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Article 8 of the worker is not the recipient of Upah and his family members including foreign nationals working in Indonesia at least 6 (six) months and members of his family as referred to in Article 6 of the letter b consists of up: a. Workers outside of a working relationship or self-worker; and b. Workers who do not include a letter that is not a recipient of the Upah.

Article 9 (1) Not a worker and a member of his family as intended

in Section 6 of the letter c is composed of: a. Investors; b. Employers; c. Retired recipient; d. Veterans; e. The Pioneers of Independence; f. Widow, widower, or orphaned child of Veterans or Pioneers

Independence; and g. is not a worker that does not include a letter a up to the letter

e that is able to pay dues. (2) The retirement recipient as referred to in paragraph (1) the letter c

consists of: a. Civil servants who cease with the right to retire; b. Members of the Indonesian Armed Forces and members of the Polri retired with the right to retire; c. State officials who cease with pension rights; d. Widow, widower, or orphaned child of the retired recipient

as referred to in the letters a, letter b, and the letter c received the pension rights;

e. the recipient of a pension other than the letter a, the letter b, and the letter c; f. Widow, widower, or orphaned child of the retired recipient

as referred to in the letter e that received the pension rights. Article 10

(1) A member of the family as referred to in Article 6 includes the lawful wife/husband, child, step child of the lawful marriage, and a valid adopted child, as many as 5 (five) persons.

(2) biological children, stepchildren, and children. of a valid marriage, and a valid adopted son as referred to in paragraph (1), with the criteria: a. no or have never been married or not have

earnings of its own; and b. not aged 21 (twenty-one) years or not aged 25

(twenty-five) years that still continue to be a formal education.

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(3) Participants instead of PBI Health Care may include other family members.

(4) Another member of the family as referred to in verse (3) includes the child to 4 (four) and beyond, the father, mother, and in-in-laws.

Third Section Enrollment Participant

Paragraph 1 General

Article 11 (1) Registration of the Health Guarantee participant as referred to

in Section 3 of the letter b is done, both alone and in group.

(2) The registration of the Health Guarantee as referred to in paragraph (1) can be performed: a. Data migration; or b. manual.

Section 12 of the Health Guarantee Registration Act as referred to in Article 11 is performed for: a. PBI Health Guarantee; and b. Not a Health Guarantee PBI.

Paragraph 2 Of The Health Guarantee PBI Participant Registration

Article 13 (1) Registration of the Health PBI participant as referred to

in Article 12 of the letter a was performed by the Minister. (2) The Minister in registering a Health Guarantee PBI participant

as referred to in paragraph (1) is conducted by migrating data as referred to in Section 11 of the paragraph (2) letter a in accordance with the format specified by BPJS Health.

Paragraph 3 Enrollment Participant is not a Health Warranty PBI

Section 14 of the participant's Registration is not a Health Warranty PBI as referred to in Article 12 of the letter b is performed against: a. Worker and family members of the family include the citizens

a foreign country who works in Indonesia at least 6 (six) months and a member of his family;

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b. Workers are not the beneficiaries and members of his family including foreign nationals working in Indonesia at least 6 (six) months and members of his family;

c. Not the worker and the family members. Section 15

(1) The Registration of the Health Guarantee for the Workers of the Upah as referred to in Article 14 of the letter is done by the Workforce.

(2) The registration of the participants for the Up-Receiver Workers is conducted by group via The identity of the BPJS Health.

(3) The registration as referred to in paragraph (2) is performed on a migration of data in accordance with the format specified by BPJS Health or manually.

(4) Registration of data data as referred to in paragraph (3) is done at least 1000 (thousand) candidates participant.

(5) The registration is manually as referred to the paragraph (3) is performed in a way: a. come directly to the BPJS Health office or through the party

third designated by BPJS Health; b. fill out the form and submit the candidate data completeness

participants. (6) The third party as referred to in paragraph (5) of the letter includes:

a. banking; b. association of professions or other associations; c. retail; and d. Other institutions.

Article 16 (1) In terms of a real Worklight does not register

It works to BPJS Health, the worker in question is entitled to register itself as a Health Security participant.

(2) Iuran A participant for a worker who lists himself as a Health Security participant as referred to in paragraph (1) remains paid in accordance with the provisions of the Health Guarantee.

Article 17 (1) The Workout of Work register its workers as

referred to in Article 15 of the paragraph (1) must Supplementing the candidate data for the most: a. The name of the candidate; b. population parent number;

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c. date of birth; and d. the name of the first-level health facility in cooperation

with BPJS Health and selected by the candidate candidate. (2) BPJS Health after receiving candidate data as

referred to in paragraph (1) li and obligations of the participants;

e. change of data and participant status;

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Second Part of the Participant

Paragraph 1 General Section 4

Participants as referred to in Section 3 of the letter a consist of: a. Healthcare PBI attendees; and b. Participant is not a Health Security PBI.

Paragraph 2 Of Health Warranty PBI Participants

Section 5 of the Health Guarantee PBI Participant as referred to in Article 4 of the letter a consists of: a. A person who is a poor facir; and b. Person is not capable.

Paragraph 3 Participants Not a Health Warranty PBI

Section 6 of the Participant is not a Health Guarantee as referred to in Article 4 of the letter b consists of: a. Workers of the Retainer and family members include the cthe Governing Government's affairs in the social sphere is conducted every 6 months in the year the budget goes and is set by the Minister for the government of government affairs in the social field.

(4) Changes and validation of the IBM Health Care PBI participant data by the Minister The following paragraph (3) is then submitted to the Minister to be registered as a Health Security PBI Participant to BPJS Health.

BAB III

DUES OF PESERATION. The Public Health Guarantee

General

Section 33 (1) of the Health Guarantee Act as referred to in

Article 2 of the letter b is required to be paid by any participant of the Health Guarantee program.

(2) Iuran as In the event of a verse (1) it shall be paid the slowest of the ten (ten) of the month. Bank that has cooperated with BPJS Health.

(3) The Health Guarantee dues for Health Guarantee participants in accordance with the provisions of the Perundang-Invitation Regulation.

Article 34 (1) BPJS Health performs collection and billing

payment dues to participants.

(2) The bill as referred to paragraph (1) at least contains the details:

a. Participant's data; and b. Nominal invoice.

Article 35

(1) Compulsory Workforce to collect dues from its workers, pay dues that are its responsibility, and lease the dues to BPJS Healthcare the slowest date of 10 (ten) each month.

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(2) For Local Government Works, the equivalent of the BPJS Healthcare as referred to in paragraph (1) is carried out through the slowest state cash account of the date of 10 (ten) each month.

(3) If 10 (10) as referred to in paragraph (1) fall on the holiday, then the dues are paid on the next day of work.

(4) The delay of the Health Guarantee payment as referred to in paragraph (1) by the employers in addition to the country ' s organizer, imposed administrative fines of 2% (two percent) per month of the total aggregate total for the time 3 (three) months, which is paid in conjunction with the total outstanding dues by the Workforce.

(5) In the case of delay payment of the Health Guarantee as referred to in paragraph (1) more than 3 (three) months, the Licensee may be temporarily suspended.

Article 36

The participant's dues as referred to in Section 33 of the paragraph (1) are paid for:

a. Health Guarantee PBI participant;

b. Employers;

c. Workers Are Not The Beneficiaries;

d. Not a Worker; and

e. Other members of the family.

Second Part

Health Guarantee PBI Participants

Section 37 (1) The Health Guarantee PBI participant as referred to in

Article 36 of the letter a paid by the Minister in accordance with the provisions The laws of the law.

(2) BPJS Healthcare upon receipt of the payment as referred to in paragraph (1) conduct a data reconciliation with the Minister.

(3) Reconciliation as referred to in paragraph (2) is exercised every 6 (six) month.

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(4) If the results of the data reconciliation as referred to in paragraph (3) occur less or more payment, excess or lack of such payment will be taken into account at the next payment of the dues.

(5) The provisions of the terms of the provision, the thawing and the liability of the funds are referred to in paragraph (1) and paragraph (2) as set forth in the Regulation of the Minister of Finance.

Third Quarter The Work

Paragraph 1 General

Article 38

The workgroup consists of:

a. The country's organizer of the country; and

b. Employers in addition to the country organizer

paragraph 2

Country organizer

section 39

The state organizer as referred to in Article 38 of the letter a consists of:

a. government; and

b. local government.

Article 40

(1) The government as referred to in Article 39 of the letter a paid the dues of the Health Assurance Participant of the Central Civil Service, Member of the Armed Forces, Member of Police, State Officials and Non-governmental employees Central Country Employee

(2) The participant in the event referred to in paragraph (1) is tuned through the country ' s cash account to BPJS Healthcare each month.

(3) BPJS Health after receiving the deposit as referred to in paragraph (2) conduct a data reconciliation with the Finance Minister.

(4) Reconciliation as referred to the paragraph (3) executed every 3 (three) months.

(5) If the results of the data reconciliation as referred to in the paragraph (4) occur less or more payment, excess or lack of such payment will be taken into account at next iuran payment.

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(6) The order of calculating, provisioning, thawing and liability of funds as referred to in paragraph (2) and paragraph (3) is exercised in accordance with the provisions of the Perundang-Invitation Regulation.

Article 41

(1) The Local Government as referred to in section 39 of the letter b paid the dues of the Health Guarantee for the Regional Civil Service and Employees Of The Non State Civil Servants.

(2) Iuran Participants as referred to in paragraph (1) are provided through a country's cash account to the BPJS Healthcare every month.

(3) The BPJS Health after receiving the deposit as referred to in paragraph (2) does a data reconciliation with the Government Area.

(4) Reconciliation as referred to in paragraph (3) executed every 3 (three) months.

(5) If the results of the data reconciliation as referred to in the paragraph (4) occur less or more payment, excess or lack of such payment will be taken into account at the next payment.

(6) Tata method The calculation, provisioning, fluid, and liability of the funds, as referred to in the paragraph (2) and paragraph (3) are executed in accordance with the provisions of the Rules of the Invitation.

paragraph 3

employers other than state organizers

section 42

(1) The employers other than the state organizer as referred to in section 38 of the letter b pay the Health Guarantee dues for the Workers and Herders and Lease it to the BPJS Health most slowly date 10 (ten) each month.

(2) The worker as referred to the paragraph (1) consists of:

a. Private employee; and

b. Workers who receive wages other than workers whose dues are paid by the country's organizing employers.

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(3) The deposit as referred to in paragraph (1) is carried out through the Virtual Account account provided by BPJS Health at the time of registration.

(4) Further provisions regarding procedures and tata The way payments are regulated by the BPJS Health Board of Directors.

Fourth Quarter

Workers Not Upah

Section 43 (1) Workers Participants Are Not Recipients of the Upah as referred to in

Article 36 of the c-letter c pays iuran H status of the membership of the Participants Are Not Health Guarantee PBI into Health Guarantee PBI Participants proposed by the Local Government.

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(2) The Minister of Foreign Affairs of Government Affairs conducted the validation of the Health Security PBI Participant data after coordinating with the Minister of Finance.

(3) Change and validation of participant data The PBI of Health Insurance by the Minister of uiring initial handling prior to

are done referrals; c. medical case backside; d. examination, treatment and the actions of dental health services

first rate; e. examination of expectate mothers, nifas, breastfeeding mothers, babies and child children

by midwives or doctors; and f. Basic medical rehabilitation.

(3) The First Level Road Rawat Health Service includes a non-specialistic health service that includes: a. services administration that includes administration fees

participant registration for the drug, provisioning and granting of referral mail to advanced health facilities for diseases that cannot be handled at first-level health facilities;

b. a promotional and preventive service that includes individual health counseling activities, basic immunization, family planning, health screening;

c. examination, treatment, and medical consultation; d. Maternity checks are pregnant, nifas, nursing mothers, and babies; e. Recovery efforts against the side effects of contraception; f. non-specialistic medical actions, both operative and non

operative; g. Drug services and medical materials are used up; h. First-degree laboratory diagnostic support check

form simple blood check (Hemoglobin, edge blood apusan, thrombocyte, leukocyte, hematocrit, eosinophils, erythrocytes, blood type, blood deposit rate, malaria), simple urine (color, weight of type, abomination, pH, leukocytes, erythrocytes), simple feces (benzidin test, microscopic worms), blood sugar in the time;

i. other simple support checks that can be performed at

first-level health facilities; j. services are back from the advanced health facility; k. Program services are returned. implementation of prolanis and home visit; and m. Basic medik rehabilitation.

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paragraph 3 of the First Level hospitalization Health Service

Section 51 (1) First-level outpatient health care includes:

a. Outpatient treatment/treatment cases that can be completed completely in the first-tier health service;

b. help of pervagam childbirth is not a high risk; c. childbirth with complications and/or bribery

pervagam to the Neonatal Emergencies Foundation (PONED) center of the Obstetrics Service (PONED);

d. Neonatal help with complications; and e. Blood transfusion services according to the competencies of health facilities

and/or medical needs. (2) The first-level outpatient health care includes services

non-specialistic health that includes: a. The service administration consists of a patient registration fee and

other administrative costs that occur during the patient ' s care or health care process

b. examination, treatment, and medical consultation; c. treatment and accommodation in the care room; d. A doctor or a paramedic. e. A copy per vagina is without a purview or with a purview; f. Diagnostic support check during maintenance; g. Drug services and medical materials run out during the

treatment; and h. Blood transfusion services according to medical indications.

Paragraph 4 of the Dental Health Service at the First Level Health Facility

Article 52 (1) Dental health services include:

a. The service administration consists of the cost of patient registration and other administrative costs that occur during the patient ' s care or health care process;

b. examination, treatment, and medical consultation; c. Premedications; d. The urgency of the oro-dental; e. Oldest tooth extraction (topical, infiltration); f. Permanent dental removal without purlit; g. a post-extraction drug; h. Composit/GIC; and i. tooth skeling.

(2) The dental health service as referred to in verse (1) is performed by a dentist.

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Paragraph 5 of Health Service by Bidan and Nurse

at First Level Health Facility Article 53

(1) In terms of the district there is no doctor based on the designation of health service chief The local district/city, the Health Social Security Organizing Board can cooperate with the practice of midwife and/or nurse according to her authority.

(2) The granting of health care by Bidan and Nurse in terms of subdistrict does not there is a doctor as it is referred to in verse (1) covering the ministry of midwife and nurse with the scope of the ministry of midwife and nurses according to its competence and authority.

(3) Bidan and nurse as referred to in verse (1) can only do referral to a doctor and/or dentist ' s health care provider First except in the help of labor, emergency conditions or patients with special conditions outside of the competence of the physician or dentistry of the first-degree health facility.

The Third Part of Health Care At the Health Facility Advanced Level

Paragraph 1

General Section 54

(1) Health Service at an advanced health facility as referred to in section 47 of the paragraph (3) of the letter b must be provided to the participant based on a referral from the first-level health facility at the advanced health facility.

(2) The Facility Advanced level health as referred to in paragraph (1) consists of: a. Primary or equivalent clinic; b. Public hospitals; and c. Special hospital.

(3) General Hospital and Special Hospital as referred to in paragraph (2) letter b and c can be Government-owned Hospital, Regional Government, TNI, Polri and Private Hospital in association with BPJS Health.

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Section 55 (1) To obtain health care at a health facility

Advanced, first-level health facility as referred to in Section 48 paragraph (3) is required to perform a referral system By referring to: a. Minister rules; b. national referral system guidelines; and c. BPJS Health service administration guidelines.

(2) In the run of advanced health care, first-level health facilities and advanced levels are required to perform a referral system

(3) The health facility may perform horizontal and vertical referrals. (4) horizontal persuasion is performed between health care in one

tier if the referencing is unable to provide health care according to the patient's needs due to the limitations of its properties, equipment and/or composure Temporary or settled.

(5) The vertical persuasion is conducted between different levels of health, can be done from a lower service level to a higher level of service or vice versa.

Article 56 (1) Participants can be excluded from the referral health care system

berjenjang at the first health facility if: a. There was an emergency; b. disaster; c. specificity of patient health problems; d. geographical considerations; and e. The availability of the facility

(2) The severity of the patient's health problems as referred to in paragraph (1) letter c is only for cases that are already enforced therapeutic plans and such therapies can only be performed at the facility. Continued health.

Article 57

(1) The health facility is required to provide plenary services includingalth care function Promotional health care, preventive, curative, rehabilitative, monastic services and emergency health services including support services that include simple laboratory checks and pharmaceutical services.

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(2) The first level health services as referred to in paragraph (1) for medical services include: a. a medical case that can be completed in service

First-degree health; b. medical cases req emergency services payment carried out by the facility

first-level health Working with BPJS Health is already included in the capitation component.

(2) Emergency services conducted by first-degree health facilities that do not cooperate with BPJS Health are charged directly by healthcare facilities to BPJS Healthcare.

(3) Further provisions concerning the the payment of emergency services as referred to in paragraph (2) is set up with the BPJS Health Board of Directors.

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Article 65

(1) Emergency service billing conducted by advanced referral health facilities in cooperation with BPJS Health is paid according to the INA-CBG ' s degan.

(2) Emergency services charges conducted by advanced-level health facilities that do not cooperate with BPJS Health are charged directly by healthcare facilities to BPJS Healthcare.

(3) Payment Emergency services as referred to in paragraph (2) use INA-CBG's tariffs in effect in the region.

(4) Tarif INA-CBG's as referred to by paragraph (3) in accordance with the Hospital class set by the Minister.

(5) Hospital that has yet to have a class designation, using the INA-CBG's Home tariff Class D.

Article 66

The health care facility that provides emergency services both in cooperation and non-working with BPJS Health, is not allowed to attract participants.

Fifth Section Drug Services, Health Tools, and

Habis Medical Materials Use

Section 67 (1) Drug Service, health tool, and medik materials are used that

is required as referred to in Section 47 of the paragraph (3) d in accordance with the indication medical is the right of health care participants.

(2) Drug services, medical materials run out, The health care tool as referred to in paragraph (1) may be provided on outpatient health care and/or hospitable either at first-level health facilities and advanced referral health facilities.

(3) Drug Services, tools health, and disposable medical materials provided to the Participants guideline on the list of medications, and medical materials are used to be used, and health tools specified in accordance with the provisions of the laws.

(4) The health care facility and its jenets are required to provide drug services, health tools, and the spent medical materials required by Participants as per medical indication.

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Article 68 (1) The health tool service at first-level health facilities already

is included in the capitation component paid by BPJS Health.

(2) The health tool services at the health facility Advanced referral level is already included in the INA-CBG ' s package.

(3) The health facility and its jenets are required to provide the health tools required by the Participant in accordance with medical indications.

(4) The health tools that are not included in the INA-CBG's package are paid for by their own claims by BPJS Health.

(5) The type of health tool as referred to in paragraph (3) is set by the Minister.

(6) In a special condition for patient safety, the health tools that are not included in the INA-CBG's package as referred to a paragraph (4) may set by the Clinical Advisory Board with BPJS Health.

(7) Tools The health that is included in the INA-CBGs package cannot be charged with BPJS Health and cannot be charged to the Participants.

(8) Further provisions on the procedures and procedures of the health tool service are not Included in the INA-CBG's package as referred to in paragraph (6) is governed by the BPJS Health Board of Directors.

Article 69 (1) Drug and medical services are used at a health facility

The first level is already included in the The capitation component paid BPJS Health.

(2) Drug Services, health tools, and use of advanced medical materials on advanced referral health facilities is one of the components paid in the INA-CBG ' s package.

(3) In terms of medication required according to medical indications on advanced referral health facilities not listed in the National Formularium, may be used another drug based on the approval of the Medik Committee and the Head/Director Home Sick.

(4) The drug services already included in the INA-CBGs package, either in reference to the National Formularium, cannot be charged separately to the BPJS Health as well as not being charged to the Participant.

Article 70 (1) BPJS Healthcare Guarantee the needs of the drug and the examination

support program feedback.

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(2) The return program is a health care provided to people with a chronic disease with stable conditions and still require treatment or long-term care treatment executed in the First-degree Health Facility on recommended/referral physician/sub specialist who treated.

(3) The type of chronic disease as referred to in verse (2), hypertension and diabetes mellitus type 2 and can be adjusted to Applicable policy.

Article 71 (1) The reverse program drug is obtained through Pharmacy or pharmacy depot

First-level health facility that works closely with BPJS Health.

(2) Examination program feedback is provided by the lab in collaboration with BPJS Health or as a The first-tier health facilities network.

(3) The drug as referred to in paragraph (1) and the allowance check as referred to in paragraph (2) are paid by BPJS Health outside the capitation fee.

(4) The drug program is back as referred to in paragraph (1) and the examination of the support as referred to in paragraph (2) Billed collectively through its own claim to BPJS Health.

(5) The cost of the drug program is made up of the price of a drug referring to the National Formularium set by the Minister and coupled with the service factors and embalage.

(6) The financing of the drug and the examination of the allowance as referred to in paragraph (4), is exercised in accordance with the provisions of the laws.

(7) Further provisions of service procedures, restrictive terms, and maximal reagents as well as the allowance of support programs are set up with the BPJS Health Board of Directors.

Part 6 of the Ambulance Service

Section 72 (1) ambulance service as referred to in Section 47 of the paragraph (3)

letter e is the transport service of a referral patient with certain conditions between health facilities accompanied by an effort or stability of the activities patient condition for patient safety interest.

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(2) Certain conditions as referred to in paragraph (1) must meet the provisions: a. the patient ' s condition according to medical indications based on the recommendation

the medical from the caring doctor; b. Maintenance-class conditions for full participant and patient rights

already treated at least 3 (three) days in one level above their right; or

c. Health of the destination.

(3, in accordance with the ability of a health facility with certain creteria in accordance with the laws.

(3) The emergency services may be provided by: a. First-Level Health Facility; b. Advanced Health Facilities; whether in cooperation with BPJS Health and not working together.

(4) Health facilities that do not cooperate with BPJS Health as referred to in paragraph (3) must immediately refer to the facility health that works with BPJS Health after its emergency is resolved and the patient in the condition can be moved.

Article 64 (1) Thenalysis of certain health care needs.

(2) The provision of certain health care facilities as referred to Verse (1) is the provision of the health care team equipped with medical equipment for provide certain medical services according to the needs in the region of the Visited.

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(3) The BPJS Health Branch Office next is coordinating with the health service, the health profession organization, and/or the health facility association to determine the health power delivery mechanism between others include: a. schedule; b. type of health care; and c. amount of health care.

(4) The delivery of health care guaranteed BPJS health can be done through cooperation with local services, other government agencies, or private.

(5) More provisions further regarding the health care delivery procedure is set with the BPJS Health Board of Directors.

BAB VII CONTROL AND COST CONTROL

Section General

Section 80 (1) Quality Control and Service Cost Control health is done

to guarantee the health service to Participant accordingly with quality established and hosted efficiently.

(2) Quality Control and charge control as referred to in paragraph (1) includes: a. assessment of healthcare technology (Health Technology Assessment)

against the development of health care use with technology;

b. clinical considerations (Clinical Advisory) of the health care provided to Participant;

c. the study and evaluation of the Health Guarantee Benefits for Participant; and

d. monitoring and evaluation of the hosting of Health Guarantee services by health facilities.

(3) Quality control and control of the cost of health care to Participants, as referred to in paragraph (1) and (2) are set by the Minister.

(4) To ensure quality control and control of the cost of healthcare to participants, health facilities in providing services: a. The drug must refer to the National Formularium; and b. Health Tools must refer to the Kompedium of the Health Tool.

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Article 81 (1) Health services to health care participants must

pay attention to the quality of the service, oriented toward the security aspects of the patient, effectiveness of action, fitness with the needs of the patient, as well as the Cost efficiency.

(2) The application of the health assurance service quality control system is conducted thoroughly covering the fulfilment of the quality of the health facility, ensuring the health care process is running by specified standard, as well as the monitoring of the participant's health data.

Section 82 of the Alignment Quality control and cost by healthcare facilities are conducted through: a. health care settings in the running

practice of the profession in accordance with competence; b. utilization of review and medical audits; c. ethics coaching and profession discipline to the health workforce;

and/or d. the monitoring and evaluation of drug use, health tools, and

medical materials are used in regular health care which is implemented through the utilization of the health information system.

Section 83 of the Smuggling of the quality and the The cost control by BPJS Health

is done through: a. Quality of the Health Facility's standards. The standard fulfilment of the health care process; and c. monitoring of the Participant's health care.

The Second Part of the Mutu Control Team and the Cost Control

Section 84 In order to host quality control and control, BPJS Healthcare form a quality control and control team consisting of an element of the profession organization, academia, and clinical experts divided in the Coordination Team and the Technical Team.

Article 85 (1) The Coordination Team as it is referred to in Section 84

is at the level: a. Center; b. Regional Division; and c. Branch

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(2) The coordination team as referred to in paragraph (1) has the function and authority to do: a. the socialization of the health care authority in the running

the practice of the profession by competence; b utilization of review and medical audits; c. ethics coaching and the discipline of the profession to the health workforce; and d. coordinate with healthcare facilities cooperating

with BPJS Healthcare in terms of: 1. Health power regulatory settings in the running

practice of the profession according to competency; 2. utilization of review and medical audits; and 3. coaching ethics and discipline of the profession to the health workforce.

Article 86 (1) The technical team as referred to in Article 84 is in any

health facility in cooperation with BPJS Health. (2) The technical team as referred to in paragraph (1) has a function and

authority as follows: a. request and obtain information for certain cases

regarding identity, diagnosis, history of illness, examination history, and the history of the participant's treatment in the form of a copy/photocopy of the medical records to the Health Facility as needed; and

b. conducting monitoring and evaluation of drug use, health tools, and medical materials spent in regular health care through the utilization of the health information system.

Article 87 To guarantee quality control and control costs Health care to BPJS Healthcare, the Minister sets the standard of health care rates that are referrers for Health Guarantee.

Article 88 (1) BPJS Health makes payments to healthcare facilities

which has provided the service to the Participant. (2) The payment of the BPJS Healthcare to the facility

health as it is referred to in paragraph (1) is determined by agreement between BPJS Health with the health facilities association in each province as well as referring to the tariff standards set by the Minister.

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(3) The association of healthcare facilities as referred to in paragraph (2) for first-degree health facilities and advanced health facilities refers to the Ministerial Decree.

(4) In terms of magnitude the payment as referred to in paragraph (2) is not agreed upon by the association of health facilities and BPJS Health, the quantity of payment on the Health Guarantee program as decided by the Minister.

BAB VIII REPORTING AND UTILIZATION REVIEW

Article 89

(1) The health facility is required to create an activity report Health services that are provided periodically every month to BPJS Healthcare.

(2) The Health Facility is required to apply Utilization Review periodically and continuously.

(3) BPJS Health is performing the implementation of the health care program.

(3) BPJS Health is performing utilization review by measuring the utilization of services based on rate, ratio as well as cost units.

(4) BPJS Healthcare based on rate, ratio as irements of the cash compensation claim as referred to in paragraph (5) are governed by the BPJS Health Board of Directors.

Article 78 Compensation is in the form of a health care delivery and the provision of a specific Health Facility as referred to in Article 75 of the paragraph (4) letter b and c may cooperate with the health service, the health profession organization, and/or the health facilities association.

Article 79 (1) If an area is set as an area is not available

the Health facility meets condition, then Branch Office conducts awell as unit cost as referred to in paragraph (3) conduct evaluation and feedback.

(5) BPJS Healthcare performs follow-up to the evaluation and feed results Back as referred to in paragraph (4) in order control of health care costs.

(6) Further provisions regarding the reporting mechanism, Utilization Review are set with the BPJS Health Board of Directors.

BAB IX

PROVISIONS SECTION 90

WARRANTY GOVERNING BODY REGULATION The Social Health came into effect on 1 January 2014.

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2014, No. 1 40

For everyone to know, ordering the Governing Body Ordinance of the Social Security Organizing Board with its placement in the State News of the Republic of Indonesia.

Set in Jakarta on January 1, 2014 THE PRINCIPAL DIRECTOR OF THE HEALTH SOCIAL SECURITY ORGANIZER, FACHMI IDRIS

Was promulred in Jakarta On January 1, 2014. MINISTER FOR LAW AND HUMAN RIGHTS REPUBLIC OF INDONESIA, AMIR SYAMSUDIN

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