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REPUBLIC OF INDONESIA NEWS
No. 370, 2016 FRANKKES. Clinical considerations. ALIGNMENT.
REPUBLIC OF INDONESIA HEALTH MINISTER REGULATION
NUMBER 5 YEAR 2016
ABOUT
STAGING CLINICAL ADVISORY (CLINICAL ADVISORY)
WITH THE GRACE OF THE ALMIGHTY GOD
MINISTER HEALTH OF THE REPUBLIC OF INDONESIA,
DRAWS: a. that in order to guarantee quality control and control
the costs in the Health Guarantee
National, clinical advisory conducted (clinical advisory)
for the health services provided to the participants
effective and efficient as needed;
b. that clinical consideration (clinical advisory)
is also done to provide completion certainty
clinical problems occurring in service
health at the hosting of Health Guarantee
National;
c. that under consideration as intended
in letter a and letter b, need to set the Regulation
Minister of Health on the Hosting Consideration
Clinical (Clinical Advisory);
Given: 1. Law No. 29 of 2004 on Practice
Medicine (State Sheet of the Republic of Indonesia Year
2004 Number 116, Additional Gazette Republic of State
Indonesia Number 4431);
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2016, No. 370 -2-
2. 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 Number 4456);
3. Law No. 36 Year 2009 concerning
Health (State Gazette of the Republic of Indonesia Year
2009 Number 144, Additional Gazette Republic of the Republic
Indonesia Number 5063);
4. Law No. 24 Year 2011 on Agency
Organizing Social Security (Republican Gazette
Indonesia In 2011 Number 116, Extra Sheet
State Republic Indonesia Number 5256);
5. Law No. 23 Year 2014 on
Local Government (Republican Gazette
Indonesia Year 2014 Number 244, Extra Sheet
State of the Republic of Indonesia Number 5587) as
has been several times amended last with Invite-
Invite Number 9 Year 2015 on Changes to
Second on Act Number 23 of 2014
about the Regional Government (Republic State Sheet
Indonesia Year 2015 Number 58, Additional Sheet
The State of the Republic of Indonesia Number 5679);
6. President's Law Number 12 Year 2013 on
Health Warranty as amended with
Presidential Regulation No. 111 of 2013 on
Changes to Presidential Regulation Number 12 Year 2013
about Warranty Health (Republic Gazette
Indonesia Tahun 2013 No. 255);
7. Health Minister Regulation No. 71 of 2013
on Health Care on Health Guarantee
National as amended by Regulation
Health Minister Number 99 Year 2015 about
The change over Health Minister Regulation No. 71
Year 2013 on Health Services on Guarantee
National Health (Republic of the Republic of Indonesia
Year 2016 Number 15);
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8. Health Minister's Rule 64 Year 2015
on the Organization and the Ministry of Health Care
(Indonesian Republic of Indonesia News 2015 Number
1508);
DECIDED:
Establishing: MINISTER REGULATION HEALTH OF
STAGING CLINICAL CONSIDERATIONS (CLINICAL
ADVISORY).
Article 1
(1) In order to guarantee quality control and cost control
in the National Health Guarantee,
The Minister is responsible for doing
clinical considerations (clinical advisory).
(2) Clinical Perscales (clinical advisory) as
referred to a paragraph (1) is performed against the effort:
a. strengthening of the system in the holding of Warranty
National Health; and
b. clinical dispute resolution.
Article 2
(1) To host clinical considerations (clinical
advisory), created the Clinical Advisory Board and Team
Clinical Perbalance of the Province.
(2) The Council Clinical considerations as referred to in
paragraph (1) are specified by the Minister.
(3) The Provincial Clinical Advisory Team as referred to
on the paragraph (1) is set by the Governor.
Article 3
Board of Scales Clinical as referred to in
Article 2 of the paragraph (1) has the following tasks:
A. provide a recommendation to the Minister of Health
in an effort to improve or improve the quality and
health care efficiency at the staging
National Health Guarantee, including based on
settlement results dispute;
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b. with BPJS Health giving the recommendation
to the Minister of Health for the drug or tool
health that can be in separate claims outside the package
Indonesian Case Based Groups (INA-CBG ' s) in case
there is special conditions for patient safety;
c. monitor and drive in their form and/or
update of clinical pathways (clinical pathway)
medic service of each patient/patient/client condition
created by Profession organizations and/or facilities
Health services both first-level and
Advanced as a primary element/reference consideration
clinical in accordance with the rules of the invite regulations-
invitation;
d. conduct a national security dispute resolution that is
a national and a clinical dispute resolution that is not
may be completed by the Provincial Clinical Perbalance Team;
e. perform assistance against Team Perscales
Clinical Province for dispute resolution at the level
Province; and
f. Performing critical insights into and creation
data documentation/information from settlement results
dispute by the Provincial Clinical Advisory Team and
The Clinical Advisory Board periodically at least-
lack of every 6 (six) months.
Article 4
The Provincial Clinical Advisory Team as referred to
in Article 2 of the paragraph (1) has the following duties:
a. resolve disputes based on adence that occurred
in the local provincial region;
b. refer to a dispute that cannot be resolved in
the provincial level to the Clinical Advisory Council;
c. report the dispute to be addressed, including
the process of progress and completion to
Council Clinical considerations; and
d. assisting the Clinical Perbalance Board in
supporting materials collection or
a dispute resolution companion for the agility
assignment and authority of the Clinical Advisory Board.
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Article 5
Further provisions regarding the holding
clinical considerations (clinical advisory) are set in the Guidelines
Staging Clinical Advisory (Clinical Advisory)
as set forth in the Attachment that is
the inseparable part of the Regulation of this Minister.
Article 6
The rules of the Minister are effective at the date
promulred.
For everyone to know, ordered
the invitational of the Minister's Rule with its placement
in the News of the Republic of Indonesia.
Specified in Jakarta
on February 11, 2016
HEALTH MINISTER
REPUBLIC OF INDONESIA,
ttd
NILA FARID MOELOEK
UNDRASED in Jakarta
on March 7, 2016
DIRECTOR GENERAL
REGULATION
MINISTRY OF LAW AND HUMAN RIGHTS
REPUBLIC OF INDONESIA,
ttd
WIDODO EKATJAHJANA
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ATTACHMENT
HEALTH MINISTER REGULATION
NUMBER 5 of 2016
ABOUT
STAGING OF CONSIDERATION
CLINICAL (CLINICAL ADVISORY)
GUIDELINE GUIDELINES CLINICAL
(CLINICAL ADVISORY)
BAB I
PRELUDE
A. Background
The implementation of the National Social Security System through the program
National Health Guarantee (JKN) has the aim to provide
the guarantee of which the basic needs of living are worth the benefits
Health maintenance and protection for each participant and/or
member of her family. Health care provided to Participant
National Health Guarantee should pay attention to the quality of service,
oriented patient safety, action effectiveness, fitness
with patient needs, as well as efficiency expenses.
The JKN is an interaction between the participant's element,
the health care facility and the organizer ' s body, which is
a fundamental, thorough, concerted, and continuous change that
continues to be require incremental reinforcement. In the organizers
there can be problems that cause a dispute between the elements-
the interacting elements. Thus, in
hosting of JKN requires systems and mechanisms in giving
considerations in dispute resolution, medik opinion (medical
judgement) as well as the consultation platform for consideration clinical (clinical
advisory). Clinical considerations are intended for health care
given to effective and appropriate patients.
In accordance with the mandate of Presidential Regulation Number 12 Year 2013
on Health Guarantee Article 43, Minister be responsible
guarantees the quality control and cost control in JKN, specifically in
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resolving the dispute as a form of the parties ' deliberations before
it is mediating or judicial for the execution of JKN to take place
effectively and efficiently. The Presidential Regulation is translated
in Health Minister Regulation No. 71 of 2013 on
Health Services On National Health Guarantee which
clarify the implementation of clinical considerations. Based on that,
needs to be formed of the Clinical Advisory Board by the Minister of Health.
The clinical considerations board is set up at the central level whereas in
the province is set up by the Clinical Perscales Team. Both Clinical and Clinical Advisory Teams are composed of organizational elements
medicine and medical academia.
To provide guidance in the holding of consideration
clinical by the Advisory Board Clinical and Clinical Perbalance Teams
The province needs to be drafted in Clinical Advisory Guidelines
(Clinical Advisory).
B. Goal
1. As a guideline in providing recommendations to the Minister
Health related to the improvement of clinical considerations
is sustained as a system reinforcement effort in
the National Health Guarantee.
2. As a guide in providing completion certainty
clinical problems occurring in health care at
hosting JKN, in particular which becomes a dispute between
participants, health care facilities, and BPJS Healthcare in
order of quality control and cost control.
C. Definition
1. The Clinical Considerations Council is a board set up by
Minister of Health composed of the health ministry elements,
organization of profession and medical academia to provide
clinical considerations in the implementation of Health Care
National.
2. The next provincial clinical considerations team is called Tim
Clinical Perconsideration is a team formed by the Governor consisting
of the elements of the Provincial Health Service, the profession organization and
the medical academic as a A representative of the Clinical Advisory Council
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in helping to resolve the clinical problem of being
a dispute at the provincial level.
3. A complainant is a National Health Security participant, facilities
health care, and/or BPJS Healthcare, which reports
dispute to the Provincial Government or Provincial Government.
4. A Clinical Problem is a problem that concerns and/or
impacts the benefit package and/or the claim payment
that occurs in the health care service of the JKN.
5. A dispute is a conflict related to a clinical problem
between the parties or after the health care
in the event of a single party
by the other to the party. The Government of the Central or Local Government
Province that causes pre-
-mediation health affairs and is not a civil and/or criminal matter.
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BAB II
ORGANIZATION AND MEMBERSHIP
A. Organizational Structure
Clinical Advisory Organization (Clinical Advisory) is performed
-level at the Provincial and Central levels. Clinical considerations at the
province are implemented by the Clinical Advisory Team, at the central level
executed by the Clinical Advisory Board.
Bagan Clinical Perbalance organization structure:
B. Membership
1. Clinical considerations board
Board of Clinical considerations based in Centre
consists of 13 (thirteen) persons consisting of element
health ministry as ex officio, the profession organization element
and Medical academia and one (one) are outside
the Ministry of Health's elements are appointed as chairman. Board
Clinical Perconsideration is set with the Minister ' s Decision
Health.
a. The term of the Board
The tenure of the Board member is 3 (three) years since
the Minister of Health's Decision on the Board
Clinical Perscales and will be reviewed at any end of the
term. For the first time the Advisory Board term
Clinical is set for 3 (three) years, but 3 (three) of 13
(thirteen) Clinical Advisory Board members can
Protector
The Director
Clinical Considerations Board
Clinical Consideration Team
Secretariat
Secretariat
Center
Province
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extended his term for 1 (one) year.
The Board of Councillors ended if:
1) his term expired;
2) withdrew;
3) passed away; or
4) dismissed from the Minister ' s Decision.
b. Post-Title
Members of the Board should not duplicate other posts that
may pose a clash of interests and/or
interfere with the performance of the Clinical Advisory Board.
c. Interest Conflicts
Members of the Board who have interests with the case
that are in dispute are mandatory to resign in
handle settlement of the case dispute.
d. Membership Terms
Clinical Advisory Board candidates must meet
requirements:
1) Indonesian citizens;
2) healthy physical and mental;
3) competent, honest, had a moral, ethical, integrity high,
has a good reputation, and understands the issue that
relates to the host;
4) is at least 40 (forty) years old;
5) is not a member of any of the political parties;
6) comes from the profession medical; and
7) has never been sentenced to prison based on verdict
the court that has obtained a fixed legal force
for committing a criminal offence threatened with
prison criminal 5 (five) years or more.
2. Clinical considerations team
Clinical considerations team based in the Province,
odd-member 3 (three) or 5 (five) persons consisting of
element of the Provincial Health Service, profession organization and academia
medicine. The Clinical Considerations Team is set with the Decision
Governor. The Clinical Considerations Team was formed most slowly January
2017.
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Before the Fixed Clinical Trial Team was formed,
the provincial-level Clinical Problems settlement assignment was conducted
by Team Monev and Clinical Perscales JKN Provincial level
Clinical Considerations. Management of the management of the field of consideration
clinical in Team Monev and Clinical Perscales JKN level
Province consists of Head of Health Services Service
Health as chairman, 1 (one) physician labor in service health
province, 1 (one) doctor power of MKEK IDI region. In
Doing the task of Team Monev and Clinical Perscales JKN
The provincial level is assisted by 1 (one) administrative people.
3. Clinical Considerations Board Secretariat
In carrying out its duties, the Clinical Advisory Board
is assisted by the secretariat based at the Center for Financing
and Health Guarantee. The Secretariat as intended
is led by a secretary who is an ex officio in the office of the official
structural that is the Health Guarantee of Health.
4. Clinical Considerations Team Secretariat
In carrying out its task, the Clinical Advisory Team
is assisted by the secretariat based in the Health Service
Province that has the task and function in the area of guarantee
health.
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BAB III
ASSIGNMENT AND AUTHORITY
A. The task and authority of the Board of Clinical considerations
The clinical considerations board is independent in retrieval
its decision and stand as an impartial party and work
objectively. In the implementation of its duties, the Board may request
the opinions/input of the appropriate or relevant experts with
the clinical issue of being a dispute. The clinical considerations board in
conduct a dispute resolution independently or in the circumstances
certain may provide a recommendation to the Minister of Health.
The resolution decision of the dispute is set by the Minister. Health.
The board is responsible and delivers a report of the results of activities
periodically at least every 6 (six) months to
the Minister of Health through the Secretary General of the Ministry of Health.
Council Clinical Considerations have the following tasks:
1. Provide recommendations to the Minister of Health in an effort
increase or improve the quality and efficiency of the service
health care for the National Health Guarantee,
including the outcome of the dispute settlement.
2. With BPJS Health giving the Minister a recommendation
Health for a drug or health tool that can be claimed
separate outside the Indonesian Case Based Groups (INA-CBG ' s)
in case there is a special condition for patient safety.
3. Monitor and drive its shape and/or update
clinical pathways (clinical pathway) medic service of each illness/condition
patients/clients made by profession organizations and/or facilities
health services as the primary element/reference considerations
clinical in accordance with the provisions of the laws.
4. Conduct a nationwide, clinical dispute resolution and
resolution of a clinical dispute that is not solved by Team
Clinical Perscales.
5. Perform assistance to the Clinical Perbalance Team for
dispute resolution at the Provincial level.
6. Critical performing of and documentation creation
data/information from the dispute settlement results by Team
Clinical Perconsideration of the Province and Clinical Advisory Board
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periodically at least every 6 (six) months.
In performing its duties, the Clinical Advisory Board
has the following authority:
1. Coordinate with the Health Technology Assessment Committee (Health
Technology Assesment), Team Tarif JKN, Monitoring and Evaluation Team,
The Fraud Prevention Team in the awarding of the recommendation, feedback,
and the proposal priority to the Health Minister as an attempt
supports the laceration of quality control and cost control in
JKN.
2. Facilitate the coordination of the JKN implementation policy that
generated related units/agencies that may incur disputes,
clinical problems and/or JKN implementation differences in
regions.
3. Provide feedback including policy analysis of
disputes to all related parties.
4. Conduct a disservice case that does not have to be completed
by the Clinical Advisory Board/Clinical Perscales Team.
5. Stop and/or continue the case check process
dispute.
6. Set up an inspection schedule and dispute case.
7. Calling and checking out the witnesses.
8. Check the documents/letters, electronic information data
(digital) of the parties and related health medical records.
9. Get the claim data or data from the mutu/cost control efforts
submitted the health facility to BPJS Health.
10. Calling and requesting witnesses/experts from as well as
coordinating the Health Technology Assessment Committee (Health
Technology Assesment), Team Tarif JKN, Monitoring and Evaluation Team,
The Fraud Prevention Team, Team Quality Control and Cost Control, Agency
Hospital Superintendent, Honorary Assembly of Central Medical Ethics
and Other Teams/agencies are related in support of
laceration of quality control and cost control in JKN.
11. Make a dispute resolution decision and propose
by the Minister of Health for a new case
at least 1 (one) month.
12. Make a decision to resolve disputes over similar cases that have been
established by the Minister of Health, including its abbreviation
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to the Clinical Perbalance Team no later than 2 (two) weeks.
13. Documenting the dispute resolution decision.
14. Make up a dispute resolution including provisions
reporting dispute resolution done by Team
Clinical Perconsideration and Clinical Perbalance Council.
B. The task and authority of the clinical considerations team
The clinical considerations team is independent in retrieval
its decision and stand as an impartial party and work
objectively. In the performance of the task, Team may request
the input/input of the experts as appropriate or relevant to the issue
clinical who becomes a dispute.
The Clinical Perbalance Team has the following tasks:
1. Resolve disputes based on adence occurring in the region
local province.
2. Referencing a dispute that cannot be resolved at the provincial level
to the Clinical Advisory Board.
3. Report on the disputes to be addressed, including the process
the development and resolution to the Review Board
Clinical.
4. Help the Board of Clinical considerations in the collection of materials-
support materials or dispute resolution for
solubility and authority of the Clinical Advisory Council.
In carrying out its duties, Team Perscales Clinical has
authorized as follows:
1. Stopping an unqualified aduan check process
terms according to the outages outage mechanism.
2. Conduct an investigation, investigate, call and request
witness/expert information.
3. Check the documents/letters, electronic information data
(digital) of the parties and related health medical records.
4. Get the claims data submitted to the health facility to BPJS
Health.
5. Call and query and check
documents/correspondence, electronic information data (digital)
experts from the Monitoring and Evaluation Team, the Fraud Prevention Team,
The Mutu Control Team and the Cost Control, Council Medik Considerations,
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BPRS Province, Honorary Assembly of Regional Ethics and
BPJS Healthcare branch and/or regional division as an effort
supports the lacerations of quality control and cost control in
JKN.
6. Make a dispute resolution decision and propose
a review of the Clinical Advisory Board for a case
new at least 1 (one) months from the start
examination.
7. Make the decision to resolve disputes over the same case
set by the Clinical Advisory Board no later than 2
(two) weeks.
8. Reports of decisions taken under the Council ' s provisions
Clinical Perscales periodically at least 2
(two) months by busan to the Provincial Health Service.
9. Documenting the dispute resolution decision on the level
province.
C. Clinical Advisory Board Secretariat assignment
The Secretariat has a duty to assist in the implementation of the tasks
Clinical Advisory Council consisting of related units in the Ministry
Health. The task of the secretariat is:
1. Perform administrative activities in order to support the activities
Clinical Advisory Board in the running of tasks and
its authority includes the drafting of the operational activities budget.
2. Inventoried and compiled a JKN-related dispute that
has, is and/or has not been completed, reported by Team
Clinical Perscales.
3. Establish a list of clinical disputes that will be completed by the Board
Clinical Perscales.
4. Inventoried and compiled settlement decisions
disputes generated by the Clinical Perbalance Council and Team
Clinical Perscales as a coaching material.
5. Executing a Clinical Review of the
Clinical Council activities.
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D. Clinical Advisory Team Secretariat task
In carrying out the task of the assisted Clinical Advisory Team
secretariat based in the Provincial Health Service. The Secretariat
is implemented by the administrative power of the element Tim Monev and
Clinical Perscales.
The secretariat task is:
1. Perform administrative activities in order to support the activities
Clinical Perscales Team in the running of tasks and
the authority includes the drafting of the operational activities budget.
2. Collecting, inventorizing, and compiling all of
related JKN complaints to the Clinical Perscales Team.
3. Set up a list of clinical disputes that will be completed by Team
Clinical Perscales.
4. Executing a Clinical Perbalance Team's activities.
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BAB IV
CLINICAL CONSIDERATIONS WORK MECHANISM
A. Workflows Support System Reinforcement
Based on the analysis of the Health Security holding policy
National or from data compilations and dispute information all over
districts/cities and/or provinces that originate from Team Secretariat
Clinical consideration after critical study, Advisory Board
Clinical provides recommendations to the Minister of Health. Critical review
is done to better understand/understand the subject matter
clinical and/or clinical disputes arising.
The Clinical Advisory Council may also provide feedback
with regard to policy analysis. to:
1. Health Technology Assesment Committee (Health Technology Assesment),
Team Tarif JKN, Team Monitoring and Evaluation, Fraud Prevention Team,
Honorary Assembly of central Medicine Ethics and Supervisory Board
Hospital.
2. Participants, patient organizations, faskes associations, profession organizations,
local governments and other stakeholders.
Clinical Advisory Council with BPJS Health as well
conduct policy analysis of Health/Drug Tool which can
be claimed separately from the Indonesian Case Based Group (INA CBG's) Package
in special condition for patient safety based on the compilation
data and dispute information about the Health Tool/medicine from
entire district/city derived from the secretariat of the Advisory Team
Clinical .
Health/drug tools referred to among others:
1. Health tools that function help the primary health tool that
be an absolute condition or an essential/essential component that
is separate from the primary health care/medication patient needs.
2. The minimum health care tool is required to
carry out the action according to the patient ' s medical indication.
B. Dispute Resolution Workflow
Clinical Dispute in the National Health Assurance Implementation
may occur between:
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1. Dispute between Health Facility with BPJS Health;
2. Dispute between Health Facility with JKN participants;
3. Disputes between BPJS Health with JKN participants.
The resolution of the dispute within the JKN is carried out from
the provincial level up to the center. However, in the event that is not available
the competency of the clinical Advisory Team on the disputed case,
then the Clinical Advisory Board may take over the settlement
the dispute.
The dispute resolution is resolved with the principle of fairness, asas
benefits, effective, and efficient. If the parties dispute in
the district/city level can already be completed by the Mutu Control Team
and the Cost Control and/or Medical Advisory Council, Tim
The local Provincial Clinical Perscales directly compile dispute
through the secretariat of the Clinical Advisory Team to be forwarded
to the Clinical Advisory Board through the Council secretariat
Clinical Perbalance.
The Dispute Settlement begins with the acceptance of an official complaint.
parties to the secretariat of the Clinical Perscales Team (Form
Request for Dispute Resolution Attached). The entire process
checks and trials are mandatory for parties, but Tim or
Clinical Advisory Board can continue the process by in absentia.
The decision is final and can still be made by Tim
Clinical Perscales after the parties acknowledge accepting and not
making an appeal attempt (if either party does not receive the results
the verdict). In the event of an appeal effort, the final
ruling and remains must be made by the Clinical Advisory Council.
The mandatory dispute decision is attended by the parties, but
The Team or the Clinical Advisory Board can read the decision
in absentia.
The Clinical Advisory Board conducts the coaching and evaluation of
compiled results from the secretariat of the Clinical Perbalance Team and the secretariat
The Clinical Advisory Council for the making new policy as
anticipating early types of dispute settlement case Previously.
1. The Complaint Mechanism
The first stage complaint begins with the receipt of the letter
The complaint of the parties disputes to the Team
Clinical Perscales through the secretariat and end with
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The preparation of the service by the Clinical Perscales Team.
a. Disputed party
The disputed party may address the complaint
in writing to the at least Clinical Advisory Team-
lack of information among others:
1) The identity of the complainants and pitted
2) The case of dispute and its chronological
3) Other supporting data
The dispute reporting form refers to the attached format.
b. Clinical Considerations team
The dispute report delivered by the Advisory Team
Clinical to the Clinical Advisory Board is a report
over a dispute that is not resolved. The report
is delivered through the Clinical Advisory Council Secretariat.
The Clinical Perbalance is delivered to the Advisory Board
Clinical, at least loading. Information included:
1) The identity of the complainants and pitters
2) The chronological summary of the events which results
the subject matter which raises
the disagreement over the Team's recommendations
Clinical Considerations Province
3) Evidence and witnesses as well as other supporting data.
2. Aduan termination mechanism
The clinical considerations team can stop the complaint if:
1) The letter without a clear identity
2) Mistaken territory
3) Mistaken person/institution
4) Wrong time (passing the 2-year deadline after incident)
5) Wrong object (not related parties and/or consideration
clinical on the basis of control of the cost control in order of JKN)
6) The same case has already been checked or decided by
Team Clinical Considerations and/or Clinical Perscales Council
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3. The Examination Mechanism
a. First level in the Clinical Advisory Team
1) Chairman of the Clinical Advisory Team assisted by the secretariat
check the validity of the parties
2) The Chairman of the Clinical Advisory Team with members checked
the party of the complainants first accompanied by evidence, witnesses,
documents submitted by the complainants.
3) The Chairman of the Clinical Advisory Team with members checked
the party pitters are accompanied by evidence, witnesses, documents that
are filed with the complainants.
4) Chairman of the Clinical considerations team with members if
requires a description Related parties,
such as: Monitoring and Evaluation Team, Prevention Team
Fraud, Team Control and Cost Control, Board
Medic Performance, Hospital Supervising Board,
Honorary Assembly of Regional Medicine Ethics and BPJS
Health branch and Regional Division, to be used
consideration materials.
5) Clinical Advisory Team Chair with members
does a hearing to make a decision.
Kuorum retrieval decision is a half plus
one of the entire members of the Clinical Advisory Team.
A different opinion (dissenting opinion) is recorded in
special.
6) The results of the decision are read out in a hearing which is attended by the
party.
7) If the examination process is required from butir1 (one)
up to item 5 (five) may be accompanied by a member of the Board
Clinical Perscales appointed by the chairman
The Clinical Advisory Board.
8) The entire The trial and outcome of the decision
is documented by the secretariat of the Clinical Perbalance Team
and reported by the chairman of the Clinical Advisory Team to
chairman of the Clinical Advisory Board through the secretariat.
9) The process examination is conducted in a closed session.
10) The entire trial process The dispute should not be
involving a lawyer representing the parties.
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11) The outcome of the decision cannot be made as a proof tool
in the judicial process.
12) The parties are given an opportunity in writing to
filing objections to the outcome of the decision.
13) The decision is final and binding if in time
at least 14 (fourteen) days after
is read not an appeal attempt by the parties.
14) Decisions as item 12 (twelve) can
be the guideline by the region Clinical Perbalance Team
another for the case same after being declared by
a special Minister of Health provisions for that (asas
precedent).
15) In carrying out a provision as item 13,
The Minister of Health can delegate to the official
appointable.
b. Level of Appeal at the Clinical Advisory Council
1) Chairman of the Clinical Advisory Board assisted by secretariat
check the validity of the parties.
2) Clinical Advisory Board Chairman with members
check out the complainants first Previously accompanied with
evidence, witnesses, documents submitted by the complainants.
3) The Chairman of the Clinical Advisory Board with members
examines the parties being accompanied by evidence, witnesses,
the documents filed with the complainants.
4) The Chairman of the Clinical Advisory Board with members if
is required examine the related parties, such as: Committee
Health Technology Assessment (Health Technology
Assesment), Team Tarif JKN, Team Monitoring and Evaluation,
Honorary Assembly of central Medical Ethics, Tim
The Fraud Prevention, and the Hospital Supervising Board.
5) The Chair of the Clinical Advisory Board with members
does the hearing to make the decision which
the arrangement and shape is standardized by the Board
Clinical Perscales. Kuorum retrieval decision
is half plus one of the overall members
Clinical Perconsideration Council. A different opinion
(dissenting opinion) is recorded in particular.
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6) The decision is documented by the secretariat and
is reported by the chairman of the Clinical Advisory Board to
the Minister of Health with the party's busan gust.
7) Decision on the Board of Perscales A clinical that has been
specified by the Minister of Health or the delegations
is delivered on the parties and becomes a reference for
Clinical Advisory Council and Clinical Perbalance Team
to resolve the dispute. The same kind.
8) The parties are prohibited from being accompanied by a professional lawyer.
9) The vetting process is conducted in a closed session.
10) The outcome of the decision cannot be made as a proof tool
in the judicial process.
11) The decision as number 5 may be a guideline
by the other regional Clinical Perconsideration Team for the case
the same one after being declared by the Council's provisions
The Clinical Perbalance is special for that (asas
precedent).
4. Reporting
Clinical Advisory Board sets up an arrangement and forms
A default performance administrative report that describes
the essence of the system of clinical considerations after
listening to suggestions The entire Clinical Advisory Team.
a. Clinical Considerations team
Clinical considerations team compiling a report to the Board
Clinical Perscales consisting of:
1) The dispute report to be completed
2) The completion of the settlement process is being resolved
3) The report of the dispute has been resolved
4) The report of the dispute cannot be completed
b. Clinical Considerations Council
1) dispute resolution decision to
specified Minister
2) dispute resolution dispute on Team
Clinical Perbalance
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2016, No. 370 -23-
C. Funding
The funds required for the implementation of clinical considerations either
in the Centre and in the Province are charged to the Revenue Budget
and State Shopping. Funding for Clinical Perconsideration activities at
the central level is derived from DIPA Center for Financing and Warranty
Health. Before the funds were allocated, for
clinical consideration activities at the provincial level, financing was sourced
from the Operational Deconcentration of Team Monev and Clinical Perscales
JKN Provinces. The mechanism for the financing of the implementation of the Clinical Perscales
in the Province refers to the Technical Lead of the Deconcentration Fund
The Program Reinforcement Program Implementation of National Health Guarantates (JKN/KIS).
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2016, No. 370 -24-
BAB V
CLOSURE
The guidelines for these Clinical considerations are expected to be capable
embodour improvement of the quality of the JKN program so that the efficiency is achieved
and the effectiveness in the The JKN program.
The Clinical Considerations guidelines are mandatory and
is executed as well as in the conduct of clinical considerations.
Participation and support of all parties to resolve any
issue occurs in clinical considerations as much needed
to support the embodiment of clinical considerations in a prime way.
HEALTH MINISTER
REPUBLIC OF INDONESIA,
ttd.
NILA FARID MOELOEK
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2016, No. 370 -25-
Form 1
FORMAT DISPUTE RESOLUTION
To: The Provincial Clinical Advisory Team
signed below, I:
Name:.
Address: <>
No. Identity: . <>
Next is called: -------------------------------------------------------------------------------- Pengadu
With these reports the alleged occurrence of a regulatory breach in
the National Health Guarantee implementation (JKN) by I. ..
Next is called: --------------------------------------------------------------------- Teradu
As for the basis and consideration of the alleged report
violation of the Code of Conduct and the Judge Behaviour Guidelines performed by
Report is as follows:
1. That is ... ... (The complaination tells the location of the dispute
which is ratted);
2. That is ... (The complainate of the event that
gives rise to a disputed dispute);
3. That is ... (The complainants explain the dispute position that
ratted);
So this complaint report I made, next I implore
to the Provincial Clinical Advisory Team to be able to follow up report
dispute complaint in this JKN in accordance with the authority owned.
Respect Us,
The Name of the Rat/Yang
Represents
Attachment:
1. Photocopying Identity (BPJS Healthcare, KTP/Sign
Identifiers
)
2. Other supporting evidence related to the report (payment proof, letter
statement, copy prescription, etc.)
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2016, No. 370 -26-
Form 2
DISPUTE RESOLUTION DECISION REPORT
The dispute resolution decision report reads:
Chapter 1 Preliminary: petitioner case applicants; description and explanation
case to be found; the purpose of the palm; the limit of the palm.
Chapter 2 of the General Occurrence Dispute: Dispute chronological, location
health facility; health facilities around; means and infrastructure that
available at the health facility; health care excellence.
Chapter 3 Results of Telaah
Chapter 4 Results of discussion and Case analysis: answer 5W + 1H
Chapter 5 Conclusions
Chapter 6 Recommendation/Verdict
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