STATE NEWS

REPUBLIC OF INDONESIA No. 2069, 2016 BPJS Kesehatran. Quality Control. Control Charges.

Application.

REGULATION OF HEALTH SOCIAL SECURITY ORGANIZER

NUMBER 8 YEAR 2016

ABOUT

APPLICATION OF QUALITY CONTROL AND COST CONTROL ON

HOSTING THE NATIONAL HEALTH GUARANTEE PROGRAM

WITH GRACE OF GOD ALMIGHTY

PRINCIPAL DIRECTOR

THE GOVERNING BODY OF SOCIAL SECURITY GUARANTEE,

DRAWS: A. that the development of a quality control system and the system

health care payments aim to

increase the effectiveness of the guarantee

health hosting;

b. that required setting up of system application

control of service quality and payment system

health care;

c. that based on consideration as

referred to in letter a and b above as well as for

running the provisions of Section 42 paragraph (3) Regulation

President Number 12 Year 2013 on Guarantee

Health as it has been several times amended

last with Presidential Regulation Number 28 of the Year

2016, need to establish the Organizing Agency Regulation

Social Security Guarantee on Application Control

Mutu and Charge Control on the Program

National Health Guarantee;

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Given: 1. Law No. 40 of the Year 2004 on System

National Social Security (Republican Gazette

Indonesia Year 2004 Number 150, Extra Sheet

State of the Republic of Indonesia No. 4456);

2. Law No. 24 Year 2011 on Agency

Social Security Organizing (State Sheet

Republic Of Indonesia In 2011 Number 116, Additional

Page Of State Of Republic Indonesia Number 5256);

3. President Regulation No. 12 of 2013 on

Health Guarantee (Republican Gazette

Indonesia Tahun 2013 No. 29) as has been

changed several times, last with Regulation

President Number 28 Year 2016 about Changes

Third in the Regulation of the President of the Republic of Indonesia

No. 12 Year 2013 on Health Guarantee

(Republic of Indonesia State Gazette 2016

Number 62);

4. Health Minister Regulation No. 71 of 2013

on Health Care on Health Guarantee

National (Republic of Indonesia State News 2013

Number 1400) as amended with

Ministerial Regulation Health Number 99 Year 2015

about Changes to Health Minister Regulation

Number 71 of 2013 on Health Care

on National Health Guarantee (State News

Republic of Indonesia Year 2016 Number 15);

5. Health Minister Rule Number 5 Year 2016

on the Clinical Considerations (Clinical

Advisory) (Republic of Indonesia State News 2016

Number 370);

6. List of Social Security Organizing Bodies

Health Number 1 Year 2014 on

Hosting of Health (State News

Republic of Indonesia of 2014 No. 1);

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DECIDED:

SET: THE GOVERNING BODY RULE OF SOCIAL SECURITY

HEALTH ON THE APPLICATION OF QUALITY CONTROL AND

COST CONTROL AT THE PROGRAM

THE HEALTH OF HEALTH CARE NASMAN.

BAB I

provisions of UMUM

Article 1

In the Social Security Organizing Agency Regulations

This health is referred to:

1. Health Assurance is a guarantee of protection

health for participants to benefit

health care and protection in

meets the basic health needs granted

to each person who has paid dues or

his dues are paid by the government.

2. The Health Social Security Organizing Board

next is abbreviated as BPJS Health is the agency

the law is set up to host the program

Health Guarantee.

3. Participants are each person, including a foreigner who

works at least 6 (six) months in Indonesia, which

has paid dues.

4. Benefits are a social security faedah that is entitled

Participants and/or family members.

5. A Health Facility is a health care facility

that is used to host efforts

individual health services, either promoting,

preventative, curative or rehabilitative performed

by Government, Local Government, and/or

Society.

6. The next First Level Health Facility

(FKTP) is a health facility that

performs a personal health service that

is non-specialistic for observation purposes,

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promotive, preventative, diagnosis, treatment, treatment,

and/or other health services.

7. Advanced Referral Health Facility

further abbreviated to FKRTL is a health facility

that performs a personal health service that

is a specialistic or sub-specialistic that includes

Advanced outpatient, advanced hospitalization

and outpatient in special care room.

Article 2

(1) Quality control and cost of health service charge

is done to guarantee the service health

to Participants in accordance with the specified quality and

hosted Efficiently.

(2) Quality control systems and service charge controls

health care at the Health Facility is conducted by

Health and BPJS Health facilities, coordinating

with the profession organization, facility association health,

County/City Health Service, Health Service

Province, and Ministry of Health.

(3) Hosting of quality control and control

health services as referred to in paragraph

(1) by BPJS Healthcare is done through fulfillment

quality standards include:

A. standard input on the Health Facility;

b. health care process standards; and

c. Standard health quality data participant.

Article 3

(1) In order to host quality control and control

health care costs as intended

in Section 2, BPJS Health applies its strategy

quality control and health care costs in

Health facilities are both in FKTP and FKRTL.

(2) Quality control and service costs

health at the Health Facility in question

on paragraph (1), performed through:

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a. creation of a quality control team and cost control;

b. the formation of the medik consideration board;

c. improved Health Facility cooperation; and

d. the application of the performance-based payment.

BAB II

TIM QUALITY CONTROL AND COST CONTROL

Part Kesatu

Structure

Section 4

(1) In order to exercise quality control and control

costs in hosting the social security program

health, BPJS Health forms the control team

quality and cost control.

(2) The control and cost control team as

referred to the paragraph (1) is divided over coordination team and

technical team.

Article 5

(1) The coordination team as referred to in Article 4

paragraph (2) consists of an element:

a. Profession organizations;

b. academic; and

c. clinical expert.

(2) The technical team as referred to in Section 4 of the paragraph (2)

consists of the clinician element which is the medical committee

the hospital in association with BPJS Health.

Article 6

(1) The coordination team and technical team as referred to

in Section 4 of the paragraph (2) are at the level:

a. center;

b. regional division; and

c. branch.

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(2) The team as referred to in paragraph (1) is in

any health facility in cooperation with BPJS

Health.

Second Section

Requirements and Membership

Paragraf Kesatu

General

Article 7

The candidate for quality control and control team is

a person who is from the element:

a. Profession organizations;

b. academic; or

c. clinical expert;

who has special expertise and/or knowledge in

the health social security field that meets the requirements

to be specified as a quality control team member and

control expenses by BPJS Healthcare Directors.

Second paragraph

Requirements

Article 8

(1) To be set to be a member of the control team

quality and control costs, one must meet

terms as follows:

a. Citizens of Indonesia;

b. Fear the Lord Almighty;

c. healthy physical and spiritual;

d. have integrity and an unreprehenable personality;

e. have the appropriate qualifications and competencies;

f. at least 40 (forty) years old; and

g. not being a suspect/defendant in

judicial process.

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(2) Requirements as referred to in paragraph (1)

are evidenced by:

a. a valid and still valid resident sign card;

b. The certificate and the transcript of the formal educational level of education

are legalized by the college where

is concerned for the degree;

c. certificate of membership of the profession society and

profession organization;

d. a medical profession registration letter;

e. medical certificate competency certificate; and

f. a statement letter is not being

suspect/defendant in the judicial process.

Third Paragraph

Tata Cara Registration

Article 9

(1) BPJS Health requests recommendation to the organization

profession, clinical expert organization as well as the faculty of medicine

in Indonesia, to submit the name of the team candidate

quality control and cost control.

(2) Submissions to quality control team member names and

cost control as set forth in paragraph (1),

at most 10 (ten) people of each

organization and academia.

(3) Against a candidate for quality control and control team

charges that have been submitted by the organization and academia

as referred to in paragraph (2), the process

checks Requirements as specified in

Article 8.

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Third Part

Tata Cara Selection and Redemption

Article 10

(1) The BPJS Health Board of Health chooses and sets

member of the quality control and control team that

meets requirements based on recommendations

profession organizations, clinical expert organizations as well as faculty

medicine in Indonesia.

(2) Prior to the designation process, BPJS Health

delivered a letter of willingness to the candidates member

team of selected quality control and control teams.

(3) Member of the team control of the selected quality and control control

as referred to in paragraph (2), set through

The BPJS Healthcare Board Decision.

(4) The cost of the quality control team and cost control

as it is referred to in paragraph (3) For 2 (two)

years since it is set.

Fourth Quarter

The Task, Responsibility and Work Results

Article 11

(1) The coordination team referred to in Section 4

paragraph (2) has the task and Liability as

follows:

a. conduct a workforce policy evaluation

health in the running of the practice of the appropriate profession

competence;

b. provide recommendations in the event of a difference

understanding between BPJS Health with FKRTL

in terms of application of medical quality;

c. doing any discussion of the proposed improvement

policy;

d. discussing the results of medical audits that require

a new policy; and

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e. conduct a health care evaluation for

participants for compiling a health care profile

by using:

1. data belongs to the quality control team and

cost control;

2. data belongs to BPJS Health that is derived from

the BPJS Healthcare application data; and

3. Other data.

(2) In addition to duties and responsibilities as intended

in paragraph (1), the central level coordination team has

the task and responsibility of compiling technical guidance

quality control and cost control in the hosting

a national health guarantee.

(3) In order to carry out the task and responsibility

as referred to in paragraph (1), the coordination team

has the authority:

a. The socialization of the health care authority in

runs the practice of the profession in accordance with

competence;

b. utilization of review and medical audits;

c. ethics coaching and profession discipline to power

health; and

d. coordinate with a health facility that

cooperated with BPJS Health in terms of:

1. health care settings

in the running of the practice of the appropriate profession

competence;

2. utilization of review and medical audits; and

3. Ethical coaching and profession discipline to

health care.

(4) The results of the coordination team as referred to

paragraph (1) as follows:

a. New policy proposals regarding authority

health care in running the profession practices

in accordance with its competitors;

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b. health care policy recommendations as well as

new policy proposals to the stakeholders

related interests;

c. completion of medical audits;

d. a national health care profile; and

e. Technical guidance of quality control team and cost control.

Article 12

(1) The technical team as referred to in Section 4 of the paragraph (2)

has the following tasks and responsibilities:

a. conduct an implementation discussion meeting

JKN that includes the health care aspect

first level and the level of health care

advanced;

b. provide recommendations in the event of a difference

understanding between BPJS Health with FKRTL

in terms of application of medical quality; and

c. conducting medical audits in accordance with the provisions

applicable.

(2) In order to execute the tasks and responsibilities

as referred to in paragraph (1), the technical team has

the authority as follows:

a. ask for information about identity, diagnosis,

history of illness, examination and history history

Participants treatment in the form of copy/photocopies

medical records to the Health Facility accordingly

needs; and

b. conducting usage monitoring and evaluation of usage

drugs, health tools, and use medical materials

in health care periodically through

utilization of the health information system.

(3) Technical team work results as referred to in paragraph

(1) as follows:

a. medical audit results; and

b. evaluation and recapitulation of the problem-

the medical problems that still have to be discussed

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further.

(4) The results of the medical audit as referred to in paragraph (3)

letters a be one of the coordination team's study materials

at the branch level.

Article 13

The team Quality control and cost control hold a meeting

at least 2 (two) times in 1 (one)

years, and if required can have a meeting

insidentil.

BAB III

DEWAN MEDIK CONSIDERATIONS

Parts Kesatu

Structure

Article 14

(1) The media considerations board as referred to

in Article 3 of the paragraph (2) of the letter b, are teams that

consists of an expert physician to be a partner in

controlling the quality and cost of health care

Participants at FKRTL.

(2) The medik consideration board as referred to in

paragraph (1), consists of:

a. the center medik consideration board; and

b. The provincial medic consideration board.

(3) The membership of the medik consideration board as

is referred to in paragraph (1), number:

a. 5-15 (five to with fifteen) people for

the central medik consideration board; and

b. 5-10 (five to ten) people for

the provincial medik consideration board.

(4) The number of members of the medik consideration board

as referred to in paragraph (3),

consider the local needs and conditions.

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Second Section

Requirements

Section 15

Requirements and terms of registration of the team member candidate

quality control and cost control as referred to

in Section 5 mutatis mutandis applies to candidates

members of the medik consideration board.

Third Section

Tata Cara Elections and Redemption

Article 16

(1) The BPJS Health Board of Directors selects and sets

members of the medik consideration board who meet

terms based on recommendations the organization of the profession,

the organization of clinical experts as well as the medical faculty in

Indonesia.

(2) Prior to the designation process, BPJS Health

delivered a letter of willingness to the prospective members

the selected medik considerations board.

(3) Selected medik board members

as referred to in paragraph (2), set through:

a. BPJS Health 's Board of Directors' decision for the board

central medik considerations; and

b. Decision of the head of the BPJS Health Regional Division

for the provincial medic consideration board.

(4) The term of the medik council consideration as

referred to paragraph (3) for 1 (one) years since

is set.

Fourth Quarter

Function and Tasks

Article 17

(1) The medik consideration board as referred to

the paragraph (1) has a function as consideration

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medical for BPJS Health in terms of licensing

health care for Participants in FKRTL.

(2) In executing the function as intended

in paragraph (3), the medik consideration board has the task

as follows:

a. recommend the decision in terms of happening

differences in understanding between BPJS Health

with FKRTL in the technical field of medical services;

b. along with the quality control and cost control team

resolve disputes in the holding

of the National Health Guarantee program; and

c. deliver a dispute that cannot

be resolved to the board of consideration clinical.

BAB IV

CLOSING provisions

Article 18

This BPJS Health Regulation is beginning to apply on the date

promulgled.

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For everyone to know, ordered

the invitation of this BPJS Regulation with

its placement in the State News of the Republic of Indonesia.

Specified in Jakarta

on December 27, 2016

PRINCIPAL DIRECTOR

GOVERNING BODY

SOCIAL HEALTH ASSURANCE,

ttd

FACHMI IDRIS

It was promulded in Jakarta

on December 29, 2016

DIRECTOR GENERAL

REGULATION

MINISTRY LAW AND HUMAN RIGHTS

REPUBLIC OF INDONESIA,

ttd

WIDODO EKATJAHJANA

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