TWENTIETH CONGRESS OF THE 
)
REPUBLIC OF THE PHILIPPINES 
)
First Regular Session 
)
SENATE
S. No. 739
'...v’-'iDflifP Ol t'U’ ii.' •
25 JUL 21 P1 -40
RUCcIVlj c
Introduced by Senator JV Ejercito
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
EXPLANATORY NOTE
Thousands of Filipinos suffer from kidney failure every year. Not that there is no 
treatment available but sadly because of the expensive cost of surviving the disease. 
Many have died silently losing their battle with chronic kidney disease (CKD). Cases of 
CKD in the Philippines have risen to 35.94% far above the global average of 9.1- 
13.4%.1
While the efforts of the government in providing and improving dialysis accessible 
to the greatest number of patients are commendable, it should not be seen as the end 
goal of the whole treatment process. Transplant remains to be the best option for 
every patient to fully recover. We believe that government intervention is an essential 
element in prolonging the life of a patient.
However, whether it be dialysis or transplant, both paths bring so much burden, 
emotionally and financially to both the patient and his or her family. Dialysis is a long 
and hard battle to be won until the option becomes more viable for the patient.
https.//capitoImedical.com.ph/articIes-and-blogs/chronic-kidney-disease-in-the-philippines-a-silent-
epidemic/#:~:text=A%202022%20study%20in%20revealed,average%20of%209.1%2D13.4%25.
1


End-Stage renal disease (ESRD) is fatal and unforgiving. It does not distinguish 
if the patient is rich or poor, making the fighting chance of the less fortunate slimmer. 
The poor becomes poorer as they are forced to sell and pawn whatever little 
possession they have to carry on with treatment. This bill seeks to change that.
The increasing number of recorded CKDs have become very alarming and a piece 
of legislation that focuses on strengthening government programs to treat such 
disease is now more than ever, necessary. While there is a welcomed development in 
the attention that PhilHealth has given in improving benefit packages in dialysis 
session, this measure intends to be a more specialized approach in the way we treat 
kidney disease.
We maintain our position that comprehensive renal replacement therapy services 
should be accessible available to all Filipinos who suffer from End Stage Kidney Disease 
(ESKD) by including it in the coverage of treatment services provided by the PhilHealth. 
Moreover, all national, provincial, and regional government hospitals, including stand­
alone dialysis facilities are required to establish, operate and maintain a dialysis service 
facility in their hospitals.
Refiling this measure is not only a simple policy decision but a moral obligation 
to help lessen the agony of our people who had to live with failing kidneys limiting 
their full potential as human beings. We are committed to be right beside every patient 
along the way with every dialysis session; successful transplant; all the way to full 
recovery.
In view of the foregoing, the passage of this bill is earnestly sought.
JV EJERCITO


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:: 
.C£\'?V
TWENTIETH CONGRESS OF THE 
REPUBLIC OF THE PHILIPPINES 
First Regular Session
)
)
)
SENATE
S. No. 739
25 JUL 21 P1 :40
RiXEIVnl' E','
Introduced by Senator JV Ejercito
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 Act."
Sec. 2. Declaration of Policy. - It is 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).
Sec. 3. Definition of Terms. - As used in this Act:
a. Dialysis facility refers to a health facility that provide treatment for ESRD to 
indigent patients and disseminates information on the various forms of RRT 
such as kidney transplantation, peritoneal dialysis and hemodialysis;
b. End Stage Rena! Disease (ESRD) refers to the final state of chronic kidney 
disease in which the kidneys no longer function well enough to support the


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needs of a patient's daily life;
c. Hemodialysis (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 Transpiant refers to a surgical procedure to a 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. Peritoneai dialysis (PD) refers to a treatment for kidney failure and a type of 
dialysis that uses the person's peritoneum of the lining of the abdominal cavity, 
as the membrane through which fluid and toxic substances are exchanged with 
blood;
g. PD first policy refers to policy where peritoneal dialysis, when feasible, is offered 
as the first dialysis modality to RRT patients;
h. Rena! Replacement Therapy (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.
Sec. 4. Establishment of Dialysis Services Wards or Units in National, Regional 
Provincial Government Hospitals. - Within five (5) years from effectivity of this Act, all 
national, regional, and provincial government hospitals, including all stand-alone 
dialysis facilities shall establish, operate and maintain a dialysis services 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 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


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shall have the necessary personnel, dialysis equipment and supplies for both
hemodialysis and peritoneal dialysis, as required by DOH and the PhiiHealth of private 
dialysis clinics.
The dialysis facilities shali further have a non-treatment place, which shall serve 
as a waiting are for chronic kidney disease (CKD) patients and a business area 
dedicated to the provision, dispiay, 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. 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.
Sec. 5. Chronic Kidney Disease (CKD) Prevention and Heaith 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 instructionai material 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.
Sec. 6. Quaiity Standards of Diaiysis Services and Transpiant Fa duties. - 
Hospitals and dialysis centers for both hemodialysis and peritoneal dialysis and 
transplant facilities shall comply with safety and quality standards of dialysis or 
transplant services, which shall be strictly monitored by the Philhealth and the Health


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Facilities and Services Regulatory Bureau of the Department of Health (DOH).
Sec. 7. Philippine Rena!Disease Registty. - 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 treatments, 
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.
Sec. 8. PhilHealth Benefit for Kidney Transplantation. - The PhilHealth benefit 
for kidney transplantation from living donors shall be expanded accordingly. This shall 
include cost of laboratory work-up for both receipt 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 once (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 Transplant Program for all organ procurement 
organizations or organ and tissue retrieval units.
The PhilHealth benefit package for kidney transplantation as the best treatment 
option that provided the highest quality of life for ESRD patients and ensure 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).
Sec. 9. PhilHealth Benefit for Dialysis Treatment - The PhilHealth shall increase 
the benefit package rate for the principal member and the members’ qualified


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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 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 included in the PhilHealth benefits 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 is hereby provided for indigents.
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 (Antis-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 
Rena! 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 patients. A PD First Policy shall be observed for all indigent patients, under 
there is a contraindication for its use in a particular patient.
Sec. 12. Treatment Options. -The PhilHealth shall develop a case 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:


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1) For the donor, screening test shall include blood typing, complete blood 
count, fasting blood sugar, creatinine, hepatitis C antibody, urinalysis, 
chest x-ray and ultrasound of the kidneys, ureter, and urinary bladder;
2) For the recipient, cardiac evaiuation 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 diaiysis 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 PhilHeaith 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.
Sec. 13. Rehabilitation Program. -The DOH, in coordination with 
the
Department of Labor and Employment (DOLE), the Technical Education and Skills 
Development Authority (TESDA), the DSWD, and other pertinent agencies, shall 
establish a comprehensive rehabilitation program for both kidney donors and diaiysis 
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.
Sec. 14. Dialysis Facility. - A dialysis facility shall be compliant with the licensing 
reguirements imposed by DOH for hemodialysis. Hospitals without dialysis facilities 
shall provide the necessary equipment and qualified staff to perform peritoneal dialysis 
services. Hospitals with existing hemodialysis facilities only, shall immediately establish 
a peritoneal dialysis unit to provide cost-effective dialysis option to patients. Hospitals 
shall equip itself with the necessary personnel, equipment and supplies as required by 
PhilHealth.
Sec. 15. Training for Peritoneal and Hemodialysis and Transpiant 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 take charge of the hemodialysis and


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peritoneal dialysis centers, operating rooms, transplant wards, and for non-medical 
barangay health workers who shall assist home based peritoneal dialysis. The NKTT 
shall accredit the centers that can provide training for these personnel and the 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, who 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 affected 
with kidney disease and to undergo treatment for it.
Sec. 18. Creation of Rena! Disease Control Program (REDCOP). - All RRT 
facilities shall create a Renal Disease Control Program (REDCOP) 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 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 (P50,000.00) but not


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more than 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 
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, upon due process and hearing. 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.
Sec. 20. Appropriations. - The initial amount necessary to implement the 
provisions of this Act shall be charged against the current year's appropriations 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 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 implement rules and regulations to 
implement the provisions of this Act.
Sec. 22. Separability Clause. - If any provision of this Act is declared invalid or 
unconstitutional, the provisions not affected thereby shall continue to be in full force 
and effect.
Sec. 23. Repealing Cause. -All laws, decrees, orders, rules and regulations or 
parts thereof which are contrary to or inconsistent with the provisions of this Act are 
hereby amended, repealed or modified accordingly.
Sec. 24. Effectivity. - This Act shall take effect immediately after fifteen (15) 
days from its publication in the Official Gazette or in a newspaper of general circulation.
Approved,