Native Hawaiian Health Care Improvement Reauthorization Act of 2009 - Reauthorizes for for FY2009-FY2014 and revises the Native Hawaiian Health Care Improvement Act. Requires any Department of Health and Human Services (HHS) grant to or contract with Papa Ola Lokahi (an organization of public agencies and private organizations focused on improving the health status of Native Hawaiians) to support community-based initiatives that reflect holistic approaches to health.
Requires Papa Ola Lokahi to report to Congress on the impact of federal and state health care financing mechanisms and policies on the health and well-being of Native Hawaiians.
Makes Papa Ola Lokahi eligible to receive research endowments under the Public Health Service Act.
Adds to authorized services the support of culturally appropriate activities enhancing health and wellness, including land-, water-, ocean-, and spiritually-based projects and programs.
Allows a priority for Native Hawaiian health scholarships to be provided to employees of the Native Hawaiian Health Care Systems and the Native Hawaiian Health Centers. Allows the provision of financial assistance to a scholarship recipient during the period of obligated service in any of such health care systems or health centers.
Authorizes Papa Ola Lokahi to provide fellowships to Native Hawaiian health professionals.
Authorizes the Secretary of Health and Human Services to allocate funds to carry out Native Hawaiian demonstration projects of national significance, including the establishment of specified Native Hawaiian Centers of Excellence. Deems the Papa Ola Lokahi as a qualified Center of Excellence.
[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4024 Introduced in House (IH)]
111th CONGRESS
1st Session
H. R. 4024
To amend the Native Hawaiian Health Care Improvement Act to revise and
extend that Act.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
November 4, 2009
Ms. Hirono (for herself and Mr. Abercrombie) introduced the following
bill; which was referred to the Committee on Energy and Commerce
_______________________________________________________________________
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 2009''.
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:
``SEC. 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. 2. Findings.
``Sec. 3. Definitions.
``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. 12. Report.
``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. 17. Severability.
``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;
``(2) Native Hawaiians--
``(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
``(ii) international law;
``(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.--
``(A) Cancer.--
``(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.
``(7) Behavioral health.--
``(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);
``(iii) in 2002--
``(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);
``(ii) in 2000--
``(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.
``In this Act:
``(1) Department.--The term `Department' means the
Department of Health and Human Services.
``(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 chronic diseases;
``(E) control of toxic agents;
``(F) occupational safety and health;
``(G) injury prevention;
``(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;
``(F) family planning;
``(G) control of stress;
``(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.
``(11) Papa ola lokahi.--
``(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--
``(I) E Ola Mau;
``(II) the Office of Hawaiian
Affairs;
``(III) Alu Like, Inc.;
``(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--
``(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) 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
``(2) the United States--
``(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.
``(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 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.
``(2) Consultation.--
``(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 2009, 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.
``(b) Consultation.--
``(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;
``(iii) counselors;
``(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 2009 through 2014.
``(2) Planning grants.--There are authorized to be
appropriated such sums as are necessary to carry out subsection
(b) for each of fiscal years 2009 through 2014.
``(3) Health services.--There are authorized to be
appropriated such sums as are necessary to carry out subsection
(c) for each of fiscal years 2009 through 2014.
``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.
``(b) Authorization of Appropriations.--There are authorized to be
appropriated such sums as are necessary to carry out subsection (a) for
each of fiscal years 2009 through 2014.
``SEC. 9. ADMINISTRATION OF GRANTS AND CONTRACTS.
``(a) Terms and Conditions.--The Secretary shall include in any
grant made or contract entered into under this Act such terms and
conditions as the Secretary considers necessary or appropriate to
ensure that the objectives of the grant or contract are achieved.
``(b) Periodic Review.--The Secretary shall periodically evaluate
the performance of, and compliance with, grants and contracts under
this Act.
``(c) Administrative Requirements.--The Secretary shall not make a
grant or enter into a contract under this Act with an entity unless the
entity--
``(1) agrees to establish such procedures for fiscal
control and fund accounting as the Secretary determines are
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 1 individual who is
fluent in English and the appropriate language to
assist in carrying out the plan;
``(4) with respect to health services that are covered
under a program under title XVIII, XIX, or XXI of the Social
Security Act (42 U.S.C. 1395 et seq.) (including any State
plan), or under any other Federal health insurance plan--
``(A) if the entity will provide under the grant or
contract any of those health services directly--
``(i) has entered into a participation
agreement under each such plan; and
``(ii) is qualified to receive payments
under the plan; and
``(B) if the entity will provide under the grant or
contract any of those health services through a
contract with an organization--
``(i) ensures that the organization has
entered into a participation agreement under
each such plan; and
``(ii) ensures that the organization is
qualified to receive payments under the plan;
and
``(5) agrees to submit to the Secretary and Papa Ola Lokahi
an annual report that--
``(A) describes the use and costs of health
services provided under the grant or contract
(including the average cost of health services per
user); and
``(B) provides such other information as the
Secretary determines to be appropriate.
``(d) Contract Evaluation.--
``(1) Determination of noncompliance.--If, as a result of
evaluations conducted by the Secretary, the Secretary
determines that an entity has not complied with or
satisfactorily performed a contract entered into under section
7, the Secretary shall, before renewing the contract--
``(A) attempt to resolve the areas of noncompliance
or unsatisfactory performance; and
``(B) modify the contract to prevent future
occurrences of the noncompliance or unsatisfactory
performance.
``(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--
``(A) shall not renew the contract with the entity;
and
``(B) may enter into a contract under section 7
with another entity referred to in section 7(a)(3) that
provides services to the same population of Native
Hawaiians served by the entity the contract with which
was not renewed by reason of this paragraph.
``(3) Consideration of results.--In determining whether to
renew a contract entered into with an entity under this Act,
the Secretary shall consider the results of the evaluations
conducted under this section.
``(4) Application of federal laws.--Each contract entered
into by the Secretary under this Act shall be in accordance
with all Federal contracting laws (including regulations),
except that, in the discretion of the Secretary, such a
contract may--
``(A) be negotiated without advertising; and
``(B) be exempted from subchapter III of chapter
31, United States Code.
``(5) Payments.--A payment made under any contract entered
into under this Act--
``(A) may be made--
``(i) in advance;
``(ii) by means of reimbursement; or
``(iii) in installments; and
``(B) shall be made on such conditions as the
Secretary determines to be necessary to carry out this
Act.
``(e) Report.--
``(1) In general.--For each fiscal year during which an
entity receives or expends funds under a grant or contract
under this Act, the entity shall submit to the Secretary and to
Papa Ola Lokahi an annual report that describes--
``(A) the activities conducted by the entity under
the grant or contract;
``(B) the amounts and purposes for which Federal
funds were expended; and
``(C) such other information as the Secretary may
request.
``(2) Audits.--The reports and records of any entity
concerning any grant or contract under this Act shall be
subject to audit by--
``(A) the Secretary;
``(B) the Inspector General of the Department of
Health and Human Services; and
``(C) the Comptroller General of the United States.
``(f) Annual Private Audit.--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 conducted by a certified public accountant to
carry out this section.
``SEC. 10. ASSIGNMENT OF PERSONNEL.
``(a) In General.--The Secretary may enter into an agreement with
Papa Ola Lokahi or any of the Native Hawaiian health care systems for
the assignment of personnel of the Department of Health and Human
Services with relevant expertise for the purpose of--
``(1) conducting research; or
``(2) providing comprehensive health promotion and disease
prevention services and health services to Native Hawaiians.
``(b) Applicable Federal Personnel Provisions.--Any assignment of
personnel made by the Secretary under any agreement entered into under
subsection (a) 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. 11. NATIVE HAWAIIAN HEALTH SCHOLARSHIPS AND FELLOWSHIPS.
``(a) Eligibility.--Subject to the availability of amounts
appropriated under subsection (c), the Secretary shall provide to Papa
Ola Lokahi, through a direct grant or a cooperative agreement, funds
for the purpose of providing scholarship and fellowship assistance,
counseling, and placement service assistance to students who are Native
Hawaiians.
``(b) Priority.--A priority for scholarships under subsection (a)
may be provided to employees of--
``(1) the Native Hawaiian Health Care Systems; and
``(2) the Native Hawaiian Health Centers.
``(c) Terms and Conditions.--
``(1) Scholarship assistance.--
``(A) In general.--The scholarship assistance under
subsection (a) shall be provided in accordance with
subparagraphs (B) through (G).
``(B) Need.--The provision of scholarships in each
type of health profession training shall correspond to
the need for each type of health professional to serve
the Native Hawaiian community in providing health
services, as identified by Papa Ola Lokahi.
``(C) Eligible applicants.--To the maximum extent
practicable, the Secretary shall select scholarship
recipients from a list of eligible applicants submitted
by Papa Ola Lokahi.
``(D) Obligated service requirement.--
``(i) In general.--An obligated service
requirement for each scholarship recipient
(except for a recipient receiving assistance
under paragraph (2)) shall be fulfilled through
service, in order of priority, in--
``(I) any of the Native Hawaiian
health care systems;
``(II) any of the Native Hawaiian
health centers;
``(III) 1 or more health
professions shortage areas, medically
underserved areas, or geographic areas
or facilities similarly designated by
the Public Health Service in the State;
``(IV) a Native Hawaiian
organization that serves a geographical
area, facility, or organization that
serves a significant Native Hawaiian
population;
``(V) any public agency or
nonprofit organization providing
services to Native Hawaiians; or
``(VI) any of the uniformed
services of the United States.
``(ii) Assignment.--The placement service
for a scholarship shall assign each Native
Hawaiian scholarship recipient to 1 or more
appropriate sites for service in accordance
with clause (i).
``(E) Counseling, retention, and support
services.--The provision of academic and personal
counseling, retention and other support services--
``(i) shall not be limited to scholarship
recipients under this section; and
``(ii) shall be made available to
recipients of other scholarship and financial
aid programs enrolled in appropriate health
professions training programs.
``(F) Financial assistance.--After consultation
with Papa Ola Lokahi, financial assistance may be
provided to a scholarship recipient during the period
that the recipient is fulfilling the service
requirement of the recipient in any of--
``(i) the Native Hawaiian health care
systems; or
``(ii) the Native Hawaiians health centers.
``(G) Distance learning recipients.--A scholarship
may be provided to a Native Hawaiian who is enrolled in
an appropriate distance learning program offered by an
accredited educational institution.
``(2) Fellowships.--
``(A) In general.--Papa Ola Lokahi may provide
financial assistance in the form of a fellowship to a
Native Hawaiian health professional who is--
``(i) a Native Hawaiian community health
representative, outreach worker, or health
program administrator in a professional
training program;
``(ii) a Native Hawaiian providing health
services; or
``(iii) a Native Hawaiian enrolled in a
certificated program 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).
``(B) Types of assistance.--Assistance under
subparagraph (A) may include a stipend for, or
reimbursement for costs associated with, participation
in a program described in that paragraph.
``(3) Rights and benefits.--An individual who is a health
professional designated in section 338A of the Public Health
Service Act (42 U.S.C. 254l) who receives a scholarship under
this subsection while fulfilling a service requirement under
that Act shall retain the same rights and benefits as members
of the National Health Service Corps during the period of
service.
``(4) No inclusion of assistance in gross income.--
Financial assistance provided under this section shall be
considered to be qualified scholarships for the purpose of
section 117 of the Internal Revenue Code of 1986.
``(d) Authorization of Appropriations.--There are authorized to be
appropriated such sums as are necessary to carry out subsections (a)
and (c)(2) for each of fiscal years 2009 through 2014.
``SEC. 12. REPORT.
``For each fiscal year, the President shall, at the time at which
the budget of the United States is submitted under section 1105 of
title 31, United States Code, submit to Congress a report on the
progress made in meeting the purposes of this Act, including--
``(1) a review of programs established or assisted in
accordance with this Act; and
``(2) an assessment of and recommendations for additional
programs or additional assistance necessary to provide, at a
minimum, health services to Native Hawaiians, and ensure a
health status for Native Hawaiians, that 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 an organization that
enters into a contract or receives grant under this Act to use in
carrying out projects or activities under the contract or grant all
existing facilities under the jurisdiction of the Secretary (including
all equipment of the facilities), in accordance with such terms and
conditions as may be agreed on for the use and maintenance of the
facilities or equipment.
``(b) Donation of Property.--The Secretary may donate to an
organization that enters into a contract or receives grant under this
Act, for use in carrying out a project or activity under the contract
or grant, any personal or real property determined to be in excess of
the needs of the Department or the General Services Administration.
``(c) Acquisition of Surplus Property.--The Secretary may acquire
excess or surplus Federal Government personal or real property for
donation to an organization under subsection (b) if the Secretary
determines that the property is appropriate for use by the organization
for the purpose for which a contract entered into or grant received by
the organization is authorized under this Act.
``SEC. 14. DEMONSTRATION PROJECTS OF NATIONAL SIGNIFICANCE.
``(a) Authority and Areas of Interest.--
``(1) In general.--The Secretary, in consultation with Papa
Ola Lokahi, may allocate amounts made available under this Act,
or any other Act, to carry out Native Hawaiian demonstration
projects of national significance.
``(2) Areas of interest.--A demonstration project described
in paragraph (1) may relate to such areas of interest as--
``(A) the development of a centralized database and
information system relating to the health care status,
health care needs, and wellness of Native Hawaiians;
``(B) 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;
``(C) the integration of Western medicine with
complementary healing practices, including traditional
Native Hawaiian healing practices;
``(D) the use of telehealth and telecommunications
in--
``(i) chronic and infectious disease
management; and
``(ii) health promotion and disease
prevention;
``(E) the development of appropriate models of
health care for Native Hawaiians and other indigenous
people, including--
``(i) the provision of culturally competent
health services;
``(ii) related activities focusing on
wellness concepts;
``(iii) the development of appropriate
kupuna care programs; and
``(iv) the development of financial
mechanisms and collaborative relationships
leading to universal access to health care; and
``(F) the establishment of--
``(i) a Native Hawaiian Center of
Excellence for Nursing at the University of
Hawai'i at Hilo;
``(ii) a Native Hawaiian Center of
Excellence for Mental Health at the University
of Hawai'i at Manoa;
``(iii) a Native Hawaiian Center of
Excellence for Maternal Health and Nutrition at
the Waimanalo Health Center;
``(iv) a Native Hawaiian Center of
Excellence for Research, Training, Integrated
Medicine at Molokai General Hospital; and
``(v) a Native Hawaiian Center of
Excellence for Complementary Health and Health
Education and Training at the Waianae Coast
Comprehensive Health Center.
``(3) Centers of excellence.--Papa Ola Lokahi, and any
centers established under paragraph (2)(F), shall be considered
to be qualified as Centers of Excellence under sections 485F
and 903(b)(2)(A) of the Public Health Service Act (42 U.S.C.
287c-32, 299a-1).
``(b) Nonreduction in Other Funding.--The allocation of funds for
demonstration projects under subsection (a) shall not result in any
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 the respective
responsibilities of those entities under this Act.
``SEC. 15. RULE OF CONSTRUCTION.
``Nothing in this Act restricts the authority of the State to
require licensing of, and issue licenses to, health practitioners.
``SEC. 16. COMPLIANCE WITH BUDGET ACT.
``Any new spending authority described in subparagraph (A) or (B)
of section 401(c)(2) of the Congressional Budget Act of 1974 (2 U.S.C.
651(c)(2)) that 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 Acts of appropriation.
``SEC. 17. SEVERABILITY.
``If any provision of this Act, or the application of any such
provision to any person or circumstance, is determined by a court of
competent jurisdiction to be invalid, the remainder of this Act, and
the application of the provision to a person or circumstance other than
that to which the provision is held invalid, shall not be affected by
that holding.''.
<all>
Introduced in House
Introduced in House
Sponsor introductory remarks on measure. (CR E2707)
Referred to the House Committee on Energy and Commerce.
Referred to the Subcommittee on Health.
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