[Senate Report 107-56]
[From the U.S. Government Publishing Office]
Calendar No. 144
107th Congress Report
SENATE
1st Session 107-56
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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.
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\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).
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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.