Republic of the Philippines 
HOUSE OF REPRESENTATIVES 
Quezon City 
NINETEENTH CONGRESS 
First Regular Session 
HOUSE BILL NO. ______ 
INTRODUCED BY REP. HARRIS CHRISTOPHER M. ONGCHUAN 
EXPLANATORY NOTE 
The State recognizes the need of every Filipino to have access to affordable and 
quality healthcare. Every administration, part of the central agenda is the 
improvement of healthcare in the Philippines, especially in the last Congress where 
discussions revolved around the lessons and the lapses from the handling of the 
COVID-19 pandemic. 
In the Philippines, one of the leading causes of death is Chronic Kidney Disease. 
In fact, End Stage Renal Disease is the 7th leading cause of death in the Philippines, 
according to the National Kidney Transplant Institute (NKTI). As such, the 
government has been exploring ways on how to improve renal treatment in the 
Philippines. During the pandemic, PhilHealth increased the dialysis coverage of all 
indigent patients from 90 sessions per year to 144 sessions for the year 2021. This 
allowed indigents avail of the needed dialysis sessions at a discounted rate. 
Given the increase in number of cases of Filipinos being diagnosed with End 
Stage Renal Disease, this bill seeks attention from legislators. The purpose of the bill 
is to create a Comprehensive Renal Replacement Therapy Strategy, and increase the 
role of PhilHealth and the Department of Health in ensuring that dialysis is readily 
and affordably available for those who need it. 
This bill was filed in the 18th Congress by Representatives Belmonte and Tan. 
It was approved by the House and was transmitted to the Senate. 
In view of the foregoing, immediate approval of this bill is earnestly sought. 
August 30, 2022
8:02 am
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 Republic of the Philippines 
HOUSE OF REPRESENTATIVES 
Quezon City 
NINETEENTH CONGRESS 
First Regular Session 
HOUSE BILL NO. _________ 
Introduced by Representative 
HARRIS CHRISTOPHER M. ONGCHUAN 
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: 
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;
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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 RT patients;  
 
j. 
RENAL REPLACEMENT THERAPY or RT 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 effectiveness 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 in 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, 
availability 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 checkup 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 availability 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 the 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 RT 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 (PhiNOS). 
 
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 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 may be needed. 
 
During the availability 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 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 
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 (PTS), and the Philippine Society of Nephrology (PS) 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 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. 
 
SECTION 18. Creation of a Renal Disease Curitrol Program. - All RRI 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. 
 
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, P 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 
effectiveness 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,