KAREN:  So in the early days, there was no certification?
 
LINDA:  There was a certification process and it did come -- it was the completing -- completion of basic training, their skills checklist, recommendations by their physician, their village doc, their Public Health nurse, the field folks, their statewide through the certification exam, written and clinical exam, but it wasn't a certification board. 

A certification board is relatively new in the network of pieces of the puzzle.  And that board was created to look at sort of standardizing the review process and also granting certification so that allows for Medicaid reimbursement, which is very new on the scene, where the health aides are able to bill, that they are -- the care that they are giving is billed and payment, then, into the health corporations. 

KAREN:  Okay.  I thought as Indian Health Service type things that they wouldn't have Medicaid billing. 

LINDA:  It depends on the individual and -- and whether they are registered for that.  And those kinds of questions probably Steve Gage or some of the other health CHAP directors could talk more about in terms of how that network happens.

KAREN:  So what you -- your involvement, the health corporations were already the ones running the program.

LINDA:  Uh-hum.

MARLA:  You weren't involved when it was Indian Health Service in that transition? 

LINDA:  I was.  Uh-hum.  I was.  I just have always been on the training side.  My -- my piece of the puzzle in this whole sort of network of folks has been basic training.  Basic, then advanced, and now course work towards those who want to get their Associates of Applied Science degree.  So that is the segment. 

And through networking with folks -- so I -- yes, going back to 1980, we had Indian Health Service Hospital relationship so that there was the IHS, YKHC, and the college. 

So there were sort of the three entities all involved in the training of health aides because we -- the training staff and center was within the community college, Kuskokwim Community College in Bethel.  The corporation hired and paid and supervised, and the hospital was our clinical facility, so that we were working in the hospital on a daily basis, but it was sort of -- it was then a really true partnership between these three agencies for the training of health aides. 

KAREN:  Uh-huh. 

LINDA:  That's in the early use.
 
And then in the late -- into the '80s and early '90s, you probably learned that's when the corporations then took over the -- the running of the hospitals throughout the state.  And they also did sort of the compact era now in the '90s and as you know, the Alaska Native Tribal Health Consortium was formed in 1998. 

And so there's just been a tremendous shift in change over time in the administrative component.  And I think to the betterment of health care and the networking of the issues.