Republic of the Philippines 
HOUSE OF REPRESENTATIVES 
Quezon City 
NINETEENTH CONGRESS 
First Regular Session 
HOUSE BILL NO. ____ 
Introduced by HON. LUIS RAYMUND “LRAY” F. VILLAFUERTE, JR.,  
HON. MIGUEL LUIS R. VILLAFUERTE, HON. TSUYOSHI ANTHONY G. HORIBATA 
AND HON. NICOLAS ENCISO VIII 
EXPLANATORY NOTE 
Kidney problems have consistently ranked among the top 10 causes of morbidity1 in the 
Philippines and took the 7th spot in leading causes of death in 20142. With an alarmingly increasing 
rate of 10 to 15 percent a year in the number of kidney disease cases estimated by the 
Department of Health3, it is not surprising that the number of Filipinos undergoing dialysis has 
gone up to 28,000.  
For Filipinos living below the poverty line, the cost of dialysis at Php 2,500 per session is too much 
to bear. Given the current situation of kidney disease in the country, a State provision for this 
particular health care issue is imperative. The increase in the cases entails an increase in support 
by the State, especially for indigent patients. 
This bill proposes to address this by establishing dialysis clinics in all national, regional, and 
provincial hospitals in the country to serve the needs of the public. The National Kidney and 
Transplant Institute serves an average of 34,000 dialysis sessions every year4 and takes in cases 
of patients from outside the National Capital Region. Branching out the units that can provide 
dialysis treatments to the regions and provinces and provide them for free, as the bill proposes, 
would help in battling the chronic kidney diseases in the country. 
The approval of this bill is earnestly sought. 
LUIS RAYMUND “LRAY” F. VILLAFUERTE, JR. 
 MIGUEL LUIS R. VILLAFUERTE 
TSUYOSHI ANTHONY G. HORIBATA 
NICOLAS ENCISO VIII 
1 http://today.mims.com/philippines-struggles-with-renal-disease 
2 http://www.manilatimes.net/kidney-disease-phs-7th-leading-cause-of-death/77716/ 
3 Ibid 
4 https://www.rappler.com/nation/97568-90-days-dialysis-philhealth-coverage 
July 14, 2022
5:03 pm
2012


Republic of the Philippines 
HOUSE OF REPRESENTATIVES 
Quezon City 
NINETEENTH CONGRESS 
First Regular Session 
HOUSE BILL NO. ____ 
Introduced by HON. LUIS RAYMUND “LRAY” F. VILLAFUERTE, JR.,  
HON. MIGUEL LUIS R. VILLAFUERTE, HON. TSUYOSHI ANTHONY G. HORIBATA 
AND HON. NICOLAS ENCISO VIII 
AN ACT 
MANDATING THE PROVISION OF COMPREHENSIVE RENAL REPLACEMENT 
THERAPY (RRT) TO PATIENTS WITH END-STAGE RENAL DISEASE IN 
NATIONAL, REGIONAL, AND PROVINCIAL GOVERNMENT HOSPITALS, 
INCREASING FOR THE PURPOSE THE PHILHEALTH PACKAGE RATE FOR 
MEMBERS AND APPROPRIATING FUNDS THEREFOR 
Be it enacted by the Senate and the 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." 
SECTION 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 
continually improve the delivery of health services and hospital facilities to make those 
accessible to all. 
In line with this policy, 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). 
SECTION 3.  Definition of Terms. — As used in this Act: 
2012


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 such as kidney transplantation, 
peritoneal dialysis and hemodialysis; 
 
b. End-Stage Renal Disease or ESRD refers to the final stage of 
chronic kidney disease in which the kidneys no longer function well 
enough to support the needs of a patient's daily life; 
 
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. Indigent refers to a patient who has no source of income or whose 
income is not sufficient for family subsistence as identified and assessed 
by the social worker of the Department of Social Welfare and 
Development (DSWD) or the social worker of the concerned local 
government unit; 
 
e. Kidney Transplant or RT refers to a surgical procedure to place a 
healthy kidney from a living 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 national, regional and provincial government or other political 
subdivisions, or any department, division, board or 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 the 
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. Renal replacement therapy or RRT refers to a therapy that partially 
replaces the functions of the normal kidney. This may be in the form of 
kidney transplantation, peritoneal dialysis, and hemodialysis. 
 
SECTION 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, regional, and provincial government hospitals, including 
all stand-alone dialysis facilities shall establish, operate and maintain a dialysis service 
facility in their hospitals. These dialysis facilities shall have all the necessary dialysis 
machines, equipment and supplies. The same hospitals and dialysis facilities are 
mandated to train nephrologists, dialysis nurses, dialysis technicians, and operating room 
nurses in both peritoneal dialysis and hemodialysis. 
All national, regional, and provincial government hospitals, including all stand-alone 
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 area shall have the 
necessary personnel, dialysis equipment and supplies for both hemodialysis and 
peritoneal dialysis, as required by the DOH and the PhilHealth 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 shall be referred to a DOH-accredited transplant 
facility to receive orientation and counseling on the advantages of undergoing 
transplantation as the best treatment for kidney failure. They shall likewise undergo 
medical evaluation for suitability of transplantation. All potential organ donors of the 
patient shall be evaluated to determine compatibility. 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 have the option to avail of kidney transplantation.  
 
SECTION 5. Chronic Kidney Disease (CKD) Prevention and Health Promotion. — 
All national, regional, and provincial 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 of developing CKD themselves, the provision of instructional materials on the 
common symptoms of kidney disease and regular conduct of educational activities such 
as healthy diet and lifestyle, availment of regular tests to diagnose kidney disease, 
information on the most common causes of kidney failure, and advisories on the 
appropriate protocols for the diagnostic evaluation of possible kidney disease. 
 
SECTION 6. Quality Standards of Dialysis Services and Transplant Facilities. — 
Hospitals and dialysis centers for both hemodialysis and peritoneal dialysis and transplant 
facilities hall comply with the safety and quality standards of dialysis or transplant 
services, which shall be strictly monitored by the PhilHealth and the Health Facilities and 
Services Regulatory Bureau of the DOH. 
 
SECTION 7. Philippine Renal 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 of all dialysis patients in the PhilHealth dialysis database shall be required 
prior to the availment of both peritoneal dialysis and hemodialysis. 
 
SECTION 8.  PhilHealth Benefit for Kidney Transplantation. — The PhilHealth Z-
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 up to one (1) year for 
the donor. 
The cost of 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 and post-
transplantation procedures and remedies and shall include cases involving ESRD 
patients. 
In order to support kidney transplantation as the best treatment option that provides 
the highest quality of life for ESRD patients and ensures the return of the patient to full 
rehabilitation, 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). 
 


SECTION 9. PhilHealth Benefit for Dialysis Treatment. — The PhilHealth shall 
increase the Z-benefit package rate for the principal member and the members' qualified 
dependents for maintenance 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 PHIC hemodialysis benefit package shall include standard 
HD treatment, dialyzer and epoetin injection, and all other supplies needed as well 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. 
 
SECTION 10. Periodic Assessment and Benefit Package Adjustments for End-
Stage Renal 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. 
 
SECTION 11. Free Dialysis Treatment to Indigent Patients. — Dialysis treatment in all 
national, regional, and provincial government hospitals shall be provided free of charge 
to indigent patients. A PD First Policy Shall be observed for all indigent patients, unless 
there is a contraindication for its use in a particular patient. 
 


SECTION 12. Treatment Options. — The PhilHealth shall develop a care rate package 
that shall provide the highest benefit for a kidney transplant procedure, peritonea! dialysis, 
and hemodialysis procedures. 
The benefit package shall include a screening test for both the kidney 
transplantation donor and recipient. The screening test for possible kidney transplantation 
of both the donor and recipient Shall include: 
1) For the donor, screening test shall 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; 
2) For the recipient, cardiac evaluation and other tests as may be 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 undergo kidney transplantation and attain full rehabilitation. 
 
 
If the patient passes the criteria for the PhilHealth 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. Rehabilitation Program. — The DOH, in coordination with the Department of 
Labor and Employment, the Technical Education and Skills Development Authority, the 
DSWD, and other pertinent agencies, shall establish a comprehensive rehabilitation 
program for both kidney donors and dialysis patients who have undergone kidney 
transplant procedures in order to help them reach their fullest physical, psychological, 
social, vocational, and educational potential consistent with 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 Hemodialysis, and Transplant Treatment and 
Services. — The DOH, National Kidney and Transplant Institute (NKTI), 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 home-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 CKD counseling clinic and shall separately provide 
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 
NKTI shall provide education and training modules for the medical staff of CKD 
counseling clinics. 
 
SEC. 17. Availment 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 costs of being afflicted with 
kidney disease and undergoing treatment for it. 
 
SEC. 18. Creation of a Rena/ Disease Control Program. — All RRT facilities shall 
create a Renal Disease Control Program that shall promote the early recognition of kidney 
disease, identify 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. 
 
SEC. 19. Penalty. — Any head or chief of hospital, administrator or officer-in-charge of a 
hospital, dialysis center, and health facility 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) up to a maximum 
of One hundred thousand pesos (P 100,000.00). 
Likewise, persons receiving free treatment of medicines for ESRD, PD or HD 
services from government hospitals, such as the PHIC, who are found selling these 
medicines or services instead of using them for their own treatment, shall be penalized 
with the suspension of their PhilHealth membership and other government assistance for 
a period of six (6) months, upon due process and hearing. If these persons are found to 
have committed the same violation for the second time, they shall be permanently 
ineligible to receive government assistance. 
 
SEC. 20. Appropriations. — The initial amount necessary to implement the provisions 
of this Act for national and regional hospitals shall be charged against the current year's 
Appropriation of the DOH. Thereafter, such sum as may be necessary for its continued 
implementation shall be included in the annual General Appropriations Act. 
For provincial hospitals, the local government concerned shall provide the 
necessary funds for the establishment and operationalization of its dialysis service units. 
 


SEC. 21. Implementing Rules and Regulations. — Within ninety (90) days from the 
effectivity of this Act, the DOH shall, in coordination with the PhilHealth, the NKTI, and 
other relevant stakeholders, issue the implementing rules and regulations to implement 
the provisions of this Act. 
 
SEC. 22. Separability Clause. — 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,