Pokok-Pokok Perubahan Pada Perpres Nomor 19 Tahun 2016

A. ASPEK KEPESERTAAN

Pasal 5 Ayat (1) berubah menjadi : Pekerja Penerima Upah dan anggota keluarganya sebagaimana dimaksud dalam Pasal 4 ayat (1) huruf a meliputi Pekerja Penerima Upah, istri/suami yang sah, anak kandung, anak tiri dari perkawinan yang sah, dan anak angkat yang sah, sebanyak-banyaknya 5 (lima) orang. Catatan : Ayat (1) penegasan Pekerja Penerima Upah dan anggota keluarganya sejumlah maksimal 5 orang meliputi Pekerja Penerima Upah, istri/suami yang sah, anak kandung, anak tiri dari perkawinan yang sah, dan anak angkat yang sah.

Pasal 12 Ayat (2) berubah menjadi : Identitas Peserta sebagaimana dimaksud pada ayat (1) berupa Kartu Indonesia Sehat yang paling sedikit memuat nama dan nomor identitas Peserta yang terintegrasi dengan Nomor Identitas Kependudukan (NIK) kecuali untuk bayi baru lahir dari ibu yang terdaftar sebagai PBI. Pasal 12 ditambah dengan Ayat (2a) yang berbunyi : Kartu Indonesia Sehat sebagaimana dimaksud pada ayat (2) diberikan kepada Peserta secara bertahap. Catatan : Penegasan bahwa identitas Peserta adalah KIS yang terintegrasi dengan NIK dan akan diberikan secara bertahap.

B. ASPEK IURAN

Pasal 16 Ayat (3) berubah menjadi : Iuran Jaminan Kesehatan bagi Peserta Pekerja Bukan Penerima Upah dan peserta bukan Pekerja dibayar oleh Peserta atau pihak lain atas nama Peserta. Catatan : Penegasan bahwa iuran Peserta PBPU dan BP dapat dibayarkan oleh orang lain atas nama Peserta.

Pasal 16A Ayat (1) berubah menjadi : Iuran Jaminan Kesehatan bagi Peserta PBI Jaminan Kesehatan serta penduduk yang didaftarkan oleh Pemerintah Daerah sebesar Rp 23.000,00 (dua puluh tiga ribu rupiah) per orang per bulan.

Pasal 16A Ayat (2) : Ketentuan besaran Iuran Jaminan Kesehatan sebagaimana dimaksud pada ayat (1) mulai berlaku pada tanggal 1 Januari 2016. Catatan : Kenaikan besaran Iuran PBI dan penduduk yang didaftarkan Pemerintah Daerah sebesar Rp 19.225,00 menjadi sebesar Rp 23.000,00 per orang per bulan yang berlaku mulai 1 Januari 2016.

Pasal 16D berubah menjadi : Batas paling tinggi Gaji atau Upah per bulan yang digunakan sebagai dasar perhitungan besaran Iuran Jaminan Kesehatan bagi Peserta Pekerja Penerima Upah sebagaimana dimaksud dalam Pasal 16C dan pegawai pemerintah non pegawai negeri sebagaimana dimaksud dalam Pasal 16B ayat (1) sebesar Rp 8.000.000,- (delapan juta rupiah). Catatan : Perubahan batas atas Gaji/Upah per bulan menjadi sebesar Rp 8.000.000,00 (Sebelum perubahan dengan menggunakan perhitungan 2 kali PTKP dengan status kawin dan 1 orang anak).

Pasal 16F berubah menjadi : Iuran Jaminan Kesehatan bagi Peserta Pekerja Bukan Penerima Upah dan Peserta bukan Pekerja :

  1. Sebesar Rp 30.000,00 (tiga puluh ribu rupiah) per orang per bulan dengan Manfaat pelayanan di ruang perawatan Kelas III.
  2. Sebesar Rp 51.000,00 (lima puluh satu ribu rupiah) per orang per bulan dengan Manfaat pelayanan di ruang perawatan Kelas II.
  3. Sebesar Rp 80.000,00 (delapan puluh ribu rupiah) per orang per bulan dengan Manfaat pelayanan di ruang perawatan Kelas I.
  4. Ketentuan besaran Iuran Jaminan Kesehatan sebagaimana dimaksud pada ayat (1) mulai berlaku pada tanggal 1 April 2016.

Catatan :  Kenaikan besaran Iuran PBPU dan BP menjadi sebesar :

  1. Dari Rp 25.500,00 menjadi Rp 30.000,00 per orang per bulan dengan Manfaat pelayanan di ruang perawatan kelas III.
  2. Dari Rp 42.500,00 menjadi Rp 51.000,00 per orang per bulan dengan Manfaat pelayanan di ruang perawatan kelas II.
  3. Dari Rp 59.500,00 menjadi Rp 80.000,00 per orang per bulan dengan Manfaat pelayanan di ruang perawatan kelas I
  4. Berlaku mulai 1 April 2016.

Pasal 16H ditambah Ayat (4) yang berbunyi : Pembayaran Iuran Jaminan Kesehatan bagi anggota keluarga yang lain sebagaimana dimaksud pada ayat (2) diawali dengan pemberian surat kuasa dari Pekerja kepada Pemberi Kerja untuk melakukan pemotongan tambahan iuran dan menyetorkan kepada BPJS Kesehatan. Catatan : Penambahan mekanisme pemberian surat kuasa dari Pekerja kepada Pemberi Kerja untuk melakukan pemotongan tambahan iuran dan menyetorkan kepada BPJS Kesehatan untuk pembayaran Iuran Jaminan Kesehatan bagi anggota keluarga yang lain.

Pasal 17 Ayat (5) yang berbunyi : “Keterlambatan pembayaran Iuran Jaminan Kesehatan sebagaimana dimaksud pada ayat (1) oleh Pemberi Kerja selain penyelenggara negara, dikenakan denda administratif sebesar 2% (dua persen) per bulan dari total iuran yang tertunggak paling banyak untuk waktu 3 (tiga) bulan, yang dibayarkan bersamaan dengan total iuran yang tertunggak oleh Pemberi Kerja” DIHAPUS DAN AKAN DIATUR TERSENDIRI.

Pasal 17 Ayat (6) yang berbunyi : “Dalam hal keterlambatan pembayaran Iuran Jaminan Kesehatan sebagaimana dimaksud pada ayat (5) lebih dari 3 (tiga) bulan, penjaminan dapat diberhentikan sementara” DIHAPUS DAN AKAN DIATUR TERSENDIRI.

Pasal 17A Ayat (3) yang berbunyi : “Keterlambatan pembayaran Iuran Jaminan Kesehatan sebagaimana dimaksud pada ayat (1), dikenakan denda keterlambatan sebesar 2% (dua persen) per bulan dari total iuran yang tertunggak paling banyak untuk waktu 6 (enam) bulan yang dibayarkan bersamaan dengan total iuran yang tertunggak” DIHAPUS DAN AKAN DIATUR TERSENDIRI.

Pasal 17A Ayat (4) yang berbunyi : “Dalam hal keterlambatan pembayaran Iuran Jaminan Kesehatan sebagaimana dimaksud pada ayat (3) lebih dari 6 (enam) bulan, penjaminan dapat diberhentikan sementara” DIHAPUS DAN AKAN DIATUR TERSENDIRI.

Terdapat penambahan Pasal 17A.1 dengan pokok-pokok subsansi sebagai berikut :

  1. Apabila Peserta terlambat membayar iuran lebih dari tanggal 10, penjaminan peserta diberhentikan sementara.
  2. Status Peserta aktif kembali apabila :
  3. Membayar iuran bulan tertunggak (maksimal 12 bulan); dan
  4. Membayar iuran bulan berjalan.
  5. Apabila Peserta akan mendapatkan pelayanan rawat inap dalam jangka waktu 45 hari sejak status kepesertaannya aktif kembali, wajib membayar denda sebesar 2,5% dari biaya pelayanan dikali bulan tertunggak (maksimal 12 bulan) atau maksimal Rp30.000.000,00
  6. Untuk Peserta PPU, pembayaran iuran tertunggak dan denda ditanggung oleh Pemberi Kerja. Ketentuan ini juga berlaku untuk Pemberi Kerja Penyelenggara Negara.
  7. Ketentuan pembayaran iuran dan denda DIKECUALIKAN untuk Peserta yang TIDAK MAMPU yang dibuktikan dengan surat keterangan dari instansi yang berwenang.
  8. Ketentuan pemberhentian sementara penjaminan Peserta dan pengenaan denda mulai berlaku pada tanggal 1 Juli 2016.

C. ASPEK PELAYANAN KESEHATAN

Pasal 21 Ayat (1) terdapat perubahan nomenklatur dari Imunisasi Dasar menjadi Imunisasi Rutin.

Pasal 21 Ayat (3) berubah menjadi : Pelayanan imunisasi rutin sebagaimana dimaksud pada ayat (1) huruf b meliputi pemberian jenis imunisasi rutin sesuai dengan ketentuan peraturan perundang- undangan. Catatan : Penegasan jenis IMUNISASI RUTIN sesuai dengan ketentuan perundang-undangan.

Pasal 21 Ayat (4) berubah menjadi : Pelayanan keluarga berencana sebagaimana dimaksud pada ayat (1) huruf c meliputi konseling, pelayanan kontrasepsi termasuk vasektomi dan tubektomi, bekerja sama dengan Badan Kependudukan dan Keluarga Berencana Nasional.

Pasal 21 ditambah dengan Ayat (4a) yang berbunyi : Ketentuan mengenai pemenuhan kebutuhan alat dan obat kontrasepsi bagi peserta Jaminan Kesehatan di Fasilitas Kesehatan diatur dengan Peraturan Kepala Badan Kependudukan dan Keluarga Berencana Nasional. Catatan : (1). Penegasan pelayanan KONTRASEPSI VASEKTOMI DAN TUBEKTOMI masuk sebagai Manfaat Promotif Preventif; (2). Amanat pengaturan pemenuhan kebutuhan alat dan obat kontrasepsi bagi peserta Jaminan Kesehatan di Fasilitas Kesehatan diatur dengan Peraturan Kepala Badan Kependudukan dan Keluarga Berencana Nasional.

Pasal 21 Ayat (5) berubah menjadi : Vaksin untuk imunisasi rutin serta alat dan obat kontrasepsi sebagaimana dimaksud pada ayat (3) dan ayat (4) disediakan oleh Pemerintah dan/atau Pemerintah Daerah sesuai dengan ketentuan peraturan perundang-undangan. Catatan : Penegasan penyediaan Vaksin untuk imunisasi rutin serta alat dan obat kontrasepsi oleh Pemerintah dan/atau Pemerintah Daerah sesuai dengan ketentuan peraturan perundang-undangan.

Pasal 22 Ayat (1) huruf b terdapat perubahan yaitu :

  1. Pelayanan transfusi darah TIDAK DIJAMIN di FKTP.
  2. Tambahan Pelayanan yang dijamin pada FKRTL yaitu : pelayanan pemeriksaan, pengobatan, dan KONSULTASI MEDIS DASAR untuk pelayanan kesehatan pada UNIT GAWAT DARURAT;
  3. Terdapat tambahan manfaat Pelayanan keluarga berencana kecuali yang telah dibiayai Pemerintah.

Pasal 23 terkait Manfaat Rawat Inap terdapat perubahan batasan kelas rawat untuk PPU dengan Gaji/Upah :

  1. Sampai dengan Rp 4.000.000,00 di kelas II.
  2. Gaji Rp 4.000.000,00 sampai dengan Rp8.000.000,00 di kelas I.
  3. Pimpinan dan anggota DPRD beserta anggota keluarganya memiliki hak ruang perawatan kelas I. (Sebelumnya menggunakan perhitungan 1,5 – 2 kali PKTP status kawin dengan anak 1).

Pasal 24 berubah dengan substansi pokok sebagai berikut :

  1. Peserta yang menginginkan kelas perawatan yang lebih tinggi dapat meningkatkan haknya. Apabila terdapat selisih biaya dapat dibayar oleh :
    • Peserta yang bersangkutan;
    • Pemberi Kerja; atau
    • Asuransi kesehatan tambahan.
  2. Peserta PBI dan penduduk yang didaftarkan Pemerintah Daerah tidak dapat meningkatkan haknya dengan mengikuti asuransi kesehatan tambahan.
  3. Pemerintah Daerah sebagai Pemberi Kerja tidak dapat membayarkan selisih biaya pelayanan kesehatan akibat peningkatan hak dari Peserta yang didaftarkannya.

Pasal 25 Penegasan pelayanan kesehatan yang TIDAK DIJAMIN khususnya :

  1. Pelayanan kesehatan yang dijamin oleh program jaminan kecelakaan kerja terhadap penyakit atau cedera akibat kecelakaan kerja atau hubungan kerja;
  2. Pelayanan kesehatan yang dijamin oleh program jaminan kecelakaan lalu lintas yang bersifat wajib sampai nilai yang ditanggung oleh program jaminan kecelakaan lalu lintas;
  3. Pengobatan komplementer, alternatif dan tradisional, yang belum dinyatakan efektif berdasarkan penilaian teknologi kesehatan (health technology assessment);
  4. Alat dan obat kontrasepsi.

D. ASPEK PENYELENGGARAAN

Pasal 27A ditambah dengan Ayat (2) yang berbunyi : “Ketentuan mengenai tata cara kerjasama sebagaimana dimaksud pada ayat (1) diatur dalam perjanjian kerja sama antara BPJS Kesehatan dan penyelenggara program jaminan sosial di bidang kecelakaan kerja dan kecelakaan lalu lintas”. Catatan : Penegasan bahwa tata cara kerja sama dengan BPJS Ketenagakerjaan dan Jasa Raharja diatur dengan perjanjian kerja sama (PKS).

Pasal 27B yang berbunyi : “Dalam hal Fasilitas Kesehatan tidak bekerja sama dengan BPJS Kesehatan, maka mekanisme penjaminannya disepakati bersama antara BPJS Kesehatan dan asuransi kesehatan tambahan atau badan penjamin lainnya” DIHAPUS karena bertentangan dengan sistem rujukan berjenjang.

Pasal 29 Ayat (2) yang berbunyi : “Dalam jangka waktu paling sedikit 3 (tiga) bulan selanjutnya Peserta berhak memilih Fasilitas Kesehatan tingkat pertama yang diinginkan” DITAMBAH ayat sehingga menjadi : Pasal 29 Ayat (2a) : Untuk kepentingan pemerataan, BPJS Kesehatan dapat melakukan pemindahan peserta dari suatu Fasilitas Kesehatan tingkat pertama ke Fasilitas Kesehatan tingkat pertama lain yang masih dalam wilayah yang sama.

Pasal 29 Ayat (2b) : Pemindahan peserta sebagaimana dimaksud pada ayat (2a) dilakukan dengan mempertimbangkan rekomendasi dari dinas kesehatan kabupaten/kota setelah berkoordinasi dengan asosiasi Fasilitas Kesehatan, dan organisasi profesi.

Pasal 29 Ayat (2c) : Dalam hal peserta yang dipindahkan sebagaimana diimaksud pada ayat (2a) keberatan, maka peserta dapat meminta untuk dipindahkan ke Fasilitas Kesehatan tingkat pertama yang diinginkannya. Catatan : Penambahan pengaturan redistribusi Peserta di FKTP untuk kepentingan pemerataan dengan memperhatikan rekomendasi Dinas Kesehatan dan berkoordinasi dengan Asosiasi Faskes dan Organisasi Profesi. Apabila Peserta keberatan dapat meminta untuk dipindahkan ke FKTP yang diinginkan.

Pasal 32 Ayat (3) diubah menjadi : Komite Nasional sebagaimana dimaksud pada ayat (2) terdiri atas unsur Kementerian Kesehatan, Badan Pengawas Obat dan Makanan, Badan Kependudukan dan Keluarga Berencana Nasional, BPJS Kesehatan, asosiasi profesi, perguruan tinggi, dan tenaga ahli. Catatan : Menambahkan keterlibatan BKKBN dalam Komite Nasional.

Pasal 32A Ayat (1) diubah menjadi : Pemerintah dan Pemerintah Daerah bertanggung jawab atas ketersediaan obat, alat kesehatan, dan bahan medis habis pakai dalam penyelenggaraan program Jaminan Kesehatan.

Pasal 32A Ayat (2) diubah menjadi : Obat, alat kesehatan, dan bahan medis habis pakai yang digunakan dalam pelayanan kesehatan yang merupakan program pemerintah disediakan oleh Pemerintah dan/atau Pemerintah Daerah sesuai dengan ketentuan peraturan perundang-undangan. Catatan : Penegasan tanggung jawab Pemerintah dan Pemerintah Daerah atas ketersediaan obat, alat kesehatan, dan bahan medis habis pakai sesuai dengan ketentuan peraturan perundang-undangan.

Pasal 36 DITAMBAH Ayat (4a) yang berbunyi : Dalam rangka pelaksanaan kerjasama dengan Fasilitas Kesehatan, BPJS Kesehatan berkoordinasi dengan dinas kesehatan kabupaten/kota. Catatan : Menambahkan pengaturan keterlibatan Dinas Kesehatan Kabupaten/Kota dalam pelaksanaan kerja sama dengan Faskes.

Terdapat penambahan Pasal 36A dengan substansi pokok yaitu :

  1. Fasilitas Kesehatan yang bekerja sama dengan BPJS Kesehatan DILARANG menarik biaya pelayanan kesehatan kepada Peserta selama Peserta mendapatkan manfaat pelayanan kesehatan sesuai dengan haknya.
  2. Dalam hal pemberian pelayanan gawat darurat, Fasilitas Kesehatan baik yang bekerja sama maupun yang tidak bekerja sama dengan BPJS Kesehatan DILARANG menarik biaya pelayanan kesehatan kepada Peserta.
  3. Biaya pelayanan kesehatan sebagaimana dimaksud pada ayat (1) dan ayat (2) ditanggung oleh BPJS Kesehatan sesuai dengan ketentuan peraturan perundang-undangan.

E. ASPEK PEMBIAYAAN

Pasal 39 DITAMBAH Ayat (5) yang berbunyi : Menteri dalam meninjau besaran kapitasi dan non kapitasi serta Indonesian Case Based Groups (INA- CBG’s) dan non Indonesian Case Based Groups (non INA-CBG’s) sebagaimana dimaksud pada ayat (4) dilakukan dengan memperhitungkan kecukupan iuran dan kesinambungan program sampai dengan 2 (dua) tahun ke depan yang dilakukan bersama dengan BPJS Kesehatan, DJSN, dan menteri yang menyelenggarakan urusan pemerintahan di bidang keuangan. Catatan : Penegasan bahwa peninjauan tarif harus memperhatikan kecukupan iuran dan kesinambungan program sampai dengan 2 tahun ke depan yang dilakukan bersama oleh Menteri Kesehatan bersama dengan BPJS Kesehatan, DJSN, dan Menteri Keuangan.

Terdapat PENAMBAHAN Pasal 39A yang berbunyi :

  1. Untuk kepentingan pembayaran biaya pelayanan kesehatan, BPJS Kesehatan dapat meminta rekam medis peserta berupa ringkasan rekam medis kepada Fasilitas Kesehatan sesuai dengan ketentuan peraturan perundang-undangan.
  2. Ringkasan rekam medis sebagaimana dimaksud pada ayat (1) paling sedikit memuat identitas pasien, diagnosis, serta riwayat pemeriksaan dan pengobatan yang ditagihkan biayanya. Catatan : Pengaturan bahwa BPJS Kesehatan dapat meminta rekam medis berupa ringkasan rekam medis.

F. ASPEK MUTU

Pasal 45 Ayat (2) diubah menjadi : Dalam hal Peserta dan/atau Fasilitas Kesehatan tidak mendapatkan pelayanan yang baik dari BPJS Kesehatan, dapat menyampaikan pengaduan kepada Kepala Dinas Kesehatan Kabupaten/Kota, Kepala Dinas Kesehatan Provinsi, dan/atau Menteri. Catatan : Pengaturan keterlibatan Dinas Kesehatan dalam menangani pengaduan Peserta dan/atau Fasilitas Kesehatan.

Penambahan BAB XIA Pasal 46A terkait Pencegahan Kecurangan (Fraud) Dalam Pelaksanaan Program Jaminan Kesehatan sebagaimana telah diatur dalam Permenkes Nomor 36 Tahun 2015 tentang Pencegahan Kecurangan (Fraud) Dalam Pelaksanaan Program Jaminan Kesehatan.

G. ASPEK PENGAWASAN

Terdapat PENAMBAHAN BAB XIII tentang PENGAWASAN yang terinci dalam Pasal 46B dan Pasal 46C.

Terdapat penambahan Pasal 46B dengan substansi pokoknya adalah : Pengaturan keterlibatan Dinas Kesehatan, Badan Pengawas Rumah Sakit Dewan Pengawas Rumah Sakit, perhimpunan/ asosiasi perumahsakitan dan/atau organisasi profesi dalam pengawasan terhadap penyelenggaraan Program Jaminan Kesehatan.

Terdapat penambahan Pasal 46C dengan substansi pokok yaitu : Pengawas Ketenagakerjaan pada instansi yang bertanggung jawab di bidang ketenagakerjaan dapat melakukan pemeriksaan terhadap Pemberi Kerja yang melakukan pelanggaran, sesuai dengan ketentuan peraturan perundang-undangan.

Demikian sekilas review terkait terbitnya Perpres Nomor 19 Tahun 2016 tentang Perubahan Atas Perpres Nomor 12 Tahun 2013 tentang Jaminan Kesehatan Nasional (JKN). Sebenarnya masih terdapat beberapa perubahan yang belum sempat ditulis secara detail, namun secara pribadi substansi-substansi pokok yang seringkali menjadi pertanyaan masyarakat sudah saya coba uraikan diatas.

Terkait perubahan nominal iuran tentu menimbulkan pro dan kontra, itu sudah pasti. Ada sedikit harapan bahwa terbitnya Permenkes tentang Standar Tarif Pelayanan Kesehatan Bagi Peserta Program JKN tinggal menunggu waktu saja. Tarif pelayanan yang dimaksud adalah nilai Kapitasi dan Tarif INA CBGs. Semoga seperti harapan pribadi saya bahwa sekitar bulan April – Juni mendatang akan terbit Permenkes ini yang kemudian diikuti oleh naiknya versi CBGs dengan perubahan tarif yang lebih baik lagi, sehingga pelayanan peserta program JKN tidak menjadi SUB STANDAR namun mengarah ke standar yang ideal berdasarkan Standar Profesi Kedokteran.

Sangat sepakat dengan salah satu poin perjuangan sahabat-sahabat DIB bahwa persoalan JKN bukan hanya masalah UNTUNG atau RUGI sebuah Faskes, namun yang lebih penting dari itu semua adalah terciptanya KENDALI BIAYA tanpa harus mengorbankan MUTU PELAYANAN. Inilah sesungguhnya hakikat dasar dari KENDALI MUTU dan KENDALI BIAYA.

Sebagai penutup…. saya tadi saat sedang menulis masih sempat-sempatnya mengkhayal hidup di sebuah negeri dimana Iuran Peserta Asuransi DIJAMIN oleh negara SEBAGIAN (bagi yang mampu) dan DIJAMIN oleh negara SELURUHNYA (bagi masyarakt tidak mampu). Sehingga adanya kenaikan iuran ini tidak akan memberatkan masyarakat. Uang nya darimana ?? Anggarannya ada kok, dana nya ada…tinggal kita mau kerja atau tidak, hanya itu, mau kerja atau tidak….. (Serasa DEJAVU….hehe)

Wasalam…

Tri Muhammad Hani
RSUD Bayu Asih Purwakarta
Jl. Veteran No. 39 Kabupaten Purwakarta – Jawa Barat

 

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