EIGHTEENTH CONGRESS OF THE 
)
REPUBLIC OF THE PHILIPPINES 
)
Second Regular Session 
)
SENATE j 
Senate Bill No. 1749
of lljf
20 JUL 28 PI :44
RtCi) . np'
INTRODUCED BY SENATOR CHRISTOPHER LAWRENCE "BONG" T. G
AN ACT
PROVIDING FOR A COMPREHENSIVE RENAL REPLACEMENT THERAPY 
(RRT) FOR PATIENTS WITH END STAGE RENAL DISEASE IN NATIONAL, 
REGIONAL, AND PROVINCIAL GOVERNMENT HOSPITALS, INCREASING THE 
PHILHEALTH PACKAGE RATE FOR RENAL REPLACEMENT THERAPY OF 
MEMBERS AND APPROPRIATING FUNDS THEREFOR
EXPLANATORY NOTE
In 2018, the Department of Health reported that one (1) person dies every 
hour from kidney failure. In fact, the approximate number of cases of kidney faiiure, 
the ninth-leading cause of death among Filipinos according to the National Kidney and 
Transplant Institute (NKTI), is more than 7,000 cases every year. According to NKTl, 
for every 1 million Filipinos, 120 are most likely to develop kidney failure. As a result, 
approximately 10,000 people need to replace their kidney function each year.1
This measure aims to make comprehensive renal replacement therapy services 
available to all Filipinos who suffer from End Stage Kidney Disease by including it in 
the coverage of treatment services provided by the PhilHeaith. It also supports kidney 
transplantation as the best treatment option that provides the highest quality of life 
for End Stage Renal Disease patients and ensures the return of the patient to full 
rehabilitation.
1 Kidney Problems on the Rise, Business Mirror Philippines, available at 
https://businessmirror.com.ph/2018/04/05/kidney-problems-on-the-rise


Among the key provisions are the the expansion of PhiiHeaith benefit packages 
for kidney transpiantation or renai replacement therapy and the provision of free 
dialysis services to indigent patients. In addition, all national, provincial, and regional 
government hospitals, including all stand-alone dialysis facilities are required to 
establish, operate and maintain a dialysis service facility in their hospital.
In view of the foregoing, the approval of this measure is earnestly sought.
i
SENATOR CHRISTOPHER LAWRENCE "BONG" T. GO


EIGHTEENTH CONGRESS OF THE 
)
REPUBLIC OF THE PHILIPPINES 
)
Second Regular Session 
)
•t*
Sa Bi No.
SENAYv49
of tbc
20 JUL28 PI :44
INTRODUCED BY SENATOR CHRISTOPHER LAWRENCE MBONG" X
AN ACT
PROVIDING A COMPREHENSIVE RENAL REPLACEMENT THERAPY (RRT) 
FOR PATIENTS WITH END STAGE RENAL DISEASE IN NATIONAL, 
REGIONAL, AND PROVINCIAL GOVERNMENT HOSPITALS, INCREASING THE 
PHILHEALTH PACKAGE RATE FOR RENAL REPLACEMENT THERAPY OF 
MEMBERS AND APPROPRIATING FUNDS THEREFOR
1
2
3
4
5
6
7
8 
9
10
11
12
13
14
15
16
17
18
19
20 
21 
22
23
24
Be it enacted by the Senate and House of Representatives of the Philippines in 
Congress assembled:
SECTION 1. Short Title. - This Act shall be known as the "Comprehensive 
Renal Replacement Therapy Act of 2020."
SEC. 2. Declaration of Policy. - It is the declared policy of the State to make 
available essential goods, health and other social services to all citizens at affordable 
cost and to deliver medical care to indigents free of charge. Pursuant to this, the State 
shall continuously improve the delivery of health services and hospital facilities to 
make those accessible to all.
Towards this end, the State shall adopt an Integrated and comprehensive 
approach to health service delivery that shall include comprehensive renal replacement 
therapy for patients who are diagnosed with End Stage Renal Disease (ESRD).
SEC. 3. Definition of Terms. -As used in this Act:
a. Dialysis facility refers to a health facility that provides treatment for ESRD 
to indigent patients and disseminates information on the various forms of 
renal replacement therapy (RRT) such as kidney transplantation, peritoneal 
dialysis and hemodialysis;
b. End Stage Rena! Disease or ESRD refers to the final stage of chronic 
kidney diseasem which the kidneys wo longer function well enough to meet 
the needs of a patient's daily life;


1
2
3
4
5
6
7
8 
9
10
11
12
13
14
15
16
17
18
19
20 
21 
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
c. Hemodialysis or HD refers to a medical procedure to remove fluid and 
waste products from the blood and to correct electrolyte imbalances using 
a synthetic membrane or dialyzer which is also referred to as an "artificial 
kidney";
d. Indigentreiexs to a patient who has no source of income or whose income 
is not sufficient for family subsistence as Identified by the Department of 
Social Welfare and Development (DSWD) or the social worker of the 
concerned local government unit;
e. Kidney transplant or KTrefers to a surgical procedure to place a healthy 
kidney from a live or deceased donor into a person whose kidneys no longer 
function sufficiently to sustain the person's life;
f. National, Regional and Provincial hospitals refer to hospitals and 
stand-alone dialysis facilities operated and maintained either partially or 
wholly by the national, regional and provincial government or other political 
subdivisions, or any department, division, board or other agency thereof;
g. No Balance Billing refers to the government policy of not charging the 
medical expenses Incurred over and beyond the PhilHealth package rates to 
a PhilHealth member who has undergone medical treatment;
h. Peritoneal dialysis or PD refers to a treatment for kidney failure and a 
type of dialysis that uses the person's peritoneum or the lining of abdominal 
cavity as the membrane through which fluid and toxic substances are 
exchanged with blood;
i. 
PD First Policy refers to the policy where peritoneal dialysis, when 
feasible, is offered as the first dialysis modality to RRT patients;
j. Renai replacement therapy or RRT refers to therapy that partially 
replaces the functions of the normal kidney. This may be in the form of 
kidney transplantation, peritoneal dialysis and hemodialysis.
SEC. 4. Establishment of Dialysis Services Wards or Units in National, Regional, 
Provincial Government Hospitals. - Within five (5) years from the effectivity of this Act, 
all national, provincial, and regional government hospitals, including all stand-alone 
dialysis facilities are hereby required to establish, operate and maintain a dialysis 
service facility in their hospital, including both peritoneal dialysis and hemodialysis.
All national, regional, and provincial government hospitals. Including all 
standalone dialysis facilities shall have a dialysis service area that is compliant with 
the licensing and accreditation requirements Imposed by the Department of Health 
(DOH) and Philippine Health Insurance Corporation (PhilHealth). The dialysis service


1
2
3
4
5
6
7
8 
9
10
11
12
13
14
15
16
17
18
19
20 
21 
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
area shall have the necessary personnel, dialysis equipment and suppiies for both 
hemodialysis and peritoneal dialysis, as required by the DOH and the PhilHeaith of 
private dialysis clinics.
The dialysis facilities shall further have a non-treatment place, which shall serve 
as a waiting area for chronic kidney disease (CKD) patients and a business area 
dedicated to the provision, display, and dissemination of Information on the 
prevention of CKD.
All patients diagnosed with ESRD must be referred to a DOH-accredited 
transplant facility to attend a pre-transplant orientation and to be counseled on the 
advantages of undergoing transplantation as the best treatment for kidney failure. 
They shall undergo medical evaluation for suitability for transplantation. All potential 
organ donors of the patient shall be evaluated to determine compatibility and medical 
suitability. If no living donors are available, the patient shall be enrolled in the 
deceased organ donor waiting list to ensure that all patients with ESRD are offered 
the option of kidney transplantation.
SEC. 5. Chronic Kidney Disease (CKD) Prevention and Heaith Promotion. - All 
national, provincial, and regional government hospitals, and stand-alone dialysis 
facilities shall establish CKD prevention strategies and health promotion activities 
which shall include advocacy activities targeting relatives of dialysis patients who are 
at high risk for developing CKD themselves, the provision of instructional materials 
and regular educational activities on the common symptoms of kidney disease such 
as its risk factors, healthy diet and lifestyle, common tests to diagnose kidney disease, 
the most common causes of kidney failure, and advisories on the appropriate protocols 
for the diagnostic evaluation of possible kidney disease.
Patients and their relatives shall be informed on the availability of the proper 
medicines from government heaith centers such as those for diabetes and 
hypertension, and the importance of the regular Intake of medicines and monitoring 
of kidney function through regular laboratory testing and regular clinic follow-up with 
a qualified physician. All activities pertaining to the aforementioned programs should 
be documented accordingly.
SEC. 6. Quality Standards of Dialysis Services and Transplant Facilities. - 
Hospitals, dialysis centers for both hemodialysis and peritoneal dialysis, and transplant 
facilities shall comply with the safety and quality standards of dialysis or transplant 
services, which shall be strictly monitored by the PhilHeaith and the Health Facilities 
and Services Regulatory Bureau of the DOH.
SEC. 7. Philippine Rena!Disease Registry. - Private and public hospitals, dialysis 
centers for both hemodialysis and peritoneal dialysis, and transplant facilities shall be 
mandated to report to the Philippine Renal Disease Registry of the DOH the incidence 
and prevalence of patients receiving peritoneal dialysis or hemodialysis treatment, and 
who have received a kidney transplant as a requirement for the renewal of their 
respective DOH licenses to operate a dialysis center or transplant facility. Registration


1
2
3
4
5
6
7
8 
9
10
11
12
13
14
15
16
17
18
19
20 
21 
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
of all dialysis patients in the PhilHealth dialysis database shall be required prior to the 
availment of benefits for both peritoneal dialysis and hemodialysis.
SEC. 8. PhilHealth Benefit for Kidney Transpiantation - The PhilHealth benefit 
for kidney transplantation from living donors shall be expanded accordingly. This shall 
include the cost of laboratory work-up for both recipient and donor candidate, 
hospitalization for the transplant operation Including induction Immunosuppression 
and maintenance oral immunosuppression, machine perfusion of procured organs, the 
cost for organ retrieval, all medications required during hospitalization, and post- 
discharge laboratory examinations up to one (1) month for the recipient and the 
donor.
The cost for organ retrieval and machine perfusion shall be established by the 
DOH-PhIlippine Organ Donation and Transplantation Program to be observed by all 
organ procurement organizations or organ and tissue retrieval units.
The PhilHealth benefit package for kidney transplantation shall cover the 
evaluation and screening of the kidney donor and recipient up to the transplant 
procedure and post-transplantation procedures and remedies, and shall include cases 
Involving End Stage Renal Disease (ESRD) patients.
In order to support kidney transplantation as the best treatment option that 
provides the highest quality of life for ESRD, the PhilHealth shall provide lifetime 
support for all maintenance immunosuppression of the transplant patient, as long as 
the transplanted organ is functioning, and the patient remains dialysis-independent.
All renal replacement therapy facilities shall be required to engage in regular 
organ donation advocacy activities. All donor- Filipino citizens shall carry the organ 
donor card to be prescribed by the DOH. Health RRT facilities will likewise establish 
an organ and tissue donor referral system that will identify all potential organ and 
tissue donors to the Philippine Network for Organ Sharing (PhilNOS).
SEC. 9. PhiiHeaith Benefit for Diaiysis Treatment -The PhilHealth shall 
increase the Z-benefit package rate for the principal member and the member's 
qualified dependents for maintenance dialysis per year for peritoneal dialysis covering 
three (3) peritoneal dialysis exchanges per day for three hundred sixty five (365) days, 
while the package rate for hemodialysis treatment shall be Increased annually to cover 
a minimum of three (3) hemodialysis sessions frequency a week, four (4) hours per 
session, or as may be necessary. The professional fee of the attending physician and 
hospital charges shall be Incorporated in the PhilHealth benefit package for dialysis 
treatment.
For purposes of providing optimal financial risk protection to the most 
vulnerable groups including the poorest of the poor, the "no balance billing policy" of 
the government shall be strictly observed in the case of indigent patients.
The breakdown of the PhiiHeaith hemodialysis benefit package shall include 
standard HD treatment inclusive of the dialyzer and all other supplies needed as well


1
2
3
4
5
6
7
8 
9
10
11
12
13
14
15
16
17
18
19
20 
21 
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
as the minimum basic laboratory tests consisting of complete blood count, creatinine, 
calcium, phosphorus, potassium, albumin, hepatitis B surface antigen (HBsAg) and 
anti-hepatitis C virus (Anti-HCV). The laboratory tests shall be done at a frequency of 
at least four (4) tests per year for the first six (6) tests, and twice a year for the last 
two (2) tests. The schedule of these tests shall be determined by the attending 
physician during the course of the annual dialysis treatment sessions.
SEC. 10. Periodic Assessment and Benefit Package Adjustments for End Stage 
Renai Disease Patients. - A periodic assessment and reasonable adjustments of the 
benefit package for dialysis and transplant patients shall be made by the PhilHealth 
after taking into consideration its financial sustainability and changes in the socio­
economic conditions of the country.
SEC. 11. Free Diaiysis Treatment to Indigent Patients. - Dialysis treatment in 
all national, regional, and provincial government hospitals shall be provided free of 
charge to indigent. A PD First Policy shall be established for all indigent patients, unless 
there is a contraindication to its use in a particular patient.
SEC. 12. Treatment Options. - The PhilHealth shall develop a package that 
shall provide the highest benefit for kidney transplant, followed by peritoneal dialysis, 
then hemodialysis.
The benefit package shall include a screening test for both the donor and 
recipient. The screening test for possible kidney transplantation of both the donor and 
recipient shall include the following:
a) For the donor, the screening testing include blood typing, complete blood 
count, fasting blood sugar, creatinine, hepatitis B surface antigen, anti­
hepatitis C antibody, urinalysis, chest x-ray and ultrasound of the kidneys, 
ureter, and urinary bladder.
b) For the recipient, cardiac evaluation and many other tests as needed.
During the availment of the full benefits of dialysis within the first two (2) years 
of dialysis initiation, the cost of dialysis treatment shall be paid for by the PhilHealth 
as described in Section 8. These options are provided to encourage more patients to 
have a kidney transplant and attain full rehabilitation.
If the patient passes the criteria for the PhilHealth Z-benefit package for 
transplantation, the expenses for selected laboratory tests may be reimbursed to the 
patient by the healthcare institution after the PhilHealth pays the benefit to the 
healthcare Institution for such laboratory expenses.
SEC. 13. Rehabiiitation Program. - The DOH, in coordination with the 
Department of Labor and Employment, Technical Education and Skills Development 
Authority, and the DSWD and other pertinent agencies, shall establish a 
comprehensive rehabilitation program for dialysis patients who have undergone 
kidney transplant, and kidney donors In order to help them reach their fullest physical, 
psychological, social, vocational, avocational, and educational potential consistent with


1
2
3
4
5
6
7
8 
9
10
11
12
13
14
15
16
17
18
19
20 
21 
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
their physiologic or anatomic condition, environmental limitations, life plans and 
desires.
SEC. 14. Dialysis Facility. - A dialysis facility shall comply with the licensing 
requirements imposed by the DOH for hemodialysis services before it operates as 
such. Hospitals desiring to provide peritoneal dialysis treatment services shall provide 
the necessary equipment and qualified staff to perform such a procedure as prescribed 
by the PhilHealth. Hospitals with existing hemodialysis facilities only shall immediately 
establish a peritoneal dialysis unit to provide a cost-effective dialysis option to patients.
SEC. 15. Training for Peritoneal and Hemodiaiysis/ and Transplant Treatment 
and Services. -The DOH, National Kidney and Transplant Institute (NKTl) Philippine 
Society for Transplant Surgeons (PSTS), and the Philippine Society of Nephrology 
(PSN) shall provide training for medical personnel such as physicians, surgeons, 
nurses, technicians and coordinators who shall work in hemodialysis and peritoneal 
dialysis facilities, operating rooms, transplant wards, and for non-medical barangay 
health workers who shall assist honie-based peritoneal dialysis treatment. The NKTI 
shall accredit the facilities that may provide training for these personnel, which training 
shall include hands-on workshops for dialysis.
SEC. 16. Establishing a Chronic Kidney Disease (CKD) Counseling Clinic. - All 
RRT facilities shall establish a chronic kidney disease (CKD) counseling clinic with 
separate personnel trained to engage patients and explain to them the normal 
functions of the kidney, the stages of CKD, the laboratory examinations routinely 
performed for CKD patients, the common medications required that can control the 
progression of kidney disease, the metabolic complications of ESRD, and the 
indications for renal replacement. These clinics shall monitor the kidney function of 
patients so that a timely referral to a nephrologist or internist/pediatrician with 
specialized training in CKD can be made.
The NKTl shall provide education and training modules for the medical staff of 
CKD counseling clinics.
SEC. 17. Avaiiment of Persons with Disability (PWD) Benefits by CKD Patients. 
- CKD patients shall be classified as PWD. They shall be entitled to PWD benefits in 
accordance with Republic Act No. 7277, otherwise known as the Magna Carta for 
Disabled Persons. The PhilHealth and DOH Health Technology Assessment Council 
shall conduct an In-depth study on both the direct and indirect cost of being afflicted 
with kidney disease and undergoing treatment for It.
SEC. 18. Creation of a Rena! Disease Control Program (REDCOP). - All RRT 
facilities shall create a Renal Disease Control Program that shall promote the early 
recognition of kidney disease. Identity persons at high risk of developing kidney 
disease and Initiate preventive strategies to either prevent the development of kidney 
disease from diabetes and hypertension, or to delay its progression to end stage renal 
disease. The DOH will establish a database of these patients to ensure that they are 
regularly monitored for disease progression and that they are receiving appropriate 
treatment for CKD.


1
2
3
4
5
6
7
8 
9
10
11
12
13
14
15
16
17
18
19
20 
21 
22
23
24
25
26
27
28
29
30
31
32
SEC. 19. Penalty. - Any hospital chief, administrator or officer-ln-charge 
of hospitals, dialysis centers, and health facilities who fails to comply with Sections 
5 and 6 of this Act shall be meted with a fine of Fifty thousand pesos (P50,000.00) 
but not more than One hundred thousand pesos (P100,000.00).
Likewise, persons receiving free treatment of medicines for End Stage Renal 
Disease or PD or HD services from government hospitals and its agencies, such as the 
PhilHealth, who are found selling these medications or services instead of using them 
for their own treatment, shall be penalized with the suspension of their PhilHealth 
membership and other government agencies for a period of six (6) months.
SEC. 20. Appropriations. - The initial amount necessary to Implement the 
provisions of this Act shall be charged against the current year's appropriation of the 
DOH. Thereafter, such sum as may be necessary for the continued implementation 
of this Act shall be included in the annual General Appropriations Act.
SEC. 21. Implementing Rules and Regulations - Within sixty (60) days from 
the effectivity of this Act, the Department of Health, in coordination with the 
PhilHealth, the NKTI, and other relevant stakeholders, shall issue the implementing 
rules and regulations to implement the provisions of this Act.
SEC. 22. Separability Cause. If any provision or part hereof is held invalid or 
unconstitutional, the remainder of the law or the provision not otherwise affected shall 
remain valid and subsisting.
SEC. 23. Repealing Clause. Any law, presidential decree or Issuance, executive 
order, letter of instruction, administrative order, rule or regulation contrary to or 
inconsistent with the provisions of this Act are hereby repealed, modified or amended 
accordingly.
SEC. 24. Effectivity. - This Act shall take effect fifteen (15) days after its 
publication in the Official Gazette or in a newspaper of general circulation.
Approved,