70 out of every 100,000 residents),
which is 61 percent higher than
Caucasian Americans, who rank second
and 161 percent higher than Japanese
Americans, who rank third.
(v) Prostate cancer.--Native Hawaiian
males have the second highest mortality
rates due to prostate cancer in the
State of Hawaii (25.86 out of every
100,000 residents) with Caucasian
Americans having the highest mortality
rate from prostate cancer (30.55 out of
every 100,000 residents).
(B) Diabetes.--With respect to diabetes, for
the years 1989 through 1991--
(i) Native Hawaiians had the highest
mortality rate due to diabetes mellitis
(34.7 out of every 100,000 residents)
in the State of Hawaii which is 130
percent higher than the statewide rate
for all other races (15.1 out of every
100,000 residents);
(ii) full-blood Hawaiians had a
mortality rate of 93.3 out of every
100,000 residents, which is 518 percent
higher than the rate for the statewide
population of all other races; and
(iii) Native Hawaiians who are less
than full-blood had a mortality rate of
27.1 out of every 100,000 residents,
which is 79 percent higher than the
rate for the statewide population of
all other races.
(C) Asthma.--With respect to asthma--
(i) in 1990, Native Hawaiians
comprised 44 percent of all asthma
cases in the State of Hawaii for those
18 years of age and younger, and 35
percent of all asthma cases reported;
and
(ii) in 1992, the Native Hawaiian
rate for asthma was 81.7 out of every
1000 residents, which was 73 percent
higher than the rate for the total
statewide population of 47.3 out of
every 1000 residents.
(D) Circulatory diseases.--
(i) Heart disease.--With respect to
heart disease--
(I) the death rate for Native
Hawaiians from heart disease
(333.4 out of every 100,000
residents) is 66 percent higher
than for the entire State of
Hawaii (201.1 out of every
100,000 residents); and
(II) Native Hawaiian males
have the greatest years of
productive life lost in the
State of Hawaii where Native
Hawaiian males lose an average
of 15.5 years and Native
Hawaiian females lose an
average of 8.2 years due to
heart disease, as compared to
7.5 years for all males in the
State of Hawaii and 6.4 years
for all females.
(ii) Hypertension.--The death rate
for Native Hawaiians from hypertension
(3.5 out 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 every1000,000 residents) is 13
percent higher than that for the entire State (51.8 out of every
100,000 residents).
(2) Infectious disease and illness.--The incidence of
AIDS for Native Hawaiians is at least twice as high per
100,000 residents (10.5 percent) than that for any
other non-Caucasian group in the State of Hawaii.
(3) Accidents.--With respect to accidents--
(A) the death rate for Native Hawaiians from
accidents (38.8 out of every 100,000 residents)
is 45 percent higher than that for the entire
State (26.8 out of every 100,000 residents);
(B) Native Hawaiian males lose an average of
14 years of productive life lost from accidents
as compared to 9.8 years for all other males in
Hawaii; and
(C) Native Hawaiian females lose an average
of 4 years of productive life lost from
accidents but this rate is the highest rate
among all females in the State of Hawaii.
(4) Dental health.--With respect to dental health--
(A) Native Hawaiian children exhibit among
the highest rates of dental caries in the
nation, and the highest in the State of Hawaii
as compared to the 5 other major ethnic groups
in the State;
(B) the average number of decayed or filled
primary teeth for Native Hawaiian children ages
5 through 9 years was 4.3 as compared with 3.7
for the entire State of Hawaii and 1.9 for the
United States; and
(C) the proportion of Native Hawaiian
children ages 5 through 12 years with unmet
treatment needs (defined as having active
dental caries requiring treatment) is 40
percent as compared with 33 percent for all
other races in the State of Hawaii.
(5) Life expectancy.--With respect to life
expectancy--
(A) Native Hawaiians have the lowest life
expectancy of all population groups in the
State of Hawaii;
(B) between 1910 and 1980, the life
expectancy of Native Hawaiians from birth has
ranged from 5 to 10 years less than that of the
overall State population average; and
(C) the most recent tables for 1990 show
Native Hawaiian life expectancy at birth (74.27
years) to be about 5 years less than that of
the total State population (78.85 years).
(6) Maternal and child health.--
(A) Prenatal care.--With respect to prenatal
care--
(i) as of 1996, Native Hawaiian
women have the highest prevalence (21
percent) of having had no prenatal care
during their first trimester of
pregnancy when compared to the 5
largest ethnic groups in the State of
Hawaii;
(ii) of the mothers in the State of
Hawaii who received no prenatal care
throughout their pregnancy in 1996, 44
percent were Native Hawaiian;
(iii) over 65 percent of the
referrals to Healthy Start in fiscal
years 1996 and 1997 were Native
Hawaiian newborns; and
(iv) in every region of the State of
Hawaii, many Native Hawaiian newborns
begin life in a potentially hazardous
circumstance, far higher than any other
racial group.
(B) Births.--With respect to births--
(i) in 1996, 45 percent of the live
births to Native Hawaiian mothers were
infants born to single mothers which
statistics indicate put infants at
higher risk of low birth weight and
infant mortality;
(ii) in 1996, of the births to
Native Hawaiian single mothers, 8
percent were low birth weight (under
2500 grams); and
(iii) of all low birth weight babies
born to single mothers in the State of
Hawaii, 44 percent were Native
Hawaiian.
(C) Teen pregnancies.--With respect to
births--
(i) in 1993 and 1994, Native
Hawaiians had the highest percentage of
teen (individuals 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
smoking by Native Hawaiians was 28.5
percent, a rate that is 53 percent
higher than that for all others races
in the State of Hawaii which is 18.6
percent;
(iii) Native Hawaiians have the
highest prevalence rates of acute
drinking (31 percent), a rate that is
79 percent higher than that for all
other races in the State of Hawaii;
(iv) the chronic drinking rate among
Native Hawaiians is 54 percent higher
than that for all other races in the
State of Hawaii;
(v) in 1991, 40 percent of the Native
Hawaiian adults surveyed reported
having used marijuana compared with 30
percent for all other races in the
State of Hawaii; and
(vi) nine percent of the Native
Hawaiian adults surveyed reported that
they are current users (within the past
year) of marijuana, compared with 6
percent for all other races in the
State of Hawaii.
(B) Crime.--With respect to crime--
(i) in 1996, of the 5,944 arrests
that were made for property crimes in
the State of Hawaii, arrests of Native
Hawaiians comprised 20 percent of that
total;
(ii) Native Hawaiian juveniles
comprised a third of all juvenile
arrests in 1996;
(iii) In 1996, Native Hawaiians
represented 21 percent of the 8,000
adults arrested for violent crimes in
the State of Hawaii, and 38 percent of
the 4,066 juvenile arrests;
(iv) Native Hawaiians are over-
represented in the prison population in
Hawaii;
(v) in 1995 and 1996 Native Hawaiians
comprised 36.5 percent of the sentenced
felon prison population in Hawaii, as
compared to 20.5 percent for Caucasian
Americans, 3.7 percent for Japanese
Americans, and 6 percent for Chinese
Americans;
(vi) in 1995 and 1996 Native
Hawaiians made up 45.4 percent of the
technical violator population, and at
the Hawaii Youth Correctional Facility,
Native Hawaiians constituted 51.6
percent of all detainees in fiscal year
1997; and
(vii) based on anecdotal information
from inmates at the Halawa Correction
Facilities, Native Hawaiians are
estimated to comprise between 60 and 70
percent of all inmates.
(8) Health professions education and training.--With
respect to health professions education and training--
(A) Native Hawaiians age 25 years and older
have a comparable rate of high school
completion, however, the rates of baccalaureate
degree achievement amongst Native Hawaiians are
less than the norm in the State of Hawaii (6.9
percent and 15.76 percent respectively).
(B) Native Hawaiian physicians make up 4
percent of the total physician workforce in the
State of Hawaii; and
(C) in fiscal year 1997, Native Hawaiians
comprised 8 percent of those individuals who
earned Bachelor's Degrees, 14 percent of those
individuals who earned professional diplomas, 6
percent of those individuals who earned
Master's Degrees, and less than 1 percent of
individuals who earned doctoral degrees at the
University of Hawaii.
Sec. 11702. Declaration of National Native Hawaiian Health P[p]olicy
(a) Congress.--The Congress hereby declares that it is the
policy of the United States in fulfillment of its special
responsibilities and legal obligations to the indigenous people
of Hawaii resulting from the unique and historical relationship
between the United States and the [Government of 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--[the nation meet the following health objectives with
respect to Native Hawaiians by the year 2000:]
(1) [Reduce coronary heart disease deaths to no more
than 100 per 100,000.] 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
(2) [Reduce stroke deaths to no more than 20 per
100,000.] 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.
[(3) Increase control of high blood pressure to at
least 50 percent of people with high blood pressure.
[(4) Reduce blood cholesterol to an average of no
more than 200 mg/dl.
[(5) Slow the rise in lung cancer deaths to achieve a
rate of no more than 42 per 100,000.
[(6) Reduce breast cancer deaths to no more than 20.6
per 100,000 women.
[(7) Increase Pap tests every 1 to 3 years to at
least 85 percent of women age 18 and older.
[(8) Increase fecal occult blood testing every 1 to 2
years to at least 50 percent of people age 50 and
older.
[(9) Reduce diabetes-related deaths to no more than
34 per 100,000.
[(10) Reduce the most severe complications of
diabetes as follows:
[(A) end-stage renal disease to no more than
1.4 in 1,000;
[(B) blindness to no more than 1.4 in 1,000;
[(C) lower extremity amputation to no more
than 4.9 in 1,000;
[(D) perinatal mortality to no more than 2
percent; and
[(E) major congenital malformations to no
more than 4 percent.
[(11) Reduce infant mortality to no more than 7
deaths per 1,000 live births.
[(12) Reduce low birth weight to no more than 5
percent of live births.
[(13) Increase first trimester prenatal care to at
least 90 percent of live births.
[(14) Reduce teenage pregnancies to no more than 50
per 1,000 girls age 17 and younger.
[(15) Reduce unintended pregnancies to no more than
30 percent of pregnancies.
[(16) Increase to at least 60 percent the proportion
of primary care providers who provide age-appropriate
preconception care and counseling.
[(17) Increase years of healthy life to at least 65
years.
[(18) Eliminate financial barriers to clinical
preventive services.
[(19) Increase childhood immunization levels to at
least 90 percent of 2-year- olds.
[(20) Reduce the prevalence of dental caries to no
more than 35 percent of children by age 8.
[(21) Reduce untreated dental caries so that the
proportion of children with untreated caries (in
permanent or primary teeth) is no more than 20 percent
among children age 6 through 8 and no more than 15
percent among adolescents age 15.
[(22) Reduce edentulism to no more than 20 percent in
people age 65 and older.
[(23) Increase moderate daily physical activity to at
least 30 percent of the population.
[(24) Reduce sedentary lifestyles to no more than 15
percent of the population.
[(25) Reduce overweight to a prevalence of no more
than 20 percent of the population.
[(26) Reduce dietary fat intake to an average of 30
percent of calories or less.
[(27) Increase to at least 75 percent the proportion
of primary care providers who provide nutrition
assessment and counseling or referral to qualified
nutritionists or dieticians.
[(28) Reduce cigarette smoking prevalence to no more
than 15 percent of adults.
[(29) Reduce initiation of smoking to no more than 15
percent by age 20.
[(30) Reduce alcohol-related motor vehicle crash
deaths to no more than 8.5 per 100,000 adjusted for
age.
[(31) Reduce alcohol use by school children age 12 to
17 to less than 13 percent.
[(32) Reduce marijuana use by youth age 18 to 25 to
less than 8 percent.
[(33) Reduce cocaine use by youth aged 18 to 25 to
less than 3 percent.
[(34) Confine HIV infection to no more than 800 per
100,000.
[(35) Reduce gonorrhea infections to no more than 225
per 100,000.
[(36) Reduce syphilis infections to no more than 10
per 100,000.
[(37) Reduce significant hearing impairment to a
prevalance of no more than 82 per 1,000.
[(38) Reduce acute middle ear infections among
children age 4 and younger, as measured by days of
restricted activity or school absenteeism, to no more
than 105 days per 100 children.
[(39) Reduce indigenous cases of vaccine-preventable
diseases as follows:
[(A) Diphtheria among individuals age 25 and
younger to 0;
[(B) Tetanus among individuals age 25 and
younger to 0;
[(C) Polio (wild-type virus) to 0;
[(D) Measles to 0;
[(E) Rubella to 0;
[(F) Congenital Rubella Syndrome to 0;
[(G) Mumps to 500; and
[(H) Pertussis to 1,000; and
[40) Reduce significant visual impairment to a
prevalence of no more other than 30 per 1,000.]
(c) Report.--The Secretary shall submit to the President,
for inclusion in each report required to be transmitted to the
Congress under section [11710 of this title] 12, a report on
the progress made in each area toward meeting [each of the
objectives described in subsection (b) of this section.] the
National policy as set forth in this section.
Sec. 11703. 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[. The master plan
shall be based upon an assessment of the health care
status and health care needs of Native Hawaiians. To
the extent practicable, assessments made as of the date
of such grant or contract shall be used by Papa Ola
Lokahi, except that any such assessment shall be
updated as appropriate.] 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) [of this section].
Sec. 11704. Functions of Papa Ola Lokahi
(a) Responsibility.--Papa Ola Lokahi shall be responsible
for the--
(1) coordination, implementation, and updating, as
appropriate, of the comprehensive health care master
plan developed pursuant to section [11703 of this
title] 5;
(2) training for the persons described in [section
11705(c)(1)(B) of this title] subparagraphs (B) and (C)
of section 7(c)(1);
(3) identification of and research into the diseases
that are most prevalent among Native Hawaiians,
including behavioral, biomedical, epidemiological, and
health services; and
(4) 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
[(4)] (5) the [development] 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 [chapter] Act.
(b) Special Project Funds.--Papa Ola Lokahi [is authorized
to] 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:
[(1)] (A) the collection and maintenance of
data associated with the health status of
Native Hawaiians;
[(2)] (B) the identification and research
into diseases affecting Native Hawaiians;
[(3)] (C) the availability of Native Hawaiian
project funds, research projects and
publications;
[(4)] (D) the collaboration of research in
the area of Native Hawaiian health; and
[(5)] (E) the timely dissemination of
information pertinent to the Native Hawaiian
health care systems.
[(d) Coordination of Programs and Services.]
(2) Consultation.--The Secretary shall provide Papa
Ola Lokahi and the Office of Hawaiian Affairs at least
one 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 the 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
administration 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 shall act as a
statewide infrastructure to provide technical support and
coordination of training and technical assistance to the Native
Hawaiian health care systems.
(f) Relations With Other Agencies.--
(1) Authority.--Papa Ola Lokahi is authorized to
enter into agreements or memoranda ofunderstanding with
relevant institions, 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.--Federally
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 service 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) The Office of Hawaiians 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 titles XVIII,
XIX, or XII of the Social
Security Act for the payment of
all or 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) Such arrangements 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
(II) other matters that would
enable Native Hawaiians to
maximize health insurance
benefits provided by Federal
and State health insurance
programs.
* * * * * * *
(4) Traditional healers.--The provision of health
services under any program operated by the Departmental
of another Federal agency including 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 Pubic Law 94-437. Such services shall
be exempt from national accreditation reviews,
including reviews conducted by the Joint Accreditation
Commission on Health Organizations and the
Rehabilitation Accreditation Commission.
Sec. 11705. Native Hawaiian health care [systems]
(a) Comprehensive Health Promotion, Disease Prevention, and
Primary Health Services.--
(1)[(A)] Grants and contracts.--The Secretary, in
consultation with Papa Ola Lokahi, may make grants to,
or enter into contract 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.
[(B)] (2) Preference.--In making grants and entering
into contracts under this [paragraph] 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.--Any entity is a qualified
entity for purposes of paragraph (1) if the entity is a
Native Hawaiian health care system.
(4) Limitation on number of entities.--The Secretary
may make a grant to, or enter into a contract with, not
more than 8 Native Hawaiian care systems under this
subsection during any fiscal year.
(b) Planning Grant or Contract.--[(2) In addition to
paragraph (1)] 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.
[(b) Qualified Entity.--An entity is a qualified entity for
purposes of subsection (a)(1) of this section if the entity is
a Native Hawaiian health care system.]
(c) Services to be Provided.--
(1) In general.--Each recipient of funds under
subsection (a)[(1)] of this section shall [provide the
following services:] 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,
counsels, and cultural educations;
(C) services of physicians, physicians'
assistants, nurse practitioners or other health
professionals;
(D) immunizations;
(E) prevention and control of diabetes, high
blood pressure, and otitis media;
(F) pregnancy and infant care; and
(G) improvement of nutrition.
[(2) In addition to the mandatory services under
paragraph (1), the following services may be provided
pursuant to subsection (a)(1) of this section:]
[(A)] (H) identification, treatment, control,
and reduction of the incidence of preventable
illnesses and conditions endemic to Native
Hawaiians;
[(B)] (I) collection of data related to the
prevention of diseases and illnesses among
Native Hawaiians; [and]
[(C)] (J) services within the meaning of the
terms ``health promotion'', ``disease
prevention'', and ``primary health services'',
as such terms are defined in section [11711] 3
of this title, which are not specifically
referred to in [paragraph (1) of this]
subsection (a)[.]; and
(K) support of culturally appropriate
activities enhancing health and wellness
including land-based, water-based; ocean-based,
and spiritually-based projects and programs.
[(3)] (2) Traditional healers.--The health care
services referred to in paragraphs (1) and (2) which
are provided under grants or contracts under subsection
(a)[(1)] of this section may be provided by traditional
Native Hawaiian healers.
[(d) Limitation of Number of Entities.--]
(d) Federal Tort Claims Act.--Individuals that provide
medical, dental, or other services referred to in subsection
(a)(1) for Native Hawaiian health care systems, including
providers of traditional Native Hawaiian healing services,
shall be treated as if such individuals were members of the
Public Health Service and shall be covered under the provisions
of section 224 of the Public Health Service Act.
(e) Site for Other Federal Payments.--A Native Hawaiian
health care system that receives funds under subsection (a)
shall provide a designated area and appropriate staff to serve
as a Federal loan repayment facility. Such facility shall be
designed to enable health and allied-health professionals to
remit payments with respect to loans provided to such
professionals under any Federal loan program.
[During a fiscal year, the Secretary under this chapter may
make a grant to, or hold a contract with, not more than 5
Native Hawaiian health care systems.]
[(e) Matching Funds.--]
[(1) The Secretary may not make a grant or provide
funds pursuant to a contract under subsection (a)(1) of
this section to a Native Hawaiian health care system--
[(A) in an amount exceeding 83.3 percent of
the costs of providing health services under
the grant or contract; and
[(B) unless the Native Hawaiian health care
system agrees that the Native Hawaiian health
care system or the State of Hawaii will make
available, directly or through donations to the
Native Hawaiian health care system, non-Federal
contributions toward such costs in an amount
equal to not less than $1 (in cash or in kind
under paragraph (2) for each $5 of Federal
funds provided in such grant or contract.
[(2) Non-Federal contributions required in paragraph
(1) may be in cash or in kind, fairly evaluated,
including plant, equipment, or services. Amounts
provided by the Federal Government or services assisted
or subsidized to any significant extent by the Federal
Government may not be included in determining the
amount of such non-Federal contributions.
[(3) The Secretary may waive the requirement
established in paragraph (1) if--
[(A) the Native Hawaiian health care system
involved is a nonprofit private entity
described in subsection (b) of this section;
and
[(B) the Secretary, in consultation with Papa
Ola Kokahi, determines that it is not feasible
for the Native Hawaiian health care system to
comply with such requirement.]
(f) Restriction on Use of Grant and Contract Funds.--The
Secretary may not make a grant to, or enter into a contract
with, any entity under subsection 9a)(1) of this section unless
the entity agrees that, amounts received pursuant to such
subsection will not, directly or through contract, be
expended--
(1) for any purpose other than the purposes described
in subsection (c) [of this section] (1);
[(2) to provide inpatient services;
[(3) to make cash payments to intended recipients of
health services; or]
[(4)] (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, or enter into a contract with, any entity
under subsection (a)[(1) of the section] 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 Appropriation.--
(1) General grants.--There are authorized to be
appropriated such sums as may be necessary for fiscal
years [1993] 2001 through [2001] 2011 to carry out
subsection [(a)(1) of this section] (b).
(2) Planning grants.--There [are] is authorized to be
appropriate such sums as may be necessary for each of
fiscal years 2001 through 2011 to carry out subsection
[(a)(2) of this section] (b).
Sec. 11706. Administrative grant for Papa Ola Kokahi
(a) In General.--In addition to any other grant or contract
under this [chapter] 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 [11703 of this
title];
(2) training for the persons described in section
[11705(c)(1)(B) of this title] 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) the [development] 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 [chapter] Act;
(5) a clearinghouse function for--
(A) the collection and maintenance of date
associated with the health status of Native
Hawaiians;
(B) the identification and research into
diseases affecting Native Hawaiians; and
(C) the availability of Native Hawaiian
project funds, research projects and
publications;
(6) [the coordination of the health care programs and
services provided to Native Hawaiians] the
establishment and maintenance of an institutional
review board for all health-related research involving
Native Hawaiians;
(7) [the administration of special project funds.]
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 are authorized
to be appropriated such sums as may be necessary for fiscal
years [1993] 2001 through [2001] 2011 to carry out subsection
(a) [of this section].
Sec. 11707. Administration of grants and contracts
(a) Terms and Conditions.--The Secretary shall include in
any grant made or contract entered into under this [chapter]
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 [chapter] Act.
(c) Administrative Requirements.--The Secretary may not
make a grant or enter into a contract under this [chapter] 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 one individual,
fluent in both English and the appropriate
language, to assist in carrying out the plan;
(4) with respect to health services that are covered
[in the plan of the State of Hawaii approved] under
programs under titles XVIII, XIX, or XXI of the Social
Security Act, including any State plan, or under any
other Federally health insurance plan--[42 U.S.C.A.
Sec. 1396 et seq.--]
(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 [utilization
and] 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) Contrary 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 [11705 of this title] 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. [If the Secretary
determines that such noncompliance or unsatisfactory
performance cannot be resolved and prevented in the
future, the Secretary shall not renew such contract
with such entity and is authorized to enter into a
contract under section 11705 of this title with another
entity referred to in section 11705(b) of this title
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 subsection].
(2) Nonrenewal.--If the Secretary determines that the
noncompliance or unsatisfactory performance described
in paragraph (1) with respect to an entity cannot be
resolved and prevented in the future, the Secretary
shall not renew the contract with such entity and may
enter into a contract under section 7 with another
entity referred to in subsection (a)(3) of such section
that provides services to the same population of Native
Hawaiians which is served by the entity whose contract
is not renewed by reason of this paragraph.
[(2)] (3) Consideration of results._In determining
whether to renew a contract entered into with an entity
under this [chapter] Act, the Secretary shall consider
the results of the evaluation under this section.
[(3)] (4) Application of federal laws._All contracts
entered into by the Secretary under this [chapter] 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.).
[(4)] (5) Payments made under any contract entered
into under this [chapter] 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 [chapter]
Act.
(e) [Limitations on Use of Funds for Administrative
Expenses] Report._
[Except for grants and contracts under section 11706 of
this title, the Secretary may not grant to, or enter into a
contract with, an entity under this chapter unless the entity
agrees that the entity will not expend more than 10 percent of
amounts received pursuant to this chapter for the purpose of
administering the grant or contract.]
[(f) Report.--]
(1) For each fiscal year during which an entity
receives or expends funds pursuant to a grant or
contract under this [chapter] Act, such entity shall
submit to the Secretary and to Papa Ola Lokahi a
[quarterly] annual report on--
(A) activities conducted by the entity under
the grant or contract;
(B) the amounts and purposes for which
Federal funds were expended; and
(C) containing such other information as the
Secretary may request.
(2) The reports and records of any entity which
concern any grant or contract under this chapter shall
be subject to audit by the Secretary, the Inspector
General of the Department of Health and Human Services,
and the Comptroller General of the United States.
(g) Annual Private Audit.--The Secretary shall allow as a
cost of any grant made or contract entered into under this
chapter the cost of an annual private audit conducted by a
certified public accountant.
Sec. 11708. Assignment of personnel
(a) In General.--The Secretary is authorized to enter into
an agreement with any entity under which the Secretary is
authorized to 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 the authority of subsection (a) of
this section 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. 11709. Native Hawaiian health scholarships and fellowships
(a) Eligibility.--Subject to the availability of [funds]
amounts appropriated under the authority of subsection (c) [of
this section,] the Secretary shall provide funds through a
direct grant or a cooperative agreement to Kamehameha Schools[/
Bishop Estate] or another Native Hawaiian organization or
health care organization with experience in the administration
of educational scholarships or placement services for the
purpose of providing scholarship assistance to students who--
(1) meet the requirements of section [254l of this
title,] 338A of the Public Health Service Act, except
for assistance as provided for under subsection (b)(2);
and
(2) are Native Hawaiians.
(b) A priority for scholarships may be provided to
employees of the Native Hawaiian Health Care Systems and the
Native Hawaiian Health Centers.
[(b)] (c) Terms and Conditions.--
(1) In general.--The scholarship assistance provided
under subsection (a) [of this section] shall be
provided under the same terms and subject to the same
conditions, regulations, and rules [that] as apply to
scholarship assistance provided under section [254l of
this title, provided that--] 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 [identified in the Native
Hawaiian comprehensive health care master plan
implemented under section 11703 of this title]
to serve the [Native Hawaiian health care
systems] Native Hawaiian Community as
identified by Papa Ola Lokahi;
[(B) the primary health services covered
under the scholarship assistance program under
this section shall be the services included
under the definition of that term under section
11711(8) of this title;]
[(C)] (B) to the maximum extent practicable,
the Secretary shall select scholarship
recipients from a list of eligible applicants
submitted by the Kamehameha Schools[/Bishop Estate] or the Native
Hawaiian organization administering the program;
[(D)] (C) the obligated service requirement
for each scholarship recipient (except for
those receiving assistance under paragraph (2))
shall be fulfilled through [the full-time
clinical or nonclinical practice of the health
profession of the scholarship recipient, in an
order of priority that would provide for
practice--] service, in order of priority, in--
(i) [first,] in any one of the [five]
Native Hawaiian health care systems;
and
(ii) [second, in--] a health
professional shortage area or medically
underserved areas, or geographic areas
or facilities similarly designated by
the United States Public Health Service
in the State of Hawaii; or
[(I) a health professional
shortage area or medically
underserved area located in the
State of Hawaii; or]
[(II)] (iii) a geographic area or
facility [that is--], or organization
that serves a significant Native
Hawaiian population;
(D) the scholarship's placement services
shall assign scholarship recipients to
appropriate sites for service.
[(aa) located in the State of Hawaii;
and]
[(bb) has a designation that is
similar to a designation described in
subclause (I) made by the Secretary,
acting through the Public Health
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) [the obligated service of a scholarship
recipient shall not be performed by the
recipient through membership in the National
Health Service Corps; and] 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 of this
Act shall be deemed ``Qualified Scholarships'' for
purposes of 26 U.S.C. section 117.
[(G) the requirements of sections 254d
through 254k of this title, section 254m of
this title, other than subsection (b)(5) of
that section, and section 254n of this title
applicable to scholarship assistance provided
under subsection (a) of this section.
[(2) The Native Hawaiian Health Scholarship program
shall not be administered by or through the Indian
Health Service.
[(c)] (d) Authorization of Appropriations.--There are
authorized to be appropriated such sums as may be necessary for
fiscal years [1993] 2001 through [2001] 2011 for the purpose of
funding the scholarship assistance provided under subsection
(a) [of this section] and fellowship assistance under
subsection (c)(2).
Sec. 11710. Report
The President shall, at the time the budget is submitted
under section 1105 of Title 31, for each fiscal year transmit
to the Congress a report on the progress made in meeting the
objectives of this chapter, including a review of programs
established or assisted pursuant to this chapter 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 receivecontracts or granst 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 of 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
Excellent 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
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 Heath 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; and
(iii) two members shall be from the
Senate and shall be appointed by the
Majority Leader;
(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
Lakahi;
(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
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 Commissions 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 ofsubsistence 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, 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 for 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
Committee 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 of 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.
Sec. 11711. Definitions
For purposes of this chapter:
(1) Department.--The term ``department'' means the
Department of Health and Human Services.
[(1)] (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 diabetes,
(E) control of toxic agents,
(F) occupational safety and health,
(G) accident prevention,
(H) fluoridation of water,
(I) control of infectious agents, and
(J) provision of mental health care.
[(2)] (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, [and]
(G) control of stress[.],
(H) reduction of major behavioral risk
factors and promotion of health 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).
[(3)] (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) [a citizen of the United States, and]
genealogical records,
(B) [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--] Kama'
aina witness verification from Native Hawaiian
Kupuna (elders); or
[(i) genealogical records,
[(ii) Kupuna (elders) or Kama'aina
(long-term community residents)
verification, or
[(iii)] (C) birth records of the State of
Hawaii or any State or territory of the United
States.
[(4)] (5) Native hawaiian health [center] care
system.--The term ``Native Hawaiian health [center]
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, and
(D) in which Native Hawaiian health
practitioners significantly participate in the
planning, management, monitoring, and
evaluation of the 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 capacity
to provide the services, and meet the
requirements, under the contract the
organization enters into with, or grant
the organization receives from, the
Secretary pursuant to this Act.
[(5)] (6) [Native hawaiian organization] Native
hawaiian health center.--The term ``Native Hawaiian
[organization''] Health Center'' means any organization
that is a primary care provider and that--
(A) [which serves the interests of Native
Hawaiians,] has a governing board that is
composed of individuals, at least 50 percent of
whom are Native Hawaiians;
(B) [which is--] has demonstrated cultural
competency in a predominately Native Hawaiian
community;
(C) services a patient population that--
(i) [recognized by Papa Ola Lokahi
for the purpose of planning,
conducting, or administering programs
(or portions of programs) authorized
under this chapter for the benefit of
Native Hawaiians, and] is made up of
individuals at least 50 percent of whom
are Native Hawaiian; or
(ii) [certified by Papa Ola Lokahi as
having the qualifications and capacity
to provide the services, and meet the
requirements, under the contract the
organization enters into with, or grant
the organization receives from, the
Secretary under this chapter,] has not
less that 2,500 Native Hawaiians as
annual users of services; and
[(C) in which Native Hawaiian health
practitioners significantly participate in the
planning, management, monitoring, and
evaluation of health services, and]
(D) [which is a public or nonprofit private
entity.] is recognized by Papa Ola Lokahi has
having met all the criteria of this paragraph.
[(6)] (7) Native hawaiian health [care system] task
force.--The term ``Native Hawaiian health [care system]
Task Force'' means [an entity--] a task force
established by the State Council of Hawaiian Homestead
Associations to implement health and wellness
strategies in Native Hawaiian communities.
[(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 Native
Hawaiian health centers 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
chapter.]
[(7)] (8) [Papa ola lokahi.--] Native hawaiian
organization._The term ``Native Hawaiian organization''
means any organization--
(A) [The term ``Papa Ola Lokahi'' means an
organization composed of--] which serves the
interests of Native Hawaiians; and
[(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 Office of Hawaiian Health of
the Hawaii State Department of Health;
[(vi) Ho'ola Lahui Hawaii, or a
health care system serving the islands
of Kaua'i and 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;
[(vii) 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;
[(viii) Na Pu'uwai or a health care
system serving the islands of Moloka'i
and 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;
[(ix) 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;
[(x) Hui Malama Ola Ha'Oiwi or a
health care system serving the island
of Hawaii, and which may be composed of
as many health care centers as are
necessary to meet the health care needs
of the Native Hawaiians of that island;
and
[(xi) such other member organizations
as the Board of Papa Ola Lokahi may
admit from time to time, based upon
satisfactory demonstration of a record
of contribution to the health and well-
being of Native Hawaiians, and upon
satisfactory development of a mission
statement in relation to this chapter,
including clearly defined goals and
objectives, a 5-year action plan
outlining the contributions that each
organization will make in carrying out
the policy of this chapter, and an
estimated budget.]
(B) [Such term does not include any such
organization identified in subparagraph (A) if
the Secretary determines that such organization
has not developed a mission statement with
clearly defined goals and objectives for the
contributions the organization will make to the
Native Hawaiian health care systems, and an
action plan for carrying out those goals and
objectives.] 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 non profit private
entity.
[(8)] (9) [Primary health services] 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.
[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
children's eye and ear examinations to
determine the need for vision and hearing
correction, perinatal services, well child
services, and family planning services);
[(D) emergency medical services;
[(E) transportation services as required for
adequate patient care;
[(F) preventive dental services; and
[(G) pharmaceutical service, as may be
appropriate for particular health centers.]
[(9)] (10) [Secretary] Papa ola lokahi.--[The term
``Secretary'' means the Secretary of Health and Human
Services.]
(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.
[(10)] (11) [Traditional native hawaiian healer--]
Primary health services.--The term ``primary health
services'' means--[The term ``traditional Native
Hawaiian healer'' means a practitioner--]
(A) [who--] services of physicians,
physicians' assistants, nurse practitioners,
and other health professionals;
[(i) is of 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--]
diagnostic laboratory and radiologic services;
[(i) direct practical association
with Native Hawaiian elders, and
[(ii) oral traditions transmitted
from generation to generation.]
(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. 11712. Rule of construction
Nothing in this chapter shall be construed to restrict the
authority of the State of Hawaii to license health
practitioners.
Sec. 11713. Compliance with Budget Act
Any new spending authority (described in [subsection
(c)(2)] subparagraph (A) [or] of (B) of section [651] 401(c)(2)
of [Title 2)] the Congressional Budget Act of 1974 (2 U.C. C.
651 (c)(2) (A) or (B))) which is provided under this [chapter]
Act shall be effective for any fiscal year only to such extent
or in such amounts as are provided in appropriation Acts.
Sec. 11714. Severability
If any provision of this chapter, or the application of any
such provision to any person or circumstances is held to be
invalid, the remainder of this chapter, 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.
APPENDIX A.--TABLE OF FEDERAL ACTS AFFECTING NATIVE HAWAIIANS
------------------------------------------------------------------------
Federal act name Session law cite Summary
------------------------------------------------------------------------
Act of June 21, 1910.......... Pub. L. No. 61- Authorizes
266, 36 Stat. appropriations for
703, 718 (1910). the Smithsonian
Institute for
ethnological
research of American
Indians and Native
Hawaiians.
Act of Mar. 4, 1911........... Pub. L. No. 62- Authorizes
525, 36 Stat. appropriations for
1363, 1395 the Smithsonian
(1911). Institute for
ethnological
research of American
Indians and Native
Hawaiians.
Act of Aug. 24, 1912.......... Pub. L. No. 63- Authorizes
302, 37 Stat. appropriations for
417, 436 (1912). the Smithsonian
Institute for
ethnological
research of American
Indians and Native
Hawaiians.
Act of June 23, 1913.......... Pub. L. No. 63-3, Authorizes
38 Stat. 4, 26 appropriations for
(1913). the Smithsonian
Institute for
ethnological
research of American
Indians and Native
Hawaiians.
Act of Aug. 1, 1914........... Pub. L. No. 63- Authorizes
161, 38 Stat. appropriations for
609, 625 (1914). the Smithsonian
Institute for
ethnological
research of American
Indians and Native
Hawaiians.
Act of Mar. 3, 1915........... Pub. L. No. 63- Authorizes
623, 38 Stat. appropriations for
822, 838 (1915). the Smithsonian
Institute for
ethnological
research of American
Indians and Native
Hawaiians.
Act of July 1, 1916........... Pub. L. No. 64- Authorizes
132, 39 Stat. appropriations for
262, 279 (1916). the Smithsonian
Institute for
ethnological
research of American
Indians and Native
Hawaiians.
Act of June 12, 1917.......... Pub. L. No. 65- Authorizes
21, 40 Stat 105, appropriations for
122 (1917). the Smithsonian
Institute for
ethnological
research of American
Indians and Native
Hawaiians.
Act of July 19, 1919.......... Pub. L. No. 66- Authorizes
21, 41 Stat. appropriations for
163, 181 (1919). the Smithsonian
Institute for
ethnological
research of American
Indians and Native
Hawaiians.
Act of July 1, 1918........... Pub. L. No. 65- Authorizes
181, 40 Stat. appropriations for
634, 651 (1918). the Smithsonian
Institute for
ethnological
research of American
Indians and Native
Hawaiians.
Act of June 5, 1920........... Pub. L. No. 66- Authorizes
246, 41 Stat. appropriations for
874, 891 (1920). the Smithsonian
Institute for
ethnological
research of American
Indians and Native
Hawaiians.
Act of Mar. 4 1921............ Pub. L. No. 66- Authorizes
388, 41 Stat. appropriations for
1367, 1383 the Smithsonian
(1921). Institute for
ethnological
research of American
Indians and Native
Hawaiians.
Act of July 9, 1921........... Pub. L. No. 66- Creates a
34, 42 Stat. 108 homesteading program
(1921). for Native
Hawaiians.
Act of June 12, 1922.......... Pub. L. No. 67- Authorizes
240, 42 Stat. appropriations for
635, 643 (1922). the Smithsonian
Institute for
ethnological
research of American
Indians and Native
Hawaiians.
Act of Feb. 3, 1923........... Pub. L. No. 67- Amends Hawaiian Homes
403, 42 Stat. Commission Act by
1221 (1923). increasing dollar
limits for
residential loans
and other
provisions.
Act of Feb. 13, 1923.......... Pub. L. No. 67- Authorizes
409, 42 Stat. appropriations for
1227, 1235 the Smithsonian
(1923). Institute for
ethnological
research of American
Indians and Native
Hawaiians.
Act of June 7, 1924........... Pub. L. No. 68- Authorizes
214, 43 Stat. appropriations for
521, 528 (1924). the Smithsonian
Institute for
ethnological
research of American
Indians and Native
Hawaiians.
Act of Mar. 3, 1925........... Pub. L. No. 68- Authorizes
586, 43 Stat. appropriations for
1198, 1206 the Smithsonian
(1925). Institute for
ethnological
research of American
Indians and Native
Hawaiians.
Act of Apr. 22, 1926.......... Pub. L. No. 69- Authorizes
141, 44 Stat. appropriations for
305, 315 (1926). the Smithsonian
Institute for
ethnological
research of American
Indians and Native
Hawaiians.
Act of Feb. 11, 1927.......... Pub. L. No. 69- Authorizes
600, 44 Stat. appropriations for
1069, 1079 the Smithsonian
91927). Institute for
ethnological
research of American
Indians and Native
Hawaiians.
Act of Mar. 7, 1928........... Pub. L. No. 70- Amends the Hawaiian
105, 45 Stat. Homes Commission Act
246 (1928). by requiring an
annual area disposal
limit and increases
the dollar amount
within the Hawaiian
Home Loan fund.
Act of May 16, 1928........... Pub. L. No. 70- Authorizes
400, 45 Stat. appropriations for
573, 583 (1928). the Smithsonian
Institute for
ethnological
research of American
Indians and Native
Hawaiians, including
excavation and
preservation of
archaeologic
remains.
Act of Feb. 20, 1929.......... Pub. L. No. 70- Authorizes
778, 45 Stat. appropriations for
1230, 1241 the Smithsonian
(1929). Institute for
ethnological
research of American
Indians and Native
Hawaiians.
Act of Apr. 19, 1930.......... Pub. L. No. 71- Authorizes
158, 46 Stat. appropriations for
229, 241 (1930). the Smithsonian
Institute for
ethnological
research of American
Indians and Native
Hawaiians.
Act of July 26, 1935.......... Pub. L. No. 74- Requires three of
223, 49 Stat. five Hawaiian Homes
504 (1935). Commission members
to be at least one-
quarter Native
Hawaiian.
Act of July 10, 1937.......... Pub. L. No. 75- Amends Hawaiian Homes
200, 50 Stat. Commission Act by
497, 503 (1937). establishing age
minimum for lessee
and adding more
lands under the Act.
Act of June 20, 1938.......... Pub. L. No. 75- Authorizes leasing
680, Sec. 3, 52 land within the
Stat. 784, 784- Hawai'i National
85 (1938). Park to Native
Hawaiians and
recognizes limited
Native Hawaiian
fishing rights in
the area.
Act of Nov. 26, 1941.......... Pub. L. No. 77- Amends Hawaiian Homes
325, Sec. 3, 55 Commission Act by
Stat. 782, 782 creating a Home
(1941). Development fund and
allowing investing
of loan fund.
Act of May 31, 1944........... Pub. L. No. 78- Amends Hawaiian Homes
320, 58 Stat. Commission Act by
260, 264 (1944). returning lands
under the
Commissions's
jurisdiction to the
Territory of
Hawai'i.
Act of June 14, 1948.......... Pub. L. No. 80- Amends Hawaiian Homes
638, 62 Stat. Commission Act by
390 (1948). authorizing
churches, hospitals,
schools, theaters,
and the Federal
government to use
the land.
Act of July 9, 1952........... Pub. L. No. 82- Amends Hawaiian Homes
481, 66 Stat. Commission Act by
511, 514 (1952). adding lands to the
Commission's
jurisdiction.
Act of July 9, 1952........... Pub. L. No. 82- Amends Hawaiian Homes
482, 66 Stat. Commission Act by
514 (1952). increasing dollar
amounts in the
Hawaiian Homes Land
Fund and the
Hawaiian Homes
Development Fund.
Act of June 18, 1954.......... Pub. L. No. 83- Amends Hawaiian Homes
417, 68 Stat. Commission Act by
263 (1954). authorizing leases
for irrigated
pastoral lands.
Hawai'i Admission Act, Act of Pub. L. No. 86-3, Admits Hawai'i as a
Mar. 18, 1959. Sec. 5(f), 73 State and
Stat. 4, 6 establishes a public
(1959). trust for the
betterment of the
conditions of Native
Hawaiians, as
defined by the
Hawaiian Homes
Commission Act.
Act of Dec. 23, 1963.......... Pub. L. No. 88- Protects the corpus
233, 77 Stat. of the public lands
472 (1963). trust, whose
intended
beneficiaries are
Native Hawaiians, by
revising procedures
under the Hawai'i
Statehood Act.
Act of July 11, 1972.......... Pub. L. No. 92- Designates Honokohau
346, 86 Stat. as a National
457 (1972). Historical Landmark
and authorizes
preservation of the
site, giving
employment
preference to and
providing training
for Native
Hawaiians.
Native American Programs Act Pub. L. No. 93- Promotes Native
of 1074. 644, Sec. 801, Hawaiian, American
88 Stat. 2291, Indian, and Alaska
2324 (1975). Native Economic and
social self-
sufficiency through
financial assistance
to agencies serving
Native Hawaiians.
Departments of Labor and Pub. L. No. 94- Appropriates funds
Health, Education, and 2006, 90 Stat. 3 for Native American
Welfare Appropriation Act, (1975). programs (includes
1976. Native Hawaiians).
Act of Oct. 17, 1976.......... Pub. L. No. 94- Preserves Kalaupapa
518, Sec. 401- Settlement and
405, 90 Stat. authorizes a
2447, 2447, 2449 preference for
(1976). former patients and
Native Hawaiians to
manage the site.
Act of Aug. 5, 1977........... Pub. L. No. 95- Amends the
93, sec. 303, comprehensive
Sec. 701(a), 91 Employment Training
Stat. 627, 650 Act of 1973 to
(1977). include employment
training programs
for Native
Hawaiians.
Joint Resolution, American Pub. L. No. 95- Recognizes the rights
Indian Religious Freedom. 341, 92 Stat. of American Indians,
469 (1977). Eskimos, Aleuts, and
Native Hawaiians to
practice their
traditional
religions.
Act of Nov. 20, 1979.......... Pub. L. No. 96- Appropriates funds
123, 93 Stat. for Native Hawaiian
923 (1979). health and human
services programs as
allowed under
authorizing
legislation,
including assistance
to research
institutions with
Indian, Alaska
Native, Native
Hawaiian, Hispanic,
and Black students.
Education Amendments of 1980.. Pub. L. No. 96- Creates Advisory
374, Sec. 1331, Council on Native
94 Stat. 1367, Hawaiian Education
1449 (1980). to study the
effectiveness of
State and Federal
education programs
for Native
Hawaiians.
Act of Dec. 22, 1980.......... Pub. L. No. 96- Establishes Kalaupapa
565, Sec. Sec. National Historic
101-110, 94 Park which shall be
Stat. 3321, 3321- administered by
23 (1980). Hansen's Disease
patients and Native
Hawaiians.
Urgent Supplemental Pub. L. No. 97- Appropriates funds
Appropriations Act, 1982. 216, 96 Stat. for nursing research
180 (1982). grants and
encourages that
priority be given to
Native Hawaiians,
other Native
Americans, native
American Pacific
Islanders, and
Hispanics.
Supplemental Appropriations Pub. L. No. 97- Appropriates funds to
Act, 1982. 257, 96 Stat. promote economic and
818 (1982). social self-
sufficiency of
Native Americans,
including Native
Hawaiians; also
appropriates funds
for Native Hawaiian
education and health
programs as allowed
under authorizing
legislation.
Act of July 30, 1983.......... Pub. L. No. 98- Appropriates funds to
63, 97 Stat. 301 address the unique
(1983). health needs of
Native Americans,
including Native
Hawaiians; also
urges the National
Cancer Institute to
give greater
attention to the
Native Hawaiian
population.
Native Hawaiian Study Pub. L. No. 96- Establishes Native
Commission Act. 565, Sec. Sec. Hawaiian Study
301-307, 94 Commission to study
Stat. 3321, 3324- the culture, needs,
27 (1980). and concerns of
Native Hawaiians.
Department of Health and Human Pub. L. No. 98- Appropriates funds to
Services Appropriations Act, 139, 97 Stat. the Administration
1984. 871 (1983). for Native Americans
which promotes
social and economic
self-sufficiency for
Native Americans,
including Native
Hawaiians; also
appropriates funds
to combat alcoholism
among Native
Hawaiians and
declares Native
Hawaiian cancer
research a priority.
Department of Labor Pub. L. No. 98- Appropriates funds
Appropriations Act, 1984. 139, 97 Stat. for vocational
871 (1983). training and other
labor services for
Native Hawaiians and
other Native
Americans.
Department of Education Pub. L. No. 98- Appropriates funds
Appropriation Act, 1984. 139, 97 Stat. for Native Hawaiian
871 (1983). education programs
as allowed under
authorizing
legislation.
Act of Dec. 21, 1982.......... Pub. L. No. 97- Appropriates funds to
377, 96 Stat. address alcohol
1830 (1982). abuse among Native
Hawaiians.
Act of Aug. 22, 1984.......... Pub. L. No. 98- Appropriates funds
396, 99 Stat. for a Native
1369 (1984). Hawaiian health
study and report.
Act of Oct. 12, 1984.......... Pub. L. No. 98- Appropriates funds
473, 99 Stat. for historic
1837 (1984). preservation of
marine resources,
including the
Hawaiian voyaging
canoe Hokule'a.
Department of Health and Human Pub. L. No. 98- Appropriates funds
Services Appropriation Act, 619, 99 Stat. for Native Hawaiian
1985. 3305 (1984). programs to promote
economic and social
self-sufficiency;
also appropriates
funds for parent-
child centers and
for Native Hawaiian
cancer research.
Department of Education Act, Pub. L. No. 98- Appropriates funds
1985. 619, 99 Stat. for Native Hawaiian
3305 (1984). education programs
as allowed under
authorizing
legislation.
Act of Dec. 19, 1985.......... Pub. L. No. 90- Appropriates funds
190, 99 Stat. for education
1185 (1985). assistance to health
profession students
who will serve
geographical
concentrations of
Native Hawaiians and
Indian reservations.
American Indian, Alaska Native Pub. L. No. 99- Authorizes grants to
and Native Hawaiian Culture 498, Sec. Sec. support a program
and Art Development Act. 1501-1503, 1521- for Native Hawaiian
1522, 100 Stat. culture and arts
1268, 1600, 1610- development.
11 (1986).
Anti-Drug Abuse Act of 1986... Pub. L. No. 99- Authorizes the Health
570, Sec. 4134, and Human Services
100 Stat. 3207, Secretary to
3207-134 (1986). contract with
organizations that
provide drug abuse
prevention,
education,
treatment, and
rehabilitation
services to Native
Hawaiians.
Act of July 11, 1987.......... Pub. L. No. 100- Appropriates funds
71, 101 Stat. for the Native
391 (1987). Hawaiian Culture and
Arts Development
Program.
Native American Programs Act Pub. L. No. 100- Establishes Native
Amendments of 1987. 175, sec. 506, Hawaiian Revolving
Sec. 803A, 101 loan fund for Native
Stat. 926, 926- Hawaiian
75 (1987). organizations and
Native Hawaiians to
promote economic
development.
Department of Health and Human Pub. L. No. 100- Appropriates funds
Services Appropriations Act, 202, 101 Stat. for Native Hawaiian
1988. 1329-263 (1987). health programs
under authorizing
legislation.
Jacob K. Javits Gifted and Pub. L. No. 100- Authorizes grants or
Talented Students Education 297, sec. 1001, contracts with
Act of 1988. Sec. Sec. 4101- institutions
4108, 102 Stat. (including Indian
130, 237 (1988). tribes and Native
Hawaiian
organizations) to
carry out programs
or projects designed
to meet the
educational needs of
gifted and talented
students.
Drug-Free Schools and Pub. L. No. 100- Authorizes education
Communities Act of 1986. 297, sec. 1001, grants, cooperative
Sec. Sec. 5112, agreements, or
5134, 102 Stat. contracts with
130, 253, 261 organizations that
(1988). primarily serve and
represent Native
Hawaiians; also
appropriates funds
for drug abuse
education and
preventive programs
for Native
Hawaiians.
Augustus F. Hawkins-Robert T. Pub. L. No. 100- Recognizes the
Stafford Elementary and 297, Sec. Sec. Federal government's
Secondary School Improvement 4001-4009, 102 legal responsibility
Amendments of 1988. Stat. 130, 358 to enforce Hawai'i's
(1988). trust
responsibilities to
Native Hawaiians and
creates new
education programs
targeting a model
curriculum, family
based education
centers, gifted and
talented, and
special education
programs.
Veterans' Benefits and Pub. L. No. 100- Adds Native Hawaiians
Services Act of 1988. 322, Sec. 413, to the Advisory
102 Stat. 487, Committee on Native
487 (1988). American Veterans
which evaluates
programs for Native
American veterans.
Indian Housing Act of 1988.... Pub. L. No. 100- Requires assessment
358, sec. 2, of the housing and
Sec. 204, 102 mortgage needs of
Stat. 676, 679 Native Hawaiians.
(1988).
National Science Foundation Pub. L. No. 100- Reserves percentage
University Infrastructure Act 418, Sec. 6402, of appropriation for
of 1988. 102 Stat. 1107, institutions of
1543 (1988). higher learning that
serve Native
Americans (including
Native Hawaiians)
and specific ethnic
groups.
Department of Health and Human Pub. L. No. 100- Appropriates funds
Service Appropriations Act, 436, 102 Stat. for Native Hawaiian
1989. 1688 (1988). health programs
under authorizing
legislation.
Native Hawaiian Health Care Pub. L. No. 100- Authorizes programs
Act of 1988. 579, 102 Stat. to improve the
2916 (1988); health status of
Pub. L. No. 100- Native Hawaiians;
690, Sec. 2301- authorizes grants or
2312, 102 Stat. contracts with Papa
4181, 4223 Ola Lokahi to
(1988). develop
comprehensive health
care mater plan to
improve Native
Hawaiian health.
Health Professions Pub. L. No. 100- Provides health
Reauthorization Act of 1988. 607, sec. 604, professionals with
Sec. 751,102 incentives to staff
Stat. 3048, 3126 health centers
(1988). serving Native
Hawaiians, Indians,
and rural areas.
Nursing Shortage Reduction and Pub. L. No. 100- Authorizes grants to
Education Extension Act of 607, sec. 714- nursing schools,
1888. 715, Sec. loan repayment
836(h), 102 incentives to
Stat. 3048, 3161 encourage work with
(1988). Native Hawaiians,
Indians, or in rural
areas, and
scholarship grants
to nursing schools
whose students serve
two years at an
Indian Health
Service facility or
a Native Hawaiian
health center.
Handicapped Programs Technical Pub. L. No. 100- Amends the Education
Amendments Act of 1988. 630, sec. 102, of the Handicapped
Sec. 616, 102 Act which provides
Stat. 3289, 3296 handicapped Native
(1988). Hawaiian (and other
native Pacific
basin) children with
a free appropriate
public education.
Business Opportunity Pub. L. No. 100- Amends the Small
Development Reform Act of 656, sec. 207, Business Act by
1988 Small Business. Sec. 8(a), 102 including
Stat. 3853, 3861 economically-
(1988). disadvantaged Native
Hawaiian
organizations as
socially and
economically
disadvantaged small
business concerns.
Comprehensive Alcohol Abuse, Pub. L. No. 100- Amends the Public
Drug Abuse, and Mental Health 690, sec. 2022, Health Service Act
Amendments Act of 1888. Sec. 1912A, 102 by establishing the
Stat. 4181, 4194 formula to fund
(1988). comprehensive
substance abuse and
treatment programs
for Native
Hawaiians.
Indian Health Care Amendments Pub. L. No. 100- Amends the Public
of 1988. 713, sec. 106, Health Service Act
Sec. 338J, 102 by creating a Native
Stat. 4784, 4787 Hawaiian Health
(1988). Professions
Scholarship program.
Department of Health and Human Pub. L. No. 101- Appropriates funds
Services Appropriations Act, 166, 103 Stat. for Native Hawaiian
1990. 1166 (1989). health programs
under authorizing
legislation.
Department of Education Pub. L. No. 101- Appropriates funds
Appropriations Act, 1990. 166, 103 Stat. for Native Hawaiian
1179 (1989). education programs
under authoring
legislation.
National Museum of the Pub. L. No. 101- Establishes the
American Indian Act. 185, 103 Stat. National Museum of
1336 (1989). the American Indian
which will study
Native Americans,
collect, preserve,
and exhibit Native
American objects,
provide a Native
American research
and study program,
and authorizes the
return of
Smithsonian-held
Native American
human remains and
funerary objects;
Native Americans
includes Native
Hawaiians.
Department of Housing and Pub. L. No. 101- Establishes
Urban Development Reform Act 235, Sec. Sec. commission to study
of 1989. 601-605, 103 and propose
Stat. 1987, 2052 solutions to Indian,
(1989). Alaska Native, and
Native Hawaiian
housing problems.
Veterans' Benefits Amendments Pub. L. No. 101- Authorizes the study
of 1989. 237, sec. 312, of Native Hawaiian
Sec. 3102, 103 veterans' and other
Stat. 2062 Native American
(1989). veterans'
participation in
Veterans Affairs'
home loan guaranty
program.
Dire Emergency Supplemental Pub. L. No. 101- Authorizes
Appropriation for Disaster 302, 104 Stat. appropriations for
Assistance, Food Stamps, 213, 239 (1990). the National
Unemployment Compensation Commission on
Administration, and other American Indian,
urgent Needs, and Transfers, Alaska Native, and
and Reducing Funds Budgeted Native Hawaiian
for Military Spending Act of housing and provides
1990. grant money to
Indian and Hawaiian
Native youth for the
Drug-Free Schools
and Communities Act.
Native American Languages Act. Pub. L. No. 101- Adopts the policy to
477, Sec. Sec. preserve, protect,
101-104, 104 and promote the
Stat. 1152, 1154 rights and freedom
(1990). of Native Americans
to use, practice,
and develop Native
American languages;
Native Americans
include Native
Hawaiians.
Department of Health and Human Pub. L. No. 101- Authorizes
Services Appropriations Act, 517, 104 Stat. appropriations for
1991. 2190 (1990). the Native Hawaiian
Health Care Act of
1988.
Department of Education Pub. L. No. 101- Authorizes
Appropriation Act, 1991. 517, 104 Stat. appropriations for
2190 (1990). Native Hawaiian
education programs
under authorizing
legislation.
Disadvantaged Minority Health Pub. L. No. 101- Authorizes grants to
Improvement Act of 1990. 527, sec. 4, health profession
Sec. 782, 104 schools to assist
Stat. 2311, 2321 programs of
(1990). excellence for
Native Hawaiians,
other Native
Americans, and
specified ethnic
groups.
Native American Graves Pub. L. No. 101- Provides for the
Protection and Repatriation 601, 104 Stat. protection of Native
Act. 3048 (1990). American graves and
repatriation of
funerary objects,
human remains, and
objects of cultural
patrimony; Native
Americans include
Native Hawaiians.
Cranston-Gonzalez National Pub. L. No. 101- Authorizes
Affordable Housing Act. 625, sec. 917, appropriations for
Sec. 109, 104 the Neighborhood
Stat. 4079, 4398 Reinvestment
(1990). Corporation which
serves rural
communities, Native
Americans, Native
Hawaiians, and other
communities in need.
Act of Nov. 29, 1990.......... Pub. L. No. 101- Amends the Public
644, sec. 401, Health Service Act
Sec. 338J(a), by providing
104 Stat. 4662, scholarship
4668 (1990). assistance to Native
Hawaiian students.
Act of Nov. 29, 1990.......... Pub. L. No. 101- Amends the American
644, sec. 501- Indian, Alaska
502, Sec. Sec. Native, and Native
1507, 1510, 104 Hawaiian Culture and
Stat. 4662, 4668 Art Development Act
(1990). by allowing interest
and earnings to be
used to carry out
the Institute's
responsibilities.
National Dropout Prevention Pub. L. No. 102- Amends the Carl D.
Act of 1991. 103, sec. 311, Perkins Vocational
Sec. 103(b), and Applied
105 Stat. 497, Technology Education
505 (1991). Act by providing
stipends to Native
Hawaiian vocational
students.
Departments of Veterans Pub. L. No. 102- Authorizes
Affairs and Housing and Urban 139, 105 Stat. appropriations for
Development, and Independent 736 (1991). the National
Agencies Appropriations Act, Commission on
1992. American Indian,
Alaska Native, and
Native Hawaiian
Housing.
Department of Health and Human Pub. L. No. 102- Appropriates funds
Services Appropriations Act, 170, 105 Stat. for Native Hawaiian
1992. 1107 (1991). health programs
under authorizing
legislation.
Department of Education Pub. L. No. 102- Appropriates funds
Appropriations Act, 1992. 170, 105 Stat. for Native Hawaiian
1107 (1991). education programs
under authorizing
legislation.
Department of Defense Pub. L. No. 102- Amends the National
Appropriations Act 1992. 172, 105 Stat. Defense
1150 (1991). Authorization Act so
that a disadvantaged
small business
concern includes a
small business
concern owned and
controlled by
socially and
economically
disadvantaged
individuals, an
Indian tribe, a
Native Hawaiian
organization, or an
organization
employing the
severely disabled.
Act of Dec. 11, 1991.......... Pub. L. No. 102- Amends title 38
218, sec. 1, (Veterans' Benefits)
Sec. 317, 105 to designate the
Stat. 1671 Chief Minority
(1991). Affairs Officer as
an adviser on the
effect of policies,
regulations, and
programs on Native
Hawaiians, other
Native Americans,
women, and minority
groups.
ADAMHA Reorganization Act Pub. L. No. 102- Amends the Public
(Alcohol, Drug Abuse, and 321, sec. 203, Health Services Act
Mental Health Administration). Sec. 1953, 106 by requiring the
Stat. 323, 409 State of Hawaii to
(1992). contract with
organizations which
plan, conduct, and
administer
comprehensive
substance abuse and
treatment programs
for Native
Hawaiians.
Higher Education Amendments of Pub. L. No. 102- Amends the Higher
1992. 325, sec. 305 Education Amendments
Sec. Sec. 357(b of 1965 by
)(7), 1406, 106 authorizing Federal
Stat. 448, 479, repayment of loan
818 (1992). for nurses working
in a Native Hawaiian
Health Center (also
in Indian Health
Service); gives
preference to
Teacher Corps
applicants intending
to teach on Indian
reservations or in
Alaska Native
villages or in areas
with high
concentrations of
Native Hawaiians;
also, authorizes
biennial education
survey on Native
Hawaiians, other
Native Americans,
and other groups
including the
disabled,
disadvantaged, and
minority students.
Higher Education Facilities Pub. L. No. 102- Amends the Higher
Act of 1992. 325, sec. 422, Education Act of
Sec. 428J(a), 1965 by authorizing
106 Stat. 448, grants and
541 (1992). fellowships to
promote higher
education of
Indians, Alaska
Natives, and Native
Hawaiians, along
with specified
ethnic groups.
Job Training Reform Amendments Pub. L. No. 102- Authorizes employment
of 1992. 367, sec. 401, and recruitment
Sec. 401, 106 preference for
Stat. 1021, 1074 Native Hawaiians,
(1992). Indians, and Alaska
Natives for a new
office that will
administer Native
American programs;
also creates a
Native American
Employment and
Training Council
with membership of
Indians, Alaska
Natives, and Native
Hawaiians that will
solicit views on
issues program
operation and
administration.
Older Americans Act Amendment Pub. L. No. 102- Amends the Older
of 1992. 375, sec. 201, Americans Act
Sec. 201(c)(3), Amendment of 1965 by
106 Stat. 1195, creating an advocate
1203 (1992). for older Indians,
Alaskan Natives, and
Native Hawaiians to
promote enhanced
delivery of services
and grants, and
authorizes
appropriations for
these activities.
Native American Programs Act Pub. L. No. 102- Amends Native
Amendments of 1992. 375, sec. 811, American Programs
822, Sec. Sec. Act by requiring the
803A, 811A, 106 filing of annual
Stat. 1195, report on the social
1295, 1296 and economic
(1992). conditions of
American Indians,
Native Hawaiians,
other Native
American Pacific
Islanders (including
American Samoan
Natives), and Alaska
Natives, and
authorizes
appropriations for
the Native American
programs.
Department of the Interior and Pub. L. No. 102- Authorizes
Related Agencies 381, 106 Stat. appropriations for
Appropriations Act, 1993. 1374 (1993). the Alaska Native
Culture and Arts
Development Act
which also provides
funds for Native
Hawaiians.
Departments of Veterans Pub. L. No. 102- Provides for
Affairs and Housing and Urban 389, 106 Stat. appropriations for
Development, and Independent 1571 (1992). the National
Agencies Appropriations Act, Commission on
1993. American Indian,
Alaska Native, and
Native Hawaiian
Housing in carrying
out functions under
the Department of
Housing and Urban
Development Reform
Act of 1989.
Department of Health and Human Pub. L. No. 102- Specifies funding
Services Appropriations Act, 394, 106 Stat. guidelines for the
1993. 1792 (1992). Native Hawaiian
Health Care Act of
1988.
Department of Education Pub. L. No. 102- Appropriates funds
Appropriations Act, 1993. 394, 106 Stat. for Native Hawaiian
1792 (1992). education programs
under authorizing
legislation.
Department of Defense Pub. L. No. 102- Amends the Native
Appropriations Act, 1993. 396, 106 Stat. Hawaiian Health Care
1876 (1993). Act of 1988 by
establishing health
goals for Native
Hawaiians and
scholarships for
Native Hawaiian
health students.
Joint Resolution to consent to Pub. L. No. 102- Agrees to the
certain amendments enacted by 398, 106 Stat. adoption of
the legislature of the State 1953 (1992). amendments enacted
of Hawai'i to the Hawaiian by the State of
Homes Commission Act, 1920. Hawai'i to the
Hawaiian Homes
Commission Act of
1920.
Veterans' Medical Programs Pub. L. No. 102- Requires development
Amendments of 1992. 405, Sec. 123, of a plan to treat
106 Stat. 1972, veterans' post-
1982 (1992). traumatic stress
disorder, especially
the needs of Native
Hawaiians, other
Native Americans,
women, and ethnic
minorities.
Health Professions Education Pub. L. No. 102- Amends the Public
Extension Amendments of 1992. 408, sec. 102, Health Services Act
Sec. 739, 106 by authorizing
Stat. 1992, 2055 grants to health
(1992). professions schools
to support programs
of excellence in
health professions
education for Native
Hawaiians, other
Native Americans,
and minority
individuals.
Nurse Education and Practice Pub. L. No. 102- Amends the Public
Improvement Amendments of 408, sec. 102, Health Service Act
1992. Sec. 846, 106 by authorizing the
Stat. 1992, 2031 repayment of school
(1992). loans for nurses who
work two years in an
Indian Health
Service health
center, in a Native
Hawaiian health
center, in a public
hospital, in a
migrant health
center, in a
community health
center, in a rural
health clinic, or in
a public or
nonprofit private
health facility.
Veterans' Home Loan Program Pub. L. No. 102- Amends Title 38 by
Amendments of 1992. 547, sec. 8, providing direct
Sec. Sec. 3761- housing loans to
3764, 106 Stat. Native American
3633, 3639 veterans (including
(1992). Native Hawaiians)
and includes the
Department of
Hawaiian Homelands
in the definition of
``tribal
organization.''
Housing and Community Pub. L. No. 102- Authorizes
Development Act of 1992. 550, sec. 128, appropriations for
Sec. 605, 106 National Commission
Stat. 3672 on American Indians,
(1992). Alaska Natives, and
Native Hawaiian
housing.
Hawai'i Tropical forest Pub. L. No. 102- Establishes the
Recovery Act. 574, Sec. 4, Hawai'i Tropical
106 Stat. 4593, Forest Recovery Task
4597 (1992). Force which will
make recommendations
for rejuvenating
Hawaii's tropical
forests, including
the traditional
practices, uses, and
needs of Native
Hawaiians in
tropical forests.
National Historic Preservation Pub. L. No. 102- Amends the National
Act Amendments of 1992. 575, sec. 4002, Historic
4006, Sec. Sec. Preservation Act to
2, 101, 106 protect Native
Stat. 4600, 4753 Hawaiian, Indian,
(1992). and Alaska Native
religious and
cultural sites,
including
authorizing direct
grants to Indian
tribes and Native
Hawaiian
organizations to
preserve, stabilize,
restore, or
rehabilitate
religious
properties.
Veterans Health Care Act of Pub. L. No. 102- Authorizes Native
1992. 585, sec. 602, Hawaiian Health
Sec. 340B, 106 centers to purchase
Stat. 4943, 4967 pharmaceuticals at
(1992). the Federal
government-
negotiated price.
Department of Health and Human Pub. L. No. 103- Authorizes
Services Appropriations Act, 112, Stat. 1082 appropriations for
1994. (1993). the Native Hawaiian
Health Care Act of
1988.
Department of Education Pub. L. No. 103- Authorizes
Appropriations Act, 1994. 112, Stat. 1082 appropriations for
(1993). Native Hawaiian
education programs
under authorizing
legislation.
100th Anniversary of the Pub. L. No. 103- Acknowledges and
Overthrow of the Hawaiian 150, 107 Stat. apologizes for the
Kingdom. 1510 (1993). United States' role
in the overthrow of
the Kingdom of
Hawai'i.
Goals 2000: Educate America Pub. L. No. 103- Establishes National
Act. 227, sec. 2-3, Education Goals for
108 Stat. 125, schools and students
129 (1994). from diverse
backgrounds,
including Indians,
Alaska Natives, and
Native Hawaiians,
the disabled, and
limited English-
speakers.
School-to-Work Opportunities Pub. L. No. 103- Establishes school-to-
Act of 1994. 239, sec. 3-4, work activities to
108 Stat. 568, improve the
572 (1994). knowledge and skills
of youths from
various backgrounds
and circumstances,
including
disadvantaged
students, students
with diverse racial,
ethnic, or cultural
backgrounds,
American Indians,
Alaska Natives,
Native Hawaiians,
students with
disabilities,
students with
limited-English
proficiency, migrant
children, school
dropouts, and
academically
talented students.
Alaska Native Culture and Arts Pub. L. No. 103- Amends the Higher
Development Act. 239, sec. 721, Education Act of
Sec. 1521, 108 1986 by authorizing
Stat. 568, 572 grants to
(1994). organizations that
primarily serve and
represent Native
Hawaiians or Alaska
Natives to support
Native culture and
art programs.
Department of Health and Human Pub. L. No. 103- Authorizes
Services Appropriations Act, 333, 108 Stat. appropriations for
1995. 2539 (1994). Native Hawaiian
health.
Department of Education Pub. L. No. 103- Authorizes
Appropriations Act, 1995. 333, 108 Stat. appropriations for
2539 (1994). Native Hawaiian
education.
Department of Defense Pub. L. No. 103- Authorizes preference
Appropriations Act, 1995. 335, 108 Stat. to Native Hawaiian
2599 (1994). contractors
restoring
Kaho'olawe's
environment.
Safe and Drug-Free Schools and Pub. L. No. 103- Authorizes grants for
Communities Act of 1994. 382, sec. 101, Native Hawaiian-
Sec. Sec. 4004, serving institutions
4011, 4118, 108 to plan, conduct,
Stat. 3518, and administer
3674, 3685 violence and drug
(1994). prevention programs.
Native Hawaiian Education Act. Pub. L. No. 103- Recognizes that
382, sec. 101, Native Hawaiians are
Sec. 9201-9212, indigenous people
108 Stat. 3518, and authorizes,
3794 (1994). among other things,
grants to assist
Native Hawaiians in
achieving national
education goals.
Jacob K. Javits Gifted and Pub. L. No. 103- Authorizes grants and/
Talented Students Education 382, sec. 101, or contracts to
Act of 1994. Sec. 10201, 108 Native Hawaiian
Stat. 3518, 3820 organizations and
(1994). Indian tribes to
assist in carrying
out programs or
projects for gifted/
talented students.
Improving America's Schools Pub. L. No. 103- Provides support,
Act of 1994. 382, sec. 101, training, assistance
Sec. 13102, 108 to grant recipients
Stat. 3518, 3878 to improve the
(1994). quality of education
for immigrants,
migrants, the poor,
American Indian,
Alaska Natives, and
Native Hawaiians.
Bilingual Education Act....... Pub. L. No. 103- Authorizes grants to
382, sec. implement new
101Sec. Sec. 71 comprehensive
01, 7104, 7136, bilingual education
108 Stat. 3518, programs for Native
3716, 3718, 3732 American and Native
(1994). Hawaiian languages.
Improving America's Schools, Pub. L. No. 103- Authorizes subgrants
Act of 1994 (Part E). 382, sec. 101, from State and local
Sec. 7501, 108 governments to
Stat. 3518, 3745 implement a
(1994). bilingual education
program for the
ancestral languages
of American Indians,
Alaska Natives, and
Native Hawaiians.
Native American Veterans' Pub. L. No. 103- Establishes memorial
Memorial Establishment Act of 384, Sec. 2, to recognize
1994. 108 Stat. 4067, contributions of
4067 (1994). Native American
Veterans (American
Indians, Native
Alaskans, and Native
Hawaiians).
Veterans' Benefits Pub. L. No. 103- Authorizes creation
Improvements Act of 1994. 446, sec. 510, of a Center for
Sec. 544, 108 Minority Veterans
stat. 4645, 4669 and Advisory
(1994). Committee on
Minority Veterans to
be more responsive
to the needs of
Native Hawaiian,
American Indian,
Alaska Native, and
ethnic minority
veterans.
Hawaiian Home Lands Recovery Pub. L. No. 104- Settles Department of
Act. 42, Sec. Sec. Hawaii Home Lands
201-06, 109 claims against the
Stat. 353, 357 Federal government
(1995). for the value of the
lost use of lands by
Native Hawaiians.
The Balanced Budget Down Pub. L. No. 104- Authorizes
Payment Act. 99, Sec. 115, appropriations to
110 Stat. 26, 29 cover termination of
(1996). Native Hawaiian and
Alaska Native
Cultural Arts
National Defense Authorization Pub. L. No. 104- Authorizes upgrading
Act for FY 1996. 106, Sec. 524, the Distinguished
110 Stat. 186 Service Cross to the
(1996). Medal of Honor for
World War II Native
American Pacific
Islander veterans
(including Native
Hawaiians).
Department of Health and Human Pub. L. No. 104- Authorizes
Services Appropriations Act, 134, 110 Stat. appropriations for
1996. 1321 (1996). the Native Hawaiian
Health Care Act of
1988.
Department of Education Pub. L. No. 104- Authorizes
Appropriations Act, 1996. 134, 110 Stat. appropriations for
1321 (1996). Native Hawaiian
education programs
under authorizing
legislation.
Child Care and Development Pub. L. No. 104- Amends the Child Care
Block Grant Amendment of 1996. 193, sec. 614, and Development
Sec. 658P, 110 Block Grant Act of
Stat. 2105, 2287 1990 by authorizing
(1996). Native Hawaiian
organizations to
apply for grants or
enter into contracts
with the Health and
Human Services
Secretary to improve
child care, increase
the availability of
early childhood
development, and
increase before and
after school care
services.
Departments of Veterans Pub. L. No. 104- Authorizes the
Affairs and Housing and Urban 204, sec. 213 Housing Secretary to
Development, and Independent Sec. 282, 110 waive anti-
Agencies Appropriations Act, Stat. 2874, 2904 discrimination
1997. (1996). provisions of the
Cranston-Gonzalez
National Affordable
Housing ACt for
lands set aside
under the Hawaiian
Homes Commission
Act, 1920.
Department of Health and Human Pub. L. No. 104- Authorizes
Services Appropriations Act, 208, 110 Stat. appropriations for
1997. 3009 (1996). the Native Hawaiian
Health Care Act
of1988 and Older
Americans Act of
1965.
Department of Education Pub. L. No. 104- Authorizes
Appropriations Act, 1997. 208, 110 Stat. appropriations for
3009 (1996). Native Hawaiian
education programs
under authorizing
legislation.
National Museum of the Pub. L. No. 104- Amends National
American Indian Act 278, sec. 4, Museum of the
Amendments of 1996. Sec. 11A, 110 American Indian Act
Stat. 3355, 3356 by authorizing
(1996). reparation of Indian
and Native Hawaiian
sacred or funerary
objects and cultural
patrimony objects.
Joint Resolution to consent to Pub. L. No. 105- Agrees to the
certain amendments enacted by 21, 111 Stat. adoption of
the legislature of the State 235 (1997). amendments enacted
of Hawai'i to the Hawaiian by the State of
Homes Commission Act, 1920. Hawai'i to the
Hawaiian Homes
Commission Act of
1920.
Department of Transportation Pub. L. No. 105- Waives repayment of
and Related Agencies 66, 111 Stat. airport funds that
Appropriations Act, 1998. 1425 (1997). were diverted for
the betterment of
American Indians,
Alaska Natives, and
Native Hawaiians.
Department of Health and Human Pub. L. No. 105- Authorizes
Services Appropriations Act, 78, 111 Stat. appropriations for
1998. 1467 (1997). the Native Hawaiian
Health Care Act and
Older Americans Act
of 1965.
Department of Education Pub. L. No. 105- Authorizes
Appropriations Act, 1998. 78, 111 Stat. appropriations for
1467 (1997). Native Hawaiian
education programs
under authorizing
legislation.
Museum and Library Services Pub. L. No. 105- Amends Museum and
Technical and Conforming 128, sec. 6, Library Services Act
Amendments of 1997. Sec. 262, 111 by authorizing
Stat. 2548, 2549 Hawaiian
(1997). organizations
eligible to receive
grants (along with
American Indian
tribes) to
electronically link
libraries with
education, social,
or information
services.
Workforce Investment Act of Pub. L. No. 105- Authorizes grants to
1998. 220, Sec. 166, Indian Tribes,
112 Stat. 936, tribal
1021 (1998). organizations,
Alaska Native
entities, Indian-
controlled
organizations, and
Native Hawaiian
organizations for
employment and
training activities.
Rehabilitation Act Amendments Pub. L. No. 105- Amends the
of 1998. 220, sec. 404, Rehabilitation Act
Sec. 101, 112 of 1973 by requiring
Stat. 936, 1163 State agencies to
(1998). consult with Indian
Tribes, tribal
organizations, and
Native Hawaiian
organizations before
adopting any
policies for
vocational
rehabilitation
services.
Higher Education Amendments of Pub. L. No. 105- Amends the Higher
1998. 244, sec. 303, Education Act of
Sec. 1001, 112 1965 by authorizing
Stat. 1581, 1638 grants to improve
(1998). education
institutions'
ability to serve
Alaska Natives and
Native Hawaiians.
Act of October 14, 1998....... Pub. L. No. 105- Amends the Native
256, sec. 12, Hawaiian Health Care
Sec. 10(b)(1), Improvement Act by
112 Stat. 1896, requiring recipients
1899 (1998). of the Native
Hawaiian Health
Scholarship Program
to work in the
Native Hawaiian
Health Care System.
Department of Health and Human Pub. L. No. 105- Authorizes
Services Appropriations Act, 277, 112 Stat. appropriations to
1999. 2681 (1998). carry out the Native
Hawaiian Health Care
Act of 1988 and the
Older Americans Act.
Department of Education Pub. L. No. 105- Authorizes
Appropriations Act, 1999. 277, 112 Stat. appropriations for
2681 (1998). Native Hawaiian
education programs
under authorizing
legislation.
Head Start Amendments of 1998. Pub. L. No. 105- Amends the Head Start
285, sec. 117, Act by requiring the
Sec. 650, 112 Secretary of Health
Stat. 2702, 2727 and Human Services
(1998). to prepare and
submit a report
concerning the
condition, location,
and ownership of
facilities used, or
available to be
used, by Native
Hawaiian Head Start
agencies.
Assets for Independence Act... Pub. L. No. 105- Authorizes Native
285, Sec. Sec. Hawaiian
401-416, 112 organizations (and
Stat. 2702, 2759 State, local, and
(1998). tribal governments)
to conduct
demonstration
projects to evaluate
the effects of
savings,
microenterprise, and
home ownership on
families and the
community.
Carl D. Perkins Vocational and Pub. L. No. 105- Authorizes grants to
Technical Education Act of 332, sec. 1, plan, conduct, and
1998. Sec. 116, 112 administer
Stat. 3076, 3095 vocational programs
(1998). for Native Hawaiians
and other Native
Americans.
Native American Programs Act Pub. L. No. 105- Amends the Native
Amendments of 1997. 361, sec. 3, Hawaiian Revolving
Sec. 803A, 112 Loan fund to include
Stat. 3278, 3278 a loan guarantee.
(1998).
National Park Service Pub. L. No. 105- Promotes the sale of
Concessions Management 391, Sec. 416, authentic American
Improvement Act of 1998. 112 Stat. 3497, Indian, Alaska
3516 (1998). Native, and Native
Hawaiian handicrafts
and makes those
revenues exempt from
franchise fees.
Health Professions Education Pub. L. No. 105- Authorizes grants to
Partnerships Act of 1998. 392, sec. 101, assist schools with
Sec. 736, 112 health professions
Stat. 3524, 3525 education programs
(1998). for Native
Hawaiians, American
Indians, Alaska
Natives, and under-
represented
minorities.
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