[Senate Report 107-56]
[From the U.S. Government Publishing Office]



                                                       Calendar No. 144
107th Congress                                                   Report
                                 SENATE
 1st Session                                                     107-56

======================================================================



 
AMENDING THE NATIVE HAWAIIAN HEALTH CARE IMPROVEMENT ACT TO REVISE AND 
                            EXTEND SUCH ACT

                                _______
                                

                August 28, 2001.--Ordered to be printed

   Filed under authority of the order of the Senate of July 30, 2001.

    Mr. Inouye, from the Committee on Indian Affairs, submitted the 
                               following

                              R E P O R T

                          [To accompany S. 87]

    The Committee on Indian Affairs, to which was referred the 
bill (S. 87) to amend the Native Hawaiian Health Care 
Improvement Act to revise and extend such Act, having 
considered the same, reports favorably thereon with amendments 
and recommends that the bill (as amended) do pass.

                                Purpose

    The purpose of S. 87, 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 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. 87 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. 87 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 Hawai`i 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.) Expanded trade with 
the United States resulted in increased western influence in 
the islands, 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 
Hawai`i to the United States. The United States minister in 
Hawai`i 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 thelawless 
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, Hawai`i 
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. In response the United States Congress in 
1920 legislated directly to benefit 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.''
    Hawai`i became a state in 1959. Under the Admissions Act, 
the title of the Hawaiian home lands (that the Hawaiian Homes 
Commission administered) was transferred from the Federal 
government to the State of Hawai`i. 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 
Hawai`i 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's report's findings as to the health 
status of Native Hawaiians was compared only to other 
populations within the State of Hawai`i, 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 Hawai`i, the Office of Technology 
Assessment report contains the following findings:
    ``The Native Hawaiian population living in Hawai`i 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 the 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 diseases 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 is 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 twenty 
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 not at all.
    In 1998, Papa Ola Lokahi updated the health care statistics 
from the original E Ola Mau report. Additionally Papa Ola 
Lokahi extrapolates the data that the Hawai`i State Department 
of Health annually gathers on Native Hawaiians 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 Hawai`i (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 Hawai`i for cancers of 
the lung, liver, pancreas and for all cancers combined, and the 
highest years of productive life lost from cancer in the State 
of Hawai`i. Native Hawaiian females ranked highest in the State 
of Hawai`i for cancers of the lung, liver, pancreas, breast, 
cervix uterus, corpus uterus, stomach, rectum, and for all 
cancers combined.
    With respect to breast cancer, Native Hawaiians have the 
highest mortality rates in the State of Hawai`i, 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 
Hawai`i 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 ate due to diabetes mellitus in the State of 
Hawai`i, 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 Hawai`i 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 statwide population.
    With respect to heart disease, the death rate for Native 
Hawaiians in 66 percent higher than for the entire State of 
Hawai`i, and Native Hawaiian males have the greatest years of 
productive life lost in the State of Hawai`i. 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 
populations groups in the State of Hawai`i. 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 the most recent data for 1990 indicates 
that Native Hawaiian life expectancy at birth is approximatley 
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 very region of the State of 
Hawai`i, 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 Hawai`i, 
44 percent were Native Hawaiians.
    In 1996, Native Hawaiian fetal mortality rates comprised 15 
percent of all fetal deaths for the State of Hawai`i. 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. 87 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. 87 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) of 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, 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 biopsycho-
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 was reached that Papa 
Ola Lokahi, the Native Hawaiian Health Board, should be the 
mechanism through which Native Hawaiian health care systems 
would 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 made to the Constitution of the 
State of Hawai`i 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 
Hawai`i; 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. Papa Ola Lokahi also 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 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 
        programs; 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 \1\ 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.
---------------------------------------------------------------------------
    \1\  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 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 a po`o (the head of the household or designated leader of 
the organization).
---------------------------------------------------------------------------
    As enacted, Public Law 100-579 authorized the establishment 
of Native Hawaiian Healing Centers on each of the islands 
comprising the State of Hawai`i, 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 multidisciplinary 
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 effective functioning 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) prevention-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 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 continental 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 February 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 theestablishment or 
recognition of the five Native Hawaiian health care systems which would 
take he 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, physician's 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, work with 
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`au 
(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-
tansmitted diseases, family planning, maternal and infant care, 
and alcohol/substance abuse. Ho`ola Lahui Hawai`i 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 
20 distinct communities and neighborhoods where native Hawaiian 
families reside. As a start, Ke Ola Mamo hasselected 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 and 
conducts 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 following 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 and 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 Hawai`i; (2) assist and promote 
personal responsibility among Native Hawaiians toward making 
sound, informed decisions which would decrease unhealthy 
behaviors and reduce mobility 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, 
and regular exercise.
    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), use of tobacco, alcohol and 
other harmful drugs, sexually transmitted disease, stress, 
cancer, the importance of sound nutrition habits, regular 
exercise, and proper maternal 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.
    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, and has 
awarded 92 scholarships since 1991. These scholarships include: 
10 bachelors of science in nursing, 2 clinical psychology 
doctoral programs, 2 dentists, 7 dental hygienists, one 
osteopathic physician, 29 allopathic physicians, 6 masters in 
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, 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 the development of a bill to reauthorize the 
Native Hawaiian Health Care Improvement Act (the Act), from 
December of 1997 through January of 1998, eight island `aha 
(island-wide conferences) were held involving more than 1,200 
individuals in an effort to identify the principle Native 
Hawaiian health and wellness issues and concerns. In March 
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 1999, a Nature 
Hawaiian Health Forum was convened to discuss major health care 
trends and strategies for health care trends and strategies for 
health care and wellness developed by the indigenous peoples of 
North America and Aotearoa (New Zealand).
    In March 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, 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

    Senate bill 87 extends the existing program authorities of 
the Act and authorizes appropriations in such sums as may be 
necessary through fiscal year 2006. The bill contains extensive 
findings on the current health status of Native Hawaiians 
including the incidence and morality 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`i and Ni`ihau. The Board of Papa Ola 
Lokahi has been expanded to include the five Native Hawaiian 
health care systems, the Kamehameha Schools (or other 
organizations responsible for placing scholars from the Native 
Hawaiian Health Scholarship Program), the Hawai`i State Primary 
Care Association (which represents the community health 
centers), the Native Hawaiian Physicians Association, and such 
other 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. Senate bill 87 establishes new objectives the 
Native Hawaiian health care systems must meet based on the 
objectives in the U.S. Surgeon General's Healthy People 2010.
    Senate bill 87 proposes that the providers of health care 
services, including traditional Native Hawaiian healers, who 
provide services under the auspices of the Native Hawaiian 
health care systems 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 for NativeHawaiians 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 
Hawai`i at Hilo, a Native Hawaiian Center for Excellence for Mental 
Health at the University of Hawai`i at Manoa, a Native Hawaiian Center 
of Maternal Health Center, a Native Hawaiian Center of Excellence for 
Research, Training, and Integrated Medicine at Moloka`i General 
Hospital, and a Native Hawaiian Center of Excellence for Complementary 
Health and Health Education and Training at the Waianae Coast 
Comprehensive Health Center.
    Senate bill 87 also authorizes the establishment of 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 extent of Native Hawaiian 
needs with regard to the provision of health services. This 
study committee would 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 exercises 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 Hawai`i. 
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 Act of 2001.

Section 2. Findings

    Subsection (a) sets forth the findings of the Congress with 
regard to the historical and legal basis for a Federal program 
designed to address the health care needs of Native Hawaiians. 
Subsection (b) sets forth the unmet needs and serious health 
disparities affecting Native Hawaiians, including chronic 
diseases and illnesses, infectious diseases and illnesses, 
injuries, dental health, life expectancy, maternal and child 
health, mental health, and health provisions education and 
training.

Section 3. Definitions

    This section sets forth the definitions of terms used in 
the Act.
    Section 2(1) defines ``Department'' to mean the Department 
of Health and Human Services.
    Section 3(2) defines ``disease prevention'' to include 
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) defines ``health promotion'' to include 
pregnancy and infant care, including prevention of fetal 
alcohol syndrome, cessation of tobacco smoking, reduction in 
the use 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) defines ``Native Hawaiian'' as 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 
genealoglogical records, kama`aina (long-term community 
residents) witness verification from 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) defines ``Native Hawaiian health care 
service'' as an entity which has the following characteristics: 
organizes under Hawai`i law; provides or arranges for health 
care services through State-licensed practitioners (where 
applicable); a public or nonprofit private entity; its Native 
Hawaiian health practitioners significantly participate in the 
planning, management, monitoring, and evaluation of health care 
services; may be composed of as many as eight Native Hawaiian 
Health Centers; is recognized by Papa Ola Lokahi for the 
purpose of planning, conducting, or administering Native 
Hawaiian programs, or portions of programs; and is certified by 
Papa Ola Lokahi as having the qualifications and the capacity 
to provide the services as specified in the contract or grant 
entered between the Native Hawaiian health care system and 
Secretary.
    Section 3(6) defines ``Native Hawaiian Health Center'' as 
an organization thatprovides primary health care services and 
which Papa Ola Lokahi has certified has met the following criteria: a 
governing board with a membership that has a minimum of fifty-percent 
(50%) 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) defines ``Native Hawaiian Health Task Force'' 
as a task force established by the State Council of Hawaiian 
Homestead Associations that implements health and wellness 
strategies in Hawai`i's Native Hawaiian communities.
    Section 3(8) defines ``Native Hawaiian organization'' as a 
public or nonprofit organization that serves Native Hawaiian 
interests and which Papa Ola Lokahi has recognized for purposes 
of planning, conducting, or administering programs (or portions 
of programs) authorized under this Act.
    Section 3(9) defines ``Office of Hawaiian Affairs'' and 
``OHA'' as the governmental entity established under the 
Hawai`i' State Constitution which is charged with the 
responsibility of formulating policy relating to Native 
Hawaiian affairs.
    Section 3(10) defines ``Papa Ola Lokahi'' as an 
organization composed of: 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); Hawai`i State Primary 
Care Association or Native Hawaiian; 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 Ha `Oiwi (or 
a health care system serving the island of Hawai`i); Ahahui O 
Na Kauka; 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. However, organizations will not be added to Papa Ola 
Lokahi if the Secretary determines that an organization has not 
developed a mission statement with clearly defined goals and 
objectives for its contributions to the Native Hawaiian health 
care systems and an action plan for carrying out those goals 
and objectives.
    Section 3(11) defines ``primary health services'' as the 
services of physicians, physician's 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) defines ``Secretary'' as the Secretary of the 
U.S. Department of Health and Human Services.
    Section 3(13) defines ``traditional Native Hawaiian 
healer'' as 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 and oral traditions 
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 
result from the unique and historical relationship between the 
United States and 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 the Surgeon General's Healthy People 
2010, and to incorporate within health programs the following 
activities: 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.progress made toward 
meeting the national policy of the Act which will be included in the 
President's report to the Congress under section 12.

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 Native Hawaiian health 
status.
    Section 5(a)(2) requires Papa Ola Lokahi and the Office of 
Hawaiian Affairs to consult with the Native Hawaiian health 
care systems, the Native Hawaiian Health Center, 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 purposes of addressing other issues to 
accomplish the objectives of this section.
    Section 5(a)(3) requires that within eighteen (18) months 
of the Act's enactment that Papa Ola Lokahi, in cooperation 
with the Office of Hawaiian Affairs and other appropriate 
agencies of the State of Hawai`i, prepare and submit a study 
report to the Congress detailing the impact of current Federal 
and state health care financing mechanisms and policies on 
Native Hawaiians' health and well-being. The report will 
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. 
The report's recommendations will 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 coordinate, implement, and update the 
master plan and to prepare the health care financing study 
report.

Section 6. Functions of Papa Ola Lokahi and Office of Hawaiian Affairs

    This section sets forth the functions of Papa Ola Lokahi 
and amends the previous Act to include the Office of Hawaiian 
Affairs.
    Section 6(a) authorizes Papa Ola Lokahi to carry out the 
following responsibilities:
          (1) coordinating, implementing, and updating the 
        comprehensive health care master plan developed under 
        section 5;
          (2) training of Native Hawaiian health care 
        practitioners, community outreach workers, counselors, 
        cultural educators, physicians, physician's assistants, 
        nurse practitioners, and other health and allied-health 
        professionals 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 of Papa Ola Lokahi's member 
        organizations will make in carrying out the policy of 
        the Act.
    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 provides 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 benefitting 
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 that Papa Ola Lokahi, to the 
extent possible, 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 
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 to 
providing health-related resources or services to the Native 
Hawaiians, the Native Hawaiian health care systems, and/or 
efforts towards carrying out the national policy of this Act.
    Section 6(f)(2) addresses health care financing as follows:
    Subsection (A) requires that Federal agencies providing 
health care financing and health care programs consult with 
Native Hawaiians and organizations providing Native Hawaiian 
health care services prior to adopting any policy or regulation 
which may impact on service provision or health insurance 
coverage. The consultation is to include but not be limited to 
identifying the impact of proposed policies, rules, or 
regulations.
    Subsection (B) authorizes the State of Hawai`i to engage in 
meaningful consultation with Native Hawaiians and organizations 
providing Native Hawaiian health care services prior to making 
any changes or initiating new programs.
    Subsection (C) authorizes the Office of Hawaiian Affairs, 
in concert with Papa Ola Lokahi, to develop consultative, 
contractual, or other arrangements with the following: the 
Centers for Medicare and Medicaid Services; the agency of the 
state which administers or supervises the administration of a 
state plan or waiver approved under Title XVIII, XIX, or XXI 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 with 
any other Federal agency or agencies providing Native Hawaiians 
with full or partial health insurance. Such arrangements may 
include but are not limited to appropriate reimbursement for 
health care services including capitation and fee for service 
rates for Native Hawaiians who are entitled to insurance, scope 
of services provided, and/or any other matters which enable 
Native Hawaiians to maximize health insurance benefits provided 
by Federal and state health insurance programs.
    Section 6(f)(3) provides that the Department and other 
Federal agencies that provide health care services 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 to be exempt from national accreditation 
reviews.

Section 7. Native Hawaiian health care systems

    This section addresses the Secretary's authority to enter 
into contracts and grants with Native Hawaiian health care 
systems for the provision of Native Hawaiian health care and 
health care referral services and the responsibilities of the 
Native Hawaiian health care systems.
    Section 7(a) authorizes the Secretary 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 and disease prevention services as well as 
primary health care services to Native Hawaiians who desire and 
are committed to bettering their own health. The Secretary may 
enter into not more than eight (8) grants or contracts, with 
preference given 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. A 
`qualified entity' for purposes of subsection 7(a)(1) means a 
Native Hawaiian health care system or a Native Hawaiian Health 
Center predominantly serving Native Hawaiians.
    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.
    Section 7(c) specifies that each qualified entity receiving 
funds under section 7(a) must ensure that the following 
services are provided: 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, physician's 
assistants, nurse practitioners, and other health 
professionals;immunizations; prevention and control of 
diabetes, hypertension, and otitis media (middle ear infection); 
pregnancy and infant care; improvement of nutrition, identification, 
treatment, control and reduction of 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 enhancing health and wellness including land-
based, ocean-based, and spiritually-based projects and programs. 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 (7)(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 receiving funds under subsection 7(a) must provide a 
designated 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 authorized under subsection 
7(a) unless the qualified entity agrees that the grant or 
contract amount will not, directly or through contract, be 
expended for the following: health care services except as 
described in section 7(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 regardless of payment ability and the entity will 
impose a charge for the delivery of health services which will 
be made according to a public schedule of charges 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 the general grant and planning grant 
activities under subsections 7(a) and 7(b) for fiscal years 
2002 through 2012.

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 following: 
the coordination, implementation, and appropriate updating of 
the comprehensive health care master plan; 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, epidemiologic 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 
to Native 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 2002 through 2012.

Section 9. Administration of grants and contracts

    This section sets forth the terms and conditions under 
which the Secretary makes grants or enters into contracts.
    Section 9(a) specifies that within any grants made or 
contracts entered include terms and conditions that 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) restricts the Secretary's authority to make 
any grant or enter into any contract under this Act with an 
entity unless the entity:
          (1) agrees to establish such procedures for fiscal 
        control and fund accounting as may be necessary to 
        ensure proper disbursement and accounting with respect 
        to the grant or contract;
          (2) agrees to ensure the confidentiality of records 
        maintained on individualsreceiving health services 
under the grant or contract;
          (3) with respect to health services provided to any 
        population of Native Hawaiians, a substantial portion 
        of whom has a limited ability to speak the English 
        language, 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 that population in the language of 
        that population 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 that are covered 
        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, the entity has entered into a 
        participation agreement under such plans and the entity 
        is qualified to receive payments under such plan, or 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 section 9.
    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 in installments and shall be made on 
such conditions as the Secretary deems necessary to carry out 
the purposes of this Act.
    Section 9(e) provides that for each fiscal year during 
which an entity receives or expends funds pursuant to a grant 
or contract under the Act, that entity is to submit an annual 
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) authorizes the Secretary to enter into an 
agreement with any entity under which the Secretary may assign 
personnel from 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.
    Section 10(b) specifies that any personnel assignment the 
Secretary agrees to 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) provides 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 Kamehameha Schools or another 
Native Hawaiian organization or health care organization with 
experience in administering education scholarships 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) provides authority for employees of the 
Native Hawaiian Health Care Systems and the Native Hawaiian 
Health Centers to have a priority for these 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 (42 U.S.C. 2541), except 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; to the maximum extent practicable, the 
Secretary is to select scholarship recipients from a list of 
eligible applicants the Kamehameha Schools or the Native 
Hawaiian organization administering the program submits; the 
obligated service requirement for each scholarship recipient is 
to be fulfilled through service, in 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 U.S. 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) provides that the scholarship program's 
placement services will assign scholarship recipients to 
appropriate sites.
    Subsection (E) further specifies that counseling, 
retention, and other support services will be available to 
scholarship recipients and other scholarship and financial aid 
programs recipients enrolled in appropriate health professions 
training programs.
    Subsection (F) provides 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 Native Hawaiian 
Health Centers.
    Section 11(c)(2) provides that the financial aid provided 
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. The financial assistance 
may include a stipend and/or reimbursement for costs associated 
with participating in the program.
    Section 11(c)(3) provides that scholarship recipients in 
health professions designated in section 338A of the Public 
Health Service Act shall have the same rights and benefits of 
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 shall be deemed `Qualified 
Scholarships' for purposes of 26 U.S.C. section 117.
    Section 11(d) authorizes the appropriation of such sums as 
may be necessary for the purpose of funding the scholarship 
assistance under subsection 11(a) for fiscal years 2002 through 
2012.

Section 12. Report

    This section provides that at the time the budget is 
submitted, the President is to transmit a report to Congress 
for each fiscal year on the progress made in meeting the Act's 
objectives. The report should include a review of programs 
established or assisted pursuant to the Act and an assessment 
and recommendation 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 personal or real property for 
donation to organizations that receive grants or contracts 
under this Act, provided that the Secretary determines that the 
property is appropriate for the organization's use for the 
purpose for which the contract or grant was authorized.

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, and 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, 
        and Integrated Medicine at Moloka`i General Hospital; 
        and for Complementary Health and Health Education and 
        Training at the Waianae Coast Comprehensive Health 
        Center. Papa Ola Lokahi and any centers established 
        under paragraph (6) shall be deemed qualified as 
        Centers of Excellence under the Public Health Service 
        Act.
    Section 14(b) provides that funds allocated for 
demonstration projects under subsection 14(a) shall not result 
in a reduction of funds, required by the Native Hawaiian health 
care systems, 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 (to be referred to 
in this Act as the ``Commission'').
    Section 15(b) provides that the Commission 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 section 15(b)(1) 
        will elect the Commission's chairperson and vice-
        chairperson.
          (2) the Native Hawaiian health care systems will 
        appoint five members, 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 153(c) provides that Commission members shall serve 
for the life of the Commission. Initial Commission members 
under subsection 15(b)(1) 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 mannerwhich 
original appointments were made.
    Section 15(d) specifies that the Commission's duties and 
functions are as follows:
          (1) review and analyze the recommendations of the 
        report of the study committee establishes under 
        subsection 15(d)(3);
          (2) make recommendations to Congress for the 
        provision of health services to Native Hawaiian 
        individuals as an entitlement, giving due regard to the 
        effects of a program on existing health care delivery 
        systems for Native Hawaiians and the effect of such 
        programs on self-determination and their 
        reconciliation;
          (3) establish a study committee composed of at least 
        ten (10) Commission members, with four appointed under 
        subsection (b)(1), five members appointed under 
        subsection 15(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 other 
                states;
                  (B) make recommendations to the Commission 
                for legislation that will provide for 
                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 recommendation 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 
                majority positions 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 (18) 
        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. Commission members appointed under 
subsection 15(b)(2) and (3) may receive compensation while the 
performing Commission business, and while serving away from 
home or regular place of business, be allowed travel expenses 
as the Commission chairperson authorizes. Commission personnel 
will be treated as if they were Senate employees for purposes 
of compensation (except for Commission members), employment 
benefits, rights, and privileges.
    Section 15(e)(2) specifies that the Commission chairperson 
shall call Commission meetings. This subsection further 
specifies that a quorum shall consist of not less than twelve 
(12) members, with not less than four (4) such members 
appointed under subsection 15(b)(1), with not less than seven 
(7) such members appointed under subsection 15(b)(2), and not 
less than one (1) member appointed under subsection 15(b)(3).
    Section 15(e)(3) authorizes Commission members to appoint 
an executive director. The executive director, with the 
Commission's approval, may appoint such personnel as the 
executive director deems appropriate. This subsection also 
specifies that theexecutive director, with the Commission's 
approval, may procure temporary and intermittent services. This 
subsection authorizes the General Services Administration Administrator 
to locate suitable office space for Commission headquarters in 
Washington, D.C. 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 (8) hearings shall be held on each of the Hawaiian 
Islands and three (3) hearings in the continental United States 
in areas where large numbers of Native Hawaiians are present. 
Such hearings shall be held to solicit the views of Native 
Hawaiians regarding the delivery of health care services to 
such individuals. 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 Centers for Medicare and Medicaid 
Services shall provide cost estimates the Commission determines 
to be necessary to carry out 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.
    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. 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 section 15. 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 Hawai`i to 
license health practitioners.

Section 17. Compliance with Budget Act

    This section provides that any new spending authority 
described in section 401(c)(2)(A) or (B) of the Congressional 
Budget Act of 1974 which is provided under the authority of the 
Act is to be effective only for any fiscal year to the extent 
or in such amounts as are provided in appropriation acts.

Section 18. Severability

    This section specifies that if any provision of the Act or 
application of any provision of the Act to any person or 
circumstances is held to be invalid, the remainder of the Act 
will be unaffected.

                          Legislative History

    On January 22, 2001 Senator Daniel K. Inouye, for himself 
and Senator Daniel K. Akaka, introduced Senate bill 87. It was 
referred to the Committee on Indian Affairs. No hearings were 
held on S. 87, however, during the 106th Congress, the 
Committee did hold a series of hearings on S. 1929 which is 
nearly identical to S. 87. Those hearings were as follows: 
Moloka`i and Kaua`i (January 18, 2000); Maui (January 19, 
2000); Hilo, Hawai`i (January 20, 2000); O`ahu (January 21, 
2000); Kona, Hawai`i and Lana`i (March 16, 2000).

            Committee Recommendation and Tabulation of Vote

    The Committee on Indian Affairs, on July 24, 2001, in an 
open business meeting, by a unanimous vote, recommended that 
the Senate pass an amendment in the nature of a substitute to 
S. 87, a bill to reauthorize and amend the Native Hawaiian 
Health Care Act.

                   Cost and Budgetary Considerations

    At the time of filing this report, the cost estimate of the 
Congressional Budget Office on S. 87 has not yet been received. 
Compliance with Senate Rule XXVI, paragraph 11(a) is therefore 
impracticable at this time.

                        Executive Communications

    The Committee received no communications from the Executive 
branch of government on S. 87.

                    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. 87 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 [comprise] begin their story 
        with the Kumulipo which details the creation and the 
        inter-relationship of all things, including their 
        evolvement as healthy and well people.
          (2) Native Hawaiians are a distinct and unique 
        indigenous [people] peoples 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 
        Hawai`i over the 19th and early 20th centuries have 
        been devastating to the health and well-being of Native 
        Hawaiians.
          (5) Native Hawaiians have never directly relinquished 
        to the United States their claims to their inherent 
        sovereignty as a people or over their national 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 Hawai`i.
          [(3)] (7) The constitution and statutes of the State 
        of Hawai`i:
                  (A) acknowledge the distinct land rights of 
                Native Hawaiian people as beneficiaries of the 
                public lands trust; and
                  (B) reaffirm and protect the unique right of 
                the Native Hawaiian people to practice and 
                perpetuate their cultural and religious 
                customs, beliefs, practices, and language.
          [(4)] (8) At the time of the arrival of the first 
        nonindigenous [people] peoples in Hawai`i in 1778, the 
        Native Hawaiian people lived in a highly organized, 
        self-sufficient, subsistence social system based on 
        communal land tenure with a sophisticated language, 
        culture, and religion.
          [(5)] (9) A unified monarchical government of the 
        Hawaiian Islands was established in 1810 under 
        Kamehameha I, the first King of Hawai`i.
          [(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 Hawai`i, [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] government of Hawai`i.
          [(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 overthrow of the indigenous and 
        lawful Government of Hawai`i 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 Hawai`i or 
        the lawful Government of Hawai`i in violation of 
        treaties between the [two] 2 nations and 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 Hawai`i, and the Hawaiian Patriotic League, 
        representing the aboriginal citizens of Hawai`i, 
        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 Hawai`i with 
        the participation of agents and citizens of the United 
        States, and the resulting deprivation of the rights of 
        Native Hawaiians to self-determination in legislation 
        enacted into law in 1993 (Public Law 103-150; 107 Stat. 
        1510).
          [(11)] (16) In 1898, the United States annexed 
        Hawai`i through the Newlands Resolution without the 
        consent of or compensation to the indigenous [people] 
        peoples 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 over 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 Hawai`i.
          [(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] Committee on 
        Territories of the House of Representatives [Committee 
        on Territories] as stating, ``One thing that impressed 
        me * * * was the fact that the natives of the islands 
        [who are our wards, I should say, and] * * * for whom 
        in a sense we are trustees, are falling off rapidly in 
        numbers 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 Hawai`i 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 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.
          [(16)] (21) Under the Act entitled ``An Act to 
        provide for the admission of the State of Hawai`i 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 
        Hawai`i but reaffirmed the trustrelationship which 
existed between the United States and the Native Hawaiian people by 
retaining the legal responsibility of the State for the betterment of 
the conditions of Native Hawaiians under section 5(f) [of the Act 
entitled ``An Act to provide for the admission of the State of Hawai`i 
into Union'', approved March 18, 1959 (73 Stat. 4, 6).] of such Act.
          (22) 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 transferred 
        from any source in trust for the Native Hawaiian 
        people, to receive payments from the State of Hawai`i 
        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 86-3), 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 
        Hawai`i.
          (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 Hawai`i 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 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 Native Hawaiian people 
        the same rights and privileges accorded to American 
        Indian, Alaska Native, Eskimo, and Aleut communities, 
        including the Native American Programs Act of 1974 [42 
        U.S.C.A. Sec. 2991 et seq.]; the American Indian 
        Religious Freedom Act [42 U.S.C.A. 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 Native 
        Hawaiian people through legislation which authorizes 
        the provision of services to Native Hawaiians, 
        specifically, the Older Americans Act of 1965 [42 
        U.S.C.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 (Public Law 100-579), the Health 
        Professions Reauthorization Act of 1988, the Nursing 
        Shortage Reduction and Education Extension Act of 1988, 
        the Handicapped Programs Technical Amendments Act of 
        1988, the Indian Health Care Amendments of 1988, and 
        the Disadvantaged Minority Health Improvement Act of 
        1990.
          [(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 
        peoples of Hawai`i, are a unique population group in 
        Hawai`i 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 committment 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 disparties 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 Hawai`i (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 
                                Hawai`i for cancers of the 
                                lung, liver and pancreas and 
                                for all cancers combined;
                                  (III) Native Hawaiian females 
                                ranked highest in the State of 
                                Hawai`i 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 Hawai`i 
                                with 8.7 years compared to 6.4 
                                yeas for other males; and
                                  (V) Native Hawaiian females 
                                have 8.2 years of productive 
                                life lost from cancer in the 
                                State of Hawai`i as compared to 
                                6.4 years for other females in 
                                the State of Hawai`i;
                          (ii) Breast cancer.--With respect to 
                        breast cancer--
                                  (I) Native Hawaiians have the 
                                highest mortality rates in the 
                                State of Hawai`i 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 Hawai`i (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 Hawai`i 
                        (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 Hawai`i (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 Hawai`i 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 Hawai`i 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 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 
                                Hawai`i (201.1 out over every 
                                100,000 residents); and
                                  (II) Native Hawaiian males 
                                have the greatest years of 
                                productive life lost in the 
                                State of Hawai`i 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 Hawai`i and 6.4 years 
                                for all females.
                          (ii) Hypertension.--The death rate 
                        for Native Hawaiians from hypertension 
                        (3.5 out of every 100,000 residents) is 
                        84 percent higher than that for the 
                        entire State (1.9 out of every 100,000 
                        residents).
                          (iii) Stroke.--The death rate for 
                        Native Hawaiians from stroke (58.3 out 
                        of every 100,000 residents) is 13 
                        percent higher than that for the entire 
                        State (51.8 out of every 100,000 
                        residents).
          (2) Infectious disease and illness.--The incidence of 
        AIDS for Native Hawaiians is at least twice as high per 
        100,000 residents (10.5 percent) than that for any 
        other non-Caucasian group in the State of Hawai`i.
          (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 
                Hawai`i; 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 Hawai`i.
          (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 Hawai`i 
                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 Hawai`i 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 Hawai`i.
          (5) Life expectancy.--With respect to life 
        expectancy--
                  (A) Native Hawaiians have the lowest life 
                expectancy of all population groups in the 
                State of Hawai`i;
                  (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 
                        Hawai`i;
                          (ii) of the mothers in the State of 
                        Hawai`i 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 
                        Hawai`i, 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 
                        Hawai`i, 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 Hawai`i (3.6 
                        percent);
                          (ii) in 1996, nearly 53 percent of 
                        all mothers in Hawai`i 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 
                        Hawai`i, 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 
                Hawai`i. However, for fetal deaths occurring in 
                mothers under the age of 18 years, 32 percent 
                were Native Hawaiian, and for mothers 18 
                through 24 years of age, 28 percent were Native 
                Hawaiians.
          (7) Mental health.--
                  (A) Alcohol and drug abuse.--With respect to 
                alcohol and drug abuse--
                          (i) Native Hawaiians represent 38 
                        percent of the total admissions to 
                        Department of Health, Alcohol, Drugs 
                        and Other Drugs, funded substance abuse 
                        treatment programs;
                          (ii) in 1997, the prevalence of 
                        smoking by Native Hawaiians was 28.5 
                        percent, a rate that is 53 percent 
                        higher than that for all other races in 
                        the State of Hawai`i 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 Hawai`i;
                          (iv) the chronic drinking rate among 
                        Native Hawaiians is 54 percent higher 
                        than that for all other races in the 
                        State off Hawai`i;
                          (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 Hawai`i; 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 Hawai`i.
                  (B) Crime.--With respect to crime--
                          (i) in 1996, of the 5,944 arrests 
                        that were made for property crimes in 
                        the State of Hawai`i, 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 Hawai`i, and 38 percent of 
                        the 4,066 juvenile arrests:
                          (iv) Native Hawaiians are over-
                        represented in the prison population in 
                        Hawai`i;
                          (v) in 1995 and 1996 Native Hawaiians 
                        comprised 36.5 percent of the sentenced 
                        felon prison population in Hawai`i, 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 Hawai`i 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 Hawai`i (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 Hawai`i; 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 Hawai`i.

Sec. 11702. Declaration of [policy] National Native Hawaiian Health 
                    Policy

    (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] peoples of Hawai`i resulting from the unique and 
historical relationship between the United States and the 
[Government of the] indigenous [people] peoples of Hawai`i--
          (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 healthand 
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 with 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 physicial 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 dietitians.
          [(28) Reduce cigarette smoking prevalence to no more 
        than 15 percent of adults.
          [(29) Reduce initiation of smoking to 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 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 
        prevalence 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 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.] 
towards meeting 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 
OlaLokahi, 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 Hawai`i, 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 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 NativeHawaiians;
                  [(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 
        once annually, an accounting of funds and services 
        provided to States and to nonprofit groups and 
        organizations from the department for the purposes set 
        forth in section 4. Such accounting shall include--
                  (A) the amount of funds expended explicitly 
                for and benefiting Native Hawaiians;
                  (B) the number of Native Hawaiians impacted 
                by these funds;
                  (C) the identification of collaborations made 
                with Native Hawaiian groups and organizations 
                in the expenditure of these funds; and
                  (D) the amount of funds used for Federal 
                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 and to Native Hawaiian Health 
Centers.
    (f) Relationships With Other Agencies.--
          (1) Authority._Papa Ola Lokahi [is authorized to] may 
        enter into agreements or memoranda of understanding 
        with relevant institutions, agencies, or organizations 
        that are capable of providing health-related resources 
        or services to Native Hawaiians and the Native Hawaiian 
        health care systems or of providing resources or 
        services for the implementation of the National policy 
        as set forth in section 4.
          (2) Health care financing.--
                  (A) Federal consultation.--Federal agencies 
                providing health care financing and carrying 
                out health care programs, including the Health 
                Care Financing Administration, shall consult 
                with Native Hawaiians and organizations 
                providing health care services to Native 
                Hawaiians prior to the adoption of any policy 
                or regulation that may impact on the provision 
                of 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 Hawai`i 
                shall engage in meaningful consultation with 
                Native Hawaiians and organizations providing 
                health care services to Native Hawaiians in the 
                State of Hawai`i prior to making any changes or 
                initiating new programs.
                  (C) Consultation on federal health insurance 
                programs.--
                          (i) The Office of Hawaiian Affairs, 
                        in collaboration with Papa Ola Lokahi, 
                        may develop consultative, contractual 
                        or other arrangements including 
                        memoranda of understanding or 
                        agreement, with--
                                  (I) the Health Care Financing 
                                Administration
                                  (II) the agency of the State 
                                of Hawai`i that administers or 
                                supervises the administration 
                                of the State plan or 
waiverapproved 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
                          (iii) other matters that would enable 
                        Native Hawaiians to maximize health 
                        insurance benefits provided by Federal 
                        and State health insurance programs.
          (3) Traditional healers.--The provision of health 
        services under any program operated by the Department 
        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 Public 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.--
          [(A)] (1) Grants and contracts._The Secretary, in 
        consultation with Papa Ola Lokahi, may make grants to, 
        or enter into contracts with, any qualified entity for 
        the purpose of providing comprehensive health promotion 
        and disease prevention services as well as primary 
        health services to Native Hawaiians who desire and are 
        committed to bettering their own health.
          [(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.--An entity is a qualified 
        entity for purposes of paragraph (1) if the entity is a 
        Native Hawaiian health care system or a Native Hawaiian 
        Health Center.
          (4) Limitation on number of entities.--The Secretary 
        may make a grant to, or enter into a contract with, not 
        more than 8 Native Hawaiian health care systems under 
        this subsection during any fiscal year.
    [2] (b) Planning Grant or Contract._In addition to 
[paragraph (1)] 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 
Hawai`i.
    [(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, 
                counselors, and cultural educators;
                  (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)] 
        paragraph (1) 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.
    (3) 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 an 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 Hawai`i 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. Amount 
        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 Lokahi, 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 (a)(1) of this section unless 
the entity agrees that, amounts received pursuantto 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] an 
entity under subsection (a) [(1) of this 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 Appropriations.--
          (1) General grants.--There [are] is authorized to be 
        appropriated such sums as may be necessary for fiscal 
        years [1993] 2002 through [2001] 2006 to carry out 
        subsection (a) [(1) of this section].
          (2) Planning grants.--There [are] is authorized to be 
        appropriated such sums as may be necessary for each of 
        fiscal years 2002 through 2006 to carry out subsection 
        [(a)(2) of this section] (b).

Sec. 11706. Administrative grant for Papa Ola Lokahi

    (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] 5;
          (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] 
        epidemiologic, 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 data 
                associated with the health status of Native 
                Hawaiians;
                  (B) the identification and research into 
                diseases affecting Native Hawaiians; and
                  (C) the availability of Native Hawaiian 
                project funds, research projects and 
                publications;
          (6) the establishment and maintenance of an 
        institutional review board for all health-related 
        research involving Native Hawaiians;
          [6] (7) the coordination of the health care programs 
        and services provided to Native Hawaiians; and
          [7] (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] 2002 through [2001] 2006 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] 1 
                individual, fluent in both English and the 
                appropriate language, to assist in carrying out 
                the plan;
          (4) with respect to health services that are covered 
        [in the plan of the State of Hawai`i approved] under 
        programs under titles XVII, XIX, or XXI of the Social 
        Security Act, [42 U.S.C.A. Sec. 1396 et seq.] including 
        any State plan, or under any other Federal health 
        insurance plan--
                  (A) if the entity will provide under the 
                grant or contract any such health services 
                directly--
                          (i) the entity had 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 organizaiton 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] use and costs of health services provided 
        under the grant or contract (including the average cost 
        of health services per user) and that provides such 
        other information as the Secretary determines to be 
        appropriate.
    (d) Contract Evaluation.--
          (1) Determination of noncompliance.--If, as a result 
        of evaluations conducted by the Secretary, the 
        Secretary determines that an entity has not complied 
        with or satisfactorily performed a contract entered 
        into under section [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.
          (2) Nonrenewal.--If the Secretary determines that 
        [such] the noncompliance orunsatisfactory performance 
described in paragraph (1) with respect to an entity cannot be resolved 
and prevented in the future, the Secretary shall not renew [such] the 
contract with such entity and [is authorized to] may enter into a 
contract under section [11705 of this title] 7 with another entity 
referred to in [section 11705(b)] subsection (a)(3) of [this title] 
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 [subsection] 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] evaluations conducted 
        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) [Limitation 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] an annual report [on]--
                  (A) on the activities conducted by the entity 
                under the grant or contract;
                  (B) on the amounts and purposes for which 
                Federal funds were expended; and
                  (C) containing such other information as the 
                Secretary may request.
          (2) Audit.--The reports and records of any entity 
        [which concern] concerning any grant or contract under 
        this [chapter] Act shall be subject to audit by the 
        Secretary, the Inspector General of the Department of 
        Health and Human Services, and the Comptroller General 
        of the United States.
    [(g)] (f) Annual Private Audit.--The Secretary shall allow 
as a cost of any grant made or contract entered into under this 
[chapter] Act 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] may 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 [2541 of this 
        title,] 338A of the Public HealthService Act (42 U.S.C. 
2541), except for assistance as provided for under subsection (b)(2); 
and
          (2) are Native Hawaiians.
    (b) Priority.--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 [2541 
        of this title, provided that--] 338A of the Public 
        Health Service Act (42 U.S.C. 2541) (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] 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] 
                service in order of priority [that would 
                provide for practice--], in--
                          (i) [first, in] any one of the [five] 
                        Native Hawaiian health care systems or 
                        Native Hawaiian Health Centers;
                          [I] (ii) [a] health [professional] 
                        professions shortage [area or] areas, 
                        medically underserved [area located] 
                        areas, or geographic areas or 
                        facilities similarly designated by the 
                        United States Public Health Service in 
                        the State of Hawai`i; or
                          [II] (iii) a [geographic area or 
                        facility that is--
                                  [(aa) located in the State of 
                                Hawai`i; 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;] geographical area, 
                                facility, 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 
                        Hawai`i; 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 
                (42 U.S.C. 2541) while they are fulfilling 
                their service requirement in any one of the 
                Native Hawaiian health care systems or Native 
                Hawaiian 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 incertificated 
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] is 
authorized to be appropriated such sums as may be necessary for 
fiscal years [1993] 2002 through [2001] 2006 for the purpose of 
funding the scholarship assistance [provided] program 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, United States Code, for each 
fiscal year transmit to the Congress a report on the progress 
made in meeting the objectives of this [chapter] Act, 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 for 
the use and maintenance of such facilities or equipment.
    (b) Donation of Property.--The Secretary may donate to 
organizations that receive contracts or grants under this Act 
any personal or real property determined to be in excess of the 
needs of the Department or the General Services Administration 
for purposes of carrying out such contracts or grants.
    (c) Acquisition of Surplus Property.--The Secretary may 
acquire excess or surplus Federal Government personal or real 
property for donation to organizations that receive contracts 
or grants under this Act if the Secretary determines that the 
property is appropriate for the use by the organization for the 
purpose for which a contract or grant is authorized under this 
Act.

SEC. 14. DEMONSTRATION PROJECTS OF NATIONAL SIGNIFICANCE.

    (a) Authority and Areas of Interest.--The Secretary, in 
consultation with Papa Ola Lokahi, may allocate amounts 
appropriated under this Act, or any other Act, to carry out 
Native Hawaiian demonstration projects of national 
significance. The areas of interest of such projects may 
include--
          (1) the development of a centralized database and 
        information system relating to the health care status, 
        health care needs, and wellness of Native Hawaiians:
          (2) the education of health professionals, and other 
        individuals in institutions of higher learning, in 
        health and allied health programs in healing practices, 
        including Native Hawaiian healing practices;
          (3) the integration of Western medicine with 
        complementary healing practices including traditional 
        Native Hawaiian healing practices;
          (4) the use of tele-wellness and telecommunications 
        in chronic disease management and health promotion and 
        disease prevention;
          (5) the development of appropriate models of health 
        care for Native Hawaiians and other indigenous peoples 
        including the provision of culturally competent health 
        services, related activities focusing on wellness 
        concepts, the development of appropriate kupuna care 
        programs, and the development of financial mechanisms 
        and collaborative relationships leading to universal 
        access to health care; and
          (6) the establishment of a Native Hawaiian Center of 
        Excellence for Nursing at the University of Hawai`i at 
        Hilo, a Native Hawaiian Center of Excellence for Mental 
        Health at the University of Hawai`i at Manoa, Native 
        Hawaiian Center of Excellence for Maternal Health and 
        Nutrition at the Waimanalo Health Center, and a Native 
        Hawaiian Center of Excellence for Research, Training, 
        and Integrated Medicine at Moloka`i 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 Health Care Entitlement Commission 
(referred to in this Act as the `Commission').
    (b) Membership.--The Commission shall be composed of 21 
members to be appointed as follows:
          (1) Congressional members.--
                  (A) Appointment.--Eight members of the 
                Commission shall be members of Congress, of 
                which--
                          (i) two members shall be from the 
                        House of Representatives and shall be 
                        appointed by the Majority Leader;
                          (ii) two members shall be from the 
                        House of Representatives and shall be 
                        appointed by the Minority Leader;
                          (iii) two members shall be from the 
                        Senate and shall be appointed by the 
                        Majority Leader; and
                          (iv) two members shall be from the 
                        Senate and shall be appointed by the 
                        Minority Leader.
                  (B) Relevant committee membership.--The 
                members of the Commission appointed under 
                subparagraph (A) shall each be members of the 
                committees of Congress that consider 
                legislation affecting the provision of health 
                care to Native Hawaiians and other Native 
                Americans.
                  (C) Chairperson.--The members of the 
                Commission appointed under subparagraph (A) 
                shall elect the chairperson and vice-
                chairperson of the Commission.
          (2) Hawaiian health members.--Eleven members of the 
        Commission shall be appointed by Hawaiian health 
        entities, of which--
                  (A) five members shall be appointed by the 
                Native Hawaiian Health Care Systems;
                  (B) one member shall be appointed by the 
                Hawai`i State Primary Care Association;
                  (C) one member shall be appointed by Papa Ola 
                Lokahi;
                  (D) one member shall be appointed by the 
                Native Hawaiian Health Task Force;
                  (E) one member shall be appointed by the 
                Office of Hawaiian Affairs; and
                  (F) two members shall be appointed by the 
                Association of Hawaiian Civic Clubs and shall 
                represent Native Hawaiian populations residing 
                in the continental United States.
          (3) Secretarial members.--Two members of the 
        Commission shall be appointed by the Secretary and 
        shall possess knowledge of Native Hawaiian health 
        concerns and wellness.
    (c) Terms.--
          (1) In general.--The members of the Commission shall 
        serve for the life of the Commission.
          (2) Initial appointment of members.--The members of 
        the Commission shall be appointed under subsection 
        (b)(1) not later than 90 days after the date of 
        enactment of this Act, and the remaining members of the 
        Commission shall be appointed not later than 60 days 
        after the date on which the members are appointed under 
        such subsection (b)(1).
          (3) Vacancies.--A vacancy in the membership of the 
        Commission shall be filled in the manner in which the 
        original appointment was made.
    (d) Duties of the Commission.--The Commission shall carry 
out the following duties and functions:
          (1) Review and analyze the recommendations of the 
        report of the study committee establishment 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 
                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 
        appointment of 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. Suchmembers 
shall receive travel expenses and per diem in lieu of subsistence in 
accordance with sections 5702 and 5703 of title 5, United States Code.
                  (B) Other members.--The members of the 
                Commission appointed under paragraphs (2) and 
                (3) of subsection (b) shall, while serving on 
                the business of the Commission (including 
                travel time), receive compensation at the per 
                diem equivalent of the rate provided for 
                individuals under level IV of the Executive 
                Schedule under section 5315 of title 5, United 
                States Code, and while serving away from their 
                home or regular place of business, be allowed 
                travel expenses, as authorized by the 
                chairperson of the Commission.
                  (C) Other personnel.--For purposes of 
                compensation (other than compensation of the 
                members of the Commission) and employment 
                benefits, rights, and privileges, all personnel 
                of the Commission shall be treated as if they 
                were employees of the Senate.
          (2) Meetings and quorum.--
                  (A) Meetings.--The Commission shall meet at 
                the call of the chairperson.
                  (B) Quorum.--A quorum of the Commission shall 
                consist of not less than 12 members, of which--
                          (i) not less than 4 of such members 
                        shall be appointees under subsection 
                        (b)(1);
                          (ii) not less than 7 of such members 
                        shall be appointees under subsection 
                        (b)(2); and
                          (iii) not less than 1 of such members 
                        shall be an appointee under subsection 
                        (b)(3).
          (3) Director and staff.--
                  (A) Executive director.--The members of the 
                Commission shall appoint an executive director 
                of the Commission. The executive director shall 
                be paid the rate of basic pay equal to that 
                under level V of the Executive Schedule under 
                section 5316 of title 5, United States Code.
                  (B) Staff.--With the approval of the 
                Commission, the executive director may appoint 
                such personnel as the executive director deems 
                appropriate.
                  (C) Applicability of civil service laws.--The 
                staff of the Commission shall be appointed 
                without regard to the provisions of title 5, 
                United States Code, governing appointments in 
                the competitive service, and shall be paid 
                without regard to the provisions of chapter 51 
                and subchapter III of chapter 53 of such title 
                (relating to classification and General 
                Schedule pay rates).
                  (D) Experts and consultants.--With the 
                approval of the Commission, the executive 
                director may procure temporary and intermittent 
                services under section 3109(b) of title 5, 
                United States Code.
                  (E) Facilities.--The Administrator of the 
                General Services Administration shall locate 
                suitable office space for the operations of the 
                Commission in Washington, D.C. and in the State 
                of Hawai`i. The Washington, D.C. facilities 
                shall serve as the headquarters of the 
                Commission while the Hawai`i 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 
                Attorney of the Centers for Medicare and 
                Medicaid Services, or both, shall provide to 
                the Commission, upon the request of the 
                Commission, such cost estimates as the 
                Commission determines to be necessary to carry 
                out its duties.
                  (B) Reimbursements.--The Commission shall 
                reimburse the Director of the Congressional 
                Budget Office for expenses relating to the 
                employment in the office of the Director of 
                such additional staff as may be necessary for 
                the Director to comply with requests by the 
                Commission under subparagraph (A).
          (4) Detail of federal employees.--Upon the request of 
        the Commission, the head of any Federal agency is 
        authorized to detail, without reimbursement, any of the 
        personnel of such agency to the Commission to assist 
        the Commission in carrying out its duties. Any such 
        detail shall not interrupt or otherwise affect the 
        civil service status or privileges of the Federal 
        employees.
          (5) Technical assistance.--Upon the request of the 
        Commission, the head of any Federal agency shall 
        provide such technical assistance to the Commission as 
        the Commission determines to be necessary to carry out 
        its duties.
          (6) Use of mails.--The Commission may use the United 
        States mails in the same manner and under the same 
        conditions as Federal agencies and shall, for purposes 
        of the frank, be considered a commission of Congress as 
        described in section 3215 of title 39, United States 
        Code.
          (7) Obtaining information.--The Commission may secure 
        directly from any Federal agency information necessary 
        to enable the Commission to carry out its duties, if 
        the information may be disclosed under section 552 of 
        title 5, United States Code. Upon request of the 
        chairperson of the Commission, the head of such agency 
        shall furnish such information to the Commission.
          (8) Support services.--Upon the request of the 
        Commission, the Administrator of General Services shall 
        provide to the Commission on a reimbursable basis such 
        administrative support services as the Commission may 
        request.
          (9) Printing.--For purposes of costs relating to 
        printing and binding, including the cost of personnel 
        detailed from the Government Printing Office, the 
        Commission shall be deemed to be a committee of 
        Congress.
    (g) Authorization of Appropriations.--There is authorized 
to be appropriated such sums as may be necessary to carry out 
this section. The amount appropriated under this subsection 
shall not result in a reduction in any other appropriation for 
health care or health services for Native Hawaiians.

SEC. 16. RULE OF CONSTRUCTION.

    Nothing in this Act shall be construed to restrict the 
authority of the State of Hawai`i 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 Hawai`i) 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 Hawai`i, 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 
                Hawai`i 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 Hawai`i;
                 (B) which provides or arranges for health care 
                services through practitioners licensed by the 
                State of Hawai`i, 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 health care services;
                 (E) which are established 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] 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] any organization that is 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 Hawai`i,
                  [(B) which provides or arranges for health 
                care services through practitioners licensed 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 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 Hawai`i;
                          [(iii) Alu Like Inc.;
                          [(iv) the University of Hawai`i;
                          [(v) the Office of Hawaiian Health of 
                        the Hawai`i State Department of Health;
                          [(vi) Ho`ola Lahui Hawai`i, 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 Hawai`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 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 
        Hawai`i 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 Hawai`i;
                          (iii) Alu Like, Inc.;
                          (iv) the University of Hawai`i
                          (v) the Hawai`i 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 Hawai`i 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 Hawai`i, 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 Hawai`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 that island;
                          (xiv) other Native Hawaiian health 
                        care systems as certified and 
                        recognized by Papa Ola Lokahi in 
                        according 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 
                speciality 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 Hawai`i to license health 
practitioners.

Sec. 11713. Compliance with Budget Act

    Any new spending authority (described in [subsection 
(c)(2)] subparagraph (A) [of] or (B) of section [651] 401(c)(2) 
of [Title 2)] the Congressional Budget Act of 1974 (2 U.S.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 for 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] 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.

                                
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