health promotion and disease prevention

health promotion and disease prevention Sec. 203. (a) The Congress finds that health promotion and disease prevention activities will— (1) improve the health and well being of Indians, and (2) reduce the expenses for medical care of Indians. (b) Section 4 (25 U.S.C. 1603), as amended by section 201(b) of this Act, is further amended by adding at the end thereof the following new subsections: “(k) ‘Health promotion’ includes— “(1) cessation of tobacco smoking, “(2) reduction in the misuse of alcohol and drugs, “(3) improvement of nutrition, “(4) improvement in physical fitness, “(5) family planning, “(6) control of stress, and “(7) pregnancy and infant care (including prevention of fetal alcohol syndrome). “(l) ‘Disease prevention’ includes— “(1) immunizations, “(2) control of high blood pressure, “(3) control of sexually transmittable diseases, “(4) prevention and control of diabetes, “(5) control of toxic agents, “(6) occupational safety and health, “(7) accident prevention. 102 STAT. 4805 “(8) fluoridation of water, and “(9) control of infectious agents.”. (c) Title II (25 U.S.C. 1621, et seq.), as amended by section 202 of this Act, is further amended by adding at the end thereof the following new sections: “health promotion and disease prevention services “Sec. 203. (a) The Secretary, acting through the Service, shall provide health promotion and disease prevention services to Indians. “(b) The Secretary shall submit to the President for inclusion in each statement which is required to be submitted to the Congress under section 201(f) an evaluation of— “(1) the health promotion and disease prevention needs of Indians, “(2) the health promotion and disease prevention activities which would best meet such needs, “(3) the internal capacity of the Service to meet such needs, and “(4) the resources which would be required to enable the Service to undertake the health promotion and disease prevention activities necessary to meet such needs. “(c)(1) The Secretary shall establish at least 1 demonstration project (but no more than 4 demonstration projects) to determine the most effective and cost-efficient means of— “(A) providing health promotion and disease prevention services, “(B) encouraging Indians to adopt good health habits, “(C) reducing health risks to Indians, particularly the risks of heart disease, cancer, stroke, diabetes, anxiety, depression, and lifestyle-related accidents, “(D) reducing medical expenses of Indians through health promotion and disease prevention activities, “(E) establishing a program— “(i) which trains Indians in the provision of health promotion and disease prevention services to members of their tribe, and “(ii) under which such Indians are available on a contract basis to provide such services to other tribes, and “(F) providing training and continuing education to employees of the Service, and to paraprofessionals participating in the Community Health Representative Program, in the delivery of health promotion and disease prevention services. “(2) The demonstration project described in paragraph (1) shall include an analysis of the cost effectiveness of organizational structures and of social and educational programs that may be useful in achieving the objectives described in paragraph (1). “(3)(A) The demonstration project described in paragraph (1) shall be conducted in association with at least one— “(i) health profession school, “(ii) allied health profession or nurse training institution, or “(iii) public or private entity that provides health care. “(B) The Secretary is authorized to enter into contracts with, or make grants to, any school of medicine or school of osteopathy for the purpose of carrying out the demonstration project described in paragraph (1). 102 STAT. 4806 “(C) Far purposes of this paragraph, the term ‘school of medicine’ and ‘school of osteopathy’ have the respective meaning given to such terms by section 701(4) of the Public Health Service Act (42 U.S.C. 292a(4)). “(4) The Secretary shall submit to Congress a final report on the demonstration project described in paragraph (1) within 60 days after the termination of such project. “(5) The demonstration project described in paragraph (1) shall be established by no later than the date that is 12 months after the date of enactment of the Indian Health Care Amendments of 1988 and shall terminate on the date that is 30 months after the date of enactment of such amendments. “(6) There are authorized to be appropriated $500,000 for the purpose of carrying out the provisions of this subsection, such sum to remain available without fiscal year limitation. “diabetes prevention, treatment, and control “Sec. 204. (a)(1) The Secretary, in consultation with the tribes, shall determine— “(A) by tribe and by Service unit of the Service, the incidence of, and the types of complications resulting from, diabetes among Indians; and “(B) based on subparagraph (A), the measures (including patient education) each Service unit should take to reduce the incidence of, and prevent, treat, and control the complications resulting from, diabetes among tribes within that Service unit. “(2) Within 18 months after the date of enactment of the Indian Health Care Amendments of 1988, the Secretary shall prepare and transmit to the President and the Congress a report describing the determinations made and measures taken under paragraph (1) and making recommendations for additional funding to prevent, treat, and control diabetes among Indians. “(b) The Secretary shall screen each Indian who receives services from the Service for diabetes and for conditions which indicate a high risk that the individual will become diabetic. Such screening may be done by a tribe or tribal organization operating health care programs or facilities with funds from the Service under the Indian Self-Determination Act. “(c)(1) The Secretary shall continue to maintain during fiscal years 1988 through 1991 each of the following model diabetes projects which are in existence on the date of enactment of the Indian Health Care Amendments of 1988: “(A) Claremore Indian Hospital in Oklahoma; “(B) Fort Totten Health Center in North Dakota; “(C) Sacaton Indian Hospital in Arizona; “(D) Winnebago Indian Hospital in Nebraska; “(E) Albuquerque Indian Hospital in New Mexico; “(F) Perry, Princeton, and Old Town Health Centers in Maine; and “(G) Bellingham Health Center in Washington. “(2) The Secretary shall establish in fiscal year 1989, and maintain during fiscal years 1989 through 1991, a model diabetes project in each of the following locations: “(A) Fort Berthold Reservation; “(B) the Navago Reservation; “(C) the Papago Reservation; 102 STAT. 4807 “(D) the Zuni Reservation; and “(E) the States of Alaska, California, Minnesota, Montana, Oregon, and Utah. “(d) The Secretary shall— “(1) employ in each area office of the Service at least one diabetes control officer who shall coordinate and manage on a full-time basis activities within that area office for the prevention, treatment, and control of diabetes; “(2) establish in each area office of the Service a registry of patients with diabetes to track the incidence of diabetes and the complications from diabetes in that area; and “(3) ensure that data collected in each area office regarding diabetes and related complications among Indians is disseminated to all other area offices. “(e) There are authorized to be appropriated such sums as may be necessary to carry out the provisions of this section. Funds appropriated under subsection (c) in any fiscal year shall be in addition to base resources appropriated to the Service for that year. “native hawaiian health promotion and disease prevention “Sec. 205. (a)(1) The Secretary shall, acting through the Public Health Service, establish in the State of Hawaii, as a demonstration project, a Native Hawaiian Program for Health Promotion and Disease Prevention for the purpose of exploring ways to meet the unique health care needs of Native Hawaiians. “(2) The demonstration program that is to be established under paragraph (1) shall— “(A) provide necessary preventive-oriented health services, including health education and mental health care, “(B) develop innovative training and research projects, “(C) establish cooperative relationships with the leadership of the Native Hawaiian community, “(D) ensure that a continuous effort is made to establish programs which can be of direct benefit to other Native American people, and “(E) assure a comprehensive effort to reduce the incidence of diabetes among Native Hawaiians. “(3) The Secretary is authorized to enter into contracts with Native Hawaiian organizations for the purpose of assisting the Secretary in meeting the objectives of the demonstration program that is to be established under paragraph (1). “(b)(1) In fulfillment of the objective set forth in subsection (a)(2)(E), the Secretary shall enter into a contract with a Native “Hawaiian organization to conduct a study to determine— “(A) the incidence of diabetes among Native Hawaiians: “(B) activities which should be undertaken— “(i) to reduce the incidence of diabetes among Native Hawaiians, “(ii) to provide Native Hawaiians with guidance in the prevention, treatment, and control of diabetes, “(iii) to provide early diagnosis of diabetes among Native Hawaiians, and “(iv) to ensure that proper continuing health care is provided to Native Hawaiians who are diagnosed as diabetic. 102 STAT. 4808 “(2) The Secretary shall enter into a contract with a Native Hawaiian organization for the purpose of preparing an inventory of all health care programs (public and private) within the State of Hawaii that are available for the treatment, prevention, or control of diabetes among Native Hawaiians. “(3) By no later than the date that is two years after the date of enactment of this section, the Native Hawaiian organization with whom the Secretary has entered into a contract, shall prepare and transmit to the Secretary a report describing the determinations made under paragraph (1), containing the inventory prepared under paragraph (2), and describing the research activities conducted under this subsection. The Secretary shall submit the report to the Congress and the President. “(c)(1) By no later than the date that is three years after the date of enactment of this section, the Secretary shall enter into a contract with a Native Hawaiian organization for the purpose of implementing a program designed— “(A) to establish a diabetes control program; “(B) to screen those Native Hawaiian individuals that have been identified as having a high risk of becoming diabetic; “(C) to effectively treat— “(i) individuals diagnosed as diabetics in order to reduce further complications from diabetes, “(ii) individuals who have a high risk of becoming diabetic in order to reduce the incidence of diabetes, and “(iii) short- and long-term complications of diabetes; “(D) to conduct for Federal, State, and other Native Hawaiian health care providers (including Native Hawaiian community health outreach workers), training programs concerning current methods of prevention, diagnosis, and treatment of diabetes and related complications among Native Hawaiians; “(E) to determine the appropriate delivery to Native Hawaiians of health care services relating to diabetes; “(F) to develop and present health education information to Native Hawaiian communities and schools concerning the prevention, treatment, and control of diabetes; and “(G) to ensure that proper continuing health care is provided to Native Hawaiians who are diagnosed as being diabetic. “(2) The Secretary shall enter into a contract with a Native Hawaiian organization for the purpose of— “(A) promoting coordination and cooperation between all health care providers in the delivery of diabetes related services to Native Hawaiians; and “(B) encouraging and funding joint projects between Federal programs, State health care facilities, community health centers, and Native Hawaiian communities for the prevention and treatment of diabetes. “(3)(A) The Secretary shall enter into a contract with a Native Hawaiian organization for the purpose of establishing a model diabetes program to serve Native Hawaiians in the State of Hawaii. “(B) The Secretary shall enter into a contract with a Native Hawaiian organization for the purpose of developing and implementing an outreach program to ensure that the achievements and benefits derived from the activities of the model diabetes program established under subparagraph (A) are applied in Native Hawaiian communities to assure the diagnosis, prevention, and treatment of diabetes among Native Hawaiians. 102 STAT. 4809 “(4) The Secretary shall submit to the Congress an annual report outlining the activities, achievements, needs, and goals of the Native Hawaiian diabetes care program established under this paragraph. “(d) The Secretary shall enter into a contract with a Native Hawaiian organization, for the purpose of developing a standardized system to collect, analyze, and report data regarding diabetes and related complications among Native Hawaiians. Such system shall be designed to facilitate dissemination of the best available information on diabetes to Native Hawaiian communities and health care professionals. “(e) The Secretary shall enter into a contract with a Native Hawaiian organization for the purpose of— “(1) conducting research concerning the causes, diagnosis, treatment, and prevention of diabetes and related complications among Native Hawaiians, and “(2) coordinating such research with all other relevant agencies and units of the government of the State of Hawaii and the Department of Health and Human Services which conduct research relating to diabetes and related complications. “(f) The Secretary shall submit to the Congress an annual report on the status and accomplishments of the progress established under this section during each of the fiscal years 1990, 1991, and 1992. “(g)(1) The Secretary shall include in any contract which the Secretary enters into with any Native Hawaiian organization under this subsection such conditions as the Secretary considers necessary to ensure that the objectives of such contract are achieved. “(2) The Secretary shall develop procedures to evaluate compliance with, and performance of, contracts entered into by Native Hawaiian organizations under this subsection. “(3) The Secretary shall conduct an evaluation of each Native Hawaiian organization which has entered into a contract under this subsection for purposes of determining the compliance of such organization with, and evaluating the performance of such organization under, such contract. “(4) If, as a result of the evaluations conducted under paragraph (3), the Secretary determines that a Native Hawaiian organization has not complied with or satisfactorily performed a contract entered into under this subsection, the Secretary shall, prior to renewing such contract, attempt to resolve the areas of noncompliance or unsatisfactory performance and modify such contract to prevent future occurrences of such noncompliance or unsatisfactory performance. If the Secretary determines that such noncompliance or unsatisfactory performance cannot be resolved and prevented in the future, the Secretary shall not renew such contract with such organization and is authorized to enter into a contract under this subsection with another Native Hawaiian organization that serves the same population of Native Hawaiians which is served by the Native Hawaiian organization whose contract is not renewed by reason of this subparagraph. “(5) In determining whether to renew a contract entered into with a Native Hawaiian organization under this subsection, the Secretary shall— “(A) review the records of the Native Hawaiian organization, and “(B) shall consider the results of the onsite evaluations conducted under paragraph (3). 102 STAT. 4810 “(6) All contracts entered into by the Secretary under this subsection shall be in accordance with all Federal contracting laws and regulations except that, in the discretion of the Secretary, such contracts may be negotiated without advertising and need not conform to the provision of the Act of August 24, 1935 (40 U.S.C. 270a, et seq.). “(7) Payments made under any contract entered into under this subsection may be made in advance, by means of reimbursement, or in installments and shall be made on such conditions as the Secretary deems necessary to carry out the purposes of this subsection. “(8) Notwithstanding any other provision of law, the Secretary may, at the request or consent of a Native Hawaiian organization, revise or amend any contract entered into by the Secretary with such organization under this subsection as necessary to carry out the purposes of this subsection. “(9)(A) For each fiscal year during which a Native Hawaiian organization receives or expends funds pursuant to a contract entered into under this subsection, such organization shall submit to the Secretary a quarterly report on— “(i) activities conducted by the organization under the contract, “(ii) the amounts and purposes for which Federal funds were expended, and “(iii) such other information as the Secretary may request. “(B) The reports and records of any Native Hawaiian organization which concern any contract entered into under this subsection shall be subject to audit by the Secretary and the Comptroller General of the United States. “(10) The Secretary shall allow as a cost of any contract entered into under this subsection the cost of an annual private audit conducted by a certified public accountant. “(11) The authority of the Secretary to enter into contracts under this subsection shall be to the extent, and in amounts, provided for in appropriation Acts. “(h) For purposes of this subsection— “(1) The term ‘Native Hawaiian’ means any individual who— “(A) is a citizen of the United States, “(B) is a resident of the State of Hawaii, and “(C) is a descendant of the aboriginal people who, prior to 1778, occupied and exercised sovereignty in the area that now constitutes the State of Hawaii, as evidenced by— “(i) genealogical records, “(ii) Kupuna (elders) or Kama’aina (long-term community residents) verification, or “(iii) birth records of the State of Hawaii. “(2) The term ‘Native Hawaiian organization’ means any organization— “(A) which serves and represents the interests of Native Hawaiians, “(B) which is recognized by the Department of Health of the State of Hawaii, the Office of Hawaiian Affairs of the State of Hawaii, and E Ola Mau for the purpose of planning, conducting, or administering programs (or portion of programs) authorized under this Act for Native Hawaiians, and 102 STAT. 4811 “(C) in which Native Hawaiian health professionals significantly participate in the planning, management, monitoring, and evaluation of health services. “(i) There are authorized to be appropriated $750,000 for each of the fiscal years 1990, 1991, 1992, and 1993, for the purpose of carrying out the provisions of this subsection. “(j) The programs and services established by this section shall not be administered by or through the Indian Health Service nor shall any funds appropriated to the Indian Health Service be used to supplement funding of such programs and services.”.