Republic of the Philippines 
HOUSE OF REPRESENTATIVES 
Quezon City, Metro Manila 
NINETEENTH CONGRESS 
First Regular Session 
HOUSE BILL NO. _______ 
Introduced by  
HONORABLE FRANZ S. PUMAREN 
EXPLANATORY NOTE 
Article II Section 15 of the Constitution enshrines that “[t]he State shall protect and 
promote the right to health of the people and instill health consciousness among them.” It is this 
pillar that guides the State’s mandate to “adopt an integrated and comprehensive approach to 
health development… [which shall be made] available to all the people at affordable cost (Article 
XIII Section 11). 
According to the latest data from the National Kidney and Transplant Institute (NKTI), 
one Filipino develops Chronic Kidney Disease (CKD) every 40 minutes, equivalent to 36 individuals 
acquiring renal disease in a single day1. An estimated 7 million Filipinos suffer from CKD in 20212. 
This makes CKD among the leading causes of mortality in the country.  
Furthermore, kidney prevalence in the Philippines is at 35.94%, one of the highest in the 
world, and is higher than the average CKD prevalence in Asia at only 11.2%, according to a 2022 
study conducted by the National Institute of Health in the US.3 
It is for the abovementioned reason that this measure is created. It seeks to provide 
assistance to all Filipinos suffering from end-stage kidney disease by developing comprehensive 
renal replacement therapy services through the expansion of the medical coverage provided by 
the PhilHealth. It aims to increase the benefit packages for kidney transplantation and the 
provision of free dialysis services to indigent Filipinos. The measure also requires all government 
1 De Villa, K. “Chronic kidney disease: 1 Filipino develops it every 40 minutes.” 25 June 2022. Philippine Daily 
Inquirer. https://nkti.gov.ph/index.php/patients-and-visitors/kidney-health-plus. 
2 Ibid. 
3 Shomosawa, T., ed. “Prevalence of chronic kidney disease stages 3-5 in low- and middle-income countries in Asia: 
A systematic review and meta-analysis.” 25 February 2022. National Library of Medicine. National Institute of Health. 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8880400. 
September 26, 2022
8:35 am
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hospitals in the country, including all stand-alone dialysis facilities, to establish, operate, and 
maintain a dialysis service facility. 
Given the foregoing, the passage of this measure is earnestly sought. 
FRANZ S. PUMAREN 
  3rd District, Quezon City 


Republic of the Philippines 
HOUSE OF REPRESENTATIVES 
Quezon City, Metro Manila 
NINETEENTH CONGRESS 
First Regular Session 
HOUSE BILL NO. _______ 
Introduced by  
HONORABLE FRANZ S. PUMAREN 
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). 
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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 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 KT 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 the 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. 
 
Patients and their relatives shall be informed on 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 check-up by a qualified physician. All activities pertaining to the aforementioned 
programs shall be documented accordingly. 
 
SECTION 6. Quality Standards of Dialysis Services and Transplant Facilities. – Hospitals and 
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 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 of 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-transplantion 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 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 citizen 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 exchange 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 physical 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, peritoneal 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: 
 


a. 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. 
b. 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 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. 
 
SECTION 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 procedure 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. 
 
SECTION 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. 
 
SECTION 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. 
 
SECTION 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. 
 
SECTION 17. Availment of Person 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 the 
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. 
 
SECTION 18. Creation of a Renal 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 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 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 (P100,000.00). 
 
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. 
 
SECTION 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. 
 
SECTION 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. 
 
SECTION 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. 
 
SECTION 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. 


 
SECTION 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,