[Senate Report 106-389] [From the U.S. Government Publishing Office] Calendar No. 765 106th Congress Report SENATE 2d Session 106-389 ====================================================================== AMENDING THE NATIVE HAWAIIAN HEALTH CARE IMPROVEMENT ACT TO REVISE AND EXTEND SUCH ACT _______ August 25, 2000.--Ordered to be printed Filed under authority of the order of the Senate of July 26, 2000 _______ Mr. Campbell, from the Committee on Indian Affairs, submitted the following R E P O R T [To accompany S. 1929] The Committee on Indian Affairs, to which was referred the bill (S. 1929) to amend the Native Hawaiian Health Care Improvement Act to revise and extend such Act, having considered the same, reports favorably thereon with an amendment in the nature of a substitute, and recommends that the bill (as amended) do pass. Purpose The purpose of S. 1929, a bill to provide for the reauthorization of the Native Hawaiian Health Care Improvement Act, is to improve the health status of Native Hawaiians through the continuation of a comprehensive health promotion and disease prevention effort that involves health education in Native Hawaiian communities, and the provision of primary care health care services using traditional Native Hawaiian healers and health care providers trained in Western medicine. In areas where there is an underutilization of existing health care delivery systems that have the capacity to provide culturally- relevant health care services, S. 1929 provides authority for the Secretary of the Department of Health and Human Services to enter into contracts with Native Hawaiian health care systems to provide health care referral services to Native Hawaiian patients. S. 1929 is intended to assure the continuity of the health care programs that are provided to Native Hawaiians under the authority of Public Law 100-579. As enacted in 1988, the Native Hawaiian Health Care Improvement Act is premised upon the findings and recommendations of the Native Hawaiian Health Research Consortium report to the Secretary of the Department of Health and Human Services of December, 1985. That report clearly indicates that the underutilization of existing health care services by Native Hawaiians can be traced to the absence of culturally-relevant services, in which traditional Native Hawaiian concepts of healing are lacking, as well as to a general perception in the Native Hawaiian community that health care services which are fundamentally based on concepts of Western medicine, will not effect the healing or cure of diseases and illnesses afflicting Native Hawaiian people. Historical Background The islands that now compose the State of Hawaii were governed by a monarchy of Native Hawaiians until 1893. The Native Hawaiian government was recognized as an independent sovereign nation by foreign governments, and treaty relationships were established with the United States (Treaty of Friendship, Commerce, and Navigation of 1849; Treaty of Commercial Reciprocity, January 30, 1875.) As a result of expanded trade with the United States, western influence in the islands increased, and in 1893, the government of Queen Liliuokalani was overthrown in an insurrection engineered by a group of western businessmen in an effort to secure the annexation of Hawaii to the United States. The United States minister in Hawaii ordered one company of marines and two companies of sailors to be landed, and the minister then recognized a new provisional government even before Queen Liliuokalani's lines of defense had surrendered. Although the provisional government sought immediate annexation by the United States, President Grover Cleveland refused to submit a treaty of annexation to the Senate, finding that the provisional government lacked the popular support of the Native Hawaiian population and that the government would not have been established but for the lawless and unauthorized military intervention of the United States. Upon the inauguration of William McKinley as the new President of the United States in 1897, however, the western businessmen that sought annexation were able to change the official U.S. position, and in 1898, Hawaii became a territory of the United States. During the first two decades of the twentieth century, the already depressed economic conditions of Native Hawaiians deteriorated further, and in 1920, the United States Congress legislated directly for the benefit of Native Hawaiians by enacting the Hawaiian Homes Commission Act, and establishing a land base for Native Hawaiians to provide a permanent homeland and to encourage agricultural pursuits. The Act placed approximately 200,000 acres under the jurisdiction of the Hawaiian Homes Commission, a branch of the territorial government established for the purpose of ``rehabilitating'' persons of at least fifty percent Native Hawaiian ancestry through a return to pastoral life. The Act also authorized the Commission to undertake ``activities having to do with the economic and social welfare of the homesteaders.'' Hawaii was admitted to statehood in 1959, and the Admissions Act transferred the title to the lands administered by the Hawaiian Homes Commission from the Federal government to the State of Hawaii. The Admissions Act requires the State to hold the lands ``as a public trust * * * for the betterment of the conditions of Native Hawaiians * * * and their use for any other object shall constitute a breach of trust for which suit may be brought by the United States. Background Language contained in the 1984 Supplemental Appropriations Act, Public Law 98-396, directed the Department of Health and Human Services to conduct a comprehensive study of the health care needs of Native Hawaiians. The study was conducted under the aegis of Region IX of the Department by a consortium of health care providers and professionals from the State of Hawaii in a predominantly volunteer effort, organized by Alu Like, Inc., a Native Hawaiian organization. An island-wide conference was held in November of 1985 in Honolulu to provide an opportunity for members of the Native Hawaiian community to review the study's findings. Recommended changes were incorporated in the final report of the Native Hawaiian Health Research Consortium, and the study was formally submitted to the Department of Health and Human Services in December of 1985. The Department submitted the report to the Congress on July 21, 1986, and the report was referred to the Select Committee on Indian Affairs. Because the Consortium report's findings as to the health status of Native Hawaiians was compared only to other populations within the State of Hawaii, the Select Committee requested that the Office of Technology Assessment (OTA), an independent agency of the Congress, undertake an analysis of Native Hawaiian health statistics as they compared to national data in other United States populations. Using the same population projection model that was employed in OTA's April 1986 report on Indian Health Care to American Indian and Alaska Native populations, and based on additional information provided by the Department of Health and the Office of Hawaiian Affairs of the State of Hawaii, the Office of Technology Assessment report contains the following findings: The Native Hawaiian population living in Hawaii consists of two groups, Hawaiians and part-Hawaiians, who are distinctly different in both age distributions and mortality rates. Hawaiians comprise less than five percent of the total Native Hawaiian population and are much older than the young and growing part-Hawaiian populations. Overall, Native Hawaiians have a death rate that is thirty- four percent higher than the death rate for the United States all races, but this composite masks the great differences that exist between Hawaiians and part-Hawaiians. Hawaiians have a death rate that is 146 percent higher than the U.S. all races rate. Part-Hawaiians also have a higher death rate, but only 17 percent greater. A comparison of age-adjusted death rates for Hawaiians and part-Hawaiians reveals that Hawaiians die at a rate 110 percent higher than part-Hawaiians, and this pattern persists for all except one of the 13 leading causes of death that are common to both groups. As in the case of the U.S. all races population, Hawaiian and part-Hawaiian males have higher death rates than their female counterparts. However, when Hawaiian and part-Hawaiian males and females are compared to their U.S. all races counterparts, females are found to have more excess deaths than males. Most of these excess deaths are accounted for by diseases of the heart and cancers, with lesser contributions from cerebrovascular disease and diabetes mellitus. Diseases of the heart and cancers account for more than half of all deaths in the U.S. all races population, and this pattern is also found in both the Hawaiian and part-Hawaiian populations, whether grouped by both sexes or by male or female. However, Hawaiians and part-Hawaiians have significantly higher death rates than their U.S. all races counterparts, with the exception of part-Hawaiian males, for whom the death rate from all causes is approximately equal to that of U.S. all races males. One disease that is particularly pervasive is diabetes mellitus, for which even part-Hawaiian males have a death rate 128 percent higher than the rate for U.S. all races males. Overall, native Hawaiians die from diabetes at a rate that is 222 percent higher than for the U.S. all races. When compared to their U.S. all races counterparts, deaths from diabetes mellitus range from 630 percent higher for Hawaiian females and 538 percent higher for Hawaiian males, to 127 percent higher for part-Hawaiian females and 128 percent higher for part- Hawaiian males.'' There is thus little doubt that the health status of Native Hawaiians is far below that of other U.S. population groups, and that in a number of areas, the evidence in compelling that Native Hawaiians constitute a population group for whom the mortality rate associated with certain diseases exceed that for other U.S. populations in alarming proportions. Native Hawaiians premise the high mortality rates and the incidence of disease that far exceed that of other populations in the United States upon the breakdown of the Hawaiian culture and belief systems, including traditional healing practices, that was brought about by western settlement, and the influx of western diseases to which the native people of the Hawaiian Islands lacked immune systems. Further, Native Hawaiians predicate the high incidence of mental illness and emotional disorders in the Native Hawaiian population as evidence of the cultural isolation and alienation of the native peoples, in a statewide population in which they now constitute only 20 percent. Settlement from both the east and the west have not only brought new diseases which decimated the Native Hawaiian population, but which devalued the customs and traditions of Native Hawaiians, and which eventually resulted in Native Hawaiians being prohibited from speaking their native tongue in school, and in many instances, at all. In 1998, Papa Ola Lokahi updated the health care statistics from the original E Ola Mau report. In addition, on an annual basis, Papa Ola Lokahi extrapolates the data on Native Hawaiians gathered yearly by the Hawaii State Department of Health from the Department's behavioral risk assessment and health surveillance survey. The findings from those assessments revealed that-- With respect to cancer, Native Hawaiians have the highest cancer mortality rates in the State of Hawaii (231 out of every 100,000 residents), 45 percent higher than that for the total State population. Native Hawaiian males have the higher cancer mortality rates in the State of Hawaii for cancers of the lung, liver and pancreas and for all cancers combined, and the highest years of productive life lost from cancer in the State of Hawaii. Native Hawaiian females ranked highest in the State of Hawaii for cancers of the lung, liver, pancreas, breast, cervix uteri, corpus uteri, stomach, and rectum, and for all cancers combined. With respect to breast cancer, Native Hawaiians have the highest mortality rates in the State of Hawaii, and nationally, Native Hawaiians have the third highest mortality rates due to breast cancer. Native Hawaiians have the highest mortality rates from cancer of the cervix and lung cancer in the State of Hawaii, and Native Hawaiian males have the second highest mortality rates due to prostate cancer in the State. For the years 1989 through 1991, Native Hawaiians had the highest mortality rate due to diabetes mellitus in the State of Hawaii, with full-blood Hawaiians having a mortality rate that is 518 percent higher than the rate for the statewide population of all other races, and Native Hawaiians who are less than full-blood having a mortality rate that is 79 percent higher than the rate for the statewide population of all other races. In 1990, Native Hawaiians represented 44 percent of all asthma cases in the State of Hawaii for those 18 years of age and younger, and 35 percent of all asthma cases reported, and in 1992, the Native Hawaiian rate for asthma was 73 percent higher than the rate for the total statewide population. With respect to heart disease, the death rate for Native Hawaiians from heart disease is 66 percent higher than for the entire State of Hawaii, and Native Hawaiian males have the greatest years of productive life lost in the State of Hawaii. The death rate for Native Hawaiians from hypertension is 84 percent higher than that for the entire State, and the death rate from stroke for Native Hawaiians is 13 percent higher than for the entire State. Native Hawaiians have the lowest life expectancy of all population groups in the State of Hawaii. Between 1910 and 1980, the life expectancy of Native Hawaiians from birth has a range from 5 to 10 years less than that of the overall State population average, and the most recent data for 1990 indicates that Native Hawaiian life expectancy at birth is approximately 5 years less than that of the total State population. With respect to prenatal care, as of 1996, Native Hawaiian women have the highest prevalence of having had no prenatal care during their first trimester of pregnancy, representing 44 percent of all such women statewide. Over 65 percent of the referrals to Healthy Start in fiscal year 1996 and 1997 were Native Hawaiian newborns, and in every region of the State of Hawaii, many Native Hawaiian newborns begin life in a potentially hazardous circumstance. In 1996, 45 percent of the live births to Native Hawaiians mothers were infants born to single mothers. Statistics indicated that infants born to single mothers have a higher risk of low birth weight and infant mortality. Of all low birth weight babies born to single mothers in the State of Hawaii, 44 percent were Native Hawaiians. In 1996, Native Hawaiian fetal mortality rates comprised 15 percent of all fetal deaths for the State of Hawaii. Thirty-two percent of all fetal deaths occurring in mothers under the age of 18 years were Native Hawaiians, and for mothers 18 through 24 years, 28 percent were Native Hawaiians. These and other health status statistics contained in the findings section of S. 1929 make clear that the health care challenges that the Native Hawaiian health care systems were established to address require reauthorization of the Native Hawaiian Health Care Improvement Act. Native Hawaiian Health Care Master Plan and Native Hawaiian Health Care Systems The concepts embodied in S. 1929 are the result of the Committee's work with Native Hawaiian health care professionals and others who are dedicated to improving the health status of Native Hawaiians. It is based on the beliefs of those with whom the Committee has consulted, that to insure that Native Hawaiians are able to achieve the healthful harmony of the self (body, mind and spirit) or lokahi, with others and all of nature, and to assure that Native Hawaiians are able to function effectively as citizens and leaders in their own homeland, there must be a restoration of cultural traditions, an integration of traditional healing methods in the health care delivery system, and a collective effort to restore to the Native Hawaiian, a sense of self esteem and self worth, both for his or her culture, as well as for the individual. E Ola Mau, a group of Native Hawaiian health care professionals, proposed that this effort begin with the development of a health care master plan, based on a bio- psycho-socio-cultural-political model that would be aimed at identifying significant events and factors related to specific health care needs and issues. E Ola Mau proposed that this master plan be implemented at every societal level (individual, household, community, county and state) in the Hawaiian Islands. It is their goal to have this Native Hawaiian way of dealing with health, eventually become an institutional part of the State's health policy for both Native Hawaiian and Non- Hawaiians. After much debate and careful consideration in the Native Hawaiian community and amongst those concerned with the health status of Native Hawaiians, a consensus wasreached that Papa Ola Lokahi, the Native Hawaiian Health Board, should be the mechanism through which Native Hawaiian health care systems were to be developed, coordinated, administered, monitored, and continually revised to meet the changing health care needs of the Native Hawaiian population. Papa Ola Lokahi is currently composed of five organizations: (1) the Office of Hawaiian Affairs, an agency of the State which was established pursuant to the authority of amendments make to the Constitution of the State of Hawaii in 1978 to assure the well-being and interests of Native Hawaiians; (2) E Ola Mau, a nonprofit organization of Native Hawaiian professionals dedicated to insuring that Native Hawaiians achieve a healthful harmony of self (body, mind and spirit) with others and all of nature, and become productive citizens and leaders in their homeland; (3) Alu Like, a Federally-funded Native Hawaiian agency that promotes vocational training and the founding of community-based organizations that promote health, education and economic development for Native Hawaiians; (4) the University of Hawaii; and (5) the Office of Hawaiian Health within the State Department of Health. Papa Ola Lokahi has assumed the primary responsibility of overseeing the development and maintenance of a Native Hawaiian Comprehensive Health Care Master Plan, and is the entity responsible for certifying to the Secretary the qualifications and capabilities of Native Hawaiian organizations that petition the Secretary to carry out, pursuant to contracts with the Secretary, the provisions of the Act. Public Law 100-579 authorized Papa Ola Lokahi, the Native Hawaiian Health Board, to-- (1) designate a chairman and vice-chairman from among its member organizations and such other officers as may be deemed necessary to carry out its responsibilities under the Act; (2) adopt bylaws and such other internal regulations or procedures as may be deemed necessary to carry out its responsibilities under the Act; (3) certify to the Secretary that a Native Hawaiian organization meets the definition of ``Native Hawaiian organization'' as set forth in the Act; (4) certify to the Secretary that a Native Hawaiian organization has the qualifications and capacity to provide the services or perform contract requirements pursuant to a contract with the Secretary; (5) oversee the development of a comprehensive native Hawaiian health care master plan; (6) assure the conduct of health status and health care needs assessments of Native Hawaiian communities desiring to participate in Native Hawaiian health care program; and (7) coordinate the activities and functions of all Native Hawaiian organizations operating health care programs pursuant to contracts with the Secretary. Public Law 100-579 envisions a comprehensive health care system that is community-based, building upon the Native Hawaiian 'ohana system (The 'ohana system is based upon the fundamental unit of societal interaction for Native Hawaiians in which a family or an organization is led by a haku, the recognized leader, whose function is to coordinate and facilitate the expertise and resources of the various households or affiliated organizations in order to accomplish a task or resolve a problem. The households or affiliated organizations are in turn led by po'o, the head of the household or designated leader of the organization.) and incorporating traditional healing (la'au lapa'au) practices with western medical services to provide a health care system that will be culturally consistent and responsive to the needs of Native Hawaiian communities. As enacted, Public Law 100-579 authorized the establishment of Native Hawaiian Healing Centers on each of the islands comprising the State of Hawaii, upon the acceptance of and in consultation with the Native Hawaiian communities on those islands, and wherever possible, using existing health care facilities and health care providers now serving the Native Hawaiian communities on those islands. These centers were intended to lead and coordinate the development and implementation of a statewide Native Hawaiian health care system, which would include: (1) a research and monitoring staff, state-certified neighborhood counselors, outreach workers and health educators, traditional Native Hawaiian healers, and Native Hawaiian cultural educators; (2) primary health care providers; (3) primary health care facilities, using existing health care facilities where practicable and acceptable to the local Native Hawaiian community; (4) participation by the State Department of Health Office of Hawaiian Health in the provision of disease prevention and health promotion programs, as well as a multi-disciplinary approach to Native Hawaiian health care which would include nursing, dental hygiene, nutrition education, maternal and infant child care education; and (5) other Federal, State, county, community and private organizations and agencies that could provide services which meet the health care needs of their respective communities. The development of the master plan by Papa Ola Lokahi was intended to include: (1) work with Native Hawaiian communities which support the establishment of a Native Hawaiian Health Center; (2) conducting a community health needs assessment survey for participating communities; (3) facilitating the development, establishment, and effectivefunctioning of such Centers on the islands of O'ahu, Moloka'i, Maui, Hawai'i, Lana'i, Kaua'i and Ni'ihau; and (4) coordinating the work of relevant agencies and organizations to provide participating communities with: (a) direct health care services and health education, including maternal and child health care and mental health care; (b) instruction in the Native Hawaiian language, cultural beliefs and traditions with an emphasis on health concepts and practices; (c) training and education of health care providers and educators and cultural educators in health promotion and disease prevention; (d) basic and applied research and monitoring of Native Hawaiian health care approaches to validate outcomes and create standards of quality care; (e) development of health care services, training and education that would have a Native Hawaiian perspective as its primary focus; (f) development of Native Hawaiian community health counselors, outreach workers, educators, and community health aide training programs; (g) preventive-oriented health care services in medical, dental, nutrition, mental health, and in other designated areas as needs assessments may identify as necessary; (h) data collection related to prevention of diseases and illnesses among Native Hawaiians; (i) medical and general health-related research into the diseases that are most prevalent among Native Hawaiians; (j) mental health research in areas of mental health problems that are most prevalent in the Native Hawaiian population; (k) ongoing health planning for further development of the Native Hawaiian health care system; and (l) the provision of health care referral services when certain health care services are not available within the Native Hawaiian Health Center. Following enactment of the Native Hawaiian Health Care Act, the Papa Ola Lokahi Board became incorporated and began working with health care providers on each island toward the development of a master plan and an island-specific plan for the provision of primary health care and health care referral services. Those involved in the planning effort ultimately determined that the health care needs of Native Hawaiians would be better served by the establishment of five Native Hawaiian health care systems which could be composed of as many health care centers as might be necessary to serve the health care needs of Native Hawaiians on each island. Accordingly, Papa Ola Lokahi certified to the Secretary that five health care systems qualified as Native Hawaiian organizations for purposes of entering into contracts with the Secretary, and plans for the provision of primary health care services or health care referral services were submitted to the Secretary in 1990. The first contract awards were made in October of 1991, and the health care systems are now engaged not only in the implementation of the plans approved by the Secretary, but the provision of health care services. The plans for each health care system vary according to the availability of and access to existing health care resources on each island and the need for primary health care services. Currently, all five Native Hawaiian health care systems have become incorporated as 501(c)(3) non-profit health care organizations. In general, the capacity to provide critical care exists only on the island of O'ahu, and thus, it has long been the pattern that if a patient requires hospitalization and complex surgery or treatment, the patient would be referred to a health care provider on the island of O'ahu. However, it is not uncommon that treatment requiring advanced medical technology must be secured in the mainland United States. The Native Hawaiian Health Care Improvement Act provides authority for the provision of health promotion, disease prevention, and primary health services to Native Hawaiians who reside in the State of Hawai'i. Federal planning funds first became available in July of 1990. However, Papa Ola Lokahi incorporated in Federal 1989 and was able to initiate its organizing activities in July 1989 with funds provided by the Hawai'i State legislature. Between July 1989 and December 1990, informational meetings and organizational activities took place throughout the state, resulting in the establishment or recognition of the five Native Hawaiian health care systems which would take the responsibility for providing services: (1) Ho'ola Lahui Hawai'i for Kaua'i and Ni'ihau; (2) Ke Ola Mamo for O'ahu; (3) Na Pu'uwai for Moloka'i and Lana'i; (4) Hui No Ke Ola Pono for Maui; and (5) Hui Malama Ola Na 'Oiwi for Hawai'i. Papa Ola Lokahi provided planning funds and technical assistance to these five health care systems, who then developed their service plans from January through June 1991, applied for funding under the Native Hawaiian Health Care Act in July 1991, and were awarded service grants in October of 1991. The basic set of services that all five health care systems must provide include: (1) outreach services to inform Native Hawaiians of the availability of health services; (2) education in health promotion and disease prevention of the Native Hawaiian population by Native Hawaiian health care practitioners, community outreach workers, counselors, and cultural educators, whenever possible; (3) services of physicians, physicians' assistants, nurse practitioners or, other health professionals; (4) immunizations; (5) prevention and control of diabetes, high blood pressure, and otitis media; (6) pregnancy and infant care; and (7) improvement of nutrition. In the initial stages, because the five health care systems needed to gain experience in managing health services and because of limited funds, each health care system concentrated on outreach, health assessments, case management, and disease prevention and health promotion activities, with the ultimate objective of providing the full range of health and medical services that are available through a typical primary care health center, and working with traditional healers so that their services will also be more readily available to Native Hawaiians. Now that the five island-wide Native Hawaiian health care systems are established and engaged in the provision of health care services, Papa Ola Lokahi's role is to provide technical and training support to the five health care systems to develop a statewide, cooperative Native Hawaiian health system, develop research activities and capacities within the five health care systems, and evaluate how well the objectives of the Native Hawaiian Health Care Act are being met. To serve the health care needs of Native Hawaiians on the islands of Kaua'i and Ni'ihau, Ho'ola Lahui Hawai'i (to preserve the Hawaiian Race) is a nonprofit organization dedicated to elevating the health status and overall living conditions of the Native Hawaiian. Ho'ola Lahui Hawai'i has established offices in Waimea and Anahola which serve as a base from which outreach is provided to the East and West sides of Kaua'i. Service to the island of Ni'ihau is provided through the office in Waimea. Ho'ola Lahui Hawai'i is working with existing health and health-related organizations in an effort to assure access to services for Native Hawaiians that were for some reason or another inaccessible or unacceptable. Ho'ola Lahui Hawai'i is organized around the concept of lokahi (unity in all aspects of life) in which they seek to maintain a balance of body, mind, and soul. As a community-based organization which works from the ground level up, the concern of Ho'ola Lahui Hawai'i for the Native Hawaiian grows out of a shared history, for those involved in Ho'ola Lahui Hawai'i are Native Hawaiian. At this time, Ho'ola Lahui Hawai'i provides health education and teaching on cancer, diabetes, hypertension, high cholesterol, gout, hygiene, and diet/exercise. Ho'ola Lahui Hawai'i also conducts monitoring on blood pressure, blood sugar, weight, and diet. Ho'ola Lahui Hawai'i offers information and referral to outside agencies through case management. In addition, Ho'ola Lahui Hawai'i is sponsoring the traditional Native Hawaiian diet regimen on the island of Kaua'i. Ho'ola Lahui Hawai'i completed one diet project in Waimea in conjunction with the State Department of Health and started another in Kapa'a in May of 1992. Traditional healing is also an area Ho'ola Lahui Hawai'i addresses with sponsorship of a statewide la'au lapa'u (training in traditional medicine) in the spring of 1992 in conjunction with E Ola Mau and Ka Wai Ola'o Kalani. In addition, Ho'ola Lahui Hawai'i offers lomi lomi (traditional massage therapy). Ho'ola Lahui Hawai'i intends to expand its services to include health education and teaching on sexually- transmitted diseases, family planning, maternal and infant care, and alcohol/substance abuse. Ho'ola Lahui Hawai'i's plans include establishing a health education component in kindergarten, elementary, and high schools, tailored to the physical and psychological needs of the particular age group. Ke Ola Mamo is committed to improving the health status of Native Hawaiians on the island of O'ahu through the development of a system of culturally-competent services that use rather than duplicate the existing health care service delivery system. Through outreach referral and case consultation, Ke Ola Mamo's goal is the empowerment of Native Hawaiian families and individuals to access appropriate health care services; the development of partnerships with existing health care services in a collaborative effort to improve access to health care; and working with Native Hawaiian communities and neighborhoods to assist them in meeting their health care needs. In 1986, there were 137,481 Native Hawaiians living on the island of O'ahu, who comprise approximately two-thirds of the total Native Hawaiian population in the entire State of Hawai'i. The Native Hawaiian population living on O'ahu can be roughly divided into three equal groups by geographic location; those living on the leeward coast, including Pearl City; those living on the windward and north coasts; and those living in the urban Honolulu complex. There are estimated to be at least twenty distinct communities and neighborhoods where Native Hawaiian families reside. As a start, Ke Ola Mamo has selected four of these communities to develop service delivery projects. Three projects involve rural communities: the Waimanalo community, the Wai'anae community, and the Ko'olauloa community. A fourth project is being proposed as a community education and planning process for the urban Honolulu communities with future service implementation proposals. The goal of Na Pu'uwai is to raise the health status of the Native Hawaiian residents of the island of Moloka'i, including Kalaupapa, and the island of Lana'i to the highest possible level and to encourage the maximum participation of Native Hawaiians to achieve this goal. The strategy of the program is two-fold: (1) to develop a personalized schedule of recommended health care activities, referred to as a ``personalized health care plan'' for each client; and (2) to use case management methodologies as a behavioral intervention to assure client adherence to their ``personalized health care plan.'' To implement this strategy, the program: (1) conducts screening and enrollment for those who are self-referred, provider-referred, or recruited by staff; (2) conducts a health risk appraisal on each enrollee to assess current health maintenance status; (3) develops a personalized health care plan with each client, based on recommended primary, secondary, and tertiary health maintenance guidelines and the client's concerns and needs; (4) coordinates and provides health promotion and disease prevention programs and health screening; (5) provides clinic-based primary health care services; (6) provides multi-disciplinary case management services as appropriate, to enrolled participants; and (7) reassesses client status as dictated in the case management plan andconducts ongoing followup on all clients, case management and non- case management. Na' Pu'uwai's service delivery plan provides for (1) direct outpatient care services of a physician and nurse; (2) case management services of a social worker and multi-disciplinary case management team; (3) direct health education and health screening services; and (4) patient followup and outreach services. Hui No Ke Ola Pono (an association to strengthen and perpetuate life) is Maui's Native Hawaiian Health Care System, providing services that are culturally relevant to Native Hawaiians of Maui, including identification, treatment, control, and reduction of the incidence of preventable illnesses and conditions frequently occurring in the Native Hawaiian population. The services provided by Hui No Ke Ola Pono include health promotion and disease prevention; referrals for immunizations; improvement of nutrition; referrals for pregnancy and infant care; prevention and control of diabetes, high blood pressure and middle ear infections; community outreach services; referrals to physician and nursing services; and education on traditional practitioner services. In addition, traditional Hawaiian healers provide the following services: ho'oponopono (family or group counseling); la'au lapa'au (traditional Hawaiian herbal medicine); and lomi lomi (Hawaiian massage therapy). Hui Malama Ola Na 'Oiwi (caring for our people) is the Native Hawaiian health care system for Native Hawaiians on the Island of Hawai'i. The program mission of Hui Malama Ola Na 'Oiwi is to assist Native Hawaiians in restoring a high quality health care system by creating and developing a non-threatening healing environment inclusive of traditional health assistance and to provide an facilitate a process of awareness and addressing the health needs, both physical and spiritual, of Native Hawaiians. Hui Malama's objectives are to (1) promote physical, emotional, and spiritual health and well-being of Native Hawaiians on the island of Hawaii; (2) assist and promote personal responsibility among Native Hawaiians toward making sound, informed decisions which would decrease unhealthy behaviors and reduce morbidity and mortality rates; (3) support and advocate the use of health care services that come from the traditions of the Native Hawaiian culture and of western science; and (4) work toward the establishment of primary health care centers in appropriate locations where quality primary care can be provided and where primary care services are not currently available. The death rates of Native Hawaiians exceed the death rates for all races in the United States caused by diseases of the heart, cancer, strokes, and diabetes. Achieving good health for Native Hawaiians appears difficult, but these diseases can be controlled through early detection, proper diet and treatment, regular exercise, etc. Hui Malama Ola Na 'Oiwi provides the following services: (1) Outreach--enrolling participants in the program, assessing their health risk factors, assisting in securing medical insurance where needed, assisting in access to a physician, providing transportation to and from the physician for those who are unable to do so, and making home visits when necessary; (2) Health promotion and disease prevention--providing education regarding the prevention and control of diabetes, high blood pressure (hypertension), misuse of tobacco, alcohol and other harmful drugs, sexually transmitted diseases, stress, cancer, the importance of sound nutrition habits, regular exercise, and proper material and infant care practices; (3) Primary health services--Hui Malama Ola Na 'Oiwi assists patients in securing access to the primary health care services of a physician, a physician's assistant, or a nurse practitioner where a doctor may not be available. Through the work of the five Native Hawaiian health care systems, on an annual basis, 20,000 Native Hawaiians continue to benefit from the range of health care services provided by the systems. Native Hawaiian Health Care Professions Scholarships The Native Hawaiian Health Care Improvement Act also provides authority for the provision of scholarships to Native Hawaiians who are seeking higher education opportunities in the health care professions. The Native Hawaiian Health Scholarship Program is administered by the Kamehameha Schools Bishop Estate, and has awarded 92 scholarships since 1991. These scholarships include: 10 bachelors of nursing, 2 clinical psychology doctoral programs, 2 dentists, 7 dental hygienists, one osteopathic physician, 29 allopathic physicians, 6 masters public health, 12 masters in social work, one nurse midwife, 3 nurse practitioners, 4 doctors of psychology, and 5 registered nurses. Nineteen of the scholarship recipients have completed their studies and their service payback requirements and are practicing in the Native Hawaiian community. Seventeen are enrolled in advanced studies, three have completed their training and are awaiting placement for the service payback requirement, three have enrolled and completed their scholarships, thirteen are in residency programs, and 24 have completed their studies and are currently providing services to the Native Hawaiian community. Reauthorization Process In order to assure the maximum involvement of Native Hawaiians in thedevelopment of a bill to reauthorize the Native Hawaiian Health Care Improvement Act, from December of 1997 through January of 1998, eight island 'aha's (island-wide conferences) were held involving more than 1,200 individuals in and effort to identify the principal Native Hawaiian health and wellness issues and concerns. In March of 1998, a statewide Native Hawaiian Health and Wellness Summit, Ka 'Uhane Lokahi, was held on the island of O'ahu, bringing together more than 600 people to identify potential health and wellness issues and concerns. In January of 1999, a Native Hawaiian Health Forum was convened to discuss major health care trends and strategies for health care and wellness developed by the indigenous peoples of North America and Aotearoa. In March of 1999, the Executive Directors of the Native Hawaiian health care systems, the members of the Papa Ola Lokahi Board, and the Director of the Native Hawaiian Health Scholarship Program met to review the Act and to incorporate recommendations from the 'aha's, the summit, and the health forum for inclusion in a bill to reauthorize the Native Hawaiian Health care Improvement Act. Thereafter, a series of public meetings were held to discuss and review a draft reauthorization bill and based upon the comments received, the bill was further refined and then circulated in the Native Hawaiian community. A final draft of the bill, incorporating and responding to recommendations received from the Native Hawaiian community, was submitted to the Congress. Summary of Major Provisions S. 1929 extends the existing program authorities of the Act and authorizes appropriations in such sums as may be necessary through fiscal year 2011. The bill contains extensive findings on the current health status of Native Hawaiians including the incidence and mortality rates associated with various forms of cancer, diabetes, asthma, circulatory diseases, infectious disease and illness, and injuries, as well as statistics on life expectancy, maternal and child health, births, teen pregnancies, fetal mortality, mental health, and health professions education and training. The bill further refines the role of Papa Ola Lokahi and the Native Hawaiian health care systems, providing authority for the establishment of additional health care systems to serve the islands of Lana's and Ni'ihau, for a total number of health care systems not to exceed eight. In addition to those organizations that originally comprised the Board of Papa Ola Lokahi, S. 1929 adds the five Native Hawaiian health care systems to the Papa Board as well as the Kamehameha Schools, and the Native State Primary Care Association which represents the community health centers, or other organizations responsible for the placement of scholars from the Native Hawaiian Scholarship Program, the Native Hawaiian Physicians Association, and such other member organizations as the Papa Ola Lokahi Board will admit based upon a satisfactory demonstration of a record of contribution to the health and well-being of Native Hawaiians. The 1992 amendments to the Act adopted the relevant health objectives of the U.S. Surgeon General's Healthy People 2000 objectives as goals to be met by the Native Hawaiian health care systems. S. 1929 establishes new objectives to be met by the Native Hawaiian health care systems, drawing upon the objectives established in the U.S. Surgeon General's Healthy People 2010 objectives. S. 1929 proposes that the providers of health care services, including the providers of traditional Native Hawaiian healing services, who provide services under the auspices of the Native Hawaiian health care systems shall be treated as members of the Public Health Service for purposes of Federal Tort Claims Act coverage. The bill also provides authorization for Papa Ola Lokahi to carry out Native Hawaiian demonstration projects of national significance in areas such as the education of health professionals, the integration of Western medicine with complementary health practices including traditional Native Hawaiian healing practices, the use of tele-wellness and telecommunications in chronic disease management and health promotion and disease prevention, the development of an appropriate model of health care of Native Hawaiians and other indigenous people, the development of a centralized data base and information system relating to the health care status, health care needs, and wellness of Native Hawaiians, and the establishment of a Native Hawaiian Center of Excellence for Nursing at the University of Hawaii at Hilo, a Native Hawaiian Center of Excellence for Mental Health at the University of Hawaii at Manoa, a Native Hawaiian Center of Excellence for Maternal Health and Nutrition at the Waimanalo Health Center, a Native Hawaiian Center of Excellence for Research, Training, and Integrated Medicine at Molokai General Hospital, and a Native Hawaiian Center of Excellence for Complementary Health and Health Education and Training at the Waianae Coast Comprehensive Health Center. S. 1929 also provides authorization for the establishment for a 21-member National Bipartisan Native Hawaiian Health Care Entitlement Commission which would in turn be authorized to establish a 10-member study committee to collect and compile data necessary to understand the extend of Native Hawaiian needs with regard to the provision of health services, and to make recommendations to the Commission for legislation that would provide for the culturally-competent and appropriate provision of health services for Native Hawaiians as an entitlement. The Provision of Federal Programs to Native Hawaiians In the exercise of the plenary power vested in the Congress in Article I, section 8, clause 3 of the United States Constitution, the Congress has exercised its authority to address the conditions of the aboriginal, indigenous, native people of the United States, including the aboriginal, indigenous, native people of the states of Alaska and Hawaii. Numerous federal laws have been enacted to address the conditions of American Indians, Alaska Natives and Native Hawaiians. One hundred and sixty Federal laws have been enacted to address the conditions of Native Hawaiians. Those laws are set forth as an appendix to this report (Appendix A). Section-by-Section Analysis Section 1. Short title The title of the Act is the Native Hawaiian Health Care Improvement Act Reauthorization of 1999. Section 2. Findings Section (a) sets forth Congress' findings which are as follows: Subsection (a)(1): Congress finds that Native Hawaiians begin their story with the Kumulipo which details the creation and inter-relationship of all things, including their evolvement as healthy and well people. Subsection (a)(2): Congress finds that Native Hawaiians are a distinct and unique indigenous people with historical continuity to the original inhabitants of the Hawaiian archipelago within Ke Moananui, the Pacific Ocean, and have a distinct society organized almost 2,000 years ago. Subsection (a)(3): Congress finds that the health and well- being of the Native Hawaiians are connected to their feelings and attachment to their lands and sea. Subsection (a)(4): Congress finds that the economic and social changes in Hawai'i over the 19th and early 20th centuries have been devastating to the health and well being of Native Hawaiians. Subsection (a)(5): Congress finds that Native Hawaiians have never directly relinquished to the United States their claims to their inherent sovereignty as a people or over their national territory, either through their monarchy or through a plebiscite or referendum. Subsection (a)(6): Congress finds that Native Hawaiians are determined to preserve and transit to future generations their ancestral territory, and cultural identity. Subsection (a)(7): Congress finds that the constitution and statutes of the State of Hawai'i acknowledge land rights of Native Hawaiian people as beneficiaries of public lands trust and protect the right of Native Hawaiian people to practice their cultural and religious practices. Subsection (a)(8): Congress finds that in 1778 at the time of first contact between non-indigenous people and Native Hawaiians, that Native Hawaiians were a highly organized, self- sufficient, subsistence social system based on communal land tenure. Native Hawaiians also had developed a sophisticated language, culture, and religion. Subsection (a)(9): Congress finds that a unified monarchial government of the Hawaiian Islands was established in 1810 under Kamehameha I, the first King of Hawai'i. Subsection (a)(10): Congress finds that throughout the 19th century and until 1893, the United States recognized the independence of the Hawaiian Nation; extended full diplomatic recognition to the Hawaiian Government; and entered into treaties and conventions with the Hawaiian monarchs to govern commerce and navigation in 1826, 1842, 1849, and 1875 and 1887. Subsection (a)(11): Congress finds that in 1892, the United States Minister, which was assigned to the sovereign and independent Kingdom of Hawai'i, conspired with a small group of non-Hawaiian residents of the Kingdom along with some residents of the United States to overthrow the indigenous and lawful government of Hawai'i. Subsection (a)(12): Congress finds that the United States Minister and the United States representative caused its armed naval forces of the United States to invade the sovereignty of the Hawaiian Nation in support of the overthrow of the indigenous and lawful Government of Hawai'i. In addition, United States Minister extended diplomatic recognition of a provisional government formed by the conspirators without the consent of the native people of Hawai'i or the lawful Government of Hawai'i in violation of treaties between the two nations and of international law. Subsection (a)(13): Congress finds that on December 18, 1893, President Grover Cleveland reported fully on the conspiracy actions and described them as acts of war which the United States should endeavor to repair. Subsection (a)(14): Congress finds that Queen Lili'uokalani, the lawful monarch of Hawai'i, and the Hawaiian Patriotic League, representing the aboriginal citizens of Hawai'i, promptly petitioned the United States for redress of the wrongs and for restoration of the indigenous government of the Hawaiian nation, but the United States did not act upon the petition. Subsection (a)(15): Congress finds that in 1993 the United States enacted Public Law 103-150 which acknowledges the overthrow of the Kingdom of Hawai'i through the participation of agents and citizens of the United States and apologizes to native Hawaiians for the resulting deprivation of their right to self-determination. Subsection (a)(16): Congress finds that in 1898, the United States annexed Hawai'i through the Newlands Resolution without the consent of or compensation to the indigenous people of Hawai'i or their sovereign government who were thereby denied the mechanism for expression of their inherent sovereignty through self-government and self-determination, their lands and ocean resources. Subsection (a)(17): Congress finds that through the Newlands Resolution and the 1900 Organic Act, the Congress received 1,750,000 acres of lands formerly owned by the Crown and Government of the Hawaiian Kingdom and exempted the lands from then existing public land laws of the United States by mandating that the revenue and proceeds from these lands be ``used solely for the benefit of the inhabitants of the Hawaiian Islands for education and other public purposes'', thereby establishing a special trust relationship between the United States and the inhabitants of Hawai'i. Subsection (a)(18): Congress finds that it enacted the Hawaiian Homes Commission Act, 1920, which designated approximately 200,000 acres of ceded public lands for Native Hawaiian homesteads was in response to the sharp decline in the Native Hawaiian population and reaffirms the trust relationship between the United States and Native Hawaiians. Subsection (a)(19): Congress finds that in 1938 they again acknowledged the unique status of the Native Hawaiian people by including the Act of June 20, 1938, a provision to lease lands within the extension to Native Hawaiians and to permit fishing in the area ``only by native Hawaiian residents of said area or of adjacent villages and by visitors under their guidance''. Subsection (a)(20): Congress finds that under the Act entitled ``An Act to provide for the admission of the State of Hawai'i into the Union'', approved March 18, 1959 the United States transferred responsibility for administration of the Hawaiian Home Lands to the State of Hawai'i but reaffirmed the trust relationship which existed between the United States and the Native Hawaiian people by retaining the exclusive power to enforce the trust, including the power to approve land exchanges and legislative amendments affecting the rights of beneficiaries under such Act. Subsection (a)(21): Congress finds that under the Act entitled ``An Act to provide for the admission of the State of Hawai'i into the Union'', approved March 18, 1959, the United States transferred responsibility for administration over portions of the ceded public lands trust not retained by the United States to the State of Hawai'i but reaffirmed the trust relationship which existed between the United States and the native Hawaiian people by retaining legal responsibility of the State for the betterment of the conditions of the Native Hawaiians under that Act. Subsection (a)(22): Congress finds that in 1978 the people of Hawai'i amended their Constitution to establish the Office of Hawaiian Affairs and assigned to that body the authority to accept and hold real and personal property in trust for Native Hawaiian people and to receive payments from the state. The Office of Hawaiian affairs is to act as the lead State agency for matters affecting the Native Hawaiian people, and to formulate policy on affairs relating to the Native Hawaiian people. Subsection (a)(23): Congress finds that it has the authority under the Constitution to legislate in matters affecting the aboriginal or indigenous peoples of the United States, including the authority to legislate in matters affecting native peoples of Alaska and Hawai'i. Subsection (a)(24): Congress finds that it has recognized the authority of the Native Hawaiian people to work towards an appropriate form of sovereignty as defined by the Native Hawaiian people themselves in provisions set forth in legislation returning the Hawaiian Island of Kaho'olawae to custodial management by the State of Hawai'i in 1994. Subsection (a)(25): Congress finds that the United States furthered the trust responsibility to better the conditions of Native Hawaiians by establishing programs to provide comprehensive health promotion and disease prevention services to maintain and improve the health status of the Native Hawaiian people. Federal assistance and health initiatives conducted by the Native Hawaiian Health Care Systems, the Native Hawaiian Health Scholarship Program, Papa Ola Lokahi, and other health institutions, accomplished through the Native Hawaiian Health Care Act of 1988 and its reauthorization, have been responsible for reducing the century-old morbidity and mortality rates of native Hawaiians. Subsection (a)(26): Congress finds that the United States has recognized and confirmed its special relationship with Native Hawaiians through theinclusion of Native Hawaiians in laws affecting Native Americans. These acts include the Native American Programs Act of 1974, the American Indian Religious Freedom Act, the National Museum of the American Indian Act, and the Native American Graves Protection and Repatriation Act. Subsection (a)(27): Congress finds that the United States has also recognized its special political relationship with Native Hawaiians through the inclusion of Native Hawaiians under the following legislation: the Older Americans Act of 1965, the Developmental Disabilities Assistance and Bill of Rights Act Amendments of 1987, the Veterans' Benefits and Services Act of 1988, the Rehabilitation Act of 1973, the Native Hawaiian Health Care Act of 1988, the Health Professions Reauthorization Act of 1988, the Nursing Shortage Reduction and Education Extension Act of 1988, the Handicapped Programs Technical Amendments Act of 1988, the Indian Health Care Amendments of 1988, and the Disadvantaged Minority Health Improvement Act of 1990. Subsection (a)(28): Congress finds that the United States has again affirmed the historical and unique relationship to the Native Hawaiian people by authorizing the provision of services to Native Hawaiians to address problems of alcohol and drug abuse under the Anti-Drug Abuse Act of 1986 (Public Law 99-570). Subsection (a)(29): Congress finds that the United States has recognized that Native Hawaiians, as aboriginal, indigenous, native people of Hawai'i, are a distinctive population group in Hawai'i and in the continental United States as has been articulated in Office of Management and Budget Circular 15 in 1997 and Presidential Executive Order No. 13125, dated June 7, 1999. Subsection (a)(30): Congress finds that despite the United States' repeated expression of its commitment to a policy of reconciliation with the Native Hawaiian people for past grievances, the unmet health needs of the Native Hawaiian people remain severe and their health status continues to be below that of the general United States population. Subsection (2)(b) describes the unmet needs and health disparities that adversely affect Native Hawaiians. Subsection (b)(1) discusses chronic diseases and illnesses affecting Native Hawaiians. It includes the following: (A) Cancer. Native Hawaiian women have the highest cancer mortality rates in the State (including breast, lung, and cervix cancer) which is 45 percent higher than that for the total State population. Native Hawaiian males have the highest cancer mortality rates in the State for cancers of the lung, liver and pancreas and for all cancers combined (including the second highest mortality rates due to prostate cancer in the State). Native Hawaiian females ranked highest in the State for cancers of the lung, liver, pancreas, breast, cervix uteri, corpus uteri, stomach, and rectum, and for all cancers combined. Native Hawaiian males have the highest years of productive life lost from cancer in the State, and Native Hawaiian females have 8.2 years of productive life lost from cancer in the State. (B) Diabetes. With respect to diabetes, for the years 1989 through 1991, Native Hawaiians had the highest mortality rate due to diabetes mellitis in the State which is 130 percent higher than the statewide rate for all other races, with full- blood Hawaiians having a mortality rate of 93.3 out of every 100,000 residents, which is 518 percent higher than the rate for the statewide population of all other races. Native Hawaiians who are less than full-blood had a mortality rate of 27.1 out of every 100,000 residents, which is 79 percent higher than the rate for the statewide population of all other races. (C) Asthma. In 1990, Native Hawaiians comprised 44 percent of all asthma cases in the State for those 18 years of age and younger, and 35 percent of all asthma cases reported, and in 1992 the Native Hawaiian rate for asthma was 81.7 out of every 1,000 residents, which was 73 percent higher than the rate for the total statewide population. (D) Circulatory diseases. The death rate for Native Hawaiians from heart disease is 66 percent higher than for the entire State. The death rate for Native Hawaiians from hypertension is 84 percent higher than that for the entire State. The death rate for Native Hawaiians from stroke is 13 percent higher than that for the entire State. Subsection (b)(2) describes infectious diseases and illnesses affecting Native Hawaiians. The incidence of AIDS for Native Hawaiians is at least twice as high per 100,000 residents than that for any other non-Caucasian group in the State. Subsection (b)(3) describes that the death rate for Native Hawaiians from accidents is 45 percent higher than that for the entire State, with Native Hawaiian males losing an average of 14 years of productive life lost from accidents and Native Hawaiian females losing an average of 4 years of productive life lost from accidents. Subsection (b)(4) describes that Native Hawaiian children exhibit among the highest rates of dental caries in the nation and State. The average number ofdecayed or filled primary teeth for Native Hawaiian children ages 5 through 9 years was 4.3 as compared with 3.7 for the entire State. The proportion of Native Hawaiian children ages 5 through 12 years with unmet treatment needs (defined as having active dental caries requiring treatment) is 40 percent as compared with 33 percent for all other races in the State. Subsection (b)(5) describes that Native Hawaiians have the lowest life expectancy of all population groups in the State of Hawai'i. The most recent tables for 1990 show Native Hawaiian life expectancy at birth to be about 5 years less than that of the total State population. Subsection (b)(6) describes the statistics for Native Hawaiian maternal and child health. Since 1996, Native Hawaiian women have the highest prevalence of having had no prenatal care during their first trimester of pregnancy, and of mothers in the State who received no prenatal care throughout their pregnancy in 1996, 44 percent were Native Hawaiian. In 1996, of the births to Native Hawaiian single mothers, 8 percent were low birth weight and of all low birth weight babies born to single mothers in the State, 44 percent were Native Hawaiian. In 1993 and 1994 Native Hawaiians had the highest percentage of teen births compared to the rate for all other races in the State, and for births to mothers age 14 years and younger in Hawai'i, Native Hawaiians comprised 66% in 1995 and 48 percent in 1996. Subsection (b)(7) describes the level of alcohol and drug abuse. Native Hawaiians represent 38 percent of the total admissions to substance abuse treatment programs in the Department of Health, Alcohol, Drugs and Other Drugs. In 1997, the prevalence of smoking by Native Hawaiians was 28.5 percent, a rate that is 53 percent higher than that for all other races in the State. Native Hawaiians have the highest prevalence rates of acute drinking, a rate that is 79 percent higher than that for all other races in the State. The chronic drinking rate among Native Hawaiians is 54 percent higher than that for all other races in the State. In 1991, 40 percent of the Native Hawaiian adults surveyed reported having used marijuana and nine percent of the Native Hawaiian adults surveyed reported that they are current users (within the past year) of marijuana. In 1996, with respect to crime, 5,944 arrests were made for property crimes in the State with Native Hawaiian arrests comprising 20 percent of that total, with Native Hawaiian juveniles comprised a third of all juvenile arrests. In 1996, Native Hawaiians represented 21 percent of the 8,000 adults arrested for violent crimes in the State of Hawai'i, and 38 percent of the 4,066 juvenile arrests. In 1995 and 1996 Native Hawaiians comprised 36.5 percent of the sentenced felon prison population in Hawai'i, comprised 45.4 percent of the technical violator population, and constituted 51.6 percent of all detainees at the Hawai'i Youth Correctional Facility in 1997. Subsection (b)(8) describes that with respect to health professions education and training, Native Hawaiians age 25 years and older have a comparable rate of high school completion, but the rates of baccalaureate degree achievement amongst Native Hawaiians are less than the norm in the State. Native Hawaiian physicians make up 4 percent of the total physician workforce in the State. Native Hawaiians comprise 8 percent of individuals who earned Bachelor's Degrees, 14 percent of individuals who earned professional diplomas, 6 percent of individuals who earned Master's Degrees, and less than 1 percent of individuals who earned doctoral degrees at the University of Hawai'i. Section 3. Definitions This section sets forth the definitions of terms used in the Act. Section 3(1) defines ``Department'' to mean the Department of Health and Human Services. Section 3(2) provides that for purposes of the Act, the term ``disease prevention'' includes immunizations, control of high blood pressure, control of sexually transmittable diseases, the prevention and control of chronic diseases, control of toxic agents, occupational safety and health, injury prevention, fluoridation of water, control of infectious agents, and provision of mental health care. Section 3(3) provides that for the purposes of the Act, the term ``health promotion'' includes pregnancy and infant care, including prevention of fetal alcohol syndrome, cessation of tobacco smoking, reduction in the misuse of alcohol and harmful illicit drugs, improvement of nutrition, improvement in physical fitness, family planning, control of stress, reduction of major behavioral risk factors, and promotion of healthy lifestyle practices, and integration of cultural approaches to health and well-being. Section 3(4) provides that for purposes of the Act, the term ``Native Hawaiian'' means any individual who is a descendant of the aboriginal people who, prior to 1778, occupied and exercised sovereignty in the area that now constitutes the State of Hawai'i as evidenced by genealogical records, or kama'aina (long-term community residents) witness verification by Native Hawaiian kupuna (elders), or birth records of the State of Hawai'i or any state or territory of the United States. Section 3(5) provides that for purposes of the Act, the term ``Native Hawaiian health care system'' means an entity which (A) is organized under the laws of the State of Hawai'i; (B) which provides or arranges for health care services through practitionerslicensed by the State of Hawai'i where licensure requirements are applicable; (C) which is a public or nonprofit private entity; (D) in which Native Hawaiian health practitioners significantly participate in the planning, management, monitoring and evaluation of health care services; (E) which may be composed of eight Native Hawaiian health care systems; and (F) which Papa Ola Lokahi recognizes for the purpose of planning, conducting, or administering programs (or portions of programs) under the authority of the Act for the benefit of Native Hawaiians and which is certified by Papa Ola Lokahi as having the qualifications and the capacity to provide the services and meet the requirements under the contract or the grant the Native Hawaiian health care system enters into with or receives from the Secretary under the Act. Section 3(6) provides that for purposes of the Act, the term ``Native Hawaiian Health Center'' means an organization which provides primary care and which Papa Ola Lokahi has recognized has met the following criteria: a governing board that is fifty-percent (50%) or more Native Hawaiians; has demonstrated cultural competency in a predominantly Native Hawaiian community; has a patient population that is either fifty-percent Native Hawaiian or number not less than 2,500 Native Hawaiian clients annually. Section 3(7) provides that for purposes of the Act, ``Native Hawaiian Health Task Force'' means a task force the State Council of Hawaiian Homestead Association establishes that implements health and wellness strategies in Native Hawaiian communities in Hawai'i. Section 3(8) provides that for purposes of the Act, ``Native Hawaiian organization'' means a public or nonprofit organization that serves Native Hawaiian interests which Papa Ola Lokahi has recognized for planning, conducting, or administering programs (or portions of programs) authorized under this Act. Section 3(9) provides that for purposes of the Act, ``Office of Hawaiian Affairs'' and ``OHA'' means the governmental entity established under the Hawai'i State Constitution which is charged with the responsibility to formulate policy relating to Native Hawaiian affairs. Section 3(10) provides that for purposes of the Act, the term ``Papa Ola Lokahi'' means an organization composed of public agencies and private organizations focusing on improving the health status of Native Hawaiians. Board members may include representatives from the following: E Ola Mau; the Office of Hawaiian Affairs; Alu Like, Inc.; the University of Hawai'i; the Hawai'i State Department of Health; the Kamehameha Schools (or other Native Hawaiian organization that administers the Native Hawaiian health scholarship program); the Hawai'i State Primary Care Association or Native Hawaiian health scholarship program); the Hawai'i State Primary Care Association or Native Hawaiian Health Centers whose patient populations are predominantly Native Hawaiian; 'Ahahui O Na Kauka (the Native Hawaiian Physicians Association); Ho'ola Lahui Hawai'i or a health care system serving the islands of Kaua'i or Ni'ihau; Ke Ola Mamo, or a health care system serving the island of O'ahu; Na Pu'uwai or a health care system serving the islands of Moloka'i and Lana'i; Hui No Ke Ola Pono, or a health care system serving the island of Maui; Hui Malama Ola Na 'Oiwi or a health care system serving the island of Hawai'i; other native Hawaiian health care systems that Papa Ola Lokahi certifies and recognizes; and such other member organizations as the Board of Papa Ola Lokahi may admit from time to time, based upon a satisfactory demonstration of a record of contribution to the health and well-being of Native Hawaiians, but with the proviso that organizations will not be part of Papa Ola Lokahi if the Secretary determines that an organization has not developed a mission statement with clearly defined goals and objectives for the contributions the organization will make to the Native Hawaiian health care systems and an action plan for carrying out those goals and objectives. Section 3(11) provides that for purposes of the Act, the term ``primary health services'' means: the services of physicians, physicians' assistants, nurse practitioners, and other health care professionals; diagnostic laboratory and radiologic services; preventive health services, including perinatal services, well child services, and family planning services, nutrition services, home health services, and other wellness services; emergency medical services; transportation services as required for adequate patient care; preventive dental services; and pharmaceutical and medicament services; primary care services which may lead to specialty and/or tertiary care; and complementary healing practices, including those performed by traditional Native Hawaiian healers. Section 3(12) provides that for purposes of the Act, the term ``Secretary'' means the Secretary of the U.S. Department of Health and Human Services. Section 3(13) provides that for purposes of the Act, the term ``traditional Native Hawaiian healer'' means a practitioner who is of Hawaiian ancestry and has the knowledge, skills, and experience in direct personal health care of individuals, and whose knowledge, skills, and experience are based on demonstrated learning of Native Hawaiian healing practices acquired by direct practical association with Native Hawaiian elders andoral traditions passed from generation to generation. Section 4. Declaration of National Native Hawaiian Health Policy This section establishes the policy of the Act. Section 4 (a) and (b) establish that it is the United States' policy, in fulfilling its special responsibilities and legal obligations to the indigenous people of Hawai'i which results from the unique and historical relationship between the United States and the government of the indigenous people of Hawai'i, to raise the health status of Native Hawaiians to the highest possible level and to provide existing Native Hawaiian health care programs with the resources necessary to effectuate this policy. Section 4 also expresses Congress' intent to raise Native Hawaiians' health status by 2010 to at least the standards contained within Healthy People 2010 or successor standards, and to incorporate the following activities within health programs: integration of cultural approaches to health and well-being; increasing the number of health and allied- health care providers who can provide culturally competent care; increasing the use of traditional Native Hawaiian foods in peoples' diets and dietary preferences including those of students and the use of traditional foods in school feeding programs; identifying and instituting Native Hawaiian cultural values and practices within the ``corporate cultures'' of organizations and agencies providing health services to Native Hawaiians; facilitating the provision of Native Hawaiian healing practices by Native Hawaiian healers for those clients desiring such assistance; and supporting training and education activities and programs in traditional Native Hawaiian healing practices by Native Hawaiian healers. Section 4(c) directs the Secretary of Health and Human Services to include in his report to the Congress, as required under section 12, a report on the progress made towards meeting the national policy of the Act. Section 5. Comprehensive Health Care Master Plan for Native Hawaiians Section 5(a)(1) authorizes the Secretary to make a grant or enter into a contract with Papa Ola Lokahi for the purpose of coordinating, implementing, and updating the Native Hawaiian comprehensive health care master plan which is designed to promote comprehensive health promotion and disease prevention services and to maintain and improve the Native Hawaiians' health status. Section 5(a)(2) is amended to require Papa Ola Lokahi and the Office of Hawaiian Affairs to consult with the Native Hawaiian health care systems, the Native Hawaiian health care centers, and the Native Hawaiian community in carrying out section 5, and authorizes Papa Ola Lokahi and the Office of Hawaiian Affairs to enter into memoranda of understanding or agreement to acquire joint funding and for other issues to accomplish the objectives of this section Section 5(a)(3) requires that within eighteen months of the Act's promulgation, that Papa Ola Lokahi cooperate with the Office of Hawaiian Affairs and other appropriate agencies of the State of Hawai'i, and prepare and submit a report to Congress detailing the impact of current Federal and State health care financing mechanisms and policies on the health and well-being of Native Hawaiians. The study is to include the impact of cultural competency, risk assessment data, eligibility requirements and exemptions, reimbursement policies and capitation rates currently in effect for service providers, and any other information that may be important to improving the health status of Native Hawaiians as it relates to health care financing, including barriers to health care. These recommendations will also be submitted to the Secretary for review and consultation with Native Hawaiians. Section 5(b) authorizes the appropriation of such sums as may be necessary to carry out subsection (a). Section 6. Functions of Papa Ola Lokahi and Office of Hawaiian Affairs This section sets forth the functions of Papa Ola Lokahi and is amended to include the Office of Hawaiian Affairs. Section 6(a) makes Papa Ola Lokahi responsible for the following: (1) coordinating, implementing, and updating the comprehensive health care master plan developed pursuant to the authority contained in section 5; (2) training of Native Hawaiian health care practitioners, community outreach workers, and counselor and cultural educators who will be involved in providing health promotion and disease prevention education; (3) identifying and researching the diseases that are most prevalent among Native Hawaiians, including behavioral, biomedical, epidemiological, and health services; (4) developing and maintaining an institutional review board for all research projects involving all aspects of Native Hawaiian health; and (5) maintaining an action plan outlining the contributions that each member ofPapa Ola Lokahi will make in carrying out the Act's policy. Section 6(b) authorizes Papa Ola Lokahi to receive special project funds that may be appropriated for the purpose of conducting research on the health status of Native Hawaiians or for the purpose of addressing the health care needs of Native Hawaiians. Section 6(c)(1) authorizes Papa Ola Lokahi to serve as a clearinghouse for the collection and maintenance of data associated with the health status of Native Hawaiians; the identification and research into diseases affecting Native Hawaiians; the availability of Native Hawaiian project funds, research projects and publications; the collaboration of research in Native Hawaiian health; and the timely dissemination of information pertinent to the Native Hawaiian health care systems. Section 6(c)(2) requires the Secretary to provide Papa Ola Lokahi and the Office of Hawaiian Affairs with at least one annual accounting of funds and services that the Department of Health and Human Services provided to states and non-profit groups and organizations in carrying out the Act's policy. This accounting will include, but not be limited to, the following: the amount of funds expended explicitly for and benefiting Native Hawaiians; the number of Native Hawaiians impacted by these funds; the identification of collaborations made with Native Hawaiian groups and organizations in the expenditure of these funds; and the amount of funds used for federal administrative purposes and for the provision of direct services to Native Hawaiians. Section 6(d)(1) requires that Papa Ola Lokahi provide annual recommendations to the Secretary regarding the allocation of all amounts appropriated under this Act. Section 6(d)(2) requires Papa Ola Lokahi, to the extent possible, to coordinate and assist the health care programs and services to Native Hawaiians. Section 6(d)(3) requires the Secretary to consult with Papa Ola Lokahi and make recommendations for Native Hawaiian representation on the President's Advisory Commission on Asian Americans and Pacific Islanders. Section 6(e) authorizes Papa Ola Lokahi to act as a statewide infrastructure to provide technical support and coordination of training and technical assistance to the Native Hawaiian health care systems and the Native Hawaiian health care centers. Section 6(f)(1) authorizes Papa Ola Lokahi to enter into agreements or memoranda of understanding with relevant institutions, agencies, or organizations that are capable of providing health-related resources or services to the Native Hawaiians and the Native Hawaiian health care systems or providing resources or services to implement the national policy of this Act as set forth in section 4. Section 6(f)(2) addresses health care financing as follows: Subsection (A) requires federal agencies that provide health care financing and health care programs to consult with Native Hawaiians and with organizations providing Native Hawaiian health care services before adopting any policy or regulation that may impact on the provision of services or health insurance coverage. The consultation is to include but not be limited to the identification of the impact of proposed policies, rules, or regulations. Subsection (B) requires that the State of Hawai'i engage in meaningful consultation with Native Hawaiians and organizations providing Native Hawaiian health care services before making changes or initiating new programs. Subsection (C) authorizes the Office of Hawaiian Affairs, in collaboration with Papa Ola Lokahi, to develop consultative, contractual, or other arrangements including memoranda of understanding or agreement with the following: the Health Care Financing Administration; the agency of the State of Hawai'i that administers or supervises the administration of the State plan or waiver approved under title XVIII, XIX, or XII of the Social Security Act for payment of all or part of the health care services to Native Hawaiians who are eligible for medical assistance under such a State plan or waiver; or any other Federal agency or agencies providing Native Hawaiians with full or partial health insurance. Such arrangements may include appropriate reimbursement for health care services including capitation and fee for service rates for Native Hawaiians who are entitled to or eligible for insurance; the scope of services provided, or other mattes which enable Native Hawaiians to maximize health insurance benefits provided by Federal and State health insurance programs. Section 6(f)(3) provides that the provision of health care services by the department and other federal agencies may include the services of traditional ``Native Hawaiian healers'' and ``traditional healers'' providing ``traditional health care practices'' as defined in section 4(r) of Public Law 94-437. Such services are exempt from national accreditation reviews, including reviews conducted by the Joint Accreditation Commission on Health Organizations and the Rehabilitation Accreditation Commission. Section 7. Native Hawaiian health care systems This section addresses the authority of the Secretary to enter into contracts and grants with Native Hawaiian healthcare systems for the provision of health care services and health care referral services to Native Hawaiians and the responsibilities of the Native Hawaiian health care systems. Section 7(a) authorizes the Secretary of Health and Human Services to consult with Papa Ola Lokahi and make grants to or enter into contracts with any qualified entity for the purpose of providing comprehensive health promotion, disease prevention services, and primary health care services provide to Native Hawaiians. The Secretary may enter into up to eight grants or contracts with preference given to Native Hawaiian health care systems and Native Hawaiian organizations. To the extent feasible, health promotion and disease prevention services shall be performed through Native Hawaiian health care systems. A ``qualified entity'' for purposes of subsection 7(a) means a Native Hawaiian health care system or a Native Hawaiian Health Care Center. Section 7(b) authorizes the Secretary to also make a grant to, or enter into a contract with, Papa Ola Lokahi for purposes of planning Native Hawaiian health care systems to serve the health needs of Native Hawaiian communities on the islands of O'ahu, Moloka'i, Maui, Hawai'i, Lana'i, Kaua'i, and Ni'ihau in the State of Hawai'i. Section 7(c) specifies that each Native Hawaiian health care system will ensure that the following services are provided or arranged: outreach services to inform Native Hawaiians of the availability of health services; health promotion and disease prevention education of Native Hawaiians by, wherever possible, Native Hawaiian health care practitioners, community outreach workers, counselors, and cultural educators; services of physicians, physicians' assistants, nurse practitioners, and other health professionals; immunizations; prevention and control of diabetes, high blood pressure, and otitis media; pregnancy and infant care; improvement of nutrition, identification, treatment, control and reduction of the incidences of preventable illnesses and conditions endemic to Native Hawaiians; collection of data related to the prevention of diseases and illnesses among Native Hawaiians; services within the meaning of the terms ``health promotion'', ``disease prevention'', and ``primary health services''; and support of culturally appropriate activities that enhance health and wellness including land-based, ocean-based, water-based, and spiritual-based projects and programs. Any of these services may be provided by traditional Native Hawaiian healers. Section 7(d) provides that individuals who provide medical, dental, or other services under subsection (a)(1) for Native Hawaiian health care systems shall be treated as if they were members of the Public Health Service and shall be covered under the provisions of section 224 of the Public Health Service Act. Section 7(e) requires that a Native Hawaiian health care system that receives funds under subsection 7(a) provide a designation area and appropriate staff to serve as a Federal loan repayment facility. This facility must be designed to enable health and allied-health professionals to remit payments to loans provided to such professionals under any Federal loan program. Section 7(f) specifies that the Secretary may not make a grant or enter into a contract as authorizes under subsection 7(a) unless the qualified entity agrees that the grant or contract amount will not, directly or through contract, be expended for: services other than services described in section (c)(1); the purchase or improvement of real property (other than minor remodeling of existing improvements to real property); or the purchase of major medical equipment. Section 7(g) provides that the Secretary may not make a grant or enter into a contract with any qualified entity under subsection 7(a) unless the qualified entity agrees that, whether health services are provided directly or through contract, health services under the grant or contract will be provided without regard to ability to pay for the health services and the entity will impose a change for the delivery of health services which will be made according to a schedule of charges that is made publically available and will be adjusted to reflect the income of the individual involved. Section 7(h) authorizes the appropriation of sums as may be necessary to carry out activities under subsections 7(a) and 7(b) for fiscal years 2001 and 2011. Section 8. Administrative grant for Papa Ola Lokahi This section authorizes the Secretary to make a grant or enter into a contract with Papa Ola Lokahi for its administrative functions. Section 8(a) authorizes the Secretary to make grants to or enter into contracts with Papa Ola Lokahi for: the coordination, implementation, and appropriate updating of the comprehensive health care master plan developed under the authority of section 5; training for persons described in section 7(c)(1); identification of and research into the diseases that are most prevalent among Native Hawaiians, including behavioral, biomedical, epidemiological and health services; the maintenance of an action plan outlining the contributions that each member organization of Papa Ola Lokahi will make in carrying out the Act's policy; a clearinghouse function for the collection and maintenance of data associated with the health status of Native Hawaiians, the identification of research into diseases affecting Native Hawaiians, and the availability of Native Hawaiian project funds, research projects, and publications; the establishment and maintenance of an institutional review board for all health-related research involving Native Hawaiians; the coordination of the health care programs and services provided toNative Hawaiians; and the administration of special project funds. Section 8(b) authorizes the appropriation of sums as may be necessary to carry out the activities in subsection 8(a) for each of fiscal years 2001 through 2011. Section 9. Administration of grants and contracts This section sets forth the terms and conditions under which the Secretary makes grants or enter into contracts. Section 9(a) specifies that within any grants made or contracts entered that the Secretary include terms and conditions the Secretary considers necessary or appropriate to ensure that the grant or contract objectives are achieved. Section 9(b) requires that the Secretary periodically evaluate the performance of and compliance with grants and contracts under this Act. Section 9(c) prohibits the Secretary from making any grant or entering into any contract with an entity unless the entity: (1) agrees to establish such procedures for fiscal control and fund accounting as may be necessary to ensure proper disbursement and accounting with respect to the grant or contract; (2) agrees to ensure the confidentiality of records maintained on individuals receiving health services under the grant or contract; (3) with respect to health services provided to any Native Hawaiian population, which substantial portion has a limited ability to speak the English language, develops and has the ability to carry out a reasonable plan to provide health services under the grant or contract through individuals who are able to communicate with that population in the language and in the most appropriate cultural context, and has designated at least one individual, fluent in both English and the appropriate language, to assist in carrying out the plan; (4) with respect to health services covered under programs under titles XVIII, XIX, or XXI of the Social Security Act, including any State plan, or under any other Federal health insurance plan if the entity will provide under the grant or contract any such health services directly, has entered into a participation agreement under such plans and the entity is qualified to receive payments under such plan. Also, if the entity will provide under the grant or contract any such health services through a contract with an organization, the organization has entered into a participation agreement under such plan, and the organization is qualified to receive payments under such plan; and (5) agrees to submit an annual report to the Secretary and to Papa Ola Lokahi that describes the use and costs of health services provided under the grant or contract, including the average cost of health services per user, and that provides such other information the Secretary determines to be appropriate. Section 9(d) addresses the Secretary's evaluation of contracts entered into by the Secretary. Subsection (1) provides that when the Secretary's evaluation reveals that an entity has not complied with or satisfactorily performed a contract entered into under section 7, that before the contract is renewed the Secretary must attempt to resolve the areas of noncompliance or unsatisfactory performance and modify the contract to prevent future noncompliance or unsatisfactory performance. Subsection (2) provides that if the Secretary determines that the noncompliance or unsatisfactory performance cannot be resolved and prevented in the future, the Secretary shall not renew that entity's contract and is authorized to enter into a new section 7 contract with a qualified entity, as defined in section 7(a)(3), that provides services to the same population of Native Hawaiians that was served by the entity whose contract was not renewed. Subsection (3) specifies that in determining whether to renew an entity's contract under the Act the Secretary shall consider the results of the evaluations undertaken under the authority of this section. Subsection (4) specifies that the contracts the Secretary enters under this Act must be in accordance with all Federal contracting laws and regulations, but that the Secretary has the discretion to negotiate contracts without advertising and may be exempt from the provisions of the Act of August 24, 1935 (40 U.S.C. 270a et seq.). Subsection (5) specifies that payments made under any contract entered into under this Act may be made in advance, by means of reimbursement or installments, and shall be made on such conditions as the Secretary deems necessary to carry out the purposes of this Act. Subsection (9)(e) provides that for each fiscal year during which any entity receives or expends funds pursuant to a grant or contract under the Act, such entity is to submit anannual report to the Secretary and to Papa Ola Lokahi on the entity's activities under the grant or contract, the amounts and purposes for which Federal funds were expended, and such other information as the Secretary may request. The reports and records of any entity concerning any grant or contract under this Act shall be subject to audit by the Secretary, the Inspector General of the Department of Health and Human Services, and the Comptroller General of the United States. Section 9(f) provides that the Secretary shall allow as a cost of any grant made or contract entered into under this Act, the cost of an annual private audit by a certified public accountant. Section 10. Assignment of personnel This section addresses the assignment of personnel by the Secretary. Section 10(a) specifies that where the Secretary may make assignments of Department of Health and Human Services personnel, the Secretary may enter into an agreement with any entity to such personnel with the expertise the entity identifies, to provide comprehensive health promotion and disease prevention services to Native Hawaiians. Section 10(b) specifies that under the authority of subsection 10(a) is to be treated as an assignment of Federal personnel to a local government that is made in accordance with subchapter VI of chapter 33 of title 5 of the United States Code. Section 11. Native Hawaiian health scholarships and fellowships Section 11(a) specifies that, subject to the availability of funds appropriated under the authority of subsection 11(c), the Secretary is to provide funds through a direct grant to or a cooperative agreement with the Kamehamedha Schools as another Native Hawaiian organization or health care organization with experience in administering education scholarship or placement services for the purpose of providing scholarship assistance to Native Hawaiian students who meet the requirements of section 338A of the Public Health Service Act, except for assistance provided for under section 11(b)(2) of this Act. Section 11(b) specifies employees of the Native Hawaiian Health Care Systems and the Native Hawaiian Health Centers may be given priority for scholarships. Section 11(c)(1) specifies that subsection 11(a) is to be provided under the same terms and subject to the same conditions, regulations, and rules that apply to scholarship assistance provided under section 338A of the Public Health Service Act, except as follows: Subsection (A) specifies that the provision of scholarships in each type of health care profession training shall correspond to the need for each type of health care professional to serve the Native Hawaiian community as Papa Ola Lokahi identifies. Subsection (B) specifies that to the maximum extent practicable, the Secretary is to select scholarship recipients from a list of eligible applicants submitted by the Kamehameha Schools (or the Native Hawaiian organization administering the program). Subsection (C) specifies that the obligated service requirement for each scholarship recipient is to be fulfilled through service in the following order of priority: in any one of the Native Hawaiian health care systems or Native Hawaiian health centers; health professions shortage areas, medically underserved areas, or geographic areas or facilities similarly designated by the United States Public Health Service in the State of Hawai'i; or a geographical area, facility, or organization that serves a significant Native Hawaiian population. Subsection (D) specifies that the scholarship program's placement services shall assign scholarship recipients to appropriate sites for service. Subsection (E) specifies that counseling, retention, and other support services will be available to any scholarship recipient and other scholarship and financial aid programs recipient enrolled in appropriate health professions training programs. Subsection (F) specifies that financial assistance may be provided to scholarship recipients in the health professions, designated in section 338A of the Public Health Service Act, while they are fulfilling their service requirement in any one of the Native Hawaiian health care systems or community health centers. Section 11(c)(2) specifies that the financial aid through fellowships may be provided to Native Hawaiian community health representatives, outreach workers, health program administrators in professional training programs, and Native Hawaiians in certificated programs provided by traditional Native Hawaiian healers using traditional Native Hawaiian healing practices. The financial assistance may include a stipend and/orreimbursement for costs associated with participating in the program. Section 11(c)(3) specifies that scholarship recipients in health professions designated in section 338A of the Public Health Service Act shall have the same rights and benefits as members of the National Health Service Corps while fulfilling their service requirements. Section 11(c)(4) provides that the financial assistance provided under section 11 of this Act shall be deemed ``Qualified Scholarships'' for purposes of section 117, title 26, United States Code. Section 11(d) authorizes the appropriation of such sums as may be necessary for the purpose of funding the scholarship assistance under subsection (a) and fellowship assistance under subsection (c)(2) for fiscal years 2001 through 2011. Section 12. Report This section provides that at the time the budget is submitted under section 1105 of title 31 of the United States Code, the President is to transmit a report to Congress for each fiscal year on the progress made in meeting the Act's objectives, including a review of programs established or assisted pursuant to the Act and an assessment and recommendations of additional programs or assistance necessary to provide health services to Native Hawaiians and to ensure a health status for Native Hawaiians which are on par with the general population's health services and health status. Section 13. Use of Federal Government facilities and sources of supply This section authorizes organizations that receive grants or contracts to have access to federal property and supplies. Section 13(a) authorizes the Secretary to allow organizations, in carrying out their grants or contracts authorized under the Act, to use existing facilities and equipment therein or under the Secretary's jurisdiction, under such terms and conditions as may be agreed upon for their use and maintenance. Section 13(b) authorizes the Secretary to donate any personal or real property determined to be in excess of the needs of the Department or the General Services Administration to organizations that receive contracts or grants for purposes of carrying out such contract or grants. Section 13(c) authorizes the Secretary to acquire excess or surplus Federal government real and personal property for donation to organizations that receive grants or contracts under this Act, provided that the Secretary determines that the organization's property use is appropriate for the purpose which a contract or grant is authorized under this Act. Section 14. Demonstration projects of national significance This section authorizes demonstration projects to improve the health status of Native Hawaiians. Section 14(a) authorizes the Secretary to consult with Papa Ola Lokahi and allocate appropriated amounts under this or any other Act to carry out Native Hawaiian demonstration projects of national significance. The project areas of interest may include the following: (1) the development of a centralized database and information system relating to Native Hawaiian health care status, health care needs, and wellness; (2) the education of health professionals, and other individuals in higher learning institutions, in health and allied health programs in healing practices, including Native Hawaiian healing practices; (3) the integration of Western medicine with complementary healing practices including traditional Native Hawaiian healing practices; (4) the use of tele-wellness and telecommunications in chronic disease management and health promotion and disease prevention; (5) the development of appropriate models of Native Hawaiian health care and other indigenous people, including the provision of culturally competent health services, related activities focusing on wellness concepts, the development of appropriate kupuna care programs, and the development of financial mechanisms and collaborative relationships leading to universal access to health care; and (6) the establishment of Native Hawaiian Centers of Excellence for Nursing at the University of Hawai'i at Hilo; for Mental Health at the University of Hawai'i at Manoa; for Maternal Health and Nutrition at the Waimanalo Health Center; and for Research, Training, Integrated Medicine at Moloka'i General Hospital; and for Complimentary Health and Health Education and Training at the Waianae Coast Comprehensive Health Center. Section 14(b) specifies that funds allocated for demonstration projects under subsection 14(a) shall not result in a reduction on funds required by the Native Hawaiianhealth care systems, the Native Hawaiian Health centers, the Native Hawaiian Health Scholarship Program, or Papa Ola Lokahi to carry out their respective responsibilities under this Act. Section 15. National Bipartisan Commission on Native Hawaiian health care entitlement This section authorizes the establishment of a commission for the purpose of examining and making recommendations to the Congress as to whether the provision of health care services to Native Hawaiians should be an entitlement program. Section 15(a) establishes a National bipartisan Native Hawaiian Health Care Entitlement Commission (the ``Commission''). Section 15(b) specifies that the Commission will be comprised of twenty-one (21) members who are appointed as follows: (1) The Majority and Minority Leaders of the House of Representatives and of the Senate will each appoint two members. These congressional commission members must also be members of congressional committees that consider legislation affecting the provision of health care to Native Hawaiians and other Native Americans. Commission members appointed under this subsection will elect the Commission's chairperson and vice- chairperson. (2) The Native Hawaiian health care systems will appoint five embers, and the Hawai'i State Primary Care Association, Papa Ola Lokahi, Native Hawaiian Health Task Force, and the Office of Hawaiian Affairs will each appoint one member. The Association of Hawaiian Civic Clubs shall appoint two members who will represent Native Hawaiian populations residing in the continental United States. (3) The Secretary shall appoint two members who possess knowledge of Native Hawaiian health concerns and wellness. Section 15(c) provides that Commission members shall serve for the life of the Commission. Initial Commission members are to be appointed not later than 90 days after the Act's enactment, with the remaining Commission members appointed not later than 60 days after the members are appointed under subsection 15(b)(1). This section also specifies that vacancies will be filled in the manner which original appointments were made. Section 15(d) specifies that the Commission's duties and functions are as follows: (1) reviewing and analyzing the recommendations of the report of the study committee establishes under subsection 15(d)(3). (2) making recommendations to Congress for the provision of health services to Native Hawaiian individuals as an entitlement, giving due regard to the effects of a program on existing health care delivery systems for Native Hawaiians and the effect of such programs on self-determination and the reconciliation of their relationship with the United States; (3) establish a study committee composed of at least ten Commission members, with four appointed under subsection (b)(1), five members appointed under subsection (b)(2), and one member the Secretary appointed under subsection 15(b)(3). The study committee will conduct the following activities: (A) to the extent necessary to carry out its duties, collect, compile, qualify, and analyze data necessary to understand the extent of Native Hawaiian needs with regard to the provision of health services, including holding hearings and soliciting the views of Native Hawaiians and Native Hawaiian organizations, and which may include authorizing and funding feasibility studies of various models for all Native Hawaiian beneficiaries and their families, including those living in the continental United States; (B) make recommendations to the Commission for legislation that will provide for the culturally-competent and appropriate provision of health services to Native Hawaiians as an entitlement which shall, at a minimum, address issues of eligibility and benefits to be provided, including recommendations regarding from whom such health services are to be provided and the cost and mechanisms for funding of the health services to be provided; (C) determine the effect of the enactment of such recommendations on the existing system of delivery of health services for Native Hawaiians; (D) determine the effect of a health service entitlement program for Native Hawaiian individuals on their self-determination and the reconciliation of their relationship with the United States; (E) within twelve months after the appointment of the Commission members, make a written report of its findings and recommendations to the Commission which shall include statements from the minority and majoritypositions of the committee and which will be disseminated to Native Hawaiian organizations, agencies, and health organizations referred to in subsection 15(b)(2) for comment to the Commission; and (F) report regularly to the full Commission regarding the findings and recommendations developed by the committee in the course of carrying out its duties under this section. (4) specifies that not later than eighteen months after the appointment of the Commission members, submit a written report to Congress containing a recommendation of policies and legislation to implement a policy that would establish a health care system for Native Hawaiians, grounded in their culture and based on the delivery of health services as an entitlement, together with a determination of the implications of such an entitlement system on existing health care delivery systems for Native Hawaiians and their self- determination and the reconciliation of their relationship with the United States. Section 15(e)(1) specifies that Commission members appointed under subsection 15(b)(1) will not receive any additional compensation, allowances, or benefits for serving on the Commission, but may receive travel expenses and per diem in lieu of subsistence in accordance with sections 5702 and 5703 of title 5, United States Code. Commission members appointed under subsections 15 (b)(2) and (b)(3) may receive compensation while performing Commission business at the per diem equivalent of the rate provided for individuals under level IV of the Executive Schedule under section 5315 of title 5, United States Code, and while serving away from home or regular place of business, be allowed travel expenses as the Commission chairperson authorizes. for purposes of compensation (except for Commission members), and for employment benefits, rights, and privileges, Commission personnel will be treated as if they were Senate employees. Section 15(e)(2) specifies that the Commission chairperson shall call Commission meetings. This subsection further specifies that a quorum must consist of not less than twelve members, with not less than four members appointed under subsection 15(b)(1), with not less than seven members appointed under subsection 15(b)(2), and with not less than one (1) member appointed under subsection 15(b)(3). Section 15(e)(3) authorizes Commission members to appoint an executive director who shall be paid the rate of basic pay equal to level V of the Executive Schedule under section 5316 of title 5, United States Code. The executive director, with the Commission's approval, may appoint such personnel as the executive director deems appropriate. The Commission staff shall be appointed without regard to title 5 provision of the United States Code governing appointments in the competitive service, and shall be paid without regard to the provisions of chapter 51 and subchapter III of chapter 53 of such title (relating to classification and General Schedule pay rates). This subsection also specifies that the executive director, with the Commission's approval, may procure temporary and intermittent services under section 3109(b) of title 5, United States Code. This subsection further authorizes the General Services Administration Administrator to locate suitable office space for Commission headquarters in Washington, DC and a Commission liaison office in the State of Hawai'i. Both offices shall include all necessary equipment and incidentals required for the Commission's proper functioning. Section 15(f)(1) authorizes the Commission to hold hearings and to undertake other activities the Commission determines to be necessary to carry out its duties, except that at least eight hearings shall be held on each of the Hawaiian Islands and three hearings in the continental United States in areas where a significant population of Native Hawaiians reside. Such hearings shall be held to solicit the views of Native Hawaiians regarding the delivery of health care services to Native Hawaiians. At least four Commission members, including at least one congressional member, must be present to constitute a hearing. Study committee hearings, authorized under subsection 15(d)(3) may be counted towards the number of hearings this paragraph requires. Section 15(f)(2) authorizes the Comptroller General, at the Commission's request, to conduct such studies or investigations as the Commission determines to be necessary to carry out its duties. Section 15(f)(3) specifies that, upon the Commission's request, the Director of the Congressional Budget Office and/or the Chief Actuary of the Health Care Financing Administration shall provide cost estimates the Commission determines to be necessary to carry outs its duties. The Commission shall reimburse the Director of the Congressional Budget Office for expenses relating to the employment in the office of the Director of such additional staff as may be necessary for the Director to comply with requests by the Commission under subsection 15(f)(3)(A). Section 15(f)(4) specifies that, at the Commission's request, the head of any Federal agency may detail its personnel to the Commission, without reimbursement, to assist in carrying out the Commission's duties. Such detail will not interrupt or otherwise affect the civil service status or privileges of the Federal employees. Section 15(f)(5) specifies that, at the Commission's request, the head of any Federal agency shall provide such technical assistance to the Commission as the Commission determines to be necessary to carry out its duties. Section 15(f)(6) authorizes the Commission to use the United States mails in the same manner and under the same conditions as Federal agencies and shall, for purposes of the frank, be considered a commission of Congress as described in section 3215 of title 39, United States Code. Section 15(f)(7) authorizes the Commission to secure directly from any Federal agency information necessary to enable the Commission to carry out its duties, if the information may be disclosed under section 552 of title 5, United States Code. Upon request of the Commission chairperson, the head of such agency shall furnish such information to the Commission. Section 15(f)(8) authorizes the Administrator of General Services, at the Commission's request, to provide the Commission with administrative support services which are provided on a reimbursable basis. Section 15(f)(9) specifies that the Commission shall be treated as a congressional committee for purposes of costs relating to printing and binding (including the cost of personnel detailed from the Government Printing Office). Section 15(g) authorizes appropriations of such sums as may be necessary to carry out this section. This appropriated amount shall not result in a reduction in any other appropriation for health care or health services for Native Hawaiians. Section 16. Rule of construction This section specifies that nothing in this Act will be construed to restrict the authority of the State of Hawaii to license health practitioners. Section 17. Compliance with Budget Act This section provides that any new spending authority described in sections 401(c)(2) (A) or (B) of the Congressional Budget At of 1974 which is provided under the authority of this Act is to be effective for any fiscal year only to the extent or in such amounts as are provided in appropriation Acts. Section 18. Severability This section provides that if any provision of the Act or the application of any provision of the Act to any person or circumstances is held to be invalid, the remainder of the Act, and the application of a provision or amendment to persons or circumstances other than those to which it is held invalid, will be unaffected. Legislative History S. 1929 was introduced on November 16, 1999, by Senator Inouye for himself and Senator Akaka, and was referred to the Committee on Indian Affairs. Hearings on S. 1929 were held on the islands of Moloka'i and Kaua'i on January 18, 2000, on the island of Maui on January 19, 2000, at Hilo, Hawaii on January 20, 2000, on the island of O'ahu on January 21, 2000, and at Kona, Hawaii and on the island of Lana'i on March 16, 2000. Committee Recommendation and Tabulation of Vote The Committee on Indian Affairs, on May 3, 2000, in an open business meeting, by a unanimous vote, recommended that the Senate pass an amendment in the nature of a substitute to S. 1929, a bill to reauthorize and amend the Native Hawaiian Health Care Act. Cost and Budgetary Considerations The cost estimate of the Congressional Budget Office on S. 1929 is set forth below. CONGRESSIONAL BUDGET OFFICE COST ESTIMATE S. 1929--Native Hawaiian Health Care Improvement Act Reauthorization of 1999 Summary: S. 1929 would reauthorize the Native Hawaiian Health Care Improvement Act. It would amend the act to reflect how current programs are operated and to treat the Native Hawaiian health systems in a manner similar to health centers authorized under the Public Health Service Act. In addition, it would create a Commission to advise the Congress whether the provision of health care services to Native Hawaiians should be an entitlement program. It also would require Federal agencies to consult with Native Hawaiians and organizations providing health care services to Native Hawaiians before adopting any policy or regulation which may impact their health services or health insurance coverage. The act is administered through the Health Resources and Services Administration. Assuming the appropriation of the necessary amounts, CBO estimates that implementing S. 1929 would cost $1 million in 2001 and a total of $19 million from 2001 through 2005. (That total assumes that the annual appropriation level is not adjusted to reflect anticipated inflation. If such adjustments are made, the five-year outlay total would be $20 million.) The legislation would not affect direct spending or receipts; therefore, pay-as-you-go procedures would not apply. S. 1929 contains no private-sector mandates as defined in the Unfunded Mandates Reform Act (UMRA). It does contain an intergovernmental mandate, but CBO estimates that the costs of the mandate would be minimal and would not exceed the threshold established in UMRA ($55 million in 2000, adjusted annually for inflation). Estimated Cost to the Federal Government: The estimated budgetary impact of S. 1929 is shown in the following table. The costs of this legislation fall within budget function 550 (health). ---------------------------------------------------------------------------------------------------------------- By fiscal year, in millions of dollars-- ----------------------------------------------------- 2000 2001 2002 2003 2004 2005 ---------------------------------------------------------------------------------------------------------------- SPENDING SUBJECT TO APPROPRIATIONS Spending Under Current Law: Budget Authority\1\................................... 5 5 0 0 0 0 Estimated Outlays..................................... 5 5 2 (\2\) 0 0 Proposed Changes: Estimated Authorization Level......................... 0 2 5 5 5 5 Estimated Outlays..................................... 0 1 3 5 5 5 Spending Under S. 1929: Estimated Authorization Level\1\...................... 5 7 5 5 5 5 Estimated Outlays..................................... 5 6 5 5 5 5 ---------------------------------------------------------------------------------------------------------------- \1\The 2000 level is the amount appropriated for that year for activities conducted under the Native Hawaiian Health Care Improvement Act. \2\Less than $500,000. Basis of Estimate: For this cost estimate, CBO assumes that the bill will be enacted by or near the start of fiscal year 2001, that the necessary amounts will be appropriated each year, and that outlays will follow historical spending rates for the authorized activities. Current programs in the act were authorized at such sums as necessary through 2001. S. 1929 would reauthorize the administrative grant for Papa Ola Lokahi, extending it through 2010. It also would reauthorize the Native Hawaiian health systems and the scholarship assistance programs, extending their authorization through 2011. Because these activities are currently authorized through 2001, this provision would not affect spending until 2002. S. 1929 would amend the requirements for Native Hawaiian health systems to remove differences in treatment between them and health centers which perform similar functions, but are authorized under the Public Health Service Act. It would remove the requirement that health systems provide matching funds to receive the full amount of the cost of providing health services under a grant or contract. Providers of services in health systems could be treated as if they were members of the Public Health Service and covered under section 224 of the Public Health Service Act, which provides for defense and payment of claims in certain malpractice and negligence suits. In addition, it would enable health systems, like health centers, to receive and use surplus buildings and equipment owned by the federal government. CBO estimates these provisions would have a negligible impact on federal spending. S. 1929 would create a commission composed of members of the Congress, individuals appointed by Hawaiian health entities, and individuals appointed by the Secretary of the Department of Health and Human Services. The initial members would be appointed within 90 days after enactment. Not later than 18 months after the last members was appointed, the commission would submit a written report to the Congress containing a recommendation of policies and legislation to establish a health care system for native Hawaiians based on the delivery of health care services as an entitlement. The bill would authorize $1.5 million in appropriations to carry out this section. S. 1929 would require federal agencies providing health care financing and carrying out health care programs to consult with Native Hawaiians and organizations providing health care services to Native Hawaiians prior to adopting any policy or regulation which may impact the provision of health services or health insurance coverage for Native Hawaiians. The consultation would include, but not be limited to, the identification of the impact of proposed policies, rules, or regulations. Depending on how the consultation would be defined, this provision could have budgetary implications. Should the consultation require a significant amount of work and time, it would delay the promulgation of rules and regulations affecting federal payment for programs such as Medicare and Medicaid. CBO cannot estimate the budgetary impact of this provision since it would depend on the rule or regulation being considered and the time necessary to perform the consultation. Pay-as-you-go considerations: None. Estimated impact on state, local, and tribal governments: The bill would require the state of Hawaii to consult with Native Hawaiians and health care organizations that provide services to Native Hawaiians before making policy changes or initiating new programs. That requirement would be an intergovernmental mandate as defined in UMRA, but CBO estimates that the costs of the mandate would be minimal and would not exceed the threshold established in UMRA ($55 million in 2000, adjusted annually for inflation). Estimated impact on the private sector: The bill contains no private-sector mandates as defined in UMRA. Estimate prepared by: Federal Costs: Cyndi Dudzinski; Impact on State, Local, and Tribal Governments: Leo Lex; and Impact on the Private Sector: Jennifer Bullard. Estimate approved by: Pete H. Fontaine, Deputy Assistant Director for Budget Analysis. Executive Communications The Committee received no communications from the Executive branch of government of S. 1929. Regulatory and Paperwork Impact Paragraph 11(b) of rule XXVI of the Standing Rules of the Senate requires each report accompanying a bill to evaluate the regulatory and paperwork impact that would be incurred in carrying out the bill. The Committee believes that the amendment in the nature of a substitute to S. 1929 will have a minimal impact on regulatory or paperwork requirements. Changes in Existing Law UNITED STATES CODE ANNOTATED TITLE 42--THE PUBLIC HEALTH AND WELFARE CHAPTER 122--NATIVE HAWAIIAN HEALTH CARE Sec. 11701. Findings [The Congress finds that:] (a) General Findings.--Congress makes the following findings: (1) Native Hawaiians begin their story with the Kumulipo which details the creation and inter- relationship of all things, including their evolvement as healthy and well people. [(1)] (2) Native Hawaiians [comprise] are a distinct and unique indigenous people with a historical continuity to the original inhabitants of the Hawaiian archipelago [whose society was organized as a Nation prior to the arrival of the first nonindigenous people in 1778.] within Ke Moananui, the Pacific Ocean, and have a distinct society organized almost 2,000 years ago. (3) The health and well-being of Native Hawaiians are intrinsically tied to their deep feelings and attachment to their lands and seas. (4) The long-range economic and social changes in Hawaii over the 19th and early 20th centuries have been devastating to the health and well-being of Native Hawaiians. (5) Native Hawaiians have never directly relinquished to the United States their claims to their inherent sovereignty as a people or over their national lands, either through their monarchy or through a plebiscite or referendum. [(2)] (6) The Native Hawaiian people are determined to preserve, develop and transmit to future generations their ancestral territory, and their cultural identity in accordance with their own spiritual and traditional beliefs, customs, practices, language, and social institutions. In referring to themselves, Native Hawaiians use the term ``Kanaka Maoli'', a term frequently used in the 19th century to describe the native people of Hawaii. [(3)] (7) The constitution and statutes of the State of Hawaii-- (A) acknowledge the distinct land rights of Native Hawaiian people as beneficiaries of the public lands trust; and (B) reaffirm and protect the unique right of the Native Hawaiian people to practice and perpetuate their cultural and religious customs, beliefs, practices, and language. [(4)] (8) At the time of the arrival of the first nonindigenous people in Hawaii in 1778, the Native Hawaiian people lived in a highly organized, self- sufficient, subsistence social system based on communal land tenure with a sophisticated language, culture, and religion. [(5)] (9) A unified monarchical government of the Hawaiian Islands was established in 1810 under Kamehameha I, the first King of Hawaii. [(6)] (10) Throughout the 19th century and until 1893, the United States-- (A) recognized the independence of the Hawaiian Nation; (B) extended full and complete diplomatic recognition to the Hawaiian Government; and (C) entered into treaties and conventions with the Hawaiian monarchs to govern commerce and navigation in 1826, 1842, 1849, 1875 and 1887. [(7)] (11) In [the year] 1893, John L. Stevens, the United States Minister assigned to the sovereign and independent Kingdom of Hawaii, [John L. Stevens,] conspired with a small group of non-Hawaiian residents of the Kingdom, including citizens of the United States, to overthrow the indigenous and lawful Government of Hawaii. [(8)] (12) In pursuance of that conspiracy, the United States Minister and the naval representative of the United States caused armed naval forces of the United States to invade the sovereign Hawaiian Nation in support of the indigenous andlawful Government of Hawaii and the United States Minister thereupon extended diplomatic recognition of a provisional government formed by the conspirators without the consent of the native people of Hawaii or the lawful Government of Hawaii in violation of treaties between the two nations of international law. [(9)] (13) In a message to Congress on December 18, 1893, then President Grover Cleveland reported fully and accurately on these illegal actions, and acknowledged that by these acts, described by the President as acts of war, the government of a peaceful and friendly people was overthrown, and the President concluded that a ``substantial wrong has thus been done which a due regard for our national character as well as the rights of the injured people required that we should endeavor to repair''. [(10)] (14) Queen Lili'uokalani, the lawful monarch of Hawaii, and the Hawaiian Patriotic League, representing the aboriginal citizens of Hawaii, promptly petitioned the United States for redress of these wrongs and for restoration of the indigenous government of the Hawaiian nation, but this petition was not acted upon. (15) The United States has acknowledged the significance of these events and has apologized to Native Hawaiians on behalf of the people of the United States for the overthrow of the Kingdom of Hawaii with the participation of agents and citizens of the United States, and the resulting deprivation of the rights of Native Hawaiians to self-determination in legislation enacted into law in 1993 (Public Law 103-150; 107 Stat. 1510). [(11)] (16) In 1898, the United States annexed Hawaii through the Newlands Resolution without the consent of or compensation to the indigenous people of Hawaii or their sovereign government who were thereby denied the mechanism for expression of their inherent sovereignty through self-government and self-determination, their lands and ocean resources. [(12)] (17) Through the Newlands Resolution and the 1900 Organic Act, the United States Congress received [1.75 million] 1,750,000 acres of lands formerly owned by the Crown and Government of the Hawaiian Kingdom and exempted the lands from then existing public land laws of the United States by mandating that the revenue and proceeds from these lands be ``used solely for the benefit of the inhabitants of the Hawaiian Islands for education and other public purposes'', thereby establishing a special trust relationship between the United States and the inhabitants of Hawaii. [(13)] (18) In 1921, Congress enacted the Hawaiian Homes Commission Act, 1920 which designated 200,000 acres of the ceded public lands for exclusive homesteading by Native Hawaiians, thereby affirming the trust relationship between the United States and the Native Hawaiians, as expressed by then Secretary of the interior Franklin K. Lane who was cited in the Committee Report of the United States House of Representatives Committee on Territories as stating, ``One thing that impressed me . . . was the fact that the natives of the islands [who are wards, I should say, and] for whom in a sense we are trustees, are falling off rapidly in number and many of them are in poverty.''. [(14)] (19) In 1938, [the United States] Congress again acknowledged the unique status of the Native Hawaiian people by including in the Act of June 20, 1938 (52 Stat. 781 et seq.), a provision to lease lands within the extension to Native Hawaiians and to permit fishing in the area ``only by native Hawaiian residents of said area or of adjacent villages and by visitors under their guidance''. [(15)] (20) Under the Act entitled ``An Act to provide for the admission of the State of Hawaii into the Union'', approved March 18, 1959 (73 Stat. 4), the United States transferred responsibility for the administration of the Hawaiian Home Lands to the State of Hawaii but reaffirmed the trust relationship which existed between the United States and the Hawaiian people by retaining the exclusive power to enforce the trust, including the power to approve land exchanges, and legislative amendments affecting the rights of beneficiaries under such Act. [(16)] (21) Under the Act entitled ``An Act to provide for the admission of the State of Hawaii into the Union'', approved March 18, 1959 (73 Stat. 4), the United States transferred responsibility for administration over portions of the ceded public lands trust not retained by the United States to the State of Hawaii but reaffirmed the trust relationship which existed between the United States and the Hawaiian people by retaining the legal responsibility of the State for the betterment of the conditions of Native Hawaiians under section 5(f) [of the Act entitled ``An Act to provide for the admission of the State of Hawaii into the Union'', approved March 18, 1959 (73 Stat. 4, 6).] of such Act. (22) In 1978, the people of Hawaii amended their Constitution to establish the Office of Hawaiian Affairs and assigned to that body the authority to accept and hold real and personal property transferred from any source in trust for the Native Hawaiian people, to receive payments from the State of Hawaii due to the Native Hawaiian people in satisfaction of the pro rata share of the proceeds of the Public Land Trust created under section 5 of the Admission Act of 1959 (Public Law 83-3), to act as the lead State agency for matters affecting the Native Hawaiian people, and to formulate policy on affairs relating to the Native Hawaiian people. [(17)] (23) The authority of the Congress under the United States Constitution to legislate in matters affecting the aboriginal or indigenous peoples of the United States includes the authority to legislate in matters affecting the native peoples of Alaska and Hawaii. (24) Further, the United States has recognized the authority of the Native Hawaiian people to continue to work towards an appropriate form of sovereignty as defined by the Native Hawaiian people themselves in provisions set forth in legislation returning the Hawaiian Island of Kaho'olawe to custodial management by the State of Hawaii in 1994. [(18)] (25) In furtherance of the trust responsibility for the betterment of the conditions of Native Hawaiians, the United States has established a program for the provision of comprehensive health promotion and disease prevention services to maintain and improve the health status of the Hawaiian people. This program is conducted by the Native Hawaiian Health Care Systems, the Native Hawaiian Health Scholarship Program and Papa Ola Lokahi. Health initiatives from these and other health institutions and agencies using Federal assistance have begun to lower the century-old morbidity and mortality rates of Native Hawaiian people by providing comprehensive disease prevention, health promotion activities and increasing the number of Native Hawaiians in the health and allied health professions. This has been accomplished through the Native Hawaiian Health Care Improvement Act of 1988 (Public Law 100-579) and its reauthorization in section 9168 of Public Law 102-396 (106 Stat. 1948). [(19)] (26) This historical and unique legal relationship has been consistently recognized and affirmed by the Congress through the enactment of Federal laws which extend to the Hawaiian people the same rights and privileges accorded to American Indian, Alaska Native, Eskimo, and Aleut communities, including the Native American Programs Act of 1974 (42 U.S.C.A. Sec. 2991 et seq.); the American Indian Religious Freedom Act (42 U.S.C.A. Sec. 1996); the National Museum of the American Indian Act (20 U.S.C.A. Sec. 80q et seq.); and the Native American Graves Protection and Repatriation Act (25 U.S.C.A. Sec. 3001 et seq.). [(20)] (27) The United States has also recognized and reaffirmed the trust relationship to the Hawaiian people through legislation which authorizes the provision of services to Native Hawaiians, specifically, the Older Americans Act of 1965 (42 U.S.C.A. Sec. 3001 et seq.), the Developmental Disabilities Assistance and Bill of Rights Act Amendments of 1987, the Veterans' Benefits and Services Act of 1988, the Rehabilitation Act of 1973 (29 U.S.C.A. Sec. 701 et seq.), the Native Hawaiian Health Care Act of 1988, the Health Professions Reauthorization Act of 1988, the Nursing Shortage Reduction and Education Extension Act of 1988, the Handicapped Programs Technical Amendments Act of 1988, the Indian Health Care Amendments of 1988, and the Disadvantaged Minority Health Improvement Act of 1990. [(21)] (28) The United States has also affirmed the historical and unique legal relationship to the Hawaiian people by authorizing the provision of services to Native Hawaiians to address problems of alcohol and drug abuse under the Anti-Drug Abuse Act of 1986 (Public Law 99-570). (29) Further, the United States has recognized that Native Hawaiians, as aboriginal, indigenous, native people of Hawaii, are a unique population group in Hawaii and in the continental United States and has so declared in Office of Management and Budget Circular 15 in 1997 and Presidential Executive Order No. 13125, dated June 7, 1999. [(22)] (30) Despite [such services,] the United States having expressed its commitment to a policy of reconciliation with the Native Hawaiian people for past grievances in Public Law 103-150 (107 Stat. 1510) the unmet health needs of the Native Hawaiian people [are] remain severe and [the] their health status [of Native Hawaiians] continues to be far below that of the general population of the United States. (b) Unmet Needs and Health Disparities.--Congress finds that the unmet needs and serious health disparities that adversely affect the Native Hawaiian people include the following: (1) Chronic disease and illness.-- (A) Cancer.-- (i) In general.--With respect to all cancer-- (I) Native Hawaiians have the highest cancer mortality rates in the State of Hawaii (231.0 out of every 100,000 residents), 45 percent higher than that for the total State population (159.7 out of every 100,000 residents); (II) Native Hawaiian males have the highest cancer mortality rates in the State of Hawaii for cancers of the lung, liver and pancreas and for all cancers combined; (III) Native Hawaiian females ranked highest in the State of Hawaii for cancers of the lung, liver, pancreas, breast, cervix uteri, corpus uteri, stomach, and rectum, and for all cancers combined; (IV) Native Hawaiian males have the highest years of productive life lost from cancer in the State of Hawaii with 8.7 years compared to 6.4 years for other males; and (V) Native Hawaiian females have 8.2 years of productive life lost from cancer in the State of Hawaii as compared to 6.4 years for other females in the State of Hawaii; (ii) Breast cancer.--With respect to breast cancer-- (I) Native Hawaiians have the highest mortality rates in the State of Hawaii from breast cancer (37.96 out of every 100,000 residents), which is 25 percent higher than that for Caucasian Americans (30.25 out of every 100,000 residents) and 106 percent higher than that for Chinese Americans (18.39 out of every 100,000 residents); and (II) nationally, Native Hawaiians have the third highest mortality rates due to breast cancer (25.0 out of every 100,000 residents) following African Americans (31.4 out of every 100,000 residents) and Caucasian Americans (27.0 out of every 100,000 residents). (iii) Cancer of the cervix.--Native Hawaiians have the highest mortality rates from cancer of the cervix in the State of Hawaii (3.82 out of every 100,000 residents) followed by Filipino Americans (3.33 out of every 100,000 residents) and Caucasian Americans (2.61 out of every 100,000 residents). (iv) Lung cancer.--Native Hawaiians have the highest mortality rates from lung cancer in the State of Hawaii (90.70 out of every 100,000 residents), which is 61 percent higher than Caucasian Americans, who rank second and 161 percent higher than Japanese Americans, who rank third. (v) Prostate cancer.--Native Hawaiian males have the second highest mortality rates due to prostate cancer in the State of Hawaii (25.86 out of every 100,000 residents) with Caucasian Americans having the highest mortality rate from prostate cancer (30.55 out of every 100,000 residents). (B) Diabetes.--With respect to diabetes, for the years 1989 through 1991-- (i) Native Hawaiians had the highest mortality rate due to diabetes mellitis (34.7 out of every 100,000 residents) in the State of Hawaii which is 130 percent higher than the statewide rate for all other races (15.1 out of every 100,000 residents); (ii) full-blood Hawaiians had a mortality rate of 93.3 out of every 100,000 residents, which is 518 percent higher than the rate for the statewide population of all other races; and (iii) Native Hawaiians who are less than full-blood had a mortality rate of 27.1 out of every 100,000 residents, which is 79 percent higher than the rate for the statewide population of all other races. (C) Asthma.--With respect to asthma-- (i) in 1990, Native Hawaiians comprised 44 percent of all asthma cases in the State of Hawaii for those 18 years of age and younger, and 35 percent of all asthma cases reported; and (ii) in 1992, the Native Hawaiian rate for asthma was 81.7 out of every 1000 residents, which was 73 percent higher than the rate for the total statewide population of 47.3 out of every 1000 residents. (D) Circulatory diseases.-- (i) Heart disease.--With respect to heart disease-- (I) the death rate for Native Hawaiians from heart disease (333.4 out of every 100,000 residents) is 66 percent higher than for the entire State of Hawaii (201.1 out of every 100,000 residents); and (II) Native Hawaiian males have the greatest years of productive life lost in the State of Hawaii where Native Hawaiian males lose an average of 15.5 years and Native Hawaiian females lose an average of 8.2 years due to heart disease, as compared to 7.5 years for all males in the State of Hawaii and 6.4 years for all females. (ii) Hypertension.--The death rate for Native Hawaiians from hypertension (3.5 out every 100,000 residents) is 84 percent higher than that for the entire State (1.9 out of every 100,000 residents). (iii) Stroke.--The death rate for Native Hawaiians from stroke (58.3 out of every1000,000 residents) is 13 percent higher than that for the entire State (51.8 out of every 100,000 residents). (2) Infectious disease and illness.--The incidence of AIDS for Native Hawaiians is at least twice as high per 100,000 residents (10.5 percent) than that for any other non-Caucasian group in the State of Hawaii. (3) Accidents.--With respect to accidents-- (A) the death rate for Native Hawaiians from accidents (38.8 out of every 100,000 residents) is 45 percent higher than that for the entire State (26.8 out of every 100,000 residents); (B) Native Hawaiian males lose an average of 14 years of productive life lost from accidents as compared to 9.8 years for all other males in Hawaii; and (C) Native Hawaiian females lose an average of 4 years of productive life lost from accidents but this rate is the highest rate among all females in the State of Hawaii. (4) Dental health.--With respect to dental health-- (A) Native Hawaiian children exhibit among the highest rates of dental caries in the nation, and the highest in the State of Hawaii as compared to the 5 other major ethnic groups in the State; (B) the average number of decayed or filled primary teeth for Native Hawaiian children ages 5 through 9 years was 4.3 as compared with 3.7 for the entire State of Hawaii and 1.9 for the United States; and (C) the proportion of Native Hawaiian children ages 5 through 12 years with unmet treatment needs (defined as having active dental caries requiring treatment) is 40 percent as compared with 33 percent for all other races in the State of Hawaii. (5) Life expectancy.--With respect to life expectancy-- (A) Native Hawaiians have the lowest life expectancy of all population groups in the State of Hawaii; (B) between 1910 and 1980, the life expectancy of Native Hawaiians from birth has ranged from 5 to 10 years less than that of the overall State population average; and (C) the most recent tables for 1990 show Native Hawaiian life expectancy at birth (74.27 years) to be about 5 years less than that of the total State population (78.85 years). (6) Maternal and child health.-- (A) Prenatal care.--With respect to prenatal care-- (i) as of 1996, Native Hawaiian women have the highest prevalence (21 percent) of having had no prenatal care during their first trimester of pregnancy when compared to the 5 largest ethnic groups in the State of Hawaii; (ii) of the mothers in the State of Hawaii who received no prenatal care throughout their pregnancy in 1996, 44 percent were Native Hawaiian; (iii) over 65 percent of the referrals to Healthy Start in fiscal years 1996 and 1997 were Native Hawaiian newborns; and (iv) in every region of the State of Hawaii, many Native Hawaiian newborns begin life in a potentially hazardous circumstance, far higher than any other racial group. (B) Births.--With respect to births-- (i) in 1996, 45 percent of the live births to Native Hawaiian mothers were infants born to single mothers which statistics indicate put infants at higher risk of low birth weight and infant mortality; (ii) in 1996, of the births to Native Hawaiian single mothers, 8 percent were low birth weight (under 2500 grams); and (iii) of all low birth weight babies born to single mothers in the State of Hawaii, 44 percent were Native Hawaiian. (C) Teen pregnancies.--With respect to births-- (i) in 1993 and 1994, Native Hawaiians had the highest percentage of teen (individuals who were less than 18 years of age) births (8.1 percent) compared to the rate for all other races in the State of Hawaii (3.6 percent); (ii) in 1996, nearly 53 percent of all mothers in Hawaii under 18 years of age were Native Hawaiian; (iii) lower rates of abortion (a third lower than for the statewide population) among Hawaiian women may account in part, for the higher percentage of live births; (iv) in 1995, of the births to mothers age 14 years and younger in Hawaii, 66 percent were Native Hawaiian; and (v) in 1996, of the births in this same group, 48 percent were Native Hawaiian. (D) Fetal mortality.--In 1996, Native Hawaiian fetal mortality rates comprised 15 percent of all fetal deaths for the State of Hawaii. However, for fetal deaths occurring in mothers under the age of 18 years, 32 percent were Native Hawaiian, and for mothers 18 through 24 years of age, 28 percent were Native Hawaiians. (7) Mental health.-- (A) Alcohol and drug abuse.--With respect to alcohol and drug abuse.-- (i) Native Hawaiians represent 38 percent of the total admissions to Department of Health, Alcohol, Drugs and Other Drugs, funded substance abuse treatment programs; (ii) in 1997, the prevalence of smoking by Native Hawaiians was 28.5 percent, a rate that is 53 percent higher than that for all others races in the State of Hawaii which is 18.6 percent; (iii) Native Hawaiians have the highest prevalence rates of acute drinking (31 percent), a rate that is 79 percent higher than that for all other races in the State of Hawaii; (iv) the chronic drinking rate among Native Hawaiians is 54 percent higher than that for all other races in the State of Hawaii; (v) in 1991, 40 percent of the Native Hawaiian adults surveyed reported having used marijuana compared with 30 percent for all other races in the State of Hawaii; and (vi) nine percent of the Native Hawaiian adults surveyed reported that they are current users (within the past year) of marijuana, compared with 6 percent for all other races in the State of Hawaii. (B) Crime.--With respect to crime-- (i) in 1996, of the 5,944 arrests that were made for property crimes in the State of Hawaii, arrests of Native Hawaiians comprised 20 percent of that total; (ii) Native Hawaiian juveniles comprised a third of all juvenile arrests in 1996; (iii) In 1996, Native Hawaiians represented 21 percent of the 8,000 adults arrested for violent crimes in the State of Hawaii, and 38 percent of the 4,066 juvenile arrests; (iv) Native Hawaiians are over- represented in the prison population in Hawaii; (v) in 1995 and 1996 Native Hawaiians comprised 36.5 percent of the sentenced felon prison population in Hawaii, as compared to 20.5 percent for Caucasian Americans, 3.7 percent for Japanese Americans, and 6 percent for Chinese Americans; (vi) in 1995 and 1996 Native Hawaiians made up 45.4 percent of the technical violator population, and at the Hawaii Youth Correctional Facility, Native Hawaiians constituted 51.6 percent of all detainees in fiscal year 1997; and (vii) based on anecdotal information from inmates at the Halawa Correction Facilities, Native Hawaiians are estimated to comprise between 60 and 70 percent of all inmates. (8) Health professions education and training.--With respect to health professions education and training-- (A) Native Hawaiians age 25 years and older have a comparable rate of high school completion, however, the rates of baccalaureate degree achievement amongst Native Hawaiians are less than the norm in the State of Hawaii (6.9 percent and 15.76 percent respectively). (B) Native Hawaiian physicians make up 4 percent of the total physician workforce in the State of Hawaii; and (C) in fiscal year 1997, Native Hawaiians comprised 8 percent of those individuals who earned Bachelor's Degrees, 14 percent of those individuals who earned professional diplomas, 6 percent of those individuals who earned Master's Degrees, and less than 1 percent of individuals who earned doctoral degrees at the University of Hawaii. Sec. 11702. Declaration of National Native Hawaiian Health P[p]olicy (a) Congress.--The Congress hereby declares that it is the policy of the United States in fulfillment of its special responsibilities and legal obligations to the indigenous people of Hawaii resulting from the unique and historical relationship between the United States and the [Government of the] indigenous peoples of Hawaii-- (1) to raise the health status of Native Hawaiians to the highest possible health level; and (2) to provide existing Native Hawaiian health care programs with all resources necessary to effectuate this policy. (b) Intent of Congress.--It is the intent of the Congress that--[the nation meet the following health objectives with respect to Native Hawaiians by the year 2000:] (1) [Reduce coronary heart disease deaths to no more than 100 per 100,000.] health care programs having a demonstrated effect of substantially reducing or eliminating the over-representation of Native Hawaiians among those suffering from chronic and acute disease and illness and addressing the health needs, including perinatal, early child development, and family-based health education, of Native Hawaiians shall be established and implemented; and (2) [Reduce stroke deaths to no more than 20 per 100,000.] the Nation raise the health status of Native Hawaiians by the year 2010 to at least the levels set forth in the goals contained within Healthy People 2010 or successor standards and to incorporate within health programs, activities defined and identified by Kanaka Maoli which may include-- (A) incorporating and supporting the integration of cultural approaches to health and well-being, including programs using traditional practices relating to the atmosphere (lewa lani), land ('aina), water (wai), or ocean (kai); (B) increasing the number of health and allied-health care providers who are trained to provide culturally competent care to Native Hawaiians; (C) increasing the use of traditional Native Hawaiian foods in peoples' diets and dietary preferences including those of students and the use of these traditional foods in school feeding programs; (D) identifying and instituting Native Hawaiian cultural values and practices within the ``corporate cultures'' of organizations and agencies providing health services to native Hawaiians; (E) facilitating the provision of Native Hawaiian healing practices by Native Hawaiian healers for those clients desiring such assistance; and (F) supporting training and education activities and programs in traditional Native Hawaiian healing practices by native Hawaiian healers. [(3) Increase control of high blood pressure to at least 50 percent of people with high blood pressure. [(4) Reduce blood cholesterol to an average of no more than 200 mg/dl. [(5) Slow the rise in lung cancer deaths to achieve a rate of no more than 42 per 100,000. [(6) Reduce breast cancer deaths to no more than 20.6 per 100,000 women. [(7) Increase Pap tests every 1 to 3 years to at least 85 percent of women age 18 and older. [(8) Increase fecal occult blood testing every 1 to 2 years to at least 50 percent of people age 50 and older. [(9) Reduce diabetes-related deaths to no more than 34 per 100,000. [(10) Reduce the most severe complications of diabetes as follows: [(A) end-stage renal disease to no more than 1.4 in 1,000; [(B) blindness to no more than 1.4 in 1,000; [(C) lower extremity amputation to no more than 4.9 in 1,000; [(D) perinatal mortality to no more than 2 percent; and [(E) major congenital malformations to no more than 4 percent. [(11) Reduce infant mortality to no more than 7 deaths per 1,000 live births. [(12) Reduce low birth weight to no more than 5 percent of live births. [(13) Increase first trimester prenatal care to at least 90 percent of live births. [(14) Reduce teenage pregnancies to no more than 50 per 1,000 girls age 17 and younger. [(15) Reduce unintended pregnancies to no more than 30 percent of pregnancies. [(16) Increase to at least 60 percent the proportion of primary care providers who provide age-appropriate preconception care and counseling. [(17) Increase years of healthy life to at least 65 years. [(18) Eliminate financial barriers to clinical preventive services. [(19) Increase childhood immunization levels to at least 90 percent of 2-year- olds. [(20) Reduce the prevalence of dental caries to no more than 35 percent of children by age 8. [(21) Reduce untreated dental caries so that the proportion of children with untreated caries (in permanent or primary teeth) is no more than 20 percent among children age 6 through 8 and no more than 15 percent among adolescents age 15. [(22) Reduce edentulism to no more than 20 percent in people age 65 and older. [(23) Increase moderate daily physical activity to at least 30 percent of the population. [(24) Reduce sedentary lifestyles to no more than 15 percent of the population. [(25) Reduce overweight to a prevalence of no more than 20 percent of the population. [(26) Reduce dietary fat intake to an average of 30 percent of calories or less. [(27) Increase to at least 75 percent the proportion of primary care providers who provide nutrition assessment and counseling or referral to qualified nutritionists or dieticians. [(28) Reduce cigarette smoking prevalence to no more than 15 percent of adults. [(29) Reduce initiation of smoking to no more than 15 percent by age 20. [(30) Reduce alcohol-related motor vehicle crash deaths to no more than 8.5 per 100,000 adjusted for age. [(31) Reduce alcohol use by school children age 12 to 17 to less than 13 percent. [(32) Reduce marijuana use by youth age 18 to 25 to less than 8 percent. [(33) Reduce cocaine use by youth aged 18 to 25 to less than 3 percent. [(34) Confine HIV infection to no more than 800 per 100,000. [(35) Reduce gonorrhea infections to no more than 225 per 100,000. [(36) Reduce syphilis infections to no more than 10 per 100,000. [(37) Reduce significant hearing impairment to a prevalance of no more than 82 per 1,000. [(38) Reduce acute middle ear infections among children age 4 and younger, as measured by days of restricted activity or school absenteeism, to no more than 105 days per 100 children. [(39) Reduce indigenous cases of vaccine-preventable diseases as follows: [(A) Diphtheria among individuals age 25 and younger to 0; [(B) Tetanus among individuals age 25 and younger to 0; [(C) Polio (wild-type virus) to 0; [(D) Measles to 0; [(E) Rubella to 0; [(F) Congenital Rubella Syndrome to 0; [(G) Mumps to 500; and [(H) Pertussis to 1,000; and [40) Reduce significant visual impairment to a prevalence of no more other than 30 per 1,000.] (c) Report.--The Secretary shall submit to the President, for inclusion in each report required to be transmitted to the Congress under section [11710 of this title] 12, a report on the progress made in each area toward meeting [each of the objectives described in subsection (b) of this section.] the National policy as set forth in this section. Sec. 11703. Comprehensive health care master plan for Native Hawaiians (a) Development.-- (1) In general.--The Secretary may make a grant to, or enter into a contract with, Papa Ola Lokahi for the purpose of coordinating, implementing and updating a Native Hawaiian comprehensive health care master plan designed to promote comprehensive health promotion and disease prevention services and to maintain and improve the health status of Native Hawaiians[. The master plan shall be based upon an assessment of the health care status and health care needs of Native Hawaiians. To the extent practicable, assessments made as of the date of such grant or contract shall be used by Papa Ola Lokahi, except that any such assessment shall be updated as appropriate.] and to support community-based initiatives that are reflective of holistic approaches to health. (2) Consultation.-- (A) In general.--Papa Ola Lokahi and the Office of Hawaiian Affairs shall consult with the Native Hawaiian health care systems, Native Hawaiian health centers, and the Native Hawaiian community in carrying out this section. (B) Memoranda of understanding.--Papa Ola Lokahi and the Office of Hawaiian Affairs may enter into memoranda of understanding or agreement for the purposes of acquiring joint funding and for other issues as may be necessary to accomplish the objectives of this section. (3) Health care financing study report.--Not later than 18 months after the date of enactment of this Act, Papa Ola Lokahi in cooperation with the Office of Hawaiian Affairs and other appropriate agencies of the State of Hawaii, including the Department of Health and the Department of Human Services and the Native Hawaiian health care systems and Native Hawaiian health centers, shall submit to Congress a report detailing the impact of current Federal and State health care financing mechanisms and policies on the health and well-being of Native Hawaiians. Such report shall include-- (A) information concerning the impact of cultural competency, risk assessment data, eligibility requirements and exemptions, and reimbursement policies and capitation rates currently in effect for service providers; (B) any other such information as may be important to improving the health status of Native Hawaiians as such information relates to health care financing including barriers to health care; and (C) the recommendations for submission to the Secretary for review and consultation with Native Hawaiians. (b) Authorization of Appropriations.--There are authorized to be appropriated such sums as may be necessary to carry out subsection (a) [of this section]. Sec. 11704. Functions of Papa Ola Lokahi (a) Responsibility.--Papa Ola Lokahi shall be responsible for the-- (1) coordination, implementation, and updating, as appropriate, of the comprehensive health care master plan developed pursuant to section [11703 of this title] 5; (2) training for the persons described in [section 11705(c)(1)(B) of this title] subparagraphs (B) and (C) of section 7(c)(1); (3) identification of and research into the diseases that are most prevalent among Native Hawaiians, including behavioral, biomedical, epidemiological, and health services; and (4) development and maintenance of an institutional review board for all research projects involving all aspects of Native Hawaiian health, including behavioral, biomedical, epidemiological, and health services studies; and [(4)] (5) the [development] maintenance of an action plan outlining the contributions that each member organization of Papa Ola Lokahi will make in carrying out the policy of this [chapter] Act. (b) Special Project Funds.--Papa Ola Lokahi [is authorized to] may receive special project funds that may be appropriated for the purpose of research on the health status of Native Hawaiians or for the purpose of addressing the health care needs of Native Hawaiians. (c) Clearinghouse.-- (1) In general.--Papa Ola Lokahi shall serve as a clearinghouse for: [(1)] (A) the collection and maintenance of data associated with the health status of Native Hawaiians; [(2)] (B) the identification and research into diseases affecting Native Hawaiians; [(3)] (C) the availability of Native Hawaiian project funds, research projects and publications; [(4)] (D) the collaboration of research in the area of Native Hawaiian health; and [(5)] (E) the timely dissemination of information pertinent to the Native Hawaiian health care systems. [(d) Coordination of Programs and Services.] (2) Consultation.--The Secretary shall provide Papa Ola Lokahi and the Office of Hawaiian Affairs at least one annually, an accounting of funds and services provided to States and to nonprofit groups and organizations from the department for the purposes set forth in section 4. Such accounting shall include-- (A) the amount of funds expended explicitly for the benefiting Native Hawaiians; (B) the number of Native Hawaiians impacted by these funds; (C) the identification of collaborations made with Native Hawaiian groups and organizations in the expenditure of these funds; and (D) the amount of funds used for Federal administration purposes and for the provision of direct services to Native Hawaiians. (d) Fiscal Allocation and Coordination of Programs and Services.-- (1) Recommendations.--Papa Ola Lokahi shall provide annual recommendations to the Secretary with respect to the allocation of all amounts appropriated under this Act. (2) Coordination.--Papa Ola Lokahi shall, to the maximum extent possible, coordinate and assist the health care programs and services provided to Native Hawaiians. (3) Representation on commission.--The Secretary, in consultation with Papa Ola Lokahi, shall make recommendations for Native Hawaiian representation on the President's Advisory Commission on Asian Americans and Pacific Islanders. (e) Technical Support.--Papa Ola Lokahi shall act as a statewide infrastructure to provide technical support and coordination of training and technical assistance to the Native Hawaiian health care systems. (f) Relations With Other Agencies.-- (1) Authority.--Papa Ola Lokahi is authorized to enter into agreements or memoranda ofunderstanding with relevant institions, agencies or organizations that are capable of providing health-related resources or services to Native Hawaiians and the Native Hawaiian health care systems or of providing resources or services for the implementation of the National policy as set forth in section 4. (2) Health care financing.-- (A) Federal consultation.--Federally providing health care financing and carrying out health care programs, including the Health Care Financing Administration, shall consult with Native Hawaiians and organizations providing health care services to Native Hawaiians prior to the adoption of any policy or regulation that may impact on the provision of service or health insurance coverage. Such consultation shall include the identification of the impact of any proposed policy, rule, or regulation. (B) State consultation.--The State of Hawaii shall engage in meaningful consultation with Native Hawaiians and organizations providing health care services to Native Hawaiians in the State of Hawaii prior to making any changes or initiating new programs. (C) Consultation on federal health insurance programs.-- (i) The Office of Hawaiians Affairs, in collaboration with Papa Ola Lokahi, may develop consultative, contractual or other arrangements including memoranda of understanding or agreement, with-- (I) the Health Care Financing Administration; (II) the agency of the State of Hawaii that administers or supervises the administration of the State plan or waiver approved under titles XVIII, XIX, or XII of the Social Security Act for the payment of all or part of the health care services provided to Native Hawaiians who are eligible for medical assistance under the State plan or waiver; or (III) any other Federal agency or agencies providing full or partial health insurance to Native Hawaiians. (ii) Such arrangements may address-- (I) appropriate reimbursement for health care services including capitation rates and fee-for-service rates for Native Hawaiians who are entitled to or eligible for insurance; (II) the scope of services; or (II) other matters that would enable Native Hawaiians to maximize health insurance benefits provided by Federal and State health insurance programs. * * * * * * * (4) Traditional healers.--The provision of health services under any program operated by the Departmental of another Federal agency including Department of Veterans Affairs, may include the services of ``traditional Native Hawaiian healers'' as defined in this Act or ``traditional healers'' providing ``traditional health care practices'' as defined in section 4(r) of Pubic Law 94-437. Such services shall be exempt from national accreditation reviews, including reviews conducted by the Joint Accreditation Commission on Health Organizations and the Rehabilitation Accreditation Commission. Sec. 11705. Native Hawaiian health care [systems] (a) Comprehensive Health Promotion, Disease Prevention, and Primary Health Services.-- (1)[(A)] Grants and contracts.--The Secretary, in consultation with Papa Ola Lokahi, may make grants to, or enter into contract with, any qualified entity for the purpose of providing comprehensive health promotion and disease prevention services as well as primary health services to Native Hawaiians who desire and are committed to bettering their own health. [(B)] (2) Preference.--In making grants and entering into contracts under this [paragraph] subsection, the Secretary shall give preference to Native Hawaiian health care systems and Native Hawaiian organizations and, to the extent feasible, health promotion and disease prevention services shall be performed through Native Hawaiian health care systems. (3) Qualified entity.--Any entity is a qualified entity for purposes of paragraph (1) if the entity is a Native Hawaiian health care system. (4) Limitation on number of entities.--The Secretary may make a grant to, or enter into a contract with, not more than 8 Native Hawaiian care systems under this subsection during any fiscal year. (b) Planning Grant or Contract.--[(2) In addition to paragraph (1)] In addition to grants and contracts under subsection (a), the Secretary may make a grant to, or enter into a contract with, Papa Ola Lokahi for the purpose of planning Native Hawaiian health care systems to serve the health needs of Native Hawaiian communities on each of the islands of O'ahu, Moloka'i, Maui, Hawai'i, Lana'i, Kaua'i, and Ni'ihau in the State of Hawaii. [(b) Qualified Entity.--An entity is a qualified entity for purposes of subsection (a)(1) of this section if the entity is a Native Hawaiian health care system.] (c) Services to be Provided.-- (1) In general.--Each recipient of funds under subsection (a)[(1)] of this section shall [provide the following services:] ensure that the following services either are provided or arranged for: (A) outreach services to inform Native Hawaiians of the availability of health services; (B) education in health promotion and disease prevention of the Native Hawaiian population by, wherever possible, Native Hawaiian health care practitioners, community outreach workers, counsels, and cultural educations; (C) services of physicians, physicians' assistants, nurse practitioners or other health professionals; (D) immunizations; (E) prevention and control of diabetes, high blood pressure, and otitis media; (F) pregnancy and infant care; and (G) improvement of nutrition. [(2) In addition to the mandatory services under paragraph (1), the following services may be provided pursuant to subsection (a)(1) of this section:] [(A)] (H) identification, treatment, control, and reduction of the incidence of preventable illnesses and conditions endemic to Native Hawaiians; [(B)] (I) collection of data related to the prevention of diseases and illnesses among Native Hawaiians; [and] [(C)] (J) services within the meaning of the terms ``health promotion'', ``disease prevention'', and ``primary health services'', as such terms are defined in section [11711] 3 of this title, which are not specifically referred to in [paragraph (1) of this] subsection (a)[.]; and (K) support of culturally appropriate activities enhancing health and wellness including land-based, water-based; ocean-based, and spiritually-based projects and programs. [(3)] (2) Traditional healers.--The health care services referred to in paragraphs (1) and (2) which are provided under grants or contracts under subsection (a)[(1)] of this section may be provided by traditional Native Hawaiian healers. [(d) Limitation of Number of Entities.--] (d) Federal Tort Claims Act.--Individuals that provide medical, dental, or other services referred to in subsection (a)(1) for Native Hawaiian health care systems, including providers of traditional Native Hawaiian healing services, shall be treated as if such individuals were members of the Public Health Service and shall be covered under the provisions of section 224 of the Public Health Service Act. (e) Site for Other Federal Payments.--A Native Hawaiian health care system that receives funds under subsection (a) shall provide a designated area and appropriate staff to serve as a Federal loan repayment facility. Such facility shall be designed to enable health and allied-health professionals to remit payments with respect to loans provided to such professionals under any Federal loan program. [During a fiscal year, the Secretary under this chapter may make a grant to, or hold a contract with, not more than 5 Native Hawaiian health care systems.] [(e) Matching Funds.--] [(1) The Secretary may not make a grant or provide funds pursuant to a contract under subsection (a)(1) of this section to a Native Hawaiian health care system-- [(A) in an amount exceeding 83.3 percent of the costs of providing health services under the grant or contract; and [(B) unless the Native Hawaiian health care system agrees that the Native Hawaiian health care system or the State of Hawaii will make available, directly or through donations to the Native Hawaiian health care system, non-Federal contributions toward such costs in an amount equal to not less than $1 (in cash or in kind under paragraph (2) for each $5 of Federal funds provided in such grant or contract. [(2) Non-Federal contributions required in paragraph (1) may be in cash or in kind, fairly evaluated, including plant, equipment, or services. Amounts provided by the Federal Government or services assisted or subsidized to any significant extent by the Federal Government may not be included in determining the amount of such non-Federal contributions. [(3) The Secretary may waive the requirement established in paragraph (1) if-- [(A) the Native Hawaiian health care system involved is a nonprofit private entity described in subsection (b) of this section; and [(B) the Secretary, in consultation with Papa Ola Kokahi, determines that it is not feasible for the Native Hawaiian health care system to comply with such requirement.] (f) Restriction on Use of Grant and Contract Funds.--The Secretary may not make a grant to, or enter into a contract with, any entity under subsection 9a)(1) of this section unless the entity agrees that, amounts received pursuant to such subsection will not, directly or through contract, be expended-- (1) for any purpose other than the purposes described in subsection (c) [of this section] (1); [(2) to provide inpatient services; [(3) to make cash payments to intended recipients of health services; or] [(4)] (2) to purchase or improve real property (other than minor remodeling of existing improvements to real property) or to purchase major medical equipment. (g) Limitation on Charges for Services.--The Secretary may not make a grant, or enter into a contract with, any entity under subsection (a)[(1) of the section] unless the entity agrees that, whether health services are provided directly or through contract-- (1) health services under the grant or contract will be provided without regard to ability to pay for the health services; and (2) the entity will impose a charge for the delivery of health services, and such charge-- (A) will be made according to a schedule of charges that is made available to the public, and (B) will be adjusted to reflect the income of the individual involved. (h) Authorization of Appropriation.-- (1) General grants.--There are authorized to be appropriated such sums as may be necessary for fiscal years [1993] 2001 through [2001] 2011 to carry out subsection [(a)(1) of this section] (b). (2) Planning grants.--There [are] is authorized to be appropriate such sums as may be necessary for each of fiscal years 2001 through 2011 to carry out subsection [(a)(2) of this section] (b). Sec. 11706. Administrative grant for Papa Ola Kokahi (a) In General.--In addition to any other grant or contract under this [chapter] Act, the Secretary may make grants to, or enter into contracts with, Papa Ola Lokahi for-- (1) coordination, implementation, and updating (as appropriate) of the comprehensive health care master plan developed pursuant to section [11703 of this title]; (2) training for the persons described in section [11705(c)(1)(B) of this title] 7(c)(1); (3) identification of and research into the diseases that are most prevalent among Native Hawaiians, including behavioral, biomedical, epidemiological, and health services; (4) the [development] maintenance of an action plan outlining the contributions that each member organization of Papa Ola Lokahi will make in carrying out the policy of this [chapter] Act; (5) a clearinghouse function for-- (A) the collection and maintenance of date associated with the health status of Native Hawaiians; (B) the identification and research into diseases affecting Native Hawaiians; and (C) the availability of Native Hawaiian project funds, research projects and publications; (6) [the coordination of the health care programs and services provided to Native Hawaiians] the establishment and maintenance of an institutional review board for all health-related research involving Native Hawaiians; (7) [the administration of special project funds.] the coordination of the health care programs and services provided to Native Hawaiians; and (8) the administration of special project funds. (b) Authorization of Appropriations.--There are authorized to be appropriated such sums as may be necessary for fiscal years [1993] 2001 through [2001] 2011 to carry out subsection (a) [of this section]. Sec. 11707. Administration of grants and contracts (a) Terms and Conditions.--The Secretary shall include in any grant made or contract entered into under this [chapter] Act such terms and conditions as the Secretary considers necessary or appropriate to ensure that the objectives of such grant or contract are achieved. (b) Periodic Review.--The Secretary shall periodically evaluate the performance of, and compliance with, grants and contracts under this [chapter] Act. (c) Administrative Requirements.--The Secretary may not make a grant or enter into a contract under this [chapter] Act with an entity unless the entity-- (1) agrees to establish such procedures for fiscal control and fund accounting as may be necessary to ensure proper disbursement and accounting with respect to the grant or contract; (2) agrees to ensure the confidentiality of records maintained on individuals receiving health services under the grant or contract; (3) with respect to providing health services to any population of Native Hawaiians, a substantial portion of which has a limited ability to speak the English language-- (A) has developed and has the ability to carry out a reasonable plan to provide health services under the grant or contract through individuals who are able to communicate with the population involved in the language and cultural context that is most appropriate; and (B) has designated at least one individual, fluent in both English and the appropriate language, to assist in carrying out the plan; (4) with respect to health services that are covered [in the plan of the State of Hawaii approved] under programs under titles XVIII, XIX, or XXI of the Social Security Act, including any State plan, or under any other Federally health insurance plan--[42 U.S.C.A. Sec. 1396 et seq.--] (A) if the entity will provide under the grant or contract any such health services directly-- (i) the entity has entered into a participation agreement under such plans; and (ii) the entity is qualified to receive payments under such plan; and (B) if the entity will provide under the grant or contract any such health services through a contract with an organization-- (i) the organization has entered into a participation agreement under such plan; and (ii) the organization is qualified to receive payments under such plan; and (5) agrees to submit to the Secretary and to Papa Ola Lokahi an annual report that describes the [utilization and] use and costs of health services provided under the grant or contract (including the average cost of health services per user) and that provides such other information as the Secretary determines to be appropriate. (d) Contrary Evaluation.-- (1) Determination of noncompliance.--If, as a result of evaluations conducted by the Secretary, the Secretary determines that an entity has not complied with or satisfactorily performed a contract entered into under section [11705 of this title] 7, the Secretary shall, prior to renewing such contract, attempt to resolve the areas of noncompliance or unsatisfactory performance and modify such contract to prevent future occurrences of such noncompliance or unsatisfactory performance. [If the Secretary determines that such noncompliance or unsatisfactory performance cannot be resolved and prevented in the future, the Secretary shall not renew such contract with such entity and is authorized to enter into a contract under section 11705 of this title with another entity referred to in section 11705(b) of this title that provides services to the same population of Native Hawaiians which is served by the entity whose contract is not renewed by reason of this subsection]. (2) Nonrenewal.--If the Secretary determines that the noncompliance or unsatisfactory performance described in paragraph (1) with respect to an entity cannot be resolved and prevented in the future, the Secretary shall not renew the contract with such entity and may enter into a contract under section 7 with another entity referred to in subsection (a)(3) of such section that provides services to the same population of Native Hawaiians which is served by the entity whose contract is not renewed by reason of this paragraph. [(2)] (3) Consideration of results._In determining whether to renew a contract entered into with an entity under this [chapter] Act, the Secretary shall consider the results of the evaluation under this section. [(3)] (4) Application of federal laws._All contracts entered into by the Secretary under this [chapter] Act shall be in accordance with all Federal contracting laws and regulations except that,in the discretion of the Secretary, such contracts may be negotiated without advertising and may be exempted from the provisions of the Act of August 24, 1935 (40 U.S.C. 270a et seq.). [(4)] (5) Payments made under any contract entered into under this [chapter] Act may be made in advance, by means of reimbursement, or in installments and shall be made on such conditions as the Secretary deems necessary to carry out the purposes of this [chapter] Act. (e) [Limitations on Use of Funds for Administrative Expenses] Report._ [Except for grants and contracts under section 11706 of this title, the Secretary may not grant to, or enter into a contract with, an entity under this chapter unless the entity agrees that the entity will not expend more than 10 percent of amounts received pursuant to this chapter for the purpose of administering the grant or contract.] [(f) Report.--] (1) For each fiscal year during which an entity receives or expends funds pursuant to a grant or contract under this [chapter] Act, such entity shall submit to the Secretary and to Papa Ola Lokahi a [quarterly] annual report on-- (A) activities conducted by the entity under the grant or contract; (B) the amounts and purposes for which Federal funds were expended; and (C) containing such other information as the Secretary may request. (2) The reports and records of any entity which concern any grant or contract under this chapter shall be subject to audit by the Secretary, the Inspector General of the Department of Health and Human Services, and the Comptroller General of the United States. (g) Annual Private Audit.--The Secretary shall allow as a cost of any grant made or contract entered into under this chapter the cost of an annual private audit conducted by a certified public accountant. Sec. 11708. Assignment of personnel (a) In General.--The Secretary is authorized to enter into an agreement with any entity under which the Secretary is authorized to assign personnel of the Department of Health and Human Services with expertise identified by such entity to such entity on detail for the purposes of providing comprehensive health promotion and disease prevention services to Native Hawaiians. (b) Applicable Federal Personnel Provisions.--Any assignment of personnel made by the Secretary under any agreement entered into under the authority of subsection (a) of this section shall be treated as an assignment of Federal personnel to a local government that is made in accordance with subchapter VI of chapter 33 of Title 5, United States Code. Sec. 11709. Native Hawaiian health scholarships and fellowships (a) Eligibility.--Subject to the availability of [funds] amounts appropriated under the authority of subsection (c) [of this section,] the Secretary shall provide funds through a direct grant or a cooperative agreement to Kamehameha Schools[/ Bishop Estate] or another Native Hawaiian organization or health care organization with experience in the administration of educational scholarships or placement services for the purpose of providing scholarship assistance to students who-- (1) meet the requirements of section [254l of this title,] 338A of the Public Health Service Act, except for assistance as provided for under subsection (b)(2); and (2) are Native Hawaiians. (b) A priority for scholarships may be provided to employees of the Native Hawaiian Health Care Systems and the Native Hawaiian Health Centers. [(b)] (c) Terms and Conditions.-- (1) In general.--The scholarship assistance provided under subsection (a) [of this section] shall be provided under the same terms and subject to the same conditions, regulations, and rules [that] as apply to scholarship assistance provided under section [254l of this title, provided that--] 338A of the Public Health Service Act (except as provided for in paragraph (2)), except that-- (A) the provision of scholarships in each type of health care profession training shall correspond to the need for each type of health care professional [identified in the Native Hawaiian comprehensive health care master plan implemented under section 11703 of this title] to serve the [Native Hawaiian health care systems] Native Hawaiian Community as identified by Papa Ola Lokahi; [(B) the primary health services covered under the scholarship assistance program under this section shall be the services included under the definition of that term under section 11711(8) of this title;] [(C)] (B) to the maximum extent practicable, the Secretary shall select scholarship recipients from a list of eligible applicants submitted by the Kamehameha Schools[/Bishop Estate] or the Native Hawaiian organization administering the program; [(D)] (C) the obligated service requirement for each scholarship recipient (except for those receiving assistance under paragraph (2)) shall be fulfilled through [the full-time clinical or nonclinical practice of the health profession of the scholarship recipient, in an order of priority that would provide for practice--] service, in order of priority, in-- (i) [first,] in any one of the [five] Native Hawaiian health care systems; and (ii) [second, in--] a health professional shortage area or medically underserved areas, or geographic areas or facilities similarly designated by the United States Public Health Service in the State of Hawaii; or [(I) a health professional shortage area or medically underserved area located in the State of Hawaii; or] [(II)] (iii) a geographic area or facility [that is--], or organization that serves a significant Native Hawaiian population; (D) the scholarship's placement services shall assign scholarship recipients to appropriate sites for service. [(aa) located in the State of Hawaii; and] [(bb) has a designation that is similar to a designation described in subclause (I) made by the Secretary, acting through the Public Health Service;] (E) the provision of counseling, retention and other support services shall not be limited to scholarship recipients, but shall also include recipients of other scholarship and financial aid programs enrolled in appropriate health professions training programs, (F) [the obligated service of a scholarship recipient shall not be performed by the recipient through membership in the National Health Service Corps; and] financial assistance may be provided to scholarship recipients in those health professions designated in such section 338A of the Public Health Service Act while they are fulfilling their service requirement in any one of the Native Hawaiian health care systems or community health centers. (2) Fellowships.--Financial assistance through fellowships may be provided to Native Hawaiian community health representatives, outreach workers, and health program administrators in professional training programs, and to Native Hawaiians in certificated programs provided by traditional Native Hawaiian healers in any of the traditional Native Hawaiian healing practices including lomi-lomi, la'au lapa'au, and ho'oponopono. Such assistance may include a stipend or reimbursement for costs associated with participation in the program. (3) Rights and benefits.--Scholarship recipients in health professions designated in section 338A of the Public Health Service Act while fulfilling their service requirements shall have all the same rights and benefits of members of the National Health Service corps during their period of service. (4) No inclusion of assistance in gross income.-- Financial assistance provided under section 11 of this Act shall be deemed ``Qualified Scholarships'' for purposes of 26 U.S.C. section 117. [(G) the requirements of sections 254d through 254k of this title, section 254m of this title, other than subsection (b)(5) of that section, and section 254n of this title applicable to scholarship assistance provided under subsection (a) of this section. [(2) The Native Hawaiian Health Scholarship program shall not be administered by or through the Indian Health Service. [(c)] (d) Authorization of Appropriations.--There are authorized to be appropriated such sums as may be necessary for fiscal years [1993] 2001 through [2001] 2011 for the purpose of funding the scholarship assistance provided under subsection (a) [of this section] and fellowship assistance under subsection (c)(2). Sec. 11710. Report The President shall, at the time the budget is submitted under section 1105 of Title 31, for each fiscal year transmit to the Congress a report on the progress made in meeting the objectives of this chapter, including a review of programs established or assisted pursuant to this chapter and an assessment and recommendations of additional programs or additional assistance necessary to, at a minimum, provide health services to Native Hawaiians, and ensure a health status for Native Hawaiians, which are at a parity with the health services available to, and the health status of, the general population. SEC. 13. USE OF FEDERAL GOVERNMENT FACILITIES AND SOURCES OF SUPPLY. (a) In General.--The Secretary shall permit organizations that receive contracts or grants under this Act, in carrying out such contracts or grants, to use existing facilities and all equipment therein or under the jurisdiction of the Secretary under such terms and conditions as may be agreed upon for the use and maintenance of such facilities or equipment. (b) Donation of Property.--The Secretary may donate to organizations that receivecontracts or granst under this Act any personal or real property determined to be in excess of the needs of the Department or the General Services Administration for purposes of carrying out such contracts or grants. (c) Acquisition of Surplus Property.--The Secretary may acquire excess of surplus Federal Government personal or real property for donation to organizations that receive contracts or grants under this Act if the Secretary determines that the property is appropriate for the use by the organization for the purpose for which a contract or grant is authorized under this Act. SEC. 14. DEMONSTRATION PROJECTS OF NATIONAL SIGNIFICANCE. (a) Authority and Areas of Interest.--The Secretary, in consultation with papa Ola Lokahi, may allocate amounts appropriated under this Act, or any other Act, to carry out Native Hawaiian demonstration projects of national significance. The areas of interest of such projects may include-- (1) the development of a centralized database and information system relating to the health care status, health care needs, and wellness of Native Hawaiians; (2) the education of health professionals, and other individuals in institutions of higher learning, in health and allied health programs in healing practices, including Native Hawaiian healing practices; (3) the integration of Western medicine with complementary healing practices including traditional Native Hawaiian healing practices; (4) the use of tele-wellness and telecommunications in chronic disease management and health promotion and disease prevention; (5) the development of appropriate models of health care for Native Hawaiians and other indigenous peoples including the provision of culturally competent health services, related activities focusing on wellness concepts, the development of appropriate kupuna care programs, and the development of financial mechanisms and collaborative relationships leading to universal access to health care; and (6) the establishment of a Native Hawaiian Center of Excellent for Nursing at the University of Hawaii at Hilo, a Native Hawaiian Center of Excellence for Mental Health at the University of Hawaii at Manoa, a Native Hawaiian Center of Excellence for Maternal health and Nutrition at the Waimanalo Health Center, and a Native Hawaiian Center of Excellence for Research, Training, Integrated Medicine at Molokai General Hospital and a Native Hawaiian Center of Excellence for Complimentary Health and Health Education and Training at the Waianae coast Comprehensive Health Center. (b) Nonreduction in Other Funding.--The allocation of funds for demonstration projects under subsection (a) shall not result in a reduction in funds required by the Native Hawaiian health care systems, the Native Hawaiian Health Centers, the Native Hawaiian Health Scholarship Program, or Papa Ola Lokahi to carry out their respective responsibilities under this Act. SEC. 15. NATIONAL BIPARTISAN COMMISSION ON NATIVE HAWAIIAN HEALTH CARE ENTITLEMENT. (a) Establishment.--There is hereby established a National Bipartisan Native Hawaiian Heath Care Entitlement Commission (referred to in this Act as the ``Commission''). (b) Membership.--The Commission shall be composed of 21 members to be appointed as follows: (1) Congressional members.-- (A) Appointment.--Eight members of the Commission shall be members of Congress, of which-- (i) two members shall be from the House of Representatives and shall be appointed by the Majority Leader; (ii) two members shall be from the House of Representatives and shall be appointed by the Minority Leader; and (iii) two members shall be from the Senate and shall be appointed by the Majority Leader; (iv) two members shall be from the Senate and shall be appointed by the Minority Leader. (B) Relevant committee membership.--The members of the Commission appointed under subparagraph (A) shall each be members of the committees of Congress that consider legislation affecting the provision of health care to Native Hawaiians and other Native Americans. (C) Chairperson.--The members of the Commission appointed under subparagraph (A) shall elect the chairperson and vice- chairperson of the Commission. (2) Hawaiian health members.--Eleven members of the Commission shall be appointed by Hawaiian health entities, of which-- (A) five members shall be appointed by the Native Hawaiian Health Care Systems; (B) one member shall be appointed by the Hawaii State Primary Care Association; (C) one member shall be appointed by Papa Ola Lakahi; (D) one member shall be appointed by the Native Hawaiian Health Task Force; (E) one member shall be appointed by the Office of Hawaiian Affairs; and (F) two members shall be appointed by Association of Hawaiian Civic Clubs and shall represent Native Hawaiian populations residing in the continental United States. (3) Secretarial members.--Two members of the Commission shall be appointed by the Secretary and shall possess knowledge of Native Hawaiian health concerns and wellness. (c) Terms.-- (1) In general.--The members of the Commissions shall serve for the life of the Commission. (2) Initial appointment of members.--The members of the Commission shall be appointed under subsection (b)(1) not later than 90 days after the date of enactment of this Act, and the remaining members of the Commission shall be appointed not later than 60 days after the date on which the members are appointed under such subsection (b)(1). (3) Vacancies.--A vacancy in the membership of the Commission shall be filled in the manner in which the original appointment was made. (d) Duties of the Commission.--The Commission shall carry out the following duties and functions: (1) Review and analyze the recommendations of the report of the study committee established under paragraph (3). (2) Make recommendations to Congress for the provision of health services to Native Hawaiian individuals as an entitlement, giving due regard to the effects of a program on existing health care delivery systems for Native Hawaiians and the effect of such programs on self-determination and the reconciliation of their relationship with the United States. (3) Establish a study committee to be composed of at least 10 members from the Commission, including 4 members of the members appointed under subsection (b)(1), 5 of the members appointed under subsection (b)(2), and 1 of the members appointed by the Secretary under subsection (b)(3), which shall-- (A) to the extent necessary to carry out its duties, collect, compile, qualify, and analyze data necessary to understand the extent of Native Hawaiian needs with regard to the provision of health services, including holding hearings and soliciting the views of Native Hawaiians and Native Hawaiian organizations, and which may include authorizing and funding feasibility studies of various models for all Native Hawaiian beneficiaries and their families, including those that live in the continental United States; (B) make recommendations to the Commission for legislation that will provide for the culturally-competent and appropriate provision of health services for Native Hawaiians as an entitlement, which shall, at a minimum, address issues of eligibility and benefits to be provided, including recommendations regarding from whom such health services are to be provided and the cost and mechanisms for funding of the health services to be provided; (C) determine the effect of the enactment of such recommendations on the existing system of delivery of health services for Native Hawaiians; (D) determine the effect of a health service entitlement program for Native Hawaiian individuals on their self-determination and the reconciliation of their relationship with the United States; (E) not later than 12 months after the date of the appointment of all members of the Commission, make a written report of its findings and recommendations to the Commission, which report shall include a statement of the minority and majority position of the committee and which shall be disseminated, at a minimum, to Native Hawaiian organizations and agencies and health organizations referred to in subsection (b)(2) for comment to the Commission; and (F) report regularly to the full Commission regarding the findings and recommendations developed by the committee in the course of carrying out its duties under this section. (4) Not later than 18 months after the date of the appointment of all members of the Commission submit a written report to Congress containing a recommendation of policies and legislation to implement a policy that would establish a health care system for Native Hawaiians, grounded in their culture, and based on the delivery of health services as an entitlement, together with a determination of the implications of such an entitlement system on existing health care delivery systems for Native Hawaiians and their self- determination and the reconciliation of their relationship with the United States. (e) Administrative Provisions.-- (1) Compensation and expenses.-- (A) Congressional members.--Each member of the Commission appointed under subsection (b)(1) shall not receive any additional compensation, allowances, or benefits by reason of their service on the Commission. Such members shall receive travel expenses and per diem in lieu ofsubsistence in accordance with sections 5702 and 5703 of title 5, United States Code. (B) Other members.--The members of the Commission appointed under paragraphs (2) and (3) of subsection (b) shall, while serving on the business of the Commission (including travel time), receive compensation at the per diem equivalent of the rate provided for individuals under level IV of the Executive Schedule under section 5315 of title 5, United States Code, and while serving away from their home or regular place of business, be allowed travel expenses, as authorized by the chairperson of the Commission. (C) Other personnel.--For purposes of compensation (other than compensation of the members of the Commission) and employment benefits, rights, and privileges, all personnel of the Commission shall be treated as if they were employees of the Senate. (2) Meetings and quorum.-- (A) Meetings.--The Commission shall meet at the call of the chairperson. (B) Quorum.--A quorum of the Commission shall consist of not less than 12 members, of which-- (i) not less than 4 of such members shall be appointees under subsection (b)(1); (ii) not less than 7 of such members shall be appointees under subsection (b)(2); and (iii) not less than 1 of such members shall be an appointee under subsection (b)(3). (3) Director and staff.-- (A) Executive director.--The members of the Commission shall appoint an executive director of the Commission. The executive director shall be paid the rate of basic pay equal to that under level V of the Executive Schedule under section 5316 of title 5, United States Code. (B) Staff.--With the approval of the Commission, the executive director may appoint such personnel as the executive director deems appropriate. (C) Applicability of civil service laws.--The staff of the Commission shall be appointed without regard to the provisions of title 5, United States Code, governing appointments in the competitive service, and shall be paid without regard to the provisions of chapter 51 and subchapter III of chapter 53 of such title (relating to classification and General Schedule pay rates). (D) Experts and consultants.--With the approval of the Commission, the executive director may procure temporary and intermittent services under section 3109(b) of title 5, United States Code. (E) Facilities.--The Administrator of the General Services Administration shall locate suitable office space for the operations of the Commission in Washington, D.C. and in the State of Hawaii. The Washington, D.C. facilities shall serve as the headquarters of the Commission while the Hawaii office shall serve a liaison function. Both such offices shall include all necessary equipment and incidentals required for the proper functioning of the Commission. (f) Powers.-- (1) Hearings and other activities.--For purposes of carrying out its duties, the Commission may hold such hearings and undertake such other activities as the Commission determines to be necessary to carry out its duties, except that at least 8 hearings shall be held on each of the Hawaiian Islands and 3 hearings in the continental United States in areas where a significant population of Native Hawaiians reside. Such hearings shall be held to solicit the views of Native Hawaiians regarding the delivery of health care services to such individuals. To constitute a hearing under this paragraph, at least 4 members of the Commission, including at least 1 member of Congress, must be present. Hearings held by the study committee established under subsection (d)(3) may be counted towards the number of hearings required under this paragraph. (2) Studies by the general accounting office.--Upon the request of the Commission, the Comptroller General shall conduct such studies or investigations as the Commission determines to be necessary to carry out its duties. (3) Cost estimates.-- (A) In general.--The Director of the Congressional Budget Office or the Chief Actuary of the Health Care Financing Administration, or both, shall provide to the Commission, upon the request of the Commission, such cost estimates as the Commission determines to be necessary to carry out its duties. (B) Reimbursements.--The Commission shall reimburse the Director of the Congressional budget Office for expenses relating to the employment in the office of the Director of such additional staff as may be necessary for the Director to comply with requests by the Commission under subparagraph (A). (4) Detail of federal employees.--Upon the request of the Commission, the head of any Federal agency is authorized to detail, without reimbursement, any of the personnel of such agency to the Commission to assist the Commission in carrying out its duties. Any such detail shall not interrupt or otherwise affect the civil service status or privileges of the Federal employees. (5) Technical assistance.--Upon the request of the Commission, the head for any Federal agency shall provide such technical assistance to the Commission as the Commission determines to be necessary to carry out its duties. (6) Use of mails.--The Commission may use the United States mails in the same manner and under the same conditions as Federal agencies and shall, for purposes of the frank, be considered a commission of Congress as described in section 3215 of title 39, United States Code. (7) Obtaining information.--The Commission may secure directly from any Federal agency information necessary to enable the Commission to carry out its duties, if the information may be disclosed under section 552 of title 5, United States Code. Upon request of the chairperson of the Commission, the head of such agency shall furnish such information to the Commission. (8) Support services.--Upon the request of the Commission, the Administrator of General Services shall provide to the Commission on a reimbursable basis such administrative support services as the Commission may request. (9) Printing.--For purposes of costs relating to printing and binding, including the cost of personnel detailed from the Government Printing Office, the Committee shall be deemed to be a committee of Congress. (g) Authorization of Appropriations.--There is authorized to be appropriated such sums as may be necessary to carry out this section. The amount appropriated under this subsection shall not result in a reduction in any other appropriation for health care of health services for Native Hawaiians. SEC. 16. RULE OF CONSTRUCTION. Nothing in this Act shall be construed to restrict the authority of the State of Hawaii to license health practitioners. SEC. 17. COMPLIANCE WITH BUDGET ACT. Any new spending authority (described in subparagraph (A) of (B) of section 401(c)(2) of the Congressional Budget Act of 1974 (2 U.S.C. 651 (c)(2)(A) or (B))) which is provided under this Act shall be effective for any fiscal year only to such extent or in such amounts as are provided for in appropriation Acts. SEC. 18. SEVERABILITY. If any provision of this Act, or the application of any such provision to any person or circumstances is held to be invalid, the remainder of this Act, and the application of such provision or amendment to persons or circumstances other than those to which it is held invalid, shall not be affected thereby. Sec. 11711. Definitions For purposes of this chapter: (1) Department.--The term ``department'' means the Department of Health and Human Services. [(1)] (2) Disease prevention.--The term ``disease prevention'' includes-- (A) immunizations, (B) control of high blood pressure, (C) control of sexually transmittable diseases, (D) prevention and control of diabetes, (E) control of toxic agents, (F) occupational safety and health, (G) accident prevention, (H) fluoridation of water, (I) control of infectious agents, and (J) provision of mental health care. [(2)] (3) Health promotion.--The term ``health promotion'' includes-- (A) pregnancy and infant care, including prevention of fetal alcohol syndrome, (B) cessation of tobacco smoking, (C) reduction in the misuse of alcohol and harmful illicit drugs, (D) improvement of nutrition, (E) improvement in physical fitness, (F) family planning, [and] (G) control of stress[.], (H) reduction of major behavioral risk factors and promotion of health lifestyle practices, and (I) integration of cultural approaches to health and well-being, including traditional practices relating to the atmosphere (lewa lani), land ('aina), water (wai), and ocean (kai). [(3)] (4) Native hawaiian.--The term ``Native Hawaiian'' means any individual who is Kanaka Maoli (a descendant of the aboriginal people, who prior to 1778, occupied and exercised sovereignty in the area that now constitutes the State of Hawaii) as evidenced by-- (A) [a citizen of the United States, and] genealogical records, (B) [a descendant of the aboriginal people, who prior to 1778, occupied and exercised sovereignty in the area that now constitutes the State of Hawaii, as evidenced by--] Kama' aina witness verification from Native Hawaiian Kupuna (elders); or [(i) genealogical records, [(ii) Kupuna (elders) or Kama'aina (long-term community residents) verification, or [(iii)] (C) birth records of the State of Hawaii or any State or territory of the United States. [(4)] (5) Native hawaiian health [center] care system.--The term ``Native Hawaiian health [center] care system'' means an entity-- (A) which is organized under the laws of the State of Hawaii, (B) which provides or arranges for health care services through practitioners licensed by the State of Hawaii, where licensure requirements are applicable, (C) which is a public or nonprofit private entity, and (D) in which Native Hawaiian health practitioners significantly participate in the planning, management, monitoring, and evaluation of the care services; (E) Which may be composed of as many as 8 Native Hawaiian health care systems as necessary to meet the health care needs of each island's Native Hawaiians; and (F) which is-- (i) recognized by Papa Ola Lokahi for the purpose of planning, conducting or administering programs, or portions of programs, authorized by this chapter for the benefit of Native Hawaiians' and (ii) certified by Papa Ola Lokahi as having the qualifications and capacity to provide the services, and meet the requirements, under the contract the organization enters into with, or grant the organization receives from, the Secretary pursuant to this Act. [(5)] (6) [Native hawaiian organization] Native hawaiian health center.--The term ``Native Hawaiian [organization''] Health Center'' means any organization that is a primary care provider and that-- (A) [which serves the interests of Native Hawaiians,] has a governing board that is composed of individuals, at least 50 percent of whom are Native Hawaiians; (B) [which is--] has demonstrated cultural competency in a predominately Native Hawaiian community; (C) services a patient population that-- (i) [recognized by Papa Ola Lokahi for the purpose of planning, conducting, or administering programs (or portions of programs) authorized under this chapter for the benefit of Native Hawaiians, and] is made up of individuals at least 50 percent of whom are Native Hawaiian; or (ii) [certified by Papa Ola Lokahi as having the qualifications and capacity to provide the services, and meet the requirements, under the contract the organization enters into with, or grant the organization receives from, the Secretary under this chapter,] has not less that 2,500 Native Hawaiians as annual users of services; and [(C) in which Native Hawaiian health practitioners significantly participate in the planning, management, monitoring, and evaluation of health services, and] (D) [which is a public or nonprofit private entity.] is recognized by Papa Ola Lokahi has having met all the criteria of this paragraph. [(6)] (7) Native hawaiian health [care system] task force.--The term ``Native Hawaiian health [care system] Task Force'' means [an entity--] a task force established by the State Council of Hawaiian Homestead Associations to implement health and wellness strategies in Native Hawaiian communities. [(A) which is organized under the laws of the State of Hawaii, [(B) which provides or arranges for health care services through practitioners licensed by the State of Hawaii, where licensure requirements are applicable, [(C) which is a public or nonprofit private entity, [(D) in which Native Hawaiian health practitioners significantly participate in the planning, management, monitoring, and evaluation of health care services, [(E) which may be composed of as many Native Hawaiian health centers as necessary to meet the health care needs of each island's Native Hawaiians, and [(F) which is-- [(i) recognized by Papa Ola Lokahi for the purpose of planning, conducting, or administering programs, or portions of programs, authorized by this chapter for the benefit of Native Hawaiians, and [(ii) certified by Papa Ola Lokahi as having the qualifications and the capacity to provide the services and meet the requirements under the contract the Native Hawaiian health care system enters into with the Secretary or the grant the Native Hawaiian health care system receives from the Secretary pursuant to this chapter.] [(7)] (8) [Papa ola lokahi.--] Native hawaiian organization._The term ``Native Hawaiian organization'' means any organization-- (A) [The term ``Papa Ola Lokahi'' means an organization composed of--] which serves the interests of Native Hawaiians; and [(i) E Ola Mau; [(ii) the Office of Hawaiian Affairs of the State of Hawaii; [(iii) Alu Like Inc.; [(iv) the University of Hawaii; [(v) the Office of Hawaiian Health of the Hawaii State Department of Health; [(vi) Ho'ola Lahui Hawaii, or a health care system serving the islands of Kaua'i and Ni'ihau, and which may be composed of as many health care centers as are necessary to meet the health care needs of the Native Hawaiians of those islands; [(vii) Ke Ola Mamo, or a health care system serving the island of O'ahu, and which may be composed of as many health care centers as are necessary to meet the health care needs of the Native Hawaiians of that island; [(viii) Na Pu'uwai or a health care system serving the islands of Moloka'i and Lana'i, and which may be composed of as many health care centers as are necessary to meet the health care needs of the Native Hawaiians of those islands; [(ix) Hui No Ke Ola Pono, or a health care system serving the island of Maui, and which may be composed of as many health care centers as are necessary to meet the health care needs of the Native Hawaiians of that island; [(x) Hui Malama Ola Ha'Oiwi or a health care system serving the island of Hawaii, and which may be composed of as many health care centers as are necessary to meet the health care needs of the Native Hawaiians of that island; and [(xi) such other member organizations as the Board of Papa Ola Lokahi may admit from time to time, based upon satisfactory demonstration of a record of contribution to the health and well- being of Native Hawaiians, and upon satisfactory development of a mission statement in relation to this chapter, including clearly defined goals and objectives, a 5-year action plan outlining the contributions that each organization will make in carrying out the policy of this chapter, and an estimated budget.] (B) [Such term does not include any such organization identified in subparagraph (A) if the Secretary determines that such organization has not developed a mission statement with clearly defined goals and objectives for the contributions the organization will make to the Native Hawaiian health care systems, and an action plan for carrying out those goals and objectives.] which is-- (i) recognized by Papa Ola Lokahi for the purpose of planning, conducting or administering programs (or portions of programs) authorized under this Act for the benefit of Native Hawaiians; and (ii) a public or non profit private entity. [(8)] (9) [Primary health services] Office of hawaiian affairs._The terms ``Office of Hawaiian Affairs'' and ``OHA'' mean the governmental entity established under Article XII, sections 5 and 6 of the Hawaii State Constitution and charged with the responsibility to formulate policy relating to the affairs of Native Hawaiians. [The term ``primary health services'' means-- [(A) services of physicians, physicians' assistants, nurse practitioners, and other health professionals; [(B) diagnostic laboratory and radiologic services; [(C) preventive health services (including children's eye and ear examinations to determine the need for vision and hearing correction, perinatal services, well child services, and family planning services); [(D) emergency medical services; [(E) transportation services as required for adequate patient care; [(F) preventive dental services; and [(G) pharmaceutical service, as may be appropriate for particular health centers.] [(9)] (10) [Secretary] Papa ola lokahi.--[The term ``Secretary'' means the Secretary of Health and Human Services.] (A) In general.--The term ``Papa Ola Lokahi'' means an organization that is composed of public agencies and private organizations focusing on improving the health status of Native Hawaiians. Board members of such organization may include representation from-- (i) E Ola Mau; (ii) the Office of Hawaiian Affairs of the State of Hawaii; (iii) Alu Like, Inc.; (iv) the University of Hawaii; (v) the Hawaii State Department of Health; (vi) the Kamehameha Schools, or other Native Hawaiian organization responsible for the administration of the Native Hawaiian Health Scholarship Program; (vii) the Hawaii State Primary Care Association, or Native Hawaiian Health Centers whose patient populations are predominantly Native Hawaiian; (viii) Ahahui O Na Kauka, the Native Hawaiian Physicians Association; (ix) Ho'ola Lahui Hawaii, or a health care system serving the islands of Kaua'i or Ni'ihau, and which may be composed of as many health care centers as are necessary to meet the health care needs of the Native Hawaiians of those islands; (x) Ke Ola Mamo, or a health care system serving the island of O'ahu and which may be composed of as many health care centers as are necessary to meet the health care needs of the Native Hawaiians of that island; (xi) Na Pu'uwai or a health care system serving the islands of Moloka'i or Lana'i, and which may be composed of as many health care centers as are necessary to meet the health care needs of the Native Hawaiians of those islands; (xii) Hui No Ke Ola Pono, or a health care system serving the island of Maui, and which may be composed of as many health care centers as are necessary to meet the health care needs of the Native Hawaiians of that island; (xiii) Hui Malama Ola Na'Oiwi, or a health care system serving the island of Hawaii, and which may be composed of as many health care centers as are necessary to meet the health care needs of the Native Hawaiians of that island; (xiv) other Native Hawaiian health care systems as certified and recognized by Papa Ola Lokahi in accordance with this Act; and (xv) such other member organizations as the Board of Papa Ola Lokahi will admit from time to time, based upon satisfactory demonstration of a record of contribution to the health and well- being of Native Hawaiians. (B) Limitation.--Such term does not include any organization described in subparagraph (A) if the Secretary determines that such organization has not developed a mission statement with clearly defined goals and objectives for the contributions the organization will make to the Native Hawaiian health care systems, the national policy as set forth in section 4, and an action plan for carrying out those goals and objectives. [(10)] (11) [Traditional native hawaiian healer--] Primary health services.--The term ``primary health services'' means--[The term ``traditional Native Hawaiian healer'' means a practitioner--] (A) [who--] services of physicians, physicians' assistants, nurse practitioners, and other health professionals; [(i) is of Hawaiian ancestry, and [(ii) has the knowledge, skills, and experience in direct personal health care of individuals, and] (B) [whose knowledge, skills, and experience are based on demonstrated learning of Native Hawaiian healing practices acquired by--] diagnostic laboratory and radiologic services; [(i) direct practical association with Native Hawaiian elders, and [(ii) oral traditions transmitted from generation to generation.] (C) preventive health services including perinatal services, well child services, family planning services, nutrition services, home health services, and, generally, all those services associated with enhanced health and wellness; (D) emergency medical services; (E) transportation services as required for adequate patient care; (F) preventive dental services; (G) pharmaceutical and medicament services; (H) primary care services that may lead to specialty or tertiary care; and (I) complimentary healing practices, including those performed by traditional Native Hawaiian healers. (12) Secretary.--The term ``Secretary'' means the Secretary of Health and Human Services. (13) Traditional native hawaiian healer.--The term ``traditional Native Hawaiian healer'' means a practitioner-- (A) who-- (i) is of Native Hawaiian ancestry; and (ii) has the knowledge, skills and experience in direct personal health care of individuals; and (B) whose knowledge, skills, and experience are based on demonstrated learning of Native Hawaiian healing practices acquired by-- (i) direct practical association with Native Hawaiian elders; and (ii) oral traditions transmitted from generation to generation. Sec. 11712. Rule of construction Nothing in this chapter shall be construed to restrict the authority of the State of Hawaii to license health practitioners. Sec. 11713. Compliance with Budget Act Any new spending authority (described in [subsection (c)(2)] subparagraph (A) [or] of (B) of section [651] 401(c)(2) of [Title 2)] the Congressional Budget Act of 1974 (2 U.C. C. 651 (c)(2) (A) or (B))) which is provided under this [chapter] Act shall be effective for any fiscal year only to such extent or in such amounts as are provided in appropriation Acts. Sec. 11714. Severability If any provision of this chapter, or the application of any such provision to any person or circumstances is held to be invalid, the remainder of this chapter, and the application of such provision or amendment to persons or circumstances other than those to which it is held invalid, shall not be affected thereby. APPENDIX A.--TABLE OF FEDERAL ACTS AFFECTING NATIVE HAWAIIANS ------------------------------------------------------------------------ Federal act name Session law cite Summary ------------------------------------------------------------------------ Act of June 21, 1910.......... Pub. L. No. 61- Authorizes 266, 36 Stat. appropriations for 703, 718 (1910). the Smithsonian Institute for ethnological research of American Indians and Native Hawaiians. Act of Mar. 4, 1911........... Pub. L. No. 62- Authorizes 525, 36 Stat. appropriations for 1363, 1395 the Smithsonian (1911). Institute for ethnological research of American Indians and Native Hawaiians. Act of Aug. 24, 1912.......... Pub. L. No. 63- Authorizes 302, 37 Stat. appropriations for 417, 436 (1912). the Smithsonian Institute for ethnological research of American Indians and Native Hawaiians. Act of June 23, 1913.......... Pub. L. No. 63-3, Authorizes 38 Stat. 4, 26 appropriations for (1913). the Smithsonian Institute for ethnological research of American Indians and Native Hawaiians. Act of Aug. 1, 1914........... Pub. L. No. 63- Authorizes 161, 38 Stat. appropriations for 609, 625 (1914). the Smithsonian Institute for ethnological research of American Indians and Native Hawaiians. Act of Mar. 3, 1915........... Pub. L. No. 63- Authorizes 623, 38 Stat. appropriations for 822, 838 (1915). the Smithsonian Institute for ethnological research of American Indians and Native Hawaiians. Act of July 1, 1916........... Pub. L. No. 64- Authorizes 132, 39 Stat. appropriations for 262, 279 (1916). the Smithsonian Institute for ethnological research of American Indians and Native Hawaiians. Act of June 12, 1917.......... Pub. L. No. 65- Authorizes 21, 40 Stat 105, appropriations for 122 (1917). the Smithsonian Institute for ethnological research of American Indians and Native Hawaiians. Act of July 19, 1919.......... Pub. L. No. 66- Authorizes 21, 41 Stat. appropriations for 163, 181 (1919). the Smithsonian Institute for ethnological research of American Indians and Native Hawaiians. Act of July 1, 1918........... Pub. L. No. 65- Authorizes 181, 40 Stat. appropriations for 634, 651 (1918). the Smithsonian Institute for ethnological research of American Indians and Native Hawaiians. Act of June 5, 1920........... Pub. L. No. 66- Authorizes 246, 41 Stat. appropriations for 874, 891 (1920). the Smithsonian Institute for ethnological research of American Indians and Native Hawaiians. Act of Mar. 4 1921............ Pub. L. No. 66- Authorizes 388, 41 Stat. appropriations for 1367, 1383 the Smithsonian (1921). Institute for ethnological research of American Indians and Native Hawaiians. Act of July 9, 1921........... Pub. L. No. 66- Creates a 34, 42 Stat. 108 homesteading program (1921). for Native Hawaiians. Act of June 12, 1922.......... Pub. L. No. 67- Authorizes 240, 42 Stat. appropriations for 635, 643 (1922). the Smithsonian Institute for ethnological research of American Indians and Native Hawaiians. Act of Feb. 3, 1923........... Pub. L. No. 67- Amends Hawaiian Homes 403, 42 Stat. Commission Act by 1221 (1923). increasing dollar limits for residential loans and other provisions. Act of Feb. 13, 1923.......... Pub. L. No. 67- Authorizes 409, 42 Stat. appropriations for 1227, 1235 the Smithsonian (1923). Institute for ethnological research of American Indians and Native Hawaiians. Act of June 7, 1924........... Pub. L. No. 68- Authorizes 214, 43 Stat. appropriations for 521, 528 (1924). the Smithsonian Institute for ethnological research of American Indians and Native Hawaiians. Act of Mar. 3, 1925........... Pub. L. No. 68- Authorizes 586, 43 Stat. appropriations for 1198, 1206 the Smithsonian (1925). Institute for ethnological research of American Indians and Native Hawaiians. Act of Apr. 22, 1926.......... Pub. L. No. 69- Authorizes 141, 44 Stat. appropriations for 305, 315 (1926). the Smithsonian Institute for ethnological research of American Indians and Native Hawaiians. Act of Feb. 11, 1927.......... Pub. L. No. 69- Authorizes 600, 44 Stat. appropriations for 1069, 1079 the Smithsonian 91927). Institute for ethnological research of American Indians and Native Hawaiians. Act of Mar. 7, 1928........... Pub. L. No. 70- Amends the Hawaiian 105, 45 Stat. Homes Commission Act 246 (1928). by requiring an annual area disposal limit and increases the dollar amount within the Hawaiian Home Loan fund. Act of May 16, 1928........... Pub. L. No. 70- Authorizes 400, 45 Stat. appropriations for 573, 583 (1928). the Smithsonian Institute for ethnological research of American Indians and Native Hawaiians, including excavation and preservation of archaeologic remains. Act of Feb. 20, 1929.......... Pub. L. No. 70- Authorizes 778, 45 Stat. appropriations for 1230, 1241 the Smithsonian (1929). Institute for ethnological research of American Indians and Native Hawaiians. Act of Apr. 19, 1930.......... Pub. L. No. 71- Authorizes 158, 46 Stat. appropriations for 229, 241 (1930). the Smithsonian Institute for ethnological research of American Indians and Native Hawaiians. Act of July 26, 1935.......... Pub. L. No. 74- Requires three of 223, 49 Stat. five Hawaiian Homes 504 (1935). Commission members to be at least one- quarter Native Hawaiian. Act of July 10, 1937.......... Pub. L. No. 75- Amends Hawaiian Homes 200, 50 Stat. Commission Act by 497, 503 (1937). establishing age minimum for lessee and adding more lands under the Act. Act of June 20, 1938.......... Pub. L. No. 75- Authorizes leasing 680, Sec. 3, 52 land within the Stat. 784, 784- Hawai'i National 85 (1938). Park to Native Hawaiians and recognizes limited Native Hawaiian fishing rights in the area. Act of Nov. 26, 1941.......... Pub. L. No. 77- Amends Hawaiian Homes 325, Sec. 3, 55 Commission Act by Stat. 782, 782 creating a Home (1941). Development fund and allowing investing of loan fund. Act of May 31, 1944........... Pub. L. No. 78- Amends Hawaiian Homes 320, 58 Stat. Commission Act by 260, 264 (1944). returning lands under the Commissions's jurisdiction to the Territory of Hawai'i. Act of June 14, 1948.......... Pub. L. No. 80- Amends Hawaiian Homes 638, 62 Stat. Commission Act by 390 (1948). authorizing churches, hospitals, schools, theaters, and the Federal government to use the land. Act of July 9, 1952........... Pub. L. No. 82- Amends Hawaiian Homes 481, 66 Stat. Commission Act by 511, 514 (1952). adding lands to the Commission's jurisdiction. Act of July 9, 1952........... Pub. L. No. 82- Amends Hawaiian Homes 482, 66 Stat. Commission Act by 514 (1952). increasing dollar amounts in the Hawaiian Homes Land Fund and the Hawaiian Homes Development Fund. Act of June 18, 1954.......... Pub. L. No. 83- Amends Hawaiian Homes 417, 68 Stat. Commission Act by 263 (1954). authorizing leases for irrigated pastoral lands. Hawai'i Admission Act, Act of Pub. L. No. 86-3, Admits Hawai'i as a Mar. 18, 1959. Sec. 5(f), 73 State and Stat. 4, 6 establishes a public (1959). trust for the betterment of the conditions of Native Hawaiians, as defined by the Hawaiian Homes Commission Act. Act of Dec. 23, 1963.......... Pub. L. No. 88- Protects the corpus 233, 77 Stat. of the public lands 472 (1963). trust, whose intended beneficiaries are Native Hawaiians, by revising procedures under the Hawai'i Statehood Act. Act of July 11, 1972.......... Pub. L. No. 92- Designates Honokohau 346, 86 Stat. as a National 457 (1972). Historical Landmark and authorizes preservation of the site, giving employment preference to and providing training for Native Hawaiians. Native American Programs Act Pub. L. No. 93- Promotes Native of 1074. 644, Sec. 801, Hawaiian, American 88 Stat. 2291, Indian, and Alaska 2324 (1975). Native Economic and social self- sufficiency through financial assistance to agencies serving Native Hawaiians. Departments of Labor and Pub. L. No. 94- Appropriates funds Health, Education, and 2006, 90 Stat. 3 for Native American Welfare Appropriation Act, (1975). programs (includes 1976. Native Hawaiians). Act of Oct. 17, 1976.......... Pub. L. No. 94- Preserves Kalaupapa 518, Sec. 401- Settlement and 405, 90 Stat. authorizes a 2447, 2447, 2449 preference for (1976). former patients and Native Hawaiians to manage the site. Act of Aug. 5, 1977........... Pub. L. No. 95- Amends the 93, sec. 303, comprehensive Sec. 701(a), 91 Employment Training Stat. 627, 650 Act of 1973 to (1977). include employment training programs for Native Hawaiians. Joint Resolution, American Pub. L. No. 95- Recognizes the rights Indian Religious Freedom. 341, 92 Stat. of American Indians, 469 (1977). Eskimos, Aleuts, and Native Hawaiians to practice their traditional religions. Act of Nov. 20, 1979.......... Pub. L. No. 96- Appropriates funds 123, 93 Stat. for Native Hawaiian 923 (1979). health and human services programs as allowed under authorizing legislation, including assistance to research institutions with Indian, Alaska Native, Native Hawaiian, Hispanic, and Black students. Education Amendments of 1980.. Pub. L. No. 96- Creates Advisory 374, Sec. 1331, Council on Native 94 Stat. 1367, Hawaiian Education 1449 (1980). to study the effectiveness of State and Federal education programs for Native Hawaiians. Act of Dec. 22, 1980.......... Pub. L. No. 96- Establishes Kalaupapa 565, Sec. Sec. National Historic 101-110, 94 Park which shall be Stat. 3321, 3321- administered by 23 (1980). Hansen's Disease patients and Native Hawaiians. Urgent Supplemental Pub. L. No. 97- Appropriates funds Appropriations Act, 1982. 216, 96 Stat. for nursing research 180 (1982). grants and encourages that priority be given to Native Hawaiians, other Native Americans, native American Pacific Islanders, and Hispanics. Supplemental Appropriations Pub. L. No. 97- Appropriates funds to Act, 1982. 257, 96 Stat. promote economic and 818 (1982). social self- sufficiency of Native Americans, including Native Hawaiians; also appropriates funds for Native Hawaiian education and health programs as allowed under authorizing legislation. Act of July 30, 1983.......... Pub. L. No. 98- Appropriates funds to 63, 97 Stat. 301 address the unique (1983). health needs of Native Americans, including Native Hawaiians; also urges the National Cancer Institute to give greater attention to the Native Hawaiian population. Native Hawaiian Study Pub. L. No. 96- Establishes Native Commission Act. 565, Sec. Sec. Hawaiian Study 301-307, 94 Commission to study Stat. 3321, 3324- the culture, needs, 27 (1980). and concerns of Native Hawaiians. Department of Health and Human Pub. L. No. 98- Appropriates funds to Services Appropriations Act, 139, 97 Stat. the Administration 1984. 871 (1983). for Native Americans which promotes social and economic self-sufficiency for Native Americans, including Native Hawaiians; also appropriates funds to combat alcoholism among Native Hawaiians and declares Native Hawaiian cancer research a priority. Department of Labor Pub. L. No. 98- Appropriates funds Appropriations Act, 1984. 139, 97 Stat. for vocational 871 (1983). training and other labor services for Native Hawaiians and other Native Americans. Department of Education Pub. L. No. 98- Appropriates funds Appropriation Act, 1984. 139, 97 Stat. for Native Hawaiian 871 (1983). education programs as allowed under authorizing legislation. Act of Dec. 21, 1982.......... Pub. L. No. 97- Appropriates funds to 377, 96 Stat. address alcohol 1830 (1982). abuse among Native Hawaiians. Act of Aug. 22, 1984.......... Pub. L. No. 98- Appropriates funds 396, 99 Stat. for a Native 1369 (1984). Hawaiian health study and report. Act of Oct. 12, 1984.......... Pub. L. No. 98- Appropriates funds 473, 99 Stat. for historic 1837 (1984). preservation of marine resources, including the Hawaiian voyaging canoe Hokule'a. Department of Health and Human Pub. L. No. 98- Appropriates funds Services Appropriation Act, 619, 99 Stat. for Native Hawaiian 1985. 3305 (1984). programs to promote economic and social self-sufficiency; also appropriates funds for parent- child centers and for Native Hawaiian cancer research. Department of Education Act, Pub. L. No. 98- Appropriates funds 1985. 619, 99 Stat. for Native Hawaiian 3305 (1984). education programs as allowed under authorizing legislation. Act of Dec. 19, 1985.......... Pub. L. No. 90- Appropriates funds 190, 99 Stat. for education 1185 (1985). assistance to health profession students who will serve geographical concentrations of Native Hawaiians and Indian reservations. American Indian, Alaska Native Pub. L. No. 99- Authorizes grants to and Native Hawaiian Culture 498, Sec. Sec. support a program and Art Development Act. 1501-1503, 1521- for Native Hawaiian 1522, 100 Stat. culture and arts 1268, 1600, 1610- development. 11 (1986). Anti-Drug Abuse Act of 1986... Pub. L. No. 99- Authorizes the Health 570, Sec. 4134, and Human Services 100 Stat. 3207, Secretary to 3207-134 (1986). contract with organizations that provide drug abuse prevention, education, treatment, and rehabilitation services to Native Hawaiians. Act of July 11, 1987.......... Pub. L. No. 100- Appropriates funds 71, 101 Stat. for the Native 391 (1987). Hawaiian Culture and Arts Development Program. Native American Programs Act Pub. L. No. 100- Establishes Native Amendments of 1987. 175, sec. 506, Hawaiian Revolving Sec. 803A, 101 loan fund for Native Stat. 926, 926- Hawaiian 75 (1987). organizations and Native Hawaiians to promote economic development. Department of Health and Human Pub. L. No. 100- Appropriates funds Services Appropriations Act, 202, 101 Stat. for Native Hawaiian 1988. 1329-263 (1987). health programs under authorizing legislation. Jacob K. Javits Gifted and Pub. L. No. 100- Authorizes grants or Talented Students Education 297, sec. 1001, contracts with Act of 1988. Sec. Sec. 4101- institutions 4108, 102 Stat. (including Indian 130, 237 (1988). tribes and Native Hawaiian organizations) to carry out programs or projects designed to meet the educational needs of gifted and talented students. Drug-Free Schools and Pub. L. No. 100- Authorizes education Communities Act of 1986. 297, sec. 1001, grants, cooperative Sec. Sec. 5112, agreements, or 5134, 102 Stat. contracts with 130, 253, 261 organizations that (1988). primarily serve and represent Native Hawaiians; also appropriates funds for drug abuse education and preventive programs for Native Hawaiians. Augustus F. Hawkins-Robert T. Pub. L. No. 100- Recognizes the Stafford Elementary and 297, Sec. Sec. Federal government's Secondary School Improvement 4001-4009, 102 legal responsibility Amendments of 1988. Stat. 130, 358 to enforce Hawai'i's (1988). trust responsibilities to Native Hawaiians and creates new education programs targeting a model curriculum, family based education centers, gifted and talented, and special education programs. Veterans' Benefits and Pub. L. No. 100- Adds Native Hawaiians Services Act of 1988. 322, Sec. 413, to the Advisory 102 Stat. 487, Committee on Native 487 (1988). American Veterans which evaluates programs for Native American veterans. Indian Housing Act of 1988.... Pub. L. No. 100- Requires assessment 358, sec. 2, of the housing and Sec. 204, 102 mortgage needs of Stat. 676, 679 Native Hawaiians. (1988). National Science Foundation Pub. L. No. 100- Reserves percentage University Infrastructure Act 418, Sec. 6402, of appropriation for of 1988. 102 Stat. 1107, institutions of 1543 (1988). higher learning that serve Native Americans (including Native Hawaiians) and specific ethnic groups. Department of Health and Human Pub. L. No. 100- Appropriates funds Service Appropriations Act, 436, 102 Stat. for Native Hawaiian 1989. 1688 (1988). health programs under authorizing legislation. Native Hawaiian Health Care Pub. L. No. 100- Authorizes programs Act of 1988. 579, 102 Stat. to improve the 2916 (1988); health status of Pub. L. No. 100- Native Hawaiians; 690, Sec. 2301- authorizes grants or 2312, 102 Stat. contracts with Papa 4181, 4223 Ola Lokahi to (1988). develop comprehensive health care mater plan to improve Native Hawaiian health. Health Professions Pub. L. No. 100- Provides health Reauthorization Act of 1988. 607, sec. 604, professionals with Sec. 751,102 incentives to staff Stat. 3048, 3126 health centers (1988). serving Native Hawaiians, Indians, and rural areas. Nursing Shortage Reduction and Pub. L. No. 100- Authorizes grants to Education Extension Act of 607, sec. 714- nursing schools, 1888. 715, Sec. loan repayment 836(h), 102 incentives to Stat. 3048, 3161 encourage work with (1988). Native Hawaiians, Indians, or in rural areas, and scholarship grants to nursing schools whose students serve two years at an Indian Health Service facility or a Native Hawaiian health center. Handicapped Programs Technical Pub. L. No. 100- Amends the Education Amendments Act of 1988. 630, sec. 102, of the Handicapped Sec. 616, 102 Act which provides Stat. 3289, 3296 handicapped Native (1988). Hawaiian (and other native Pacific basin) children with a free appropriate public education. Business Opportunity Pub. L. No. 100- Amends the Small Development Reform Act of 656, sec. 207, Business Act by 1988 Small Business. Sec. 8(a), 102 including Stat. 3853, 3861 economically- (1988). disadvantaged Native Hawaiian organizations as socially and economically disadvantaged small business concerns. Comprehensive Alcohol Abuse, Pub. L. No. 100- Amends the Public Drug Abuse, and Mental Health 690, sec. 2022, Health Service Act Amendments Act of 1888. Sec. 1912A, 102 by establishing the Stat. 4181, 4194 formula to fund (1988). comprehensive substance abuse and treatment programs for Native Hawaiians. Indian Health Care Amendments Pub. L. No. 100- Amends the Public of 1988. 713, sec. 106, Health Service Act Sec. 338J, 102 by creating a Native Stat. 4784, 4787 Hawaiian Health (1988). Professions Scholarship program. Department of Health and Human Pub. L. No. 101- Appropriates funds Services Appropriations Act, 166, 103 Stat. for Native Hawaiian 1990. 1166 (1989). health programs under authorizing legislation. Department of Education Pub. L. No. 101- Appropriates funds Appropriations Act, 1990. 166, 103 Stat. for Native Hawaiian 1179 (1989). education programs under authoring legislation. National Museum of the Pub. L. No. 101- Establishes the American Indian Act. 185, 103 Stat. National Museum of 1336 (1989). the American Indian which will study Native Americans, collect, preserve, and exhibit Native American objects, provide a Native American research and study program, and authorizes the return of Smithsonian-held Native American human remains and funerary objects; Native Americans includes Native Hawaiians. Department of Housing and Pub. L. No. 101- Establishes Urban Development Reform Act 235, Sec. Sec. commission to study of 1989. 601-605, 103 and propose Stat. 1987, 2052 solutions to Indian, (1989). Alaska Native, and Native Hawaiian housing problems. Veterans' Benefits Amendments Pub. L. No. 101- Authorizes the study of 1989. 237, sec. 312, of Native Hawaiian Sec. 3102, 103 veterans' and other Stat. 2062 Native American (1989). veterans' participation in Veterans Affairs' home loan guaranty program. Dire Emergency Supplemental Pub. L. No. 101- Authorizes Appropriation for Disaster 302, 104 Stat. appropriations for Assistance, Food Stamps, 213, 239 (1990). the National Unemployment Compensation Commission on Administration, and other American Indian, urgent Needs, and Transfers, Alaska Native, and and Reducing Funds Budgeted Native Hawaiian for Military Spending Act of housing and provides 1990. grant money to Indian and Hawaiian Native youth for the Drug-Free Schools and Communities Act. Native American Languages Act. Pub. L. No. 101- Adopts the policy to 477, Sec. Sec. preserve, protect, 101-104, 104 and promote the Stat. 1152, 1154 rights and freedom (1990). of Native Americans to use, practice, and develop Native American languages; Native Americans include Native Hawaiians. Department of Health and Human Pub. L. No. 101- Authorizes Services Appropriations Act, 517, 104 Stat. appropriations for 1991. 2190 (1990). the Native Hawaiian Health Care Act of 1988. Department of Education Pub. L. No. 101- Authorizes Appropriation Act, 1991. 517, 104 Stat. appropriations for 2190 (1990). Native Hawaiian education programs under authorizing legislation. Disadvantaged Minority Health Pub. L. No. 101- Authorizes grants to Improvement Act of 1990. 527, sec. 4, health profession Sec. 782, 104 schools to assist Stat. 2311, 2321 programs of (1990). excellence for Native Hawaiians, other Native Americans, and specified ethnic groups. Native American Graves Pub. L. No. 101- Provides for the Protection and Repatriation 601, 104 Stat. protection of Native Act. 3048 (1990). American graves and repatriation of funerary objects, human remains, and objects of cultural patrimony; Native Americans include Native Hawaiians. Cranston-Gonzalez National Pub. L. No. 101- Authorizes Affordable Housing Act. 625, sec. 917, appropriations for Sec. 109, 104 the Neighborhood Stat. 4079, 4398 Reinvestment (1990). Corporation which serves rural communities, Native Americans, Native Hawaiians, and other communities in need. Act of Nov. 29, 1990.......... Pub. L. No. 101- Amends the Public 644, sec. 401, Health Service Act Sec. 338J(a), by providing 104 Stat. 4662, scholarship 4668 (1990). assistance to Native Hawaiian students. Act of Nov. 29, 1990.......... Pub. L. No. 101- Amends the American 644, sec. 501- Indian, Alaska 502, Sec. Sec. Native, and Native 1507, 1510, 104 Hawaiian Culture and Stat. 4662, 4668 Art Development Act (1990). by allowing interest and earnings to be used to carry out the Institute's responsibilities. National Dropout Prevention Pub. L. No. 102- Amends the Carl D. Act of 1991. 103, sec. 311, Perkins Vocational Sec. 103(b), and Applied 105 Stat. 497, Technology Education 505 (1991). Act by providing stipends to Native Hawaiian vocational students. Departments of Veterans Pub. L. No. 102- Authorizes Affairs and Housing and Urban 139, 105 Stat. appropriations for Development, and Independent 736 (1991). the National Agencies Appropriations Act, Commission on 1992. American Indian, Alaska Native, and Native Hawaiian Housing. Department of Health and Human Pub. L. No. 102- Appropriates funds Services Appropriations Act, 170, 105 Stat. for Native Hawaiian 1992. 1107 (1991). health programs under authorizing legislation. Department of Education Pub. L. No. 102- Appropriates funds Appropriations Act, 1992. 170, 105 Stat. for Native Hawaiian 1107 (1991). education programs under authorizing legislation. Department of Defense Pub. L. No. 102- Amends the National Appropriations Act 1992. 172, 105 Stat. Defense 1150 (1991). Authorization Act so that a disadvantaged small business concern includes a small business concern owned and controlled by socially and economically disadvantaged individuals, an Indian tribe, a Native Hawaiian organization, or an organization employing the severely disabled. Act of Dec. 11, 1991.......... Pub. L. No. 102- Amends title 38 218, sec. 1, (Veterans' Benefits) Sec. 317, 105 to designate the Stat. 1671 Chief Minority (1991). Affairs Officer as an adviser on the effect of policies, regulations, and programs on Native Hawaiians, other Native Americans, women, and minority groups. ADAMHA Reorganization Act Pub. L. No. 102- Amends the Public (Alcohol, Drug Abuse, and 321, sec. 203, Health Services Act Mental Health Administration). Sec. 1953, 106 by requiring the Stat. 323, 409 State of Hawaii to (1992). contract with organizations which plan, conduct, and administer comprehensive substance abuse and treatment programs for Native Hawaiians. Higher Education Amendments of Pub. L. No. 102- Amends the Higher 1992. 325, sec. 305 Education Amendments Sec. Sec. 357(b of 1965 by )(7), 1406, 106 authorizing Federal Stat. 448, 479, repayment of loan 818 (1992). for nurses working in a Native Hawaiian Health Center (also in Indian Health Service); gives preference to Teacher Corps applicants intending to teach on Indian reservations or in Alaska Native villages or in areas with high concentrations of Native Hawaiians; also, authorizes biennial education survey on Native Hawaiians, other Native Americans, and other groups including the disabled, disadvantaged, and minority students. Higher Education Facilities Pub. L. No. 102- Amends the Higher Act of 1992. 325, sec. 422, Education Act of Sec. 428J(a), 1965 by authorizing 106 Stat. 448, grants and 541 (1992). fellowships to promote higher education of Indians, Alaska Natives, and Native Hawaiians, along with specified ethnic groups. Job Training Reform Amendments Pub. L. No. 102- Authorizes employment of 1992. 367, sec. 401, and recruitment Sec. 401, 106 preference for Stat. 1021, 1074 Native Hawaiians, (1992). Indians, and Alaska Natives for a new office that will administer Native American programs; also creates a Native American Employment and Training Council with membership of Indians, Alaska Natives, and Native Hawaiians that will solicit views on issues program operation and administration. Older Americans Act Amendment Pub. L. No. 102- Amends the Older of 1992. 375, sec. 201, Americans Act Sec. 201(c)(3), Amendment of 1965 by 106 Stat. 1195, creating an advocate 1203 (1992). for older Indians, Alaskan Natives, and Native Hawaiians to promote enhanced delivery of services and grants, and authorizes appropriations for these activities. Native American Programs Act Pub. L. No. 102- Amends Native Amendments of 1992. 375, sec. 811, American Programs 822, Sec. Sec. Act by requiring the 803A, 811A, 106 filing of annual Stat. 1195, report on the social 1295, 1296 and economic (1992). conditions of American Indians, Native Hawaiians, other Native American Pacific Islanders (including American Samoan Natives), and Alaska Natives, and authorizes appropriations for the Native American programs. Department of the Interior and Pub. L. No. 102- Authorizes Related Agencies 381, 106 Stat. appropriations for Appropriations Act, 1993. 1374 (1993). the Alaska Native Culture and Arts Development Act which also provides funds for Native Hawaiians. Departments of Veterans Pub. L. No. 102- Provides for Affairs and Housing and Urban 389, 106 Stat. appropriations for Development, and Independent 1571 (1992). the National Agencies Appropriations Act, Commission on 1993. American Indian, Alaska Native, and Native Hawaiian Housing in carrying out functions under the Department of Housing and Urban Development Reform Act of 1989. Department of Health and Human Pub. L. No. 102- Specifies funding Services Appropriations Act, 394, 106 Stat. guidelines for the 1993. 1792 (1992). Native Hawaiian Health Care Act of 1988. Department of Education Pub. L. No. 102- Appropriates funds Appropriations Act, 1993. 394, 106 Stat. for Native Hawaiian 1792 (1992). education programs under authorizing legislation. Department of Defense Pub. L. No. 102- Amends the Native Appropriations Act, 1993. 396, 106 Stat. Hawaiian Health Care 1876 (1993). Act of 1988 by establishing health goals for Native Hawaiians and scholarships for Native Hawaiian health students. Joint Resolution to consent to Pub. L. No. 102- Agrees to the certain amendments enacted by 398, 106 Stat. adoption of the legislature of the State 1953 (1992). amendments enacted of Hawai'i to the Hawaiian by the State of Homes Commission Act, 1920. Hawai'i to the Hawaiian Homes Commission Act of 1920. Veterans' Medical Programs Pub. L. No. 102- Requires development Amendments of 1992. 405, Sec. 123, of a plan to treat 106 Stat. 1972, veterans' post- 1982 (1992). traumatic stress disorder, especially the needs of Native Hawaiians, other Native Americans, women, and ethnic minorities. Health Professions Education Pub. L. No. 102- Amends the Public Extension Amendments of 1992. 408, sec. 102, Health Services Act Sec. 739, 106 by authorizing Stat. 1992, 2055 grants to health (1992). professions schools to support programs of excellence in health professions education for Native Hawaiians, other Native Americans, and minority individuals. Nurse Education and Practice Pub. L. No. 102- Amends the Public Improvement Amendments of 408, sec. 102, Health Service Act 1992. Sec. 846, 106 by authorizing the Stat. 1992, 2031 repayment of school (1992). loans for nurses who work two years in an Indian Health Service health center, in a Native Hawaiian health center, in a public hospital, in a migrant health center, in a community health center, in a rural health clinic, or in a public or nonprofit private health facility. Veterans' Home Loan Program Pub. L. No. 102- Amends Title 38 by Amendments of 1992. 547, sec. 8, providing direct Sec. Sec. 3761- housing loans to 3764, 106 Stat. Native American 3633, 3639 veterans (including (1992). Native Hawaiians) and includes the Department of Hawaiian Homelands in the definition of ``tribal organization.'' Housing and Community Pub. L. No. 102- Authorizes Development Act of 1992. 550, sec. 128, appropriations for Sec. 605, 106 National Commission Stat. 3672 on American Indians, (1992). Alaska Natives, and Native Hawaiian housing. Hawai'i Tropical forest Pub. L. No. 102- Establishes the Recovery Act. 574, Sec. 4, Hawai'i Tropical 106 Stat. 4593, Forest Recovery Task 4597 (1992). Force which will make recommendations for rejuvenating Hawaii's tropical forests, including the traditional practices, uses, and needs of Native Hawaiians in tropical forests. National Historic Preservation Pub. L. No. 102- Amends the National Act Amendments of 1992. 575, sec. 4002, Historic 4006, Sec. Sec. Preservation Act to 2, 101, 106 protect Native Stat. 4600, 4753 Hawaiian, Indian, (1992). and Alaska Native religious and cultural sites, including authorizing direct grants to Indian tribes and Native Hawaiian organizations to preserve, stabilize, restore, or rehabilitate religious properties. Veterans Health Care Act of Pub. L. No. 102- Authorizes Native 1992. 585, sec. 602, Hawaiian Health Sec. 340B, 106 centers to purchase Stat. 4943, 4967 pharmaceuticals at (1992). the Federal government- negotiated price. Department of Health and Human Pub. L. No. 103- Authorizes Services Appropriations Act, 112, Stat. 1082 appropriations for 1994. (1993). the Native Hawaiian Health Care Act of 1988. Department of Education Pub. L. No. 103- Authorizes Appropriations Act, 1994. 112, Stat. 1082 appropriations for (1993). Native Hawaiian education programs under authorizing legislation. 100th Anniversary of the Pub. L. No. 103- Acknowledges and Overthrow of the Hawaiian 150, 107 Stat. apologizes for the Kingdom. 1510 (1993). United States' role in the overthrow of the Kingdom of Hawai'i. Goals 2000: Educate America Pub. L. No. 103- Establishes National Act. 227, sec. 2-3, Education Goals for 108 Stat. 125, schools and students 129 (1994). from diverse backgrounds, including Indians, Alaska Natives, and Native Hawaiians, the disabled, and limited English- speakers. School-to-Work Opportunities Pub. L. No. 103- Establishes school-to- Act of 1994. 239, sec. 3-4, work activities to 108 Stat. 568, improve the 572 (1994). knowledge and skills of youths from various backgrounds and circumstances, including disadvantaged students, students with diverse racial, ethnic, or cultural backgrounds, American Indians, Alaska Natives, Native Hawaiians, students with disabilities, students with limited-English proficiency, migrant children, school dropouts, and academically talented students. Alaska Native Culture and Arts Pub. L. No. 103- Amends the Higher Development Act. 239, sec. 721, Education Act of Sec. 1521, 108 1986 by authorizing Stat. 568, 572 grants to (1994). organizations that primarily serve and represent Native Hawaiians or Alaska Natives to support Native culture and art programs. Department of Health and Human Pub. L. No. 103- Authorizes Services Appropriations Act, 333, 108 Stat. appropriations for 1995. 2539 (1994). Native Hawaiian health. Department of Education Pub. L. No. 103- Authorizes Appropriations Act, 1995. 333, 108 Stat. appropriations for 2539 (1994). Native Hawaiian education. Department of Defense Pub. L. No. 103- Authorizes preference Appropriations Act, 1995. 335, 108 Stat. to Native Hawaiian 2599 (1994). contractors restoring Kaho'olawe's environment. Safe and Drug-Free Schools and Pub. L. No. 103- Authorizes grants for Communities Act of 1994. 382, sec. 101, Native Hawaiian- Sec. Sec. 4004, serving institutions 4011, 4118, 108 to plan, conduct, Stat. 3518, and administer 3674, 3685 violence and drug (1994). prevention programs. Native Hawaiian Education Act. Pub. L. No. 103- Recognizes that 382, sec. 101, Native Hawaiians are Sec. 9201-9212, indigenous people 108 Stat. 3518, and authorizes, 3794 (1994). among other things, grants to assist Native Hawaiians in achieving national education goals. Jacob K. Javits Gifted and Pub. L. No. 103- Authorizes grants and/ Talented Students Education 382, sec. 101, or contracts to Act of 1994. Sec. 10201, 108 Native Hawaiian Stat. 3518, 3820 organizations and (1994). Indian tribes to assist in carrying out programs or projects for gifted/ talented students. Improving America's Schools Pub. L. No. 103- Provides support, Act of 1994. 382, sec. 101, training, assistance Sec. 13102, 108 to grant recipients Stat. 3518, 3878 to improve the (1994). quality of education for immigrants, migrants, the poor, American Indian, Alaska Natives, and Native Hawaiians. Bilingual Education Act....... Pub. L. No. 103- Authorizes grants to 382, sec. implement new 101Sec. Sec. 71 comprehensive 01, 7104, 7136, bilingual education 108 Stat. 3518, programs for Native 3716, 3718, 3732 American and Native (1994). Hawaiian languages. Improving America's Schools, Pub. L. No. 103- Authorizes subgrants Act of 1994 (Part E). 382, sec. 101, from State and local Sec. 7501, 108 governments to Stat. 3518, 3745 implement a (1994). bilingual education program for the ancestral languages of American Indians, Alaska Natives, and Native Hawaiians. Native American Veterans' Pub. L. No. 103- Establishes memorial Memorial Establishment Act of 384, Sec. 2, to recognize 1994. 108 Stat. 4067, contributions of 4067 (1994). Native American Veterans (American Indians, Native Alaskans, and Native Hawaiians). Veterans' Benefits Pub. L. No. 103- Authorizes creation Improvements Act of 1994. 446, sec. 510, of a Center for Sec. 544, 108 Minority Veterans stat. 4645, 4669 and Advisory (1994). Committee on Minority Veterans to be more responsive to the needs of Native Hawaiian, American Indian, Alaska Native, and ethnic minority veterans. Hawaiian Home Lands Recovery Pub. L. No. 104- Settles Department of Act. 42, Sec. Sec. Hawaii Home Lands 201-06, 109 claims against the Stat. 353, 357 Federal government (1995). for the value of the lost use of lands by Native Hawaiians. The Balanced Budget Down Pub. L. No. 104- Authorizes Payment Act. 99, Sec. 115, appropriations to 110 Stat. 26, 29 cover termination of (1996). Native Hawaiian and Alaska Native Cultural Arts National Defense Authorization Pub. L. No. 104- Authorizes upgrading Act for FY 1996. 106, Sec. 524, the Distinguished 110 Stat. 186 Service Cross to the (1996). Medal of Honor for World War II Native American Pacific Islander veterans (including Native Hawaiians). Department of Health and Human Pub. L. No. 104- Authorizes Services Appropriations Act, 134, 110 Stat. appropriations for 1996. 1321 (1996). the Native Hawaiian Health Care Act of 1988. Department of Education Pub. L. No. 104- Authorizes Appropriations Act, 1996. 134, 110 Stat. appropriations for 1321 (1996). Native Hawaiian education programs under authorizing legislation. Child Care and Development Pub. L. No. 104- Amends the Child Care Block Grant Amendment of 1996. 193, sec. 614, and Development Sec. 658P, 110 Block Grant Act of Stat. 2105, 2287 1990 by authorizing (1996). Native Hawaiian organizations to apply for grants or enter into contracts with the Health and Human Services Secretary to improve child care, increase the availability of early childhood development, and increase before and after school care services. Departments of Veterans Pub. L. No. 104- Authorizes the Affairs and Housing and Urban 204, sec. 213 Housing Secretary to Development, and Independent Sec. 282, 110 waive anti- Agencies Appropriations Act, Stat. 2874, 2904 discrimination 1997. (1996). provisions of the Cranston-Gonzalez National Affordable Housing ACt for lands set aside under the Hawaiian Homes Commission Act, 1920. Department of Health and Human Pub. L. No. 104- Authorizes Services Appropriations Act, 208, 110 Stat. appropriations for 1997. 3009 (1996). the Native Hawaiian Health Care Act of1988 and Older Americans Act of 1965. Department of Education Pub. L. No. 104- Authorizes Appropriations Act, 1997. 208, 110 Stat. appropriations for 3009 (1996). Native Hawaiian education programs under authorizing legislation. National Museum of the Pub. L. No. 104- Amends National American Indian Act 278, sec. 4, Museum of the Amendments of 1996. Sec. 11A, 110 American Indian Act Stat. 3355, 3356 by authorizing (1996). reparation of Indian and Native Hawaiian sacred or funerary objects and cultural patrimony objects. Joint Resolution to consent to Pub. L. No. 105- Agrees to the certain amendments enacted by 21, 111 Stat. adoption of the legislature of the State 235 (1997). amendments enacted of Hawai'i to the Hawaiian by the State of Homes Commission Act, 1920. Hawai'i to the Hawaiian Homes Commission Act of 1920. Department of Transportation Pub. L. No. 105- Waives repayment of and Related Agencies 66, 111 Stat. airport funds that Appropriations Act, 1998. 1425 (1997). were diverted for the betterment of American Indians, Alaska Natives, and Native Hawaiians. Department of Health and Human Pub. L. No. 105- Authorizes Services Appropriations Act, 78, 111 Stat. appropriations for 1998. 1467 (1997). the Native Hawaiian Health Care Act and Older Americans Act of 1965. Department of Education Pub. L. No. 105- Authorizes Appropriations Act, 1998. 78, 111 Stat. appropriations for 1467 (1997). Native Hawaiian education programs under authorizing legislation. Museum and Library Services Pub. L. No. 105- Amends Museum and Technical and Conforming 128, sec. 6, Library Services Act Amendments of 1997. Sec. 262, 111 by authorizing Stat. 2548, 2549 Hawaiian (1997). organizations eligible to receive grants (along with American Indian tribes) to electronically link libraries with education, social, or information services. Workforce Investment Act of Pub. L. No. 105- Authorizes grants to 1998. 220, Sec. 166, Indian Tribes, 112 Stat. 936, tribal 1021 (1998). organizations, Alaska Native entities, Indian- controlled organizations, and Native Hawaiian organizations for employment and training activities. Rehabilitation Act Amendments Pub. L. No. 105- Amends the of 1998. 220, sec. 404, Rehabilitation Act Sec. 101, 112 of 1973 by requiring Stat. 936, 1163 State agencies to (1998). consult with Indian Tribes, tribal organizations, and Native Hawaiian organizations before adopting any policies for vocational rehabilitation services. Higher Education Amendments of Pub. L. No. 105- Amends the Higher 1998. 244, sec. 303, Education Act of Sec. 1001, 112 1965 by authorizing Stat. 1581, 1638 grants to improve (1998). education institutions' ability to serve Alaska Natives and Native Hawaiians. Act of October 14, 1998....... Pub. L. No. 105- Amends the Native 256, sec. 12, Hawaiian Health Care Sec. 10(b)(1), Improvement Act by 112 Stat. 1896, requiring recipients 1899 (1998). of the Native Hawaiian Health Scholarship Program to work in the Native Hawaiian Health Care System. Department of Health and Human Pub. L. No. 105- Authorizes Services Appropriations Act, 277, 112 Stat. appropriations to 1999. 2681 (1998). carry out the Native Hawaiian Health Care Act of 1988 and the Older Americans Act. Department of Education Pub. L. No. 105- Authorizes Appropriations Act, 1999. 277, 112 Stat. appropriations for 2681 (1998). Native Hawaiian education programs under authorizing legislation. Head Start Amendments of 1998. Pub. L. No. 105- Amends the Head Start 285, sec. 117, Act by requiring the Sec. 650, 112 Secretary of Health Stat. 2702, 2727 and Human Services (1998). to prepare and submit a report concerning the condition, location, and ownership of facilities used, or available to be used, by Native Hawaiian Head Start agencies. Assets for Independence Act... Pub. L. No. 105- Authorizes Native 285, Sec. Sec. Hawaiian 401-416, 112 organizations (and Stat. 2702, 2759 State, local, and (1998). tribal governments) to conduct demonstration projects to evaluate the effects of savings, microenterprise, and home ownership on families and the community. Carl D. Perkins Vocational and Pub. L. No. 105- Authorizes grants to Technical Education Act of 332, sec. 1, plan, conduct, and 1998. Sec. 116, 112 administer Stat. 3076, 3095 vocational programs (1998). for Native Hawaiians and other Native Americans. Native American Programs Act Pub. L. No. 105- Amends the Native Amendments of 1997. 361, sec. 3, Hawaiian Revolving Sec. 803A, 112 Loan fund to include Stat. 3278, 3278 a loan guarantee. (1998). National Park Service Pub. L. No. 105- Promotes the sale of Concessions Management 391, Sec. 416, authentic American Improvement Act of 1998. 112 Stat. 3497, Indian, Alaska 3516 (1998). Native, and Native Hawaiian handicrafts and makes those revenues exempt from franchise fees. Health Professions Education Pub. L. No. 105- Authorizes grants to Partnerships Act of 1998. 392, sec. 101, assist schools with Sec. 736, 112 health professions Stat. 3524, 3525 education programs (1998). for Native Hawaiians, American Indians, Alaska Natives, and under- represented minorities. ------------------------------------------------------------------------