110th CONGRESS
1st Session
S. 429
To amend the Native Hawaiian Health Care Improvement Act to revise
and extend that Act.
IN THE SENATE OF THE UNITED STATES
January 30, 2007
Mr. INOUYE (for himself and Mr. AKAKA) introduced the following bill; which
was read twice and referred to the Committee on Indian Affairs
A BILL
To amend the Native Hawaiian Health Care Improvement Act to revise
and extend that Act.
Be it enacted by the Senate and House of Representatives of the United
States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the `Native Hawaiian Health Care Improvement Reauthorization
Act of 2007'.
SEC. 2. AMENDMENT TO THE NATIVE HAWAIIAN HEALTH CARE IMPROVEMENT ACT.
The Native Hawaiian Health Care Improvement Act (42 U.S.C. 11701 et seq.)
is amended to read as follows:
`SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
`(a) Short Title- This Act may be cited as the `Native Hawaiian Health Care
Improvement Act'.
`(b) Table of Contents- The table of contents of this Act is as follows:
`Sec. 1. Short title; table of contents.
`Sec. 4. Declaration of national Native Hawaiian health policy.
`Sec. 5. Comprehensive health care master plan for Native Hawaiians.
`Sec. 6. Functions of Papa Ola Lokahi.
`Sec. 7. Native Hawaiian health care.
`Sec. 8. Administrative grant for Papa Ola Lokahi.
`Sec. 9. Administration of grants and contracts.
`Sec. 10. Assignment of personnel.
`Sec. 11. Native Hawaiian health scholarships and fellowships.
`Sec. 13. Use of Federal Government facilities and sources of supply.
`Sec. 14. Demonstration projects of national significance.
`Sec. 15. Rule of construction.
`Sec. 16. Compliance with Budget Act.
`SEC. 2. FINDINGS.
`(a) In General- Congress finds that--
`(1) Native Hawaiians begin their story with the Kumulipo, which details
the creation and interrelationship of all things, including the evolvement
of Native Hawaiians as healthy and well people;
`(A) are a distinct and unique indigenous people with a historical continuity
to the original inhabitants of the Hawaiian archipelago within Ke Moananui,
the Pacific Ocean; and
`(B) have a distinct society that was first organized almost 2,000 years
ago;
`(3) the health and well-being of Native Hawaiians are intrinsically tied
to the deep feelings and attachment of Native Hawaiians to their lands
and seas;
`(4) the long-range economic and social changes in Hawai'i over the 19th
and early 20th centuries have been devastating to the health and well-being
of Native Hawaiians;
`(5) Native Hawaiians have never directly relinquished to the United States
their claims to their inherent sovereignty as a people or over their national
territory, either through their monarchy or through a plebiscite or referendum;
`(6) the Native Hawaiian people are determined to preserve, develop, and
transmit to future generations, in accordance with their own spiritual
and traditional beliefs, their customs, practices, language, social institutions,
ancestral territory, and cultural identity;
`(7) in referring to themselves, Native Hawaiians use the term `Kanaka
Maoli', a term frequently used in the 19th century to describe the native
people of Hawai'i;
`(8) the constitution and statutes of the State of Hawai'i--
`(A) acknowledge the distinct land rights of Native Hawaiian people
as beneficiaries of the public lands trust; and
`(B) reaffirm and protect the unique right of the Native Hawaiian people
to practice and perpetuate their cultural and religious customs, beliefs,
practices, and language;
`(9) at the time of the arrival of the first nonindigenous people in Hawai'i
in 1778, the Native Hawaiian people lived in a highly organized, self-sufficient,
subsistence social system based on communal land tenure with a sophisticated
language, culture, and religion;
`(10) a unified monarchical government of the Hawaiian Islands was established
in 1810 under Kamehameha I, the first King of Hawai'i;
`(11) throughout the 19th century 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;
`(12) in 1893, John L. Stevens, the United States Minister assigned to
the sovereign and independent Kingdom of Hawai'i, 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
Hawai'i;
`(13) in pursuance of that conspiracy--
`(A) the United States Minister and the naval representative of the
United States caused armed forces of the United States Navy to invade
the sovereign Hawaiian Nation in support of the overthrow of the indigenous
and lawful Government of Hawai'i; and
`(B) after that overthrow, the 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--
`(i) treaties between the Government of Hawai'i and the United States;
and
`(14) in a message to Congress on December 18, 1893, President Grover
Cleveland--
`(A) reported fully and accurately on those illegal actions;
`(B) acknowledged that by those acts, described by the President as
acts of war, the government of a peaceful and friendly people was overthrown;
and
`(C) 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';
`(15) 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 those wrongs and restoration
of the indigenous government of the Hawaiian nation, but no action was
taken on that petition;
`(16) in 1993, Congress enacted Public Law 103-150 (107 Stat. 1510), in
which Congress--
`(A) acknowledged the significance of those events; and
`(B) apologized to Native Hawaiians on behalf of the people of the United
States for the overthrow of the Kingdom of Hawai'i with the participation
of agents and citizens of the United States, and the resulting deprivation
of the rights of Native Hawaiians to self-determination;
`(17) between 1897 and 1898, when the total Native Hawaiian population
in Hawai'i was less than 40,000, more than 38,000 Native Hawaiians signed
petitions (commonly known as `Ku'e Petitions') protesting annexation by
the United States and requesting restoration of the monarchy;
`(18) despite Native Hawaiian protests, in 1898, the United States--
`(A) annexed Hawai'i through Resolution No. 55 (commonly known as the
`Newlands Resolution') (30 Stat. 750), without the consent of, or compensation
to, the indigenous people of Hawai'i or the sovereign government of
those people; and
`(B) denied those people the mechanism for expression of their inherent
sovereignty through self-government and self-determination of their
lands and ocean resources;
`(19) through the Newlands Resolution and the Act of April 30, 1900 (commonly
known as the `1900 Organic Act') (31 Stat. 141, chapter 339), the United
States--
`(A) received 1,750,000 acres of land formerly owned by the Crown and
Government of the Hawaiian Kingdom; and
`(B) exempted the land from then-existing public land laws of the United
States by mandating that the revenue and proceeds from that land 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;
`(20) in 1921, Congress enacted the Hawaiian Homes Commission Act, 1920
(42 Stat. 108, chapter 42), which--
`(A) designated 200,000 acres of the ceded public land for exclusive
homesteading by Native Hawaiians; and
`(B) affirmed the trust relationship between the United States and Native
Hawaiians, as expressed by Secretary of the Interior Franklin K. Lane,
who was cited in the Committee Report of the Committee on Territories
of the House of Representatives as stating, `One thing that impressed
me . . . was the fact that the natives of the islands . . . for whom
in a sense we are trustees, are falling off rapidly in numbers and many
of them are in poverty.';
`(21) in 1938, Congress again acknowledged the unique status of the Native
Hawaiian people by including in the Act of June 20, 1938 (52 Stat. 781),
a provision--
`(A) to lease land within the extension to Native Hawaiians; and
`(B) to permit fishing in the area `only by native Hawaiian residents
of said area or of adjacent villages and by visitors under their guidance';
`(22) under the Act of March 18, 1959 (48 U.S.C. prec. 491 note; 73 Stat.
4), the United States--
`(A) transferred responsibility for the administration of the Hawaiian
home lands to the State; but
`(B) reaffirmed the trust relationship that 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
that Act;
`(23) under the Act referred to in paragraph (22), the United States--
`(A) transferred responsibility for administration over portions of
the ceded public lands trust not retained by the United States to the
State; but
`(B) reaffirmed the trust relationship that existed between the United
States and the Native Hawaiian people by retaining the legal responsibility
of the State for the betterment of the conditions of Native Hawaiians
under section 5(f) of that Act (73 Stat. 6);
`(24) in 1978, the people of Hawai'i--
`(A) amended the constitution of Hawai'i to establish the Office of
Hawaiian Affairs; and
`(B) assigned to that Office the authority--
`(i) to accept and hold in trust for the Native Hawaiian people real
and personal property transferred from any source;
`(ii) to receive payments from the State owed to the Native Hawaiian
people in satisfaction of the pro rata share of the proceeds of the
public land trust established by section 5(f) of the Act of March
18, 1959 (48 U.S.C. prec. 491 note; 73 Stat. 6);
`(iii) to act as the lead State agency for matters affecting the Native
Hawaiian people; and
`(iv) to formulate policy on affairs relating to the Native Hawaiian
people;
`(25) the authority of Congress under the Constitution to legislate in
matters affecting the aboriginal or indigenous people of the United States
includes the authority to legislate in matters affecting the native people
of Alaska and Hawai'i;
`(26) the United States has recognized the authority of the Native Hawaiian
people to continue to work toward an appropriate form of sovereignty,
as defined by the Native Hawaiian people in provisions set forth in legislation
returning the Hawaiian Island of Kaho`olawe to custodial management by
the State in 1994;
`(27) 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;
`(28) that program is conducted by the Native Hawaiian Health Care Systems
and Papa Ola Lokahi;
`(29) health initiatives implemented by those and other health institutions
and agencies using Federal assistance have been responsible for reducing
the century-old morbidity and mortality rates of Native Hawaiian people
by--
`(A) providing comprehensive disease prevention;
`(B) providing health promotion activities; and
`(C) increasing the number of Native Hawaiians in the health and allied
health professions;
`(30) those accomplishments have been achieved through implementation
of--
`(A) the Native Hawaiian Health Care Act of 1988 (Public Law 100-579);
and
`(B) the reauthorization of that Act under section 9168 of the Department
of Defense Appropriations Act, 1993 (Public Law 102-396; 106 Stat. 1948);
`(31) the historical and unique legal relationship between the United
States and Native Hawaiians has been consistently recognized and affirmed
by Congress through the enactment of more than 160 Federal laws that extend
to the Native Hawaiian people the same rights and privileges accorded
to American Indian, Alaska Native, Eskimo, and Aleut communities, including--
`(A) the Native American Programs Act of 1974 (42 U.S.C. 2991 et seq.);
`(B) the American Indian Religious Freedom Act (42 U.S.C. 1996);
`(C) the National Museum of the American Indian Act (20 U.S.C. 80q et
seq.); and
`(D) the Native American Graves Protection and Repatriation Act (25
U.S.C. 3001 et seq.);
`(32) the United States has recognized and reaffirmed the trust relationship
to the Native Hawaiian people through legislation that authorizes the
provision of services to Native Hawaiians, specifically--
`(A) the Older Americans Act of 1965 (42 U.S.C. 3001 et seq.);
`(B) the Developmental Disabilities Assistance and Bill of Rights Act
Amendments of 1987 (42 U.S.C. 6000 et seq.);
`(C) the Veterans' Benefits and Services Act of 1988 (Public Law 100-322);
`(D) the Rehabilitation Act of 1973 (29 U.S.C. 701 et seq.);
`(E) the Native Hawaiian Health Care Act of 1988 (42 U.S.C. 11701 et
seq.);
`(F) the Health Professions Reauthorization Act of 1988 (Public Law
100-607; 102 Stat. 3122);
`(G) the Nursing Shortage Reduction and Education Extension Act of 1988
(Public Law 100-607; 102 Stat. 3153);
`(H) the Handicapped Programs Technical Amendments Act of 1988 (Public
Law 100-630);
`(I) the Indian Health Care Amendments of 1988 (Public Law 100-713);
and
`(J) the Disadvantaged Minority Health Improvement Act of 1990 (Public
Law 101-527);
`(33) the United States has affirmed that 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 (21 U.S.C. 801 note; Public Law 99-570);
`(34) in addition, the United States--
`(A) has recognized that Native Hawaiians, as aboriginal, indigenous,
native people of Hawai'i, are a unique population group in Hawai'i and
in the continental United States; and
`(B) has so declared in--
`(i) the documents of the Office of Management and Budget entitled--
`(I) `Standards for Maintaining, Collecting, and Presenting Federal
Data on Race and Ethnicity' and dated October 30, 1997; and
`(II) `Provisional Guidance on the Implementation of the 1997 Standards
for Federal Data on Race and Ethnicity' and dated December 15, 2000;
`(ii) the document entitled `Guidance on Aggregation and Allocation
of Data on Race for Use in Civil Rights Monitoring and Enforcement'
(Bulletin 00-02 to the Heads of Executive Departments and Establishments)
and dated March 9, 2000;
`(iii) the document entitled `Questions and Answers when Designing
Surveys for Information Collections' (Memorandum for the President's
Management Council) and dated January 20, 2006;
`(iv) Executive order number 13125 (64 Fed. Reg. 31105; relating to
increasing participation of Asian Americans and Pacific Islanders
in Federal programs) (June 7, 1999);
`(v) the document entitled `HHS Tribal Consultation Policy' and dated
January 2005; and
`(vi) the Department of Health and Human Services Intradepartment
Council on Native American Affairs, Revised Charter, dated March 7,
2005; and
`(35) despite the United States having expressed in Public Law 103-150
(107 Stat. 1510) its commitment to a policy of reconciliation with the
Native Hawaiian people for past grievances--
`(A) the unmet health needs of the Native Hawaiian people remain severe;
and
`(B) the health status of the Native Hawaiian people continues to be
far below that of the general population of the United States.
`(b) Finding of 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-
`(i) IN GENERAL- With respect to all cancer--
`(I) as an underlying cause of death in the State, the cancer mortality
rate of Native Hawaiians of 218.3 per 100,000 residents is 50 percent
higher than the rate for the total population of the State of 145.4
per 100,000 residents;
`(II) Native Hawaiian males have the highest cancer mortality rates
in the State for cancers of the lung, colon, and rectum, and for
all cancers combined;
`(III) Native Hawaiian females have the highest cancer mortality
rates in the State for cancers of the lung, breast, colon, rectum,
pancreas, stomach, ovary, liver, cervix, kidney, and uterus, and
for all cancers combined; and
`(IV) for the period of 1995 through 2000--
`(aa) the cancer mortality rate for all cancers for Native Hawaiian
males of 217 per 100,000 residents was 22 percent higher than the rate for
all males in the State of 179 per 100,000 residents; and
`(bb) the cancer mortality rate for all cancers for Native Hawaiian
females of 192 per 100,000 residents was 64 percent higher than the rate
for all females in the State of 117 per 100,000 residents.
`(ii) BREAST CANCER- With respect to breast cancer--
`(I) Native Hawaiians have the highest mortality rate in the State
from breast cancer (30.79 per 100,000 residents), which is 33 percent
higher than the rate for Caucasian Americans (23.07 per 100,000
residents) and 106 percent higher than the rate for Chinese Americans
(14.96 per 100,000 residents); and
`(II) nationally, Native Hawaiians have the third-highest mortality
rate as a result of breast cancer (25.0 per 100,000 residents),
behind African Americans (31.4 per 100,000 residents) and Caucasian
Americans (27.0 per 100,000 residents).
`(iii) CANCER OF THE CERVIX- Native Hawaiians have the highest mortality
rate as a result of cancer of the cervix in the State (3.65 per 100,000
residents), followed by Filipino Americans (2.69 per 100,000 residents)
and Caucasian Americans (2.61 per 100,000 residents).
`(iv) LUNG CANCER- Native Hawaiian males and females have the highest
mortality rates as a result of lung cancer in the State, at 74.79
per 100,000 for males and 47.84 per 100,000 females, which are higher
than the rates for the total population of the State by 48 percent
for males and 93 percent for females.
`(v) PROSTATE CANCER- Native Hawaiian males have the third-highest
mortality rate as a result of prostate cancer in the State (21.48
per 100,000 residents), with Caucasian Americans having the highest
mortality rate as a result of prostate cancer (23.96 per 100,000 residents).
`(B) DIABETES- With respect to diabetes, in 2004--
`(i) Native Hawaiians had the highest mortality rate as a result of
diabetes mellitis (28.9 per 100,000 residents) in the State, which
is 119 percent higher than the rate for all racial groups in the State
(13.2 per 100,000 residents);
`(ii) the prevalence of diabetes for Native Hawaiians was 12.7 percent,
which is 87 percent higher than the total prevalence for all residents
of the State of 6.8 percent; and
`(iii) a higher percentage of Native Hawaiians with diabetes experienced
diabetic retinopathy, as compared to other population groups in the
State.
`(C) ASTHMA- With respect to asthma and lower respiratory disease--
`(i) in 2004, mortality rates for Native Hawaiians (31.6 per 100,000
residents) from chronic lower respiratory disease were 52 percent
higher than rates for the total population of the State (20.8 per
100,000 residents); and
`(ii) in 2005, the prevalence of current asthma in Native Hawaiian
adults was 12.8 percent, which is 71 percent higher than the prevalence
of the total population of the State of 7.5 percent.
`(D) CIRCULATORY DISEASES-
`(i) HEART DISEASE- With respect to heart disease--
`(I) in 2004, the mortality rate for Native Hawaiians as a result
of heart disease (305.5 per 100,000 residents) was 86 percent higher
than the rate for the total population of the State (164.3 per 100,000
residents); and
`(II) in 2005, the prevalence for heart attack was 4.4 percent for
Native Hawaiians, which is 22 percent higher than the prevalence
for the total population of 3.6 percent.
`(ii) CEREBROVASCULAR DISEASES- With respect to cerebrovascular diseases--
`(I) the mortality rate from cerebrovascular diseases for Native
Hawaiians (75.6 percent) was 64 percent higher than the rate for
the total population of the State (46 percent); and
`(II) in 2005, the prevalence for stroke was 4.9 percent for Native
Hawaiians, which is 69 percent higher than the prevalence for the
total population of the State (2.9 percent).
`(iii) OTHER CIRCULATORY DISEASES- With respect to other circulatory
diseases (including high blood pressure and atherosclerosis)--
`(I) in 2004, the mortality rate for Native Hawaiians of 20.6 per
100,000 residents was 46 percent higher than the rate for the total
population of the State of 14.1 per 100,000 residents; and
`(II) in 2005, the prevalence of high blood pressure for Native
Hawaiians was 26.7 percent, which is 10 percent higher than the
prevalence for the total population of the State of 24.2 percent.
`(2) INFECTIOUS DISEASE AND ILLNESS- With respect to infectious disease
and illness--
`(A) in 1998, Native Hawaiians comprised 20 percent of all deaths resulting
from infectious diseases in the State for all ages; and
`(B) the incidence of acquired immune deficiency syndrome for Native
Hawaiians is at least twice as high per 100,000 residents (10.5 percent)
than the incidence for any other non-Caucasian group in the State.
`(3) INJURIES- With respect to injuries--
`(A) the mortality rate for Native Hawaiians as a result of injuries
(32 per 100,000 residents) is 16 percent higher than the rate for the
total population of the State (27.5 per 100,000 residents);
`(B) 32 percent of all deaths of individuals between the ages of 18
and 24 years resulting from injuries were Native Hawaiian; and
`(C) the 2 primary causes of Native Hawaiian deaths in that age group
were motor vehicle accidents (30 percent) and intentional self-harm
(39 percent).
`(4) DENTAL HEALTH- With respect to dental health--
`(A) Native Hawaiian children experience significantly higher rates
of dental caries and unmet treatment needs as compared to other children
in the continental United States and other ethnic groups in the State;
`(B) the prevalence rate of dental caries in the primary (baby) teeth
of Native Hawaiian children aged 5 to 9 years of 4.2 per child is more
than twice the national average rate of 1.9 per child in that age range;
`(C) 81.9 percent of Native Hawaiian children aged 6 to 8 have 1 or
more decayed teeth, as compared to--
`(i) 53 percent for children in that age range in the continental
United States; and
`(ii) 72.7 percent of other children in that age range in the State;
and
`(D) 21 percent of Native Hawaiian children aged 5 demonstrate signs
of baby bottle tooth decay, which is generally characterized as severe,
progressive dental disease in early childhood and associated with high
rates of dental disorders, as compared to 5 percent for children of
that age in the continental United States.
`(5) LIFE EXPECTANCY- With respect to life expectancy--
`(A) Native Hawaiians have the lowest life expectancy of all population
groups in the State;
`(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;
`(C) the most recent tables for 1990 show Native Hawaiian life expectancy
at birth (74.27 years) to be approximately 5 years less than that of
the total State population (78.85 years); and
`(D) except as provided in the life expectancy calculation for 1920,
Native Hawaiians have had the shortest life expectancy of all major
ethnic groups in the United States since 1910.
`(6) MATERNAL AND CHILD HEALTH-
`(A) IN GENERAL- With respect to maternal and child health, in 2000--
`(i) 39 percent of all deaths of children under the age of 18 years
in the State were Native Hawaiian;
`(ii) perinatal conditions accounted for 38 percent of all Native
Hawaiian deaths in that age group;
`(iii) Native Hawaiian infant mortality rates (9.8 per 1,000 live
births) are--
`(I) the highest in the State; and
`(II) 151 percent higher than the rate for Caucasian infants (3.9
per 1,000 live births); and
`(iv) Native Hawaiians have 1 of the highest infant mortality rates
in the United States, second only to the rate for African Americans
of 13.6 per 1,000 live births.
`(B) PRENATAL CARE- With respect to prenatal care--
`(i) as of 2005, Native Hawaiian women have the highest prevalence
(20.9 percent) of having had no prenatal care during the first trimester
of pregnancy, as compared to the 5 largest ethnic groups in the State;
`(ii) of the mothers in the State who received no prenatal care in
the first trimester, 33 percent were Native Hawaiian;
`(iii) in 2005, 41 percent of mothers with live births who had not
completed high school were Native Hawaiian; and
`(iv) in every region of the State, many Native Hawaiian newborns
begin life in a potentially hazardous circumstance, far higher than
any other racial group.
`(C) BIRTHS- With respect to births, in 2005--
`(i) 45.2 percent of live births to Native Hawaiian mothers were nonmarital,
putting the affected infants at higher risk of low birth weight and
infant mortality;
`(ii) of the 2,934 live births to Native Hawaiian single mothers,
9 percent were low birth weight (defined as a weight of less than
2,500 grams); and
`(iii) 43.7 percent of all low birth-weight infants born to single
mothers in the State were Native Hawaiian.
`(D) TEEN PREGNANCIES- With respect to births, in 2005--
`(i) Native Hawaiians had the highest rate of births to mothers under
the age of 18 years (5.8 percent), as compared to the rate of 2.7
percent for the total population of the State; and
`(ii) nearly 62 percent of all mothers in the State under the age
of 19 years were Native Hawaiian.
`(E) FETAL MORTALITY- With respect to fetal mortality, in 2005--
`(i) Native Hawaiians had the highest number of fetal deaths in the
State, as compared to Caucasian, Japanese, and Filipino residents;
and
`(ii)(I) 17.2 percent of all fetal deaths in the State were associated
with expectant Native Hawaiian mothers; and
`(II) 43.5 percent of those Native Hawaiian mothers were under the
age of 25 years.
`(A) ALCOHOL AND DRUG ABUSE- With respect to alcohol and drug abuse--
`(i)(I) in 2005, Native Hawaiians had the highest prevalence of smoking
of 27.9 percent, which is 64 percent higher than the rate for the
total population of the State (17 percent); and
`(II) 53 percent of Native Hawaiians reported having smoked at least
100 cigarettes in their lifetime, as compared to 43.3 percent for
the total population of the State;
`(ii) 33 percent of Native Hawaiians in grade 8 have smoked cigarettes
at least once in their lifetime, as compared to--
`(I) 22.5 percent for all youth in the State; and
`(II) 28.4 percent of residents of the United States in grade 8;
`(iii) Native Hawaiians have the highest prevalence of binge drinking
of 19.9 percent, which is 21 percent higher than the prevalence for
the total population of the State (16.5 percent);
`(iv) the prevalence of heavy drinking among Native Hawaiians (10.1
percent) is 36 percent higher than the prevalence for the total population
of the State (7.4 percent);
`(v)(I) in 2003, 17.2 percent of Native Hawaiians in grade 6, 45.1
percent of Naive Hawaiians in grade 8, 68.9 percent of Native Hawaiians
in grade 10, and 78.1 percent of Native Hawaiians in grade 12 reported
using alcohol at least once in their lifetime, as compared to 13.2,
36.8, 59.1, and 72.5 percent, respectively, of all adolescents in
the State; and
`(II) 62.1 percent Native Hawaiians in grade 12 reported being drunk
at least once, which is 20 percent higher than the percentage for
all adolescents in the State (51.6 percent);
`(vi) on entering grade 12, 60 percent of Native Hawaiian adolescents
reported having used illicit drugs, including inhalants, at least
once in their lifetime, as compared to--
`(I) 46.9 percent of all adolescents in the State; and
`(II) 52.8 of adolescents in the United States;
`(vii) on entering grade 12, 58.2 percent of Native Hawaiian adolescents
reported having used marijuana at least once, which is 31 percent
higher than the rate of other adolescents in the State (44.4 percent);
`(viii) in 2006, Native Hawaiians represented 40 percent of the total
admissions to substance abuse treatment programs funded by the State
Department of Health; and
`(ix) in 2003, Native Hawaiian adolescents reported the highest prevalence
for methamphetamine use in the State, followed by Caucasian and Filipino
adolescents.
`(B) CRIME- With respect to crime--
`(i) during the period of 1992 to 2002, Native Hawaiian arrests for
violent crimes decreased, but the rate of arrest remained 38.3 percent
higher than the rate of the total population of the State;
`(ii) the robbery arrest rate in 2002 among Native Hawaiian juveniles
and adults was 59 percent higher (6.2 arrests per 100,000 residents)
than the rate for the total population of the State (3.9 arrests per
100,000 residents);
`(I) Native Hawaiian men comprised between 35 percent and 43 percent
of each security class in the State prison system;
`(II) Native Hawaiian women comprised between 38.1 percent to 50.3
percent of each class of female prison inmates in the State;
`(III) Native Hawaiians comprised 39.5 percent of the total incarcerated
population of the State; and
`(IV) Native Hawaiians comprised 40 percent of the total sentenced
felon population in the State, as compared to 25 percent for Caucasians,
12 percent for Filipinos, and 5 percent for Samoans;
`(iv) Native Hawaiians are overrepresented in the State prison population;
`(v) of the 2,260 incarcerated Native Hawaiians, 70 percent are between
20 and 40 years of age; and
`(vi) based on anecdotal information, Native Hawaiians are estimated
to comprise between 60 percent and 70 percent of all jail and prison
inmates in the State.
`(C) DEPRESSION AND SUICIDE- With respect to depression and suicide--
`(i)(I) in 1999, the prevalence of depression among Native Hawaiians
was 15 percent, as compared to the national average of approximately
10 percent; and
`(II) Native Hawaiian females had a higher prevalence of depression
(16.9 percent) than Native Hawaiian males (11.9 percent);
`(I) Native Hawaiian adolescents had a significantly higher suicide
attempt rate (12.9 percent) than the rate for other adolescents
in the State (9.6 percent); and
`(II) 39 percent of all Native Hawaiian adult deaths were due to
suicide; and
`(iii) in 2006, the prevalence of obsessive compulsive disorder among
Native Hawaiian adolescent girls was 17.7 percent, as compared to
a rate of--
`(I) 9.2 percent for Native Hawaiian boys and non-Hawaiian girls;
and
`(II) a national rate of 2 percent.
`(8) OVERWEIGHTNESS AND OBESITY- With respect to overweightness and obesity--
`(A) during the period of 2000 through 2003, Native Hawaiian males and
females had the highest age-adjusted prevalence rates for obesity (40.5
and 32.5 percent, respectively), which was--
`(i) with respect to individuals of full Native Hawaiian ancestry,
145 percent higher than the rate for the total population of the State
(16.5 per 100,000); and
`(ii) with respect to individuals with less than 100 percent Native
Hawaiian ancestry, 97 percent higher than the total population of
the State; and
`(B) for 2005, the prevalence of obesity among Native Hawaiians was
43.1 percent, which was 119 percent higher than the prevalence for the
total population of the State (19.7 percent).
`(9) FAMILY AND CHILD HEALTH- With respect to family and child health--
`(A) in 2000, the prevalence of single-parent families with minor children
was highest among Native Hawaiian households, as compared to all households
in the State (15.8 percent and 8.1 percent, respectively);
`(B) in 2002, nonmarital births accounted for 56.8 percent of all live
births among Native Hawaiians, as compared to 34 percent of all live
births in the State;
`(C) the rate of confirmed child abuse and neglect among Native Hawaiians
has consistently been 3 to 4 times the rates of other major ethnic groups,
with a 3-year average of 63.9 cases in 2002, as compared to 12.8 cases
for the total population of the State;
`(D) spousal abuse or abuse of an intimate partner was highest for Native
Hawaiians, as compared to all cases of abuse in the State (4.5 percent
and 2.2 percent, respectively); and
`(E)(i) 1/2 of uninsured adults in the State have family incomes below
200 percent of the Federal poverty level; and
`(ii) Native Hawaiians residing in the State and the continental United
States have a higher rate of uninsurance than other ethnic groups in
the State and continental United States (14.5 percent and 9.5 percent,
respectively).
`(10) HEALTH PROFESSIONS EDUCATION AND TRAINING- With respect to health
professions education and training--
`(A) in 2003, adult Native Hawaiians had a higher rate of high school
completion, as compared to the total adult population of the State (49.4
percent and 34.4 percent, respectively);
`(B) Native Hawaiian physicians make up 4 percent of the total physician
workforce in the State; and
`(C) in 2004, Native Hawaiians comprised--
`(i) 11.25 percent of individuals who earned bachelor's degrees;
`(ii) 6 percent of individuals who earned master's degrees;
`(iii) 3 percent of individuals who earned doctorate degrees;
`(iv) 7.9 percent of the credited student body at the University of
Hawai'i;
`(v) 0.4 percent of the instructional faculty at the University of
Hawai'i at Manoa; and
`(vi) 8.4 percent of the instructional faculty at the University of
Hawai'i Community Colleges.
`SEC. 3. DEFINITIONS.
`(1) DEPARTMENT- The term `Department' means the Department of Health
and Human Services.
`(2) DISEASE PREVENTION- The term `disease prevention' includes--
`(B) control of high blood pressure;
`(C) control of sexually transmittable diseases;
`(D) prevention and control of chronic diseases;
`(E) control of toxic agents;
`(F) occupational safety and health;
`(H) fluoridation of water;
`(I) control of infectious agents; and
`(J) provision of mental health care.
`(3) HEALTH PROMOTION- The term `health promotion' includes--
`(A) pregnancy and infant care, including prevention of fetal alcohol
syndrome;
`(B) cessation of tobacco smoking;
`(C) reduction in the misuse of alcohol and harmful illicit drugs;
`(D) improvement of nutrition;
`(E) improvement in physical fitness;
`(H) reduction of major behavioral risk factors and promotion of healthy
lifestyle practices; and
`(I) integration of cultural approaches to health and well-being (including
traditional practices relating to the atmosphere (lewa lani), land (`aina),
water (wai), and ocean (kai)).
`(4) HEALTH SERVICE- The term `health service' means--
`(A) service provided by a physician, physician's assistant, nurse practitioner,
nurse, dentist, or other health professional;
`(B) a diagnostic laboratory or radiologic service;
`(C) a preventive health service (including a perinatal service, well
child service, family planning service, nutrition service, home health
service, sports medicine and athletic training service, and, generally,
any service associated with enhanced health and wellness);
`(D) emergency medical service, including a service provided by a first
responder, emergency medical technician, or mobile intensive care technician;
`(E) a transportation service required for adequate patient care;
`(F) a preventive dental service;
`(G) a pharmaceutical and medicament service;
`(H) a mental health service, including a service provided by a psychologist
or social worker;
`(I) a genetic counseling service;
`(J) a health administration service, including a service provided by
a health program administrator;
`(K) a health research service, including a service provided by an individual
with an advanced degree in medicine, nursing, psychology, social work,
or any other related health program;
`(L) an environmental health service, including a service provided by
an epidemiologist, public health official, medical geographer, or medical
anthropologist, or an individual specializing in biological, chemical,
or environmental health determinants;
`(M) a primary care service that may lead to specialty or tertiary care;
and
`(N) a complementary healing practice, including a practice performed
by a traditional Native Hawaiian healer.
`(5) 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), as evidenced by--
`(A) genealogical records;
`(B) kama`aina witness verification from Native Hawaiian Kupuna (elders);
or
`(C) birth records of the State or any other State or territory of the
United States.
`(6) NATIVE HAWAIIAN HEALTH CARE SYSTEM- The term `Native Hawaiian health
care system' means any of up to 8 entities in the State that--
`(A) is organized under the laws of the State;
`(B) provides or arranges for the provision of health services for Native
Hawaiians in the State;
`(C) is a public or nonprofit private entity;
`(D) has Native Hawaiians significantly participating in the planning,
management, provision, monitoring, and evaluation of health services;
`(E) addresses the health care needs of an island's Native Hawaiian
population; and
`(F) is recognized by Papa Ola Lokahi--
`(i) for the purpose of planning, conducting, or administering programs,
or portions of programs, authorized by this Act for the benefit of
Native Hawaiians; and
`(ii) as having the qualifications and the capacity to provide the
services and meet the requirements under--
`(I) the contract that each Native Hawaiian health care system enters
into with the Secretary under this Act; or
`(II) the grant each Native Hawaiian health care system receives
from the Secretary under this Act.
`(7) NATIVE HAWAIIAN HEALTH CENTER- The term `Native Hawaiian Health Center'
means any organization that is a primary health care provider that--
`(A) has a governing board composed of individuals, at least 50 percent
of whom are Native Hawaiians;
`(B) has demonstrated cultural competency in a predominantly Native
Hawaiian community;
`(C) serves a patient population that--
`(i) is made up of individuals at least 50 percent of whom are Native
Hawaiian; or
`(ii) has not less than 2,500 Native Hawaiians as annual users of
services; and
`(D) is recognized by Papa Ola Lokahi as having met each of the criteria
described in subparagraphs (A) through (C).
`(8) NATIVE HAWAIIAN HEALTH TASK FORCE- The term `Native Hawaiian Health
Task Force' means a task force established by the State Council of Hawaiian
Homestead Associations to implement health and wellness strategies in
Native Hawaiian communities.
`(9) NATIVE HAWAIIAN ORGANIZATION- The term `Native Hawaiian organization'
means any organization that--
`(A) serves the interests of Native Hawaiians; and
`(B)(i) is recognized by Papa Ola Lokahi for planning, conducting, or
administering programs authorized under this Act for the benefit of
Native Hawaiians; and
`(ii) is a public or nonprofit private entity.
`(10) OFFICE OF HAWAIIAN AFFAIRS- The term `Office of Hawaiian Affairs'
means the governmental entity that--
`(A) is established under article XII, sections 5 and 6, of the Hawai'i
State Constitution; and
`(B) charged with the responsibility to formulate policy relating to
the affairs of Native Hawaiians.
`(A) IN GENERAL- The term `Papa Ola Lokahi' means an organization that--
`(i) is composed of public agencies and private organizations focusing
on improving the health status of Native Hawaiians; and
`(ii) governed by a board the members of which may include representation
from--
`(II) the Office of Hawaiian Affairs;
`(IV) the University of Hawaii;
`(V) the Hawai'i State Department of Health;
`(VI) the Native Hawaiian Health Task Force;
`(VII) the Hawai'i State Primary Care Association;
`(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 (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 (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 (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 (which may be composed of as many health care centers as
are necessary to meet the health care needs of the Native Hawaiians
of that island);
`(XIII) Hui Malama Ola Na `Oiwi, or a health care system serving
the island of Hawai'i (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) such other Native Hawaiian health care systems as are 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
shall admit from time to time, based on satisfactory demonstration
of a record of contribution to the health and well-being of Native
Hawaiians.
`(B) EXCLUSION- The term `Papa Ola Lokahi' does not include any organization
described in subparagraph (A) for which the Secretary has made a determination
that the organization has not developed a mission statement that includes--
`(i) clearly-defined goals and objectives for the contributions the
organization will make to--
`(I) Native Hawaiian health care systems; and
`(II) the national policy described in section 4; and
`(ii) an action plan for carrying out those goals and objectives.
`(12) SECRETARY- The term `Secretary' means the Secretary of Health and
Human Services.
`(13) STATE- The term `State' means the State of Hawaii.
`(14) TRADITIONAL NATIVE HAWAIIAN HEALER- The term `traditional Native
Hawaiian healer' means a practitioner--
`(i) is of Native Hawaiian ancestry; and
`(ii) has the knowledge, skills, and experience in direct personal
health care of individuals; and
`(B) the knowledge, skills, and experience of whom are based on demonstrated
learning of Native Hawaiian healing practices acquired by--
`(i) direct practical association with Native Hawaiian elders; and
`(ii) oral traditions transmitted from generation to generation.
`SEC. 4. DECLARATION OF NATIONAL NATIVE HAWAIIAN HEALTH POLICY.
`(a) Declaration- Congress declares that it is the policy of the United
States, in fulfillment of special responsibilities and legal obligations
of the United States to the indigenous people of Hawai'i resulting from
the unique and historical relationship between the United States and the
indigenous people of Hawaii--
`(1) to raise the health status of Native Hawaiians to the highest practicable
health level; and
`(2) to provide Native Hawaiian health care programs with all resources
necessary to effectuate that policy.
`(b) Intent of Congress- It is the intent of Congress that--
`(1) health care programs having a demonstrated effect of substantially
reducing or eliminating the overrepresentation of Native Hawaiians among
those suffering from chronic and acute disease and illness, and addressing
the health needs of Native Hawaiians (including perinatal, early child
development, and family-based health education needs), shall be established
and implemented; and
`(A) raise the health status of Native Hawaiians by the year 2010 to
at least the levels described in the goals contained within Healthy
People 2010 (or successor standards); and
`(B) incorporate within health programs in the United States activities
defined and identified by Kanaka Maoli, such as--
`(i) 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);
`(ii) increasing the number of Native Hawaiian health and allied-health
providers who provide care to or have an impact on the health status
of Native Hawaiians;
`(iii) increasing the use of traditional Native Hawaiian foods in--
`(I) the diets and dietary preferences of people, including those
of students; and
`(II) school feeding programs;
`(iv) identifying and instituting Native Hawaiian cultural values
and practices within the corporate cultures of organizations and agencies
providing health services to Native Hawaiians;
`(v) facilitating the provision of Native Hawaiian healing practices
by Native Hawaiian healers for individuals desiring that assistance;
`(vi) supporting training and education activities and programs in
traditional Native Hawaiian healing practices by Native Hawaiian healers;
and
`(vii) demonstrating the integration of health services for Native
Hawaiians, particularly those that integrate mental, physical, and
dental services in health care.
`(c) Report- The Secretary shall submit to the President, for inclusion
in each report required to be submitted to Congress under section 12, a
report on the progress made toward meeting the national policy described
in this section.
`SEC. 5. COMPREHENSIVE HEALTH CARE MASTER PLAN FOR NATIVE HAWAIIANS.
`(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 that
is designed--
`(A) to promote comprehensive health promotion and disease prevention
services;
`(B) to maintain and improve the health status of Native Hawaiians;
and
`(C) to support community-based initiatives that are reflective of holistic
approaches to health.
`(A) IN GENERAL- In carrying out this section, Papa Ola Lokahi and the
Office of Hawaiian Affairs shall consult with representatives of--
`(i) the Native Hawaiian health care systems;
`(ii) the Native Hawaiian health centers; and
`(iii) the Native Hawaiian community.
`(B) MEMORANDA OF UNDERSTANDING- Papa Ola Lokahi and the Office of Hawaiian
Affairs may enter into memoranda of understanding or agreement for the
purpose of acquiring joint funding, or for such other purposes as are
necessary, to accomplish the objectives of this section.
`(3) HEALTH CARE FINANCING STUDY REPORT-
`(A) IN GENERAL- Not later than 18 months after the date of enactment
of the Native Hawaiian Health Care Improvement Reauthorization Act of
2007, Papa Ola Lokahi, in cooperation with the Office of Hawaiian Affairs
and other appropriate agencies and organizations in the State (including
the Department of Health and the Department of Human Services of the
State) and appropriate Federal agencies (including the Centers for Medicare
and Medicaid Services), shall submit to Congress a report that describes
the impact of Federal and State health care financing mechanisms and
policies on the health and well-being of Native Hawaiians.
`(B) COMPONENTS- The report shall include--
`(i) information concerning the impact on Native Hawaiian health and
well-being of--
`(I) cultural competency;
`(II) risk assessment data;
`(III) eligibility requirements and exemptions; and
`(IV) reimbursement policies and capitation rates in effect as of
the date of the report for service providers;
`(ii) such other similar information as may be important to improving
the health status of Native Hawaiians, as that information relates
to health care financing (including barriers to health care); and
`(iii) recommendations for submission to the Secretary, for review
and consultation with the Native Hawaiian community.
`(b) Authorization of Appropriations- There are authorized to be appropriated
such sums as are necessary to carry out subsection (a).
`SEC. 6. FUNCTIONS OF PAPA OLA LOKAHI.
`(a) In General- Papa Ola Lokahi--
`(1) shall be responsible for--
`(A) the coordination, implementation, and updating, as appropriate,
of the comprehensive health care master plan under section 5;
`(B) the training and education of individuals providing health services;
`(C) the identification of and research (including behavioral, biomedical,
epidemiological, and health service research) into the diseases that
are most prevalent among Native Hawaiians; and
`(D) the 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 service
research;
`(2) may receive special project funds (including research endowments
under section 736 of the Public Health Service Act (42 U.S.C. 293)) made
available for the purpose of--
`(A) research on the health status of Native Hawaiians; or
`(B) addressing the health care needs of Native Hawaiians; and
`(3) shall serve as a clearinghouse for--
`(A) the collection and maintenance of data associated with the health
status of Native Hawaiians;
`(B) the identification and research into diseases affecting Native
Hawaiians;
`(C) the availability of Native Hawaiian project funds, research projects,
and publications;
`(D) the collaboration of research in the area of Native Hawaiian health;
and
`(E) the timely dissemination of information pertinent to the Native
Hawaiian health care systems.
`(1) IN GENERAL- The Secretary and the Secretary of each other Federal
agency shall--
`(A) consult with Papa Ola Lokahi; and
`(B) provide Papa Ola Lokahi and the Office of Hawaiian Affairs, at
least once annually, an accounting of funds and services provided by
the Secretary to assist in accomplishing the purposes described in section
4.
`(2) COMPONENTS OF ACCOUNTING- The accounting under paragraph (1)(B) shall
include an identification of--
`(A) the amount of funds expended explicitly for and benefitting Native
Hawaiians;
`(B) the number of Native Hawaiians affected by those funds;
`(C) the collaborations between the applicable Federal agency and Native
Hawaiian groups and organizations in the expenditure of those funds;
and
`(D) the amount of funds used for--
`(i) Federal administrative purposes; and
`(ii) the provision of direct services to Native Hawaiians.
`(c) 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 made available
under this Act.
`(2) COORDINATION- Papa Ola Lokahi shall, to the maximum extent practicable,
coordinate and assist the health care programs and services provided to
Native Hawaiians under this Act and other Federal laws.
`(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.
`(d) Technical Support- Papa Ola Lokahi shall provide statewide infrastructure
to provide technical support and coordination of training and technical
assistance to--
`(1) the Native Hawaiian health care systems; and
`(2) the Native Hawaiian health centers.
`(e) Relationships With Other Agencies-
`(1) AUTHORITY- Papa Ola Lokahi may enter into agreements or memoranda
of understanding with relevant institutions, agencies, or organizations
that are capable of providing--
`(A) health-related resources or services to Native Hawaiians and the
Native Hawaiian health care systems; or
`(B) resources or services for the implementation of the national policy
described in section 4.
`(2) HEALTH CARE FINANCING-
`(A) FEDERAL CONSULTATION-
`(i) IN GENERAL- Before adopting any policy, rule, or regulation that
may affect the provision of services or health insurance coverage
for Native Hawaiians, a Federal agency that provides health care financing
and carries out health care programs (including the Centers for Medicare
and Medicaid Services) shall consult with representatives of--
`(I) the Native Hawaiian community;
`(II) Papa Ola Lokahi; and
`(III) organizations providing health care services to Native Hawaiians
in the State.
`(ii) IDENTIFICATION OF EFFECTS- Any consultation by a Federal agency
under clause (i) shall include an identification of the effect of
any policy, rule, or regulation proposed by the Federal agency.
`(B) STATE CONSULTATION- Before making any change in an existing program
or implementing any new program relating to Native Hawaiian health,
the State shall engage in meaningful consultation with representatives
of--
`(i) the Native Hawaiian community;
`(ii) Papa Ola Lokahi; and
`(iii) organizations providing health care services to Native Hawaiians
in the State.
`(C) CONSULTATION ON FEDERAL HEALTH INSURANCE PROGRAMS-
`(i) IN GENERAL- The Office of Hawaiian Affairs, in collaboration
with Papa Ola Lokahi, may develop consultative, contractual, or other
arrangements, including memoranda of understanding or agreement, with--
`(I) the Centers for Medicare and Medicaid Services;
`(II) the agency of the State that administers or supervises the
administration of the State plan or waiver approved under title
XVIII, XIX, or XXI of the Social Security Act (42 U.S.C. 1395 et
seq.) for the payment of all or a part of the health care services
provided to Native Hawaiians who are eligible for medical assistance
under the State plan or waiver; or
`(III) any other Federal agency providing full or partial health
insurance to Native Hawaiians.
`(ii) CONTENTS OF ARRANGEMENTS- An arrangement under clause (i) may
address--
`(I) appropriate reimbursement for health care services, including
capitation rates and fee-for-service rates for Native Hawaiians
who are entitled to or eligible for insurance;
`(II) the scope of services; or
`(III) other matters that would enable Native Hawaiians to maximize
health insurance benefits provided by Federal and State health insurance
programs.
`(3) TRADITIONAL HEALERS-
`(A) IN GENERAL- The provision of health services under any program
operated by the Department or another Federal agency (including the
Department of Veterans Affairs) may include the services of--
`(i) traditional Native Hawaiian healers; or
`(ii) traditional healers providing traditional health care practices
(as those terms are defined in section 4 of the Indian Health Care
Improvement Act (25 U.S.C. 1603).
`(B) EXEMPTION- Services described in subparagraph (A) shall be exempt
from national accreditation reviews, including reviews conducted by--
`(i) the Joint Commission on Accreditation of Healthcare Organizations;
and
`(ii) the Commission on Accreditation of Rehabilitation Facilities.
`SEC. 7. NATIVE HAWAIIAN HEALTH CARE.
`(a) Comprehensive Health Promotion, Disease Prevention, and Other Health
Services-
`(1) GRANTS AND CONTRACTS- The Secretary, in consultation with Papa Ola
Lokahi, may make grants to, or enter into contracts with 1 or more Native
Hawaiian health care systems for the purpose of providing comprehensive
health promotion and disease prevention services, as well as other health
services, to Native Hawaiians who desire and are committed to bettering
their own health.
`(2) LIMITATION ON NUMBER OF ENTITIES- The Secretary may make a grant
to, or enter into a contract with, not more than 8 Native Hawaiian health
care systems under this subsection for any fiscal year.
`(b) Planning Grant or Contract- In addition to grants and contracts under
subsection (a), the Secretary may make a grant to, or enter into a contract
with, Papa Ola Lokahi for the purpose of planning Native Hawaiian health
care systems to serve the health needs of Native Hawaiian communities on
each of the islands of O`ahu, Moloka`i, Maui, Hawai`i, Lana`i, Kaua`i, Kaho`lawe,
and Ni`ihau in the State.
`(c) Health Services To Be Provided-
`(1) IN GENERAL- Each recipient of funds under subsection (a) may provide
or arrange for--
`(A) outreach services to inform and assist Native Hawaiians in accessing
health services;
`(B) education in health promotion and disease prevention for Native
Hawaiians that, wherever practicable, is provided by--
`(i) Native Hawaiian health care practitioners;
`(ii) community outreach workers;
`(iv) cultural educators; and
`(v) other disease prevention providers;
`(C) services of individuals providing health services;
`(D) collection of data relating to the prevention of diseases and illnesses
among Native Hawaiians; and
`(E) support of culturally appropriate activities that enhance health
and wellness, including land-based, water-based, ocean-based, and spiritually-based
projects and programs.
`(2) TRADITIONAL HEALERS- The health care services referred to in paragraph
(1) that are provided under grants or contracts under subsection (a) may
be provided by traditional Native Hawaiian healers, as appropriate.
`(d) Federal Tort Claims Act- An individual who provides a medical, dental,
or other service referred to in subsection (a)(1) for a Native Hawaiian
health care system, including a provider of a traditional Native Hawaiian
healing service, shall be--
`(1) treated as if the individual were a member of the Public Health Service;
and
`(2) subject to section 224 of the Public Health Service Act (42 U.S.C.
233).
`(e) Site for Other Federal Payments-
`(1) IN GENERAL- A Native Hawaiian health care system that receives funds
under subsection (a) may serve as a Federal loan repayment facility.
`(2) REMISSION OF PAYMENTS- A facility described in paragraph (1) shall
be designed to enable health and allied-health professionals to remit
payments with respect to loans provided to the professionals under any
Federal loan program.
`(f) Restriction on Use of Grant and Contract Funds- The Secretary shall
not make a grant to, or enter into a contract with, an entity under subsection
(a) unless the entity agrees that amounts received under the grant or contract
will not, directly or through contract, be expended--
`(1) for any service other than a service described in subsection (c)(1);
`(2) to purchase or improve real property (other than minor remodeling
of existing improvements to real property); or
`(3) to purchase major medical equipment.
`(g) Limitation on Charges for Services- The Secretary shall not make a
grant to, or enter into a contract with, an entity under subsection (a)
unless the entity agrees that, whether health services are provided directly
or under a contract--
`(1) any health service under the grant or contract will be provided without
regard to the ability of an individual receiving the health service to
pay for the health service; and
`(2) the entity will impose for the delivery of such a health service
a charge that is--
`(A) made according to a schedule of charges that is made available
to the public; and
`(B) adjusted to reflect the income of the individual involved.
`(h) Authorization of Appropriations-
`(1) GENERAL GRANTS- There are authorized to be appropriated such sums
as are necessary to carry out subsection (a) for each of fiscal years
2007 through 2012.
`(2) PLANNING GRANTS- There are authorized to be appropriated such sums
as are necessary to carry out subsection (b) for each of fiscal years
2007 through 2012.
`(3) HEALTH SERVICES- There are authorized to be appropriated such sums
as are necessary to carry out subsection (c) for each of fiscal years
2007 through 2012.
`SEC. 8. ADMINISTRATIVE GRANT FOR PAPA OLA LOKAHI.
`(a) In General- In addition to any other grant or contract under this Act,
the Secretary may make grants to, or enter into contracts with, Papa Ola
Lokahi for--
`(1) coordination, implementation, and updating (as appropriate) of the
comprehensive health care master plan developed under section 5;
`(2) training and education for providers of health services;
`(3) identification of and research (including behavioral, biomedical,
epidemiologic, and health service research) into the diseases that are
most prevalent among Native Hawaiians;
`(4) a clearinghouse function for--
`(A) the collection and maintenance of data associated with the health
status of Native Hawaiians;
`(B) the identification and research into diseases affecting Native
Hawaiians; and
`(C) the availability of Native Hawaiian project funds, research projects,
and publications;
`(5) the establishment and maintenance of an institutional review board
for all health-related research involving Native Hawaiians;
`(6) the coordination of the health care programs and services provided
to Native Hawaiians; and
`(7) the administration of special project funds
