Republic of the Philippines 
House of Representatives 
Quezon City, Metro Manila 
NINETEENTH CONGRESS 
First Regular Session 
House Bill No. _______ 
INTRODUCED BY REP. PM VARGAS 
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 
EXPLANATORY NOTE 
Kidney diseases are the seventh leading cause of death in the 
Philippines. According to the Department of Health, 23,000 Filipinos 
underwent dialysis due to kidney failure in 2013, nearly four times higher 
than the 4,000 cases recorded in 2004, or a 10 to 15 percent increase a year. 
Dialysis is very costly for most Filipinos who suffer from chronic kidney 
diseases. To have adequate treatment, a patient has to spend Php25,000 to 
Php46,000 per month. 
This bill seeks to ease the financial burden of patients suffering from 
renal failure. It seeks to provide a comprehensive renal replacement therapy 
for patients with end stage renal disease in national, regional, and provincial 
government hospitals, increasing the PhilHealth package rate for renal 
replacement therapy of PhilHealth members. 
In view of the foregoing, the passage of this bill is earnestly sought. 
REP. PM VARGAS   
Fifth District, Quezon City 
August 10, 2022
5:55 pm
3497


Republic of the Philippines 
House of Representatives 
Quezon City, Metro Manila 
NINETEENTH CONGRESS 
First Regular Session 
House Bill No. _______ 
INTRODUCED BY REP. PM VARGAS 
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 
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. – The State shall endeavor to make 
essential goods, health and other social services available to all the people at 
affordable cost. There shall be priority for the needs of the underprivileged 
sick, elderly, disabled women and children. The state shall endeavor to 
provide free medical care to the less fortunate.   
It is hereby declared a policy of the State to adopt an integrated and 
comprehensive 
approach 
to 
health 
development 
that 
will 
provide 
Comprehensive Renal Replacement Therapy (RRT) to improve the delivery of 
health care services to patients diagnosed with End Stage Renal Disease 
(ESRD), and to encourage them to have a kidney transplant, primarily within 
the first two (2) years of dialysis treatment.  
SECTION 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
3497


various forms of RRT 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 meet the needs of 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. This is accomplished 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 by the 
Department of Social Welfare and Development (DSWD) through the 
National Household Targeting System (NHTS) for Poverty Reduction, 
or those patients who are indigents but are not listed in the NHTS 
as assessed by the municipal social development officer;  
e. Kidney transplant or KT refers to a surgical procedure to place a 
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 (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. Renal replacement therapy or RRT refers to the 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 Service 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. The same 
hospitals and dialysis facilities should also be mandated to train 
nephrologists, dialysis nurses, dialysis technicians, and operating room 
nurses in both peritoneal dialysis and hemodialysis. 
 
All national, provincial and regional government hospitals, including 
stand alone dialysis facilities shall have a dialysis service area compliant with 
the licensing and accreditation requirements imposed by the Department of 
Health (DOH) and Philippine Health Insurance Corporation (PhilHealth), 
respectively for private dialysis clinics. It shall be provided with the necessary 
personnel and equipped with complete dialysis equipment and supplies for 
both hemodialysis and peritoneal dialysis, as required by the DOH and the 
PhilHealth from private dialysis clinics.  
 
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 will undergo medical evaluation for 
sustainability for transplantation. For those found medically suitable for 
transplantation, all potential organ donors of the patient shall be evaluated 
to determine compatibility and medical suitability. If no living donors are 
available then the patient will be enrolled in the deceased organ donor waiting 
list. This will ensure that all patients with ESRD are offered the option of 
kidney transplantation.  
 
SECTION 5. Chronic Kidney Disease (CKD) Prevention and Health 
Promotion – All national, provincial and regional government hospitals, and 
stand alone dialysis facilities should establish CKD prevention strategies and 
health promotion activities which 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, 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 should be informed about the availability of 
the proper medicines from government health 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.  
 
SECTION 6.  Quality Standards of Dialysis 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 
PhilHealth 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 license to 
operate a dialysis center or transplant facility Registration of all dialysis 
patients in the PhilHealth Dialysis database will be required prior to receiving 
benefits for both peritoneal dialysis and hemodialysis.  
 
SECTION 8. PhilHealth Benefit for Kidney Transplantation. – 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 the hospital stay, as well as 
post discharge laboratories up to one (1) month for the recipient, and up to 
one (1) year for the donor.  
 
 
The cost for organ retrieval and machine perfusion will be established 
by the DOH-Philippine Organ Donation Program for all organ procurement 
organizations.  
 
 
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. This 
is inclusive of both pre- and post-kidney transplantation measures for the 
benefit of End Stage Renal Disease patients.  
 
 
In order to support 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, the PhilHealth and 
the Philippine Charity Sweepstakes Office (PCSO) shall provide support for all 
maintenance immunosuppression for the lifetime 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 that will provide education for all 
Filipinos to carry the organ donor card. Facilities will likewise establish a 


potential deceased organ donor referral system that will identify all potential 
deceased organ donors to the Philippines Network for Organ Sharing.    
 
SECTION 9.   PhilHealth Benefit for Dialysis Treatment. – The PhilHealth 
shall increase the Z-benefit package rate for the principal member and each 
of one’s qualified dependents on 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 span of ninety (90) 
hemodialysis sessions per year. The professional fee of the attending 
physician and hospital charges shall be included in the PhilHealth benefits 
for dialysis treatment.  
 
The remaining sessions for both peritoneal dialysis and hemodialysis 
shall be paid for by the Philippine Charity Sweepstakes Office.  
 
For the 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 is hereby provided for indigents.  
 
The breakdown of the PHIC hemodialysis benefit package shall include 
standard HD treatment inclusive of the dialyzer 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 as identified by the Department 
of Social Welfare and Development using the National Household Targeting 
System for Poverty Reduction. A PD First Policy shall be established for all 
indigent patients, unless there is a contraindication to its use in a particular 
patient.  
 


SECTION 12. Treatment Options. – The PhilHealth shall develop a package 
that will 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 shall include the following:  
 
1) 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.  
2) 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 and the PCSO 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 benefit package for 
transplantation, the expenses for lab work-up shall be reimbursed to the 
patient by the healthcare institution after the PhilHealth pays the benefit to 
the healthcare institution.  
 
The cost of the operation for transplantation shall be included in the 
PhilHealth Z-benefit package which includes a month of post-hospital 
discharge laboratory tests for the recipient and a none (1) year follow up 
laboratory tests for the donor. The Z-benefit package shall be expanded 
accordingly.  
 
The immunosuppression medications needed by the transplant patient, 
if there is no graft rejection, shall be lifelong. For PhilHealth patients, these 
medicines shall be provided for one (1) year by PCSO. After the first year, the 
patient may reapply with the PCSO for assistance for such medications.  
 
SECTION 13. Rehabilitation 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 ESRD patients who have 
undergone kidney transplant in order to help them reach their fullest 
physical, psychological, social, and vocational avocational, and educational 
potential 
consistent 
with 
their 
physiologic 
or 
anatomic 
condition, 
environmental limitations, life plans and desires.  


 
SECTION 14. Dialysis Facility. – A dialysis facility shall be compliant with 
the licensing requirements imposed under DOH Administrative Order No. 
2012-0001 dated January 26, 2012 for hemodialysis, and PhilHealth- 
Accreditation for peritoneal dialysis facilities. Hospitals without dialysis 
facilities first put up the necessary equipment and qualified staff to perform 
peritoneal dialysis services. For hospitals with existing hemodialysis facilities, 
a peritoneal dialysis unit shall be established immediately so that this more 
cost-effective dialysis option can be made available to patients. Hospitals shall 
preferentially be provided with the necessary personnel, equipment and 
supplies as required by PhilHealth for accredited facilities.  
 
SECTION 15. Training for Peritoneal and Hemodialysis Treatment and 
Services. – The DOH, National Kidney and Transplant Institute (NKTI) and 
the Philippine Society of Nephrology (PSN) shall provide training for medical 
personnel such as physicians to take charge of the hemodialysis and 
peritoneal dialysis centers, hemodialysis and peritoneal dialysis nurses, 
hemodialysis and peritoneal dialysis technicians, operating room nurses, 
transplant ward nurses, transplant coordinators, and non-medical barangay 
health workers to support home based peritoneal dialysis. The NKTI shall 
accredit the centers that can provide training for the above personnel and 
training should include hands-on workshops for dialysis.  
 
SECTION 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 
laboratories 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 he kidney function of patients so that a timely referral to 
a nephrologist or internists/ pediatrician with specialized training in CKD can 
be made, with the timely initiation of Renal Replacement Therapy to prevent 
requiring emergency treatment.  
 
The NKTI shall provide education and training modules for the medical 
staff of CKD counselling clinics.  
 
SECTION 17. Creation of a Renal Disease Control Program (REDCOP). – 
All RRT facilities shall create a Renal Disease Control Program (REDCOP), 
following the model of the NKTI, that shall promote the early recognition of 
kidney disease, identify persons at high risk for the development of kidney 
disease and initiate preventive strategies to either prevent the development of 
kidney disease (i.e., 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.  
 
SECTION 18. Authority to Receive Donations and Exemptions from 
Donor’s Taxes, Customs and Tariff Duties. – The DOH shall be authorized 
to receive donations, gifts and bequests in order to augment the funding for 
the establishment of the dialysis wards/ units created in accordance with this 
Act. All Donations, contributions or endowments which may be made by 
persons or entities to the dialysis wards/units in national, regional and 
provincial, hospitals and the importation of medical equipment and 
machineries, spare parts and other medical equipment used solely and 
exclusively by the dialysis wards or units shall be exempt from income or 
donor’s taxes, any other direct or indirect taxes, wharf age fees and other 
charges and restrictions. 
 
SECTION 19. Penalty. – Any hospital chief, administrator or officer-in-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 
(PhP50,000.00) but not more than One Hundred Thousand Pesos (Php 
100,000.00).  
 
Likewise, persons receiving free treatment of medicines for End Stage 
Renal disease or PD or HD services from government hospitals and its 
agencies (i.e. PCSO, PHIC) 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 shall be ineligible for 
assistance from PCSO and other government agencies for a period of one (1) 
year. If these persons are found to be engaged in the selling of medications or 
services allotted for their care for the second time, they shall be permanently 
ineligible to receive government assistance.  
 
SECTION 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.  
 
SECTION 21. Implementing Rules and Regulations. -  Within sixty (60) 
days from the effectivity of this Act, the Secretary of Health, in coordination 
with the President of PhilHealth, the Executive Director of the NKTI, and other 
relevant stakeholders, shall issue the implementing rules and regulations to 
implement the provisions of this Act.  
   
 


SECTION 22. Repealing Clause. – All laws, presidential decrees, executive 
orders, letter of instruction, administrative order, rules and regulation 
contrary to or inconsistent with the provisions of this Act are hereby repealed 
or modified accordingly. 
 
SECTION 23. Separability Clause. – If any provision of this act is held 
invalid or unconstitutional, the other provision not affected hereby shall 
remain valid and subsisting. 
 
SECTION 24. Effectivity. – This Act shall take effect fifteen (15) days after 
its publication either in the Official Gazette or in a newspaper of general 
circulation. 
 
Approved,