Materi Yankes Novotel

8/18/2019 Materi Yankes Novotel

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PELAKSANAAN PROGRAM JKN TAHUN 2016

Bandar Lampung, 6 APRIL 2016


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PENYELENGGARAAN JKN

JAMINAN KES NASIONAL

FASKESBPJSKESPEMERINTAH

PENYELENGGARA

JKN

PELAYANAN

KESEHATANREGULATOR

3


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UUD 1945

Pasal 34 ayat

(2) UU NO. 40 /2004

Ttg SJSN : Dasar

PengaturanPrgra! Ja!"nan

#ese$atan

UU N. 24/2011 Ttg

%PJS : Dasar

Peneta&an %PJS

#ese$atan se'aga"Pelasana Prgra!

Ja!"nan #ese$atan

P*P*S N. 12 /2013 tentang Ja!"nan

#ese$atan 'eserta Peru'a$annya

(P*P*S N. 111 /2013 +an N. 19/201,) :

Dasar &eras"nal Pelasanaan Ja!"nan

#ese$atan

PP N. 101 / 2012 +an PP

N. -,/2015 ttg Pener"!a

%antuan uran (P%)

Ja!"nan #ese$atan: Dasar

Peneta&an Peserta P%

a"r "s""n +an T"+a

a!&u(Ps. 1- UU SJSN : uran

Prgra! Ja!"nan Ss"al

'ag" a"r "s"n +an Orang

T"+a a!&u D"'ayar le$

Pe!er"nta$

Ps. 19 UU %PJS :

Pe!er"nta$ Pusat

e!'ayar +an enyetr

uran untu P% &a+a %PJS)

Dasar

Perintah

Konstitusi

Lahirnya

SJSN Melalui

UU

Peraturan

#e!enss:Peraturan

%PJS

Pasal 34“Nea!a"e#e"$a#

%a# s&s'e" (a"a#s)s&al $a&sel*!*+!a%,a' -a#"e"$e!-a,a%a#"as,a!a%a',a# le"a+-a# '&-a%"a".*ses*a&-e#a#"a!'a$a'%e"a#*s&aa#/

Regulasi

Peraturan

#e!enes


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.&!nl"ne.net

DESAIN JAMINAN KESEHATAN NASIONAL

PROVIDER PESERTA/PASIEN

BPJS KES

Pelayanan KesehatanKOMPREHENSIF

Prospektif Pembayaran

iuran

Paket Benet

PENYELENGGARAAN NIRLABA, DANA AMANAH PORTABILITAS , PROFESIONAL,PELAYANAN

TERSTRUKTUR , BERKEADILAN, SOLIDARITAS SOSIAL,

MENDORONG : PENERAPAN SPM, STANDAR/MUTU, TARIF, WIN-WIN

SOLUTION, RS TIDAK DIRUGIKAN, YANKES LEBIH FAIR, KOMPETISI/PERSAINGAN USAHA

JKN

TERKENALI

KONTRAK /MO TELAA! TILISASI

KONTROL,PEN"A#ASANSTANDAR, DSB

Regula!"


5/66

Ma#aa' (a"a# %ese+a'a# $e!s&a' .ela,a#a#

.e!se)!a#a# ,a# "e#a%*. .ela,a#a# .!)")'&

.!e5e#'& %*!a'& -a# !e+a$&l&'a'& 'e!"as*% )$a'-a# $a+a# "e-&s +a$&s .a%a& ,a# -&.e!l*%a#

PAKET MANFAAT JKN

Pela,a#a# ,a# -&$a'as& "el&.*'&$%a&a ma'a, a(a' )an'u d*ngar +*ar-nga-d., a(a' )an'u g*ra% +'ng%a'p*nangga, %ur- rda dan %r*'.,

Pela,a#a# , '&-a% -&(a"$a. T-da% *ua- pr*dur

). P*(aanan d-(uar a%* 3g )*%*r4aama dng BPJS&. P*(aanan )*r'u4uan %m*'-%,d. "*n*ra( &*&% up, p*ng)a'an a('*rna'-5,*. P*ng)a'an un'u% m*ndapa'%an %*'urunan,

P*ng)a'an Imp'*n-,5. P*(aanan K* Pada Saa' B*n&ana Dang. Pa-*n Bunu D-r- /P*na%-' 3g T-m)u( A%-)a'

K**nga4aan n'u% M*n-%a D-r- S*nd-r-/ BunuD-r-/Nar%)a


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6

ARAH PENGEMB PEMBIAAAN ! JK KEDEPAN


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PENGEMB PEMBIAAAN ! JAMINAN KES

"

Arah penyesuaian peran, bergerak dengan prioritas pada pengemb pembiayaan

kesehatan serta pemantapan pengemb dan pelaksanaan jaminan kesehatan

JAMKESMAS #$$$$$%

BIAKES #$$%

SASARAN&'ERSELENGGARA

NA PENGUA'AN

JKN

ERA SEBELUM JKN

ERA JKN

BIAKES #$$$$$%

JAMKES #$$%


8/66

PENGEMB BIAKES ! JAMKES

(

PEMBIAAAN

KESEHA'AN

J#NPR)GRAMKESMAS

PEMBIAAAN

KESEHA'AN


9/66

KEMENKES

*

PEMBIAAAN KES UKP JKN

UUD +*,- #Ps .(/ 0,%/UU No1 ,23.22,/

UU No1 .,3.2++

PP +2+3.2+./ PP

"63.2+-PERPRES +. /

+++ 'H .2+0 4an

+*3.2+6 serta 0.3.2+,1

PERMENKES 6*3.2+0

! -*3.2+,/ "+3.2+0 !

**3.2+- +*3.2+,/."3.2+,

4an .(3.2+,1

Ja5inan

Perlin4ungan

Kesehatan

agi seluruh

7en4u4u83

5asyara8at


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SUMBER PEMBIAAAN JKN

+2

IURAN N)N PBI#PEKERJA DAN

PEMBERI KERJA%

IURAN PBI APBNIURAN PBI APBD

BIAA

ANKES

BIAA

)PERASI)NAL

BIAA 9ADANGAN

BPJS KESEHA'AN

BIAA PELAANAN KES

PENDANAAN JKN

JASPEL

DUKUNGAN

)PERASI)NAL ANKES

P))LING IURAN

BAAR

:ASKES


11/66

JKN

DI KRTL


12/66


13/66

ALUR PENGEL)LAAN DANA JKN

DI :KR'L

+0

BPJS KES

RS SDH BLUD

PENGAJUAN KLAIM

#INA 9BG?s%

RS BLM

BLUD

PENGAJUAN KLAIM

#INA 9BG?s%

BAAR KLAIM

L A P

) R

KAS DAERAH

#KASDA%

S

E ' ) R

AN

KES

AN

KES

RKA@DPA RSSESUAI

RBA@DPA

BLUD

PEMAN:AA'AN DANA JKN DI :KR'L


14/66

KEMENKES

+,

PEMAN:AA'AN DANA JKN DI :KR'L

PERMENKES .(3.2+,

RKA@DPA3RBA@DPA

RS

Menyusun ! Mengusul8an 8eg

1. JASPEL 02@-2

2. DUKUNGAN )PPELA #)at/ BHP/

Al8es/ A45/ 4ll%

D)KUMAN ANGGARAN PEMAN:AA'AN

PED)MAN PELAKSANAAN JKN

DIPA

SA'

KER

Untu !e!anaatan e!'al" #la"! yang tela$ +"ter"!a #*T6 !enyusun +an

!engusulan +ala! 'entu eg"atan &a+a +u!en anggaran sesua" +engan

e'utu$an !as"ng!as"ng. Se'aga"!ana +"atur +ala! P*N#S 27/2014 #*T6

+a&at !engalas"an J8SP6 seesar 02@-2 +ar" #la"! yang +"ter"!a +an s"sanya

untu Duungan O&eras"nal Pelayanan #ese$atan


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Per!asala$an Pelasanaan J#N :

1. Pergu' N. 27 Ta$un 2015 Tentang Peru'a$an

8tas Pergu' N. 43 Ta$un 2013 Tentang

Pe+!an Pelasanaan S"ste! *uuan

Pelayanan #ese$atan2. #!&etens" SD

3. S"ste! "nr!as" ruuan 'erenang

4. Pen+"a!an %PJS ter$a+a& +ter5. #re+ens"all"ng ases Ole$ %PJS

,. De"n"s" st S$er"ng 6anut Pena'aran


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Pergu' N. 27 Ta$un 2015 Tentang Peru'a$an

8tas Pergu' N. 43 Ta$un 2013 Tentang

Pe+!an Pelasanaan S"ste! *uuanPelayanan #ese$atan

Pergu' "n" +"a+"an +asar 'ag" %PJS untu

t"+a !e!'ayaran la"! +engan alasan sala$

&rse+ur '"la &as"en +"layan" +" ases yangt"+a sesua" +engan reg"nal &as"en.

Pergu' "n" 'ertentangan +engan $a &as"en

untu !e!"l"$ &elayanan ese$atan +an+"!anaa$ leta &rta'"l"tas J#N;

8+a e $aat"ran *S untu !elayan" &as"en

+"luar reg"nal se!est"nya se$"ngga &leyanan

yang +"'er"an t"+a &t"!al.


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18/66

3. S"ste! "nr!as" ruuan

'erenang S"ste! "nr!as" ruuan 'erenang

'elu! +"alanan se$"ngga $al "n" uga

!erug"an &as"en.

Se'elu! !eruu ases yang !eruu

su+a$ +a&at !e!ast"an 'a$a &as"en

+a&at +"tangan" +" ases tuuan.


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4. Pe!'"aran %PJS ter$a+a& Pelayanan +ter

S&es"al"s +engan


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5. #re+ens"all"ng ases Ole$ %PJS

Dala! Per&res N. 19 Ta$un 201, Pasal 3, 8yat

4 (a) +"se'utan =Dala! ranga &elasanaan era

sarana +engan as"l"tas #ese$atan %PJS

#ese$atan 'err+"nas" +engan +"nas ese$atana'u&aten/ta>. ?al "n" !enegasan &elasanaan

&asal 35 &er&res 12 ta$un 2013 'a$a &a+a

+asarnya eterse+"aan ases +an naes a+ala$

tanggung aa' &e!er"nta$ +an &e!+a. 8an teta&" enyataan yang a+a +"la&angan

&eraturan "n" 'elu! +"alanan le$ %PJS.


21/66

Penga+uan asyaraat

all Prate yang +"lauan le$ sala$

satu l"n" #l"n" elauan O&eras"

Se


22/66

,. De"n"s" st S$ar"ng

nt$ #asus :

Pas"en #elas 2 +"raat +"elas !anaa$


23/66


24/66

Slus"

e!'uat regulas" Pergu' yang le'"$ ter&er"n


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ungs" Pert"!'angan #l"n"s

(l"n"


26/66

De"n"s"

e7a# Pe!'&"$a#a# Kl&s ada(a d*=an ang d-)*n'u%(* M*n'*r-K**a'an ang '*rd-r- dar- unur %*m*n'*r-an %**a'an,rgan-a- pr5*- dan a%ad*m-- %*d%'*ran un'u%

m*m)*r-%an p*r'-m)angan %(-n- da(am p*(a%anaan Jam-nan K**a'an Na-na(<

T&" Pe!'&"$a#a# Kl&s ada(a '-m ang d-)*n'u% (*"u)*rnur '*rd-r- dar- unur D-na K**a'an Pr8-n-,

rgan-a- pr5*- dan a%ad*m-- %*d%'*ran *)aga-p*r=a%-(an D*=an P*r'-m)angan K(-n- da(am m*m)an'um*n*(*a-%an p*rma(aan %(-n- ang m*n4ad- *ng%*'a d-'-ng%a' pr8-n-<

Pe#a-* ada(a p**r'a Jam-nan K**a'an Na-na(,


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De"n"s" (2)

Pe!"asala+a# Kl&s ada(a maa(a angm*nang%u' dan/a'au )*rdampa% '*radappa%*' man5aa' dan/a'au p*m)aaran %(a-m

ang '*r4ad- da(am p*(aanan %**a'an padap*n*(*nggaraan JKN<

Se#%e'a ada(a %*'-da%*paaman ang '*r%a-'

p*rmaa(aan %(-n- an'ar p-a% p*ngadu pada aa'a'au *uda p*(aanan %**a'an da(amp*n*(*nggaraan JKN ang )*r=u4ud d-adu%anna a'up-a% (* p-a% (a-nna %*pada P*m*r-n'a Pua'a'au P*m*r-n'a Da*ra Pr8-n- ang m*m)-dang-uruan %**a'an ang )*r-5a' pra? m*d-a- dan '-da%m*rupa%an p*r%ara p*rda'a dan/a'au p-dana


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6e!'aga engurus asala$ Tera"t J#N

T"! #en+al"

utu

#en+al" %"aya

Dean

Pert"!'angan

e+"

%a+an

Pengaas

*u!a$ Sa"t

8nt" rau+

Dean

Pert"!'angan

#l"n"s

##

a'ang

##

"laya

##

Pusat

%PJS #a'/#ta

Au'ernur

#D# enes

T"!

T"!

Pen


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#eanggtaan

a< D*=an P*r'-m)angan K(-n-

Jum(a @ 1> rang

'*rd-r- dar- @

unur %*m*n'*r-an %**a'an *)aga-ex ofcio

unur rgan-a- pr5*- a%ad*m-- %*d%'*ran

K*'ua dar- (uar unur K*m*n'*r-anK**a'an


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1< Maa Ja)a'anD*=an

> 'aun *4a% d-'*'ap%anna

K*pu'uan M*n'*r- K**a'an '*n'angD*=an P*r'-m)angan K(-n-

D-'-n4au u(ang *'-ap a%-r maa 4a)a'an<

> dar- 1> rang angg'a D*=an

P*r'-m)angan K(-n- dapa' d-p*rpan4angmaa 4a)a'anna *(ama 1 'aun *'*(amaa 4a)a'an )*ra%-r

Ja)a'an Angg'a D*=an )*ra%-rapa)-(a @

Maa 4a)a'anna )*ra%-r$

M*ngundur%an d-r-$

M*n-ngga( dun-a$ a'au

D-)*r*n'-%an )*rdaar%an %*pu'uanM*n'*r-


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2< Rang%ap Ja)a'an

Angg'a D*=an '-da% )(* m*rang%ap 4a)a'an (a-n ang dapa' m*n-m)u(%an)*n'uran %*p*n'-ngan dan/a'aum*ngganggu %-n*r4a D*=an P*r'-m)anganK(-n-<

>


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S,a!a'Kea#)'aa#

8al)# e7a# Pe!'&"$a#a# Kl&s +a!*s

"e"e#*+& .e!s,a!a'a##arga n*gara Indn*-a$

S*a' 9-% dan m*n'a($

:a%ap, 4u4ur, m*m-(-%- mra(, *'-%a, -n'*gr-'a ang'-ngg-, m*m-(-%- r*pu'a- ang )a-%, dan m*maam-maa(a ang )*r%a-'an d*ngan p*n*(*nggaraan $B*ru-a pa(-ng r*nda 0 +*mpa' pu(u. 'aun$

T-da% m*n4ad- angg'a a(a a'u par'a- p(-'-%$

B*raa( dar- pr5*- %*d%'*ran$

T-da% p*rna d-p-dana p*n4ara )*rdaar%an pu'uanp*ngad-(an ang '*(a m*mp*r(* %*%ua'an u%um'*'ap %ar*na m*(a%u%an '-nda% p-dana ang d-an&amd*ngan p-dana p*n4ara +(-ma. 'aun a'au (*)-<

' T" P " ' #l" "


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'. T"! Pert"!'angan #l"n"s

T-m P*r'-m)angan K(-n- )*r%*dudu%an d-

Pr8-n-, B*rangg'a%an gan4-( an'ara >? rang ang

'*rd-r- dar- @ unur rgan-a- pr5*-

a%ad*m-- %*d%'*ran<

T-mP*r'-m)angan K(-n- d-'*'ap%and*ngan K*pu'uan "u)*rnur

T-m P*r'-m)angan K(-n- d-)*n'u% pa(-ng (am)a' Januar- 201C


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Trans"s" T"!

S*)*(um T-m P*r'-m)angan K(-n- ang)*r-5a' '*'ap d-)*n'u%, 'ugap*n*(*a-an p*rmaa(aan K(-n- '-ng%a'pr8-n- d-(a%u%an (* T&" M)#e5-a# Pe!'&"$a#a# Kl&s JKN7 '-ng%a'

Pr8-n- $&-a# Pe!'&"$a#a# Kl&s< K*angg'aan p*r'-m)angan %(-n- da(am

T-m Mn*8 dan P*r'-m)angan K(-n- JKN7'-ng%a' Pr8-n- '*rd-r- dar- Ka)-d 3an%*D-na K**a'an *)aga- %*'ua, 1 +a'u.'*naga d%'*r d- d-na %**a'an pr8-n-,1 +a'u. '*naga d%'*r dar- MKEK IDI=-(aa<

Da(am M*(a%u%an 'u an a T-m Mn*8


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Da(am m*(a%ana%an 'ugana, D*=anP*r'-m)angan K(-n- d-)an'u (**%r*'ar-a' ang )*r%*dudu%an d-Pua' P*m)-aaan dan Jam-nan

K**a'an< S*%r*'ar-a' *)aga-mana d-ma%ud

d-p-mp-n (* *%r*'ar- ang *&araeks ofcio d-4a)a' (* p*4a)a'

'ru%'ura( ang m*m)-dang- Jam-nanK**a'an<


37/66

Da(am m*(a%ana%an 'ugana, T-mP*r'-m)angan K(-n- Pr8-n- d-)an'u(* *%r*'ar-a' ang )*r%*dudu%an d-

D-na K**a'an Pr8-n- ang m*m-(-%-'uga dan 5ung- d- )-dang Jam-nanK**a'an<

+. Seretar"at T"!


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TUA8S D8N N8NA

A T*as -a# 9e7e#a# e7a#Pe!'&"$a#a# Kl&s

D*=an P*r'-m)angan K(-n- )*r-5a'-nd*p*nd*n da(am p*ngam)-(an

%*pu'uanna dan )*rd-r- *)aga- p-a%-mpar-a( dan )*%*r4a *&ara )*%'-5<

Da(am P*(a%anaan 'ugana, D*=an dapa'm*m-n'a p*ndapa'/ mau%an dar- para a(-

*ua- a'au r*(*8an d*ngan maa(a %(-n-ang m*n4ad- *ng%*'a<

D*=an m*(a%u%an p*n*(*a-an *ng%*'adapa' m*m)*r-%an r*%m*nda- %*padaM*n'*r- K**a'an

D*=an )*r'an un a=a) dan m*n am a-%an


39/66


40/66

en+uung Penguatan S"ste! (2)

e!antau +an !en+rng +"'entunya clinical pathway

&elayanan !e+" yang +"'uat le$ rgan"sas" &res"

+an/atau as"l"tas &elayanan ese$atan se'aga"unsur/a


41/66

2< P*n*(*a-anS*ng%*'a K(-n-

M*(a%u%an p*n*(*a-an *ng%*'a%(-n- ang )*r-5a' na-na( danp*n*(*a-an *ng%*'a %(-n- ang

'-da% dapa' d-*(*a-%an (* T-mP*r'-m)angan K(-n-<

M*(a%u%an p*ndamp-ngan '*radap T-mP*r'-m)angan K(-n- un'u% p*n*(*a-an*ng%*'a d- '-ng%a' Pr8-n-

eenang Dean Pert"!'angan #l"n"s:


42/66

eenang Dean Pert"!'angan #l"n"s:

aBe!%))!-as& -e#a# K)"&'e Pe#&la&a# Te%#)l)&Kese+a'a# :Healthe!hnolo"y #ssesment ; T&" Ta!& JKN T&" M)#&')!-a# E5al*as& T&" Pe#ea+a# F!a*- -ala" .e"$e!&a#!e%)"e#-as& *".a# $al&% -a# *s*la# .!&)!&'as %e.a-aMe#'e!& Kese+a'a# se$aa& *.a,a "e#-*%*#'e!la%sa#a#,a %e#-al& "*'* -a# %e#-al& $&a,a -ala"

JKN

$Me"as&l&'as& %))!-as& %e$&(a%a# .e#,ele#a!aa# JKN ,a# -&+as&l%a# *#&'


43/66

eenang Dean Pert"!'angan#l"n"s:

*< M*ng*n'-%an dan/a'au m*(an4u'%an pr*p*m*r-%aan %au*ng%*'a<

d< M*nuun 4ad=a( p*m*r-%aan dan p*n-dangan%au *ng%*'a<

5


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5


45/66


46/66

#eelasan #eenangan

P*mu'u *ng%*'a R*%m*nda'r 4ad-'ma'- *%*%u'r-a( *ua-%*=*nanganna

!ana g %uu g 8-a M*n%*

ung- )g ma4*(-/ma%ama7 m-r-pa%-m r -mpar-a( -nd*p*nd*n Fm*m-(-%- ur-d-%-7/%*%uaaan%*ma%amaan '*r*nd-r-

B*r4*n4ang, d-)a'a- )and-ng7 1 %a(- +''a( @ 2

'aap. SOP u'% pr* m*m)ua' pu'uan %au

p*dmanm-r-p u%um a&ara7

P-a% g '*rp*r-%a @ )*ra% d-damp-ng-


47/66

atatan : OUTPUT Dean Pert #l"n#e!eng"atan Putusan :

D*=an P*r' K(-n Na d-ang%a' (*M*n%*

T-m P*r' K(-n @ / M*n%* +p*4a)a'%*m%* d- prp7 *ua- 2>/1 ''g

O'da G p-mp-nan da*ra/Kad-n%* a/nM*n%*

E%*%u- 8-a a'aan7 p-a% '*r%*na @

Dr 8-a TKMKB, a'au 8-a RS/KTLa'au KTP, a'au 8-a IDI/MKEK

BPJS da / BPJS Pua'

Pa-*n d-pu'u%an

ADA “ASAS PRESEDEN”/YURISPRUDENSI UTK

EFEKTIVITAS & EFISIENSI

+ T" P t" ' #l" "


48/66

ugas +an eenang T"! Pert"!'angan #l"n"s

T*as T&" Pe!'&"$a#a# Kl&s a-ala+

M*n*(*a-%an *ng%*'a )*rdaar%an aduanang '*r4ad- d- =-(aa pr8-n- *'*mpa'<

M*ru4u% *ng%*'a ang '-da% dapa' d-*(*a-%an

d- '-ng%a'pr8-n- %*pada D*=an P*r'-m)angan K(-n-<

M*(apr%an *ng%*'a ang a%an d-'angan-,'*rmau% pr* p*r%*m)angan dan

p*n*(*a-anna %*pada D*=an P*r'-m)anganK(-n-<

M*m)an'u D*=an P*r'-m)angan K(-n- da(amp*ngumpu(an )aan?)aan p*ndu%ung a'au

p*ndamp-ngan p*n*(*a-an *ng%*'a un'u%

eenang T"! Pert"!'angan #l"n"s:


49/66


M*ng*n'-%an pr* p*m*r-%aan aduan ang '-da%m*m*nu-

ara' *ua- m*%an-m* p*ng*n'-an aduan<

M*(a%u%an p*m*r-%aan, -n8*'-ga-, m*mangg-( danm*m-n'a %*'*rangan a%-/a(-<

M*m*r-%a d%um*n/ura'?m*nura', da'a -n5rma-*(*%'rn-%

+d-g-'a(. dar- para p-a% dan r*%am m*d- %**a'an'*r%a-'<

M*ndapa'%an da'a %(a-m ang d-a4u%an 5a-(-'a

%**a'an %* BPJS K**a'an< M*mangg-( dan m*m-n'a %*'*rangan *r'a

m*m*r-%a d%um*n/ura'?m*nura', da'a -n5rma-*(*%'rn-% +d-g-'a(. a%-/a(- dar- T-m Mn-'r-ng dan

E8a(ua-, T-m P*n&*gaan raud, T-m K*nda(- Mu'udan K*nda(- B-aa, D*=an P*r'-m)angan M*d-%,


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M*m)ua' %*pu'uan p*n*(*a-an *ng%*'adan m*nguu(%an p*n*'apanna %*padaD*=an P*r'-m)angan K(-n- un'u% %au ang)aru *(am)a'?(am)a'na 1 +a'u. )u(an *4a%d-mu(a-na p*m*r-%aan<

M*m)ua' %*pu'uan p*n*(*a-an *ng%*'a%au *4*n- ang '*(a d-'*'ap%an (*D*=an P*r'-m)angan K(-n- *(am)a'?(am)a'na 2 +dua. m-nggu<

M*(apr%an %*pu'uan ang d-am)-()*rdaar%an %*'*'apan D*=an P*r'-m)anganK(-n- *&ara )*r%a(a *(am)a'? (am)a'na*'-ap 2 +dua. )u(an d*ngan '*m)uan %* D-naK**a'an Pr8-n-<

M*nd%um*n'a-%an %*pu'uan p*n*(*a-an

Tugas Seretar"at Dean Pert"!'angan #l"n"s


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Tugas Seretar"at Dean Pert"!'angan #l"n"s

M*m)an'u P*(a%anaan 'uga D*=an P*r'-m)anganK(-n-

T*rd-r- dar- n-' '*r%a-' d- K*m*n'*r-an K**a'an<

Tuga *%r*'ar-a' ada(a@1< M*(a%u%an %*g-a'an adm-n-'ra- da(am rang%a

m*ndu%ung %*g-a'an D*=an P*r'-m)angan K(-n- da(amm*n4a(an%an 'uga dan =*=*nangna '*rmau%p*nuunan anggaran %*g-a'an p*ra-na(<

2< M*ng-n8*n'ar-a- dan m*ng%mp-(a- *ng%*'a '*r%a-' JKN )a-% ang '*(a, *dang dan/a'au )*(um d-*(*a-%an,

ang d-(apr%an (* T-m P*r'-m)angan K(-n-<>< M*nuun da5'ar *ng%*'a %(-n- ang a%an d- *(*a-%an

(* D*=an P*r'-m)angan K(-n-<

< M*ng-n8*n'ar-a- dan m*ngmp-(a- %*pu'uanp*n*(*a-an *ng%*'a ang d-a-(%an (* D*=anP*r'-m)angan K(-n- dan T-m P*r'-m)angan K(-n- *)aga-)aan p*m)-naan<


52/66

Tugas Seretar"at T"! Pert"!'angan #l"n"s

B*r%*dudu%an d- D-na K**a'an Pr8-n-< D-(a%ana%an (* '*naga adm-n-'ra'-5 dar-

unur T-mMn*8 dan P*r'-m)angan K(-n-<

Tuga *%r*'ar-a' ada(a@1< M*(a%u%an %*g-a'an adm-n-'ra- da(am rang%am*ndu%ung %*g-a'an T-m P*r'-m)angan K(-n-da(am m*n4a(an%an 'uga dan =*=*nangna'*rmau% p*nuunan anggaran %*g-a'anp*ra-na(<

2< M*ngumpu(%an, m*ng-n8*n'ar-a-, danm*ng%mp-(a- *mua p*ngaduan '*r%a-' JKN angmau% %* T-m P*r'-m)angan K(-n-<

>< M*nuun da5'ar *ng%*'a %(-n- ang a%an d-*(*a-%an (* T-m

P*r'-m)angan K(-n-<< M*(a%ana%an *nd%um*n'a-an %* -a'an T-m

MEKANISME KERJA


53/66

1. 8lur #era en+uung Penguatan S"ste!

Kmp-(a- da'a dan-n5rma- *ng%*'aKa)upa'*n/K'a/Pr8-n

-

T*(aa %r-'- dan/a'auana(-- %*)-4a%an (*

D*=an P*r'-m)anganK(-n-

R*%m*nda-H

Km-'* PTK, T-m Tar-5 JKN, T-m Mn*8, T-mP*n&*gaan raud,MKEK pua' dan BPRS

P**r'a, rgan-a- pa-*n,a-a- 5a%*, rgan-a-pr5*-, p*m*r-n'a da*radan p*mang%u %*p*n'-ngan

(a-n

mpan)a(-%

R*%m*nda- %*padaM*n'*r- K**a'an, BPJS

K**a'an, dan p-a%?p-a%

p*mang%u %*p*n'-ngan (a-n

MEKANISME KERJA


54/66

D*=an P*r'-m)angan K(-n- )*rama BPJSK**a'an 4uga m*(a%u%an ana(-- %*)-4a%an'*radap A(a' K**a'an/O)a' ang dapa'd-%(a-m '*rp-a dar- Pa%*' Indn*-an :a*Ba*d "rup +INA :B";. da(am %nd--

%uu un'u% %**(ama'an pa-*n %mp-(a-da'a dan -n5rma- *ng%*'a '*n'ang A(a'K**a'an/)a' '*r*)u' dar- *(uru%a)upa'*n/%'a

A(a' K**a'an/)a' d-ma%udan'ara (a-n@ A(a' %**a'an ang 5ung-na m*m)an'u a(a'

%**a'an u'ama ang m*n4ad- ara' mu'(a%a'au %mpn*n p*n'-ng/**n-a( ang '*rp-adar- a(a' %**a'an u'ama/)a' ang d-)u'u%anpa-*n<

A(a' %**a'an ang 4um(ana *&ara m-n-mumd- *r(u%an un'u% m*(a%ana%an '-nda%an *ua-


55/66

#8NS #*J8

Al*! Ke!(a Pe#,elesa&a# Se#%e'a

S*ng%*'a dapa' '*r4ad- an'ara @ a-(-'a K**a'an d*ngan BPJS K**a'an,

a-(-'a K**a'an d*ngan p**r'a JKN, BPJS K**a'an d*ngan p**r'a JKN<

D-(a%u%an *&ara )*r4*n4ang dar- '-ng%a'pr8-n- ampa- d*ngan pua'

Pr-n-p P*n*(*a-an *ng%*'a@ K*ad-(an, AaMan5aa', E5*%'-5, dan E9-*n


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A(ur K*r4a P*n*(*a-an S*ng%*'a

Da(am a( *ng%*'a d- '-ng%a'

%a)upa'*n/%'a uda dapa' d-*(*a-%an(* TKMKB dan/a'au DPM, T-mP*r'-m)angan K(-n- Pr8-n- *'*mpa'(angung m*ng%mp-(a- *ng%*'a '*r*)u'

m*(a(u- *%r*'ar-a' T-m P*r'-m)angan K(-n- d-'*ru%an %*pada D*=an P*r'-m)anganK(-n- m*(a(u- *%r*'ar-a' D*=anP*r'-m)angan K(-n-<

P*n*(*a-an S*ng%*'a d-mu(a- dar-d-'*r-mana aduan r*m- para p-a% angmau% %* *%r*'ar-a' T-m P*r'-m)anganK(-n-

S*(uru pr* p*m*r-%aan dan



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K*pu'uan ang )*r-5a' 9na( dan '*'ap dapa'd-)ua' (* T-m P*r'-m)angan K(-n- *'*(a

para p-a% m*na'a%an m*n*r-ma +'-da%)and-ng.

Apa)-(a '*rdapa' upaa )and-ng, pu'uan ang)*r-5a' 9na( dan '*'ap aru d-)ua' (*

D*=an P*r'-m)angan K(-n-<P*m)a&aan %*pu'uan *ng%*'a =a4-) d-ad-r-para p-a%, namun T-m a'au D*=anP*r'-m)angan K(-n- dapa' m*m)a&a%an

%*pu'uan *&ara in absentia.

D*=an P*r'-m)angan K(-n- m*(a%u%anp*m)-naan dan *8a(ua- dar- a-( %mp-(a-dar- *%r*'ar-a' T-m P*r'-m)angan K(-n- dan*%r*'ar-a' D*=an P*r'-m)an an K(-n- un'u%


58/66

Sans" Putusan Penyelesa"an

Sengeta

T*radap BPJSK )aar %(a-m, u)a%*)-4a%an

'*%n-

T*radap K*mK* u)a %*)-4a%an,ang '*r'u4u %*pada @ T-m !TA, T-mAn'- raud, TKMKB, MKEK, OP, dan T-m?'-m (a-nna<

T*radap Pr8-d*r D%'*r R:A -ngga%* d-agn- a=a(

T*radap Pr8-d*r KTP dan KRTL

T*radap pa-*n

Pe#a-*


59/66

!a-*

a# Kl&sP!)5s&

Pe!'&"$a#a# Kl&sS*ng%*'a d- a%*

da(amP*n*(*nggaraan

JKN

P*ngaduan *&ara '*r'u(-dar- p*ngadu d-'*r-ma(* S*%r*'ar-a' T-m

P*m*r-%aK*)aan

para p-a%

D-(a%u%anP*m*r-%aan

T-ng%a' P*r'ama

'*radapP*ngaduan

Lapran P*ngaduan dar- T-md-'*r-ma (* S*%r*'ar-a'D*=an

P*m*r-%aK*)aan

para p-a%

D-(a%u%anP*m*r-%aan

T-ng%a' Band-ng

'*radapP*ngaduan

P*ngaduan *&ara'*r'u(- dar- P-a%

angB*r*ng%*'a

Band-nga'aPu'uan

T-mH K*pu'uan

P*n*(*a-anS*ng%*'a T-mP*r'-m)angan K(-n-

K*pu'uanP*n*(*a-an

S*ng%*'aLapran P*ngaduanm*ng*na- *ng%*'aang '-da% dapa'

d-*(*a-%an

K*pu'uanP*n*(*a-an

S*ng%*'a D*=anP*r'-m)angan

K(-n-

adaPu'uan

T-mH


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K*'ua T-m P*r'-m)anganK(-n- d-)an'u

*%r*'ar-a' m*ng*&*%

%*a)aan para p-a%

K*pu'uanP*n*(*a-anS*ng%*'a T-mP*r'-m)angan

K(-n-

K*'ua T-m P*r'-m)anganK(-n- )*rama angg'a

m*m*r-%a p-a%P*ngadu


m*m*r-%a p-a% T*radu

K*'ua T-mP*r'-m)angan K(-n-

)*rama angg'aapa)-(a d-p*r(u%anm*m*r-%a p-a%?p-a%'*r%a-' un'u% d-4ad-%an)aan p*r'-m)angan


m*(a%u%an -dang

un'u% m*m)ua'%*pu'uan

AdaPu'uan T-mH

Lapran P*ngaduanm*ng*na-

*ng%*'a ang'-da% dapa'd-*(*a-%an

ean"s!e Pe!er"saan T"ngat %an+"ng


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ean"s!e Pe!er"saan T"ngat %an+"ng

K*'ua D*=anP*r'-m)angan K(-n-d-)an'u *%r*'ar-a'

m*ng*&*% %*a)aanpara p-a%

K*pu'uanP*n*(*a-an

S*ng%*'a D*=anP*r'-m)angan

B(-n-

K*'ua D*=an P*r'-m)anganK(-n- )*rama angg'a

m*m*r-%a p-a% P*ngadu

K*'ua D*=an P*r'-m)anganK(-n- )*rama angg'am*m*r-%a p-a% T*radu

K*'ua D*=an P*r'-m)anganK(-n- )*rama angg'a

apa)-(a d-p*r(u%anm*m*r-%a p-a%?p-a%'*r%a-' un'u% d-4ad-%an)aan p*r'-m)angan

K*'ua D*=anP*r'-m)angan K(-n-

)*rama angg'am*(a%u%an -dang un'u%

m*m)ua' %*pu'uan

D"larang +"+a!&"ng" &enga


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%e'era&a Te!&late Penyelesa"an Sengeta

:(-n-&a( "u-d*(-n* :(-n-&a( A(gr-'ma

Imp(-%a- :'-ng ?

m*ng-%a'

Pela&ran


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Pela&ran

T-m P*r'-m)angan K(-n-

T-m P*r'-m)angan K(-n- m*nuun (apran %*pada D*=anP*r'-m)angan K(-n- ang '*rd-r- dar- @

Lapran *ng%*'a ang a%an d-*(*a-%an

Lapran pr* p*n*(*a-an ang *dangd-*(*a-%an

Lapran *ng%*'a ang '*(a d-*(*a-%an Lapran *ng%*'a ang '-da% dapa'

d-*(*a-%an

D*=an P*r'-m)angan K(-n-

Lapran %*pu'uan p*n*(*a-an *ng%*'aun'u% d-'*'ap%an M*n'*r-

Lapran umpan )a(-% p*n*(*a-an *ng%*'apada T-m

P*r'-m)angan K(-n-


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Pen+anaan Dana ang d-p*r(u%an un'u% p*(a%anaan

p*r'-m)angan K(-n- )a-% d- Pua' maupun d-Pr8-n- d-)*)an%an %*pada AnggaranP*ndapa'an dan B*(an4a N*gara<

P*ndanaan un'u% %*g-a'an P*r'-m)angan K(-n- d-

'-ng%a' pua' )*raa( dar- DIPA Pua' P*m)-aaandan Jam-nan K**a'an<

S*)*(um dana '*r*)u' d-a(%a-%an *&ara '*'ap,un'u% %*g-a'an p*r'-m)angan %(-n- d- '-ng%a'pr8-n-, p*m)-aaan )*rum)*r dar- dana

D*%n*n'ra- Op*ra-na( T-m Mn*8 danP*r'-m)angan K(-n- JKN Pr8-n-<

M*%an-m* p*m)-aaan p*(a%anaanP*r'-m)angan K(-n- pada Pr8-n- m*nga&u pada

P*'un4u% T*%n- Dana D*%n*n'ra- Prgram


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#es"!&ulan

De Pert #l"n +"$ara&an !a$a!a$ "!&ars"al "n+e&en+en sengeta J#N s'g u&aya a$"r +" eenangan

eseut" es +"tenga$ ungs" le!'aga/un"t s&t : %P*S T"!

8nt" rau+ T"! tar" T"! ?T8 DP T##% %PJS !au&un

!ael"s et"a/+"s"&l"n &res"

Sengeta l"n"s +l! art" luas se&anang !enyangut tr"&art"t : %PJS E &rC"+er es &as"en

Tugas a+a 2 la"n sela"n !a$a!a$ +"lanutan +g ungs" F

eenangan !as"ng!as"ng

#eanggtaannya : SD !&eten (terlat"$) F tere


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n'u% Indn*-a ang (*)- *a'

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KESEH T

N

N SION L

Materi Yankes Novotel

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