NINETEENTH CONGRESS OF THE 
)
REPUBLIC OF THE PHILIPPINES 
)
First Regular Session 
)
Senate
ot tl)f ^'CCiftavp
*22 OCT 27 P4:ll
SENATE
RECEIVED BY;
Introduced by SENATOR RAMON BONG REVILLA, JR.
AN ACT
REQUIRING ALL NATIONAL, REGIONAL, AND PROVINCIAL GOVERNMENT 
HOSPITALS TO ESTABLISH, OPERATE AND MAINTAIN A DIALYSIS WARD 
OR UNIT IN THEIR RESPECTIVE HOSPITAL AND PROVIDING FREE 
DIALYSIS TREATMENT TO INDIGENT PATIENTS
EXPLANATORY NOTE
One Filipino develops chronic renal failure every hour or about 120 Filipinos per 
million population per year. More than 5,000 Filipino patients are presently undergoing 
dialysis and approximately 1.1 million people worldwide are on renal replacement 
therapy (NKTl, 2020). Kidney diseases have consistently ranked in the 10 most deadly 
diseases both in the Philippines and worldwide.
In this light, it is imperative that the State adopts a systematic and far-reaching 
strategy to address this health issue. This bill proposes to equip local government units 
(LGUs) to deal with these kinds of diseases in their respective units. Instead of patients 
going to the Metro for treatment, we urge the LGUs to be able to treat their 
constituents in their own local hospitals.
Furthermore, this proposed measure expands the coverage of benefits for 
kidney patients. This will aid significantly in the finances of the patients. More 
importantly, this bill institutionalizes free dialysis treatment to indigent patients.
This bill is in consonance with the mandate of the Constitution to make health 
services accessible to our countrymen at affordable cost.
For the efficient delivery of healthcare services to the Filipino people, swift 
passage of this proposed measure is earnestly sought.
RAMON
EVILLA, JR.H


NINETEENTH CONGRESS OF THE 
REPUBLIC OF THE PHILIPPINES 
First Regular Session
)
)
)
SENATE
Jennie
o( t!j?
*22 OCT 27 P4:ll
s. No. 1434
RECEiVtD BV:
Introduced by SENATOR RAMON BONG REVILLA, JR.
AN ACT
REQUIRING ALL NATIONAL, REGIONAL, AND PROVINCIAL GOVERNMENT 
HOSPITALS TO ESTABLISH, OPERATE AND MAINTAIN A DIALYSIS WARD 
OR UNIT IN THEIR RESPECTIVE HOSPITAL AND PROVIDING FREE 
DIALYSIS TREATMENT TO INDIGENT PATIENTS
Be it enacted by the Senate and House of Representatives of the Philippines in 
Congress assembled:
1 
Section 1. Short Title. - This Act shall be known as the "Free Dialysis for the
2 
Indigent Act of2022."
3 
Sec. 2. Declaration of Policy. - It is a declared policy of the State to adopt an
4 
integrated and comprehensive approach to health development that will provide
5 
Comprehensive Renal Replacement Therapy (RRT) to improve the delivery of health
6 
care services to patients diagnosed with End Stage Renal Disease (ESRD), and to
7 
encourage them to have a kidney transplant, primarily within the first two (2) years
8 
of starting dialysis.
9 
The State shall endeavour to make essential goods, health and other social
10 
services available to all the people at affordable cost. There shall be priority for the
11 
needs of the underprivileged sick, elderly, disabled, women and children. Moreover,
12 
the state shall undertake to provide free medical care to indigents.
13 
It is also hereby declared as a policy of the State to improve the delivery of
14 
health care services to the people and to ensure that hospital facilities are available,
15 
affordable and accessible to the people.
16 
Sec. 3. Definition of Terms. - As used in this Act, the following terms are hereby
17 
defined:


1
2
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4
5
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7
8 
9
10
11
12
13
14
15
16
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18
19
20 
21 
22
23
24
25
26
27
28
29
30
31
a. Dialysis facility refers to a health facility that provides 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 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 the daily life;
c. Hemodialysis or HD refers to a medical procedure to remove fluid 
and waste products from the blood and correct electrolyte 
imbalances. This is accomplished using a synthetic membrane or 
dialyzer, which is also referred to as "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 
standalone 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 the


1 
abdominal cavity) as the membrane through which fluid and toxic
2 
substances are exchanged with blood;
3 
i. PD First Policy refers to the policy where peritoneal dialysis, when
4 
feasible, is offered as the first dialysis modality to RRT patients;
5 
j, Rena! Replacement Therapy or RRT refers to therapy that partially
6 
replaces the functions of the normal kidney. This may be in the form
7 
of kidney transplantation, peritoneal dialysis and hemodialysis.
8 
Sec. 4. - Establishment of Dialysis Services Wards or Units in National,
9 
Regional, and Provincial Government Hospitals. - Within three (3) years from the
10 
effectivity of this Act, all national, provincial, and regional government hospitals,
11 
including all stand alone dialysis facilities, are hereby required to establish, operate
12 
and maintain a dialysis service facility in their hospital, including both peritoneal
13 
dialysis and hemodialysis. The same hospitals and dialysis facilities should also be
14 
mandated to train nephrologists, dialysis nurses, dialysis technicians, and operating
15 
room nurses in both peritoneal dialysis and hemodialysis.
16 
All national, provincial, and regional government hospitals, including stand
17 
alone dialysis facilities, shall have a dialysis service area compliant with the licensing
18 
and accreditation requirements, imposed by the Department of Health (DOH) and
19 
Philippine Health Insurance Corporation (PhilHealth), respectively, for private dialysis
20 
clinics. It shall further be provided with the necessary personnel and supplies for both
21 
hemodialysis and peritoneal dialysis, as required by the DOH and the PhilHealth from
22 
private dialysis clinics.
23 
All patients diagnosed with ESRD must be referred to a DOH-accredited
24 
transplant facility to attend a pre-transplant orientation and to be counseled on the
25 
advantages of undergoing transplantation as the best treatment for kidney failure.
26 
They will undergo medical evaluation for suitability for transplantation. For those found
27 
medically suitable for transplantation, ail potential organ donors of the patient shall
28 
be evaluated to determine compatibility and medical suitability. If no living donors are
29 
available then the patient will be enrolled in the deceased organ donor waiting list.
30 
This will ensure that all patients with ESRD are offered the option of kidney
31 
transplantation.
32


1 
Sec. 5. Chronic Kidney Disease (CKD) Prevention and Heaith Promotion. - All
2 
national, regional, and provincial government hospitals, and stand alone dialysis
3 
facilities should establish CKD prevention strategies and health promotion activities
4 
which include: advocacy activities targeting relatives of dialysis patients who are at
5 
risk for developing CKD themselves, the provision of instructional materials and regular
6 
educational activities on the common symptoms of kidney disease such as its risk
7 
factors, healthy diet and lifestyle, common tests to diagnose kidney disease, the most
8 
common causes of kidney failure, and advisories on the appropriate protocols for the
9 
diagnostic evaluation of possible kidney disease.
10 
Patients and their relatives should be informed about the availability of the
11 
proper medicines from government health centers, such as those for diabetes and
12 
hypertension, and the importance of the regular intake of medicines and monitoring
13 
of kidney function through regular laboratory testing and regular clinic follow-up with
14 
a qualified physician. All activities pertaining to the aforementioned programs should
15 
be documented accordingly.
16 
Sec. 6. Quaiity Standard of Diaiysis Services and Transpiant Faciiities. -
17 
Hospitals, dialysis centers for both hemodialysis and peritoneal dialysis, and transplant
18 
facilities shall comply with the safety and quality standards of dialysis or transplant
19 
services, which shall be strictly monitored by the PhilHealth and the Health Facilities
20 
and Services Regulatory Bureau of the DOH.
21 
Sec. 7. Phiiippine RenaiDisease Registry. - Private and public hospitals, dialysis
22 
centers for both hemodialysis and peritoneal dialysis, and transplant facilities shall be
23 
mandated to report to the Philippine Renal Disease Registry of the DOH the incidence
24 
and prevalence of patients receiving peritoneal dialysis or hemodialysis treatment, and
25 
who have received a kidney transplant as a requirement for the renewal of their
26 
respective DOH licenses to operate a dialysis center, or transplant facility Registration
27 
of all dialysis patients in the PhilHealth dialysis database will be required prior to the
28 
availment of benefits for both peritoneal dialysis and hemodialysis.
29 
Sec. 8. PhiiHeaith Benefit for Kidney Transpiantation. - The PhilHealth benefit
30 
for kidney transplantation from living donors shall be expanded accordingly. This shall
31 
include the cost of laboratory work-up for both recipient and donor candidate,
32 
hospitalization for the transplant operation including induction immunosuppression


1 
and maintenance oral immunosuppression, machine perfusion of procured organs, the
2 
cost for organ retrieval, all medications required during the hospital stay, as well as
3 
post discharge laboratories up to 1 month for the recipient, and up to 1 year for the
4 
donor.
5 
The cost for organ retrieval and machine perfusion will be established by the
6 
DOH-Philippine organ Donation Program for all organ procurement organizations.
7 
The PhilHealth benefit package for kidney transplantation shall cover the
8 
evaluation and screening of the kidney donor and recipient up to the transplant
9 
procedure and post-transplantation procedures and remedies. This is inclusive of both
10 
pre- and post- kidney transplantation measures for the benefit of End Stage Renal
11 
Disease patients.
12 
In order to support kidney transplantation as the best treatment option that
13 
provides the highest quality of life for End Stage Renal Disease patients and ensures
14 
the return of the patient to full rehabilitation, the PhilHealth and the Philippine Charity
15 
Sweepstakes office (PCSO) shall provide support for all maintenance
16 
immunosuppression for the lifetime of the transplant patient, as long as the
17 
transplanted organ is functioning and the patient remains dialysis-independent.
18 
All renal replacement therapy facilities shall be required to engage in regular
19 
organ donation advocacy that will provide education for all Filipinos to carry the organ
20 
donor card. Facilities will likewise establish a potential deceased organ donor referral
21 
system that will identify all potential deceased organ donors to the Philippine Network
22 
for Organ Sharing.
23 
Sec. 9. PhilHealth Benefit for Dialysis Treatment - The PhilHealth shall increase
24 
the Z-benefit package rate for the principal member and each of one's qualified
25 
dependent on maintenance dialysis per year for peritoneal dialysis covering three (3)
26 
peritoneal dialysis exchanges per day for three hundred sixty five days (365) days,
27 
while the package rate for hemodialysis treatment shall be increased annually to cover
28 
a span of ninety (90) hemodialysis sessions per year. The professional fee of the
29 
attending physician and hospital charges shall be included in the PhilHealth benefits
30 
for dialysis treatment. The remaining sessions for both peritoneal dialysis and
31 
hemodialysis shall be paid for by the Philippine Charity Sweepstakes Office.


1 
For purposes of providing optimal financial risk protection to the most
2 
vulnerable groups, including the poorest of the poor, the "No Balance Billing Policy" of
3 
the government is hereby provided for indigents.
4 
The breakdown of the PHC hemodialysis benefit package shall include standard
5 
HD treatment inclusive of the dialyzer and all other supplies needed as well as the
6 
minimum basic laboratory tests consisting of complete blood count, creatinine,
7 
calcium, phosphorus, potassium, albumin, hepatitis B surface antigen (HBsAG) and
8 
anti-hepatitis C Virus (Anti-HCV). The laboratory tests shall be done at a frequency of
9 
at least four (4) tests per year for the first six (6) tests, and twice a year for the last
10 
two (2) tests. The schedule of these tests shall be determined by the attending
11 
physician during the course of the annual dialysis treatment sessions.
12 
Sec. 10. Periodic Assessment and Benefit Package Adjustments for End Stage
13 
Rena! Disease Patients. - A periodic assessment and reasonable adjustments of the
14 
benefit package for dialysis and transplant patients shall be made by PhilHealth after
15 
taking into consideration its financial sustainability and changes in the socio-economic
16 
conditions of the country.
17 
Sec. 11. Free Dialysis Treatment to Indigent Patients. - Dialysis treatments in
18 
all national, regional and provincial government hospitals shall be provided free of
19 
charge to indigent patients, as identified by the Department of Social Welfare and
20 
Development (DSWD) using the National Household Targeting System for Poverty
21 
Reduction. A PD First Policy shall be established for all indigent patients, unless there
22 
is a contraindication to its use in a particular patient.
23 
Sec. 12. Treatment Options. - The PhilHealth shall develop a package that will
24 
provide the highest benefit for kidney transplant, followed by peritoneal dialysis, the
25 
hemodialysis.
26 
The benefit package shall include a screening test for both the donor and
27 
recipient. The screening test for possible kidney transplantation of both the donor and
28 
recipient shall include the following:
29
30 
1. For the donor, the screening testing includes blood typing, complete blood
31 
count, fasting blood sugar, creatinine, hepatitis B surface antigen, anti-hepatitis


1 
C antibody, urinalysis, chest x-ray and ultrasound of the kidneys, ureter, and
2 
urinary bladder.
3 
2. For the recipient, cardiac evaluation and many other tests as needed.
4 
During the availment of the full benefits of dialysis within the first two (2) years
5 
of dialysis initiation, the cost of dialysis treatment shall be paid for by the PhilHealth
6 
and the PCSO as described in section 8. These options are provided to encourage
7 
more patients to have a kidney transplant and attain fuil rehabilitation.
8 
If the patient passes the criteria for the PhilHealth benefit package for
9 
transplantation, the expenses for lab work-up shall be reimbursed to the patient by
10 
the healthcare institution after PhilHealth pays the benefit to the healthcare institution.
11 
The cost of the operation for the transplantation shall be included in the
12 
PhilHealth Z-benefit package which includes a month of post-hospital discharge
13 
laboratory tests for the recipient and a one (1) year follow up laboratory tests for the
14 
donor. The Z-benefit package shall be expanded accordingly.
15 
The immunosuppression medications needed by the transplant patient, if there
16 
is no graft rejection, shall be lifelong. For PhilHealth patients, these medicines shall be
17 
provided for one (1) year by PCSO. After the first year, the patient may reapply with
18 
the PCSO for assistance for such medications.
19 
Sec. 13. Rehabilitation Program. - The DOH, in coordination with the
20 
Department of Labor and Empioyment (DOLE), Technical Education and Skills
21 
Development Authority (TESDA), and the DSWD and other pertinent agencies, shall
22 
establish a comprehensive rehabilitation program for ESRD patients who have
23 
undergone kidney transplant, in order to help them reach their fullest physical,
24 
psychological, social, vocational, avocational, and educational potential consistent with
25 
their physiologic or anatomic condition, environmentai limitations, life plans and
26 
desires.
27 
Sec. 14. Dialysis Facility. - A dialysis facility shall be compliant with the licensing
28 
requirements imposed under the DOH Administrative Order No. 2012-0001 dated
29 
January 26, 2012 for hemodialysis, and PhilHealth-Accreditation for peritoneal dialysis
30 
facilities. Hospitals without dialysis facilities first put up the necessary equipment and
31 
qualified staff to perform peritoneal dialysis services. For hospitals with existing
32 
hemodiaiysis facilities, a peritoneai dialysis unit shall be established immediateiy so


1 
that this more cost-effective dialysis option can be made available to patients.
2 
Hospitals shall preferably be provided with the necessary personnel, equipment and
3 
supplies as required by PhilHealth for accredited facilities.
4 
Sec. 15. Training for Peritoneal and Hemodialysis Treatment and Services. -
5 
The DOH, National Kidney and Transplant Institute (NKTl) and the Philippine Society
6 
of Nephrology (PSN) shall provide training for medical personnel such as physicians to
7 
take charge of the hemodialysis and peritoneal dialysis centers, hemodialysis and
8 
peritoneal dialysis nurses, hemodialysis and peritoneal dialysis technicians, operating
9 
room nurses, transplant ward nurses, transplant coordinators, and non-medical
10 
barangay health workers to support home based peritoneal dialysis. The NKTl shall
11 
accredit centers that can provide training for the above personnel and training should
12 
include hands-on workshops for dialysis.
13 
Sec. 16. Establishing a Chronic Kidney Disease (CKD) Counseling Clinic. - All
14 
RRT facilities shall establish a chronic kidney disease (CKD) counseling clinic with
15 
separate personnel trained to engage patients and explain to them the normal
16 
functions of the kidney, the stages of CKD, the laboratories routinely performed for
17 
CKD patients, the common medications required that can control the progression of
18 
kidney disease, the metabolic complications of ESRD, and the indications for renal
19 
replacement. These clinics shall monitor the kidney function of patients so that a timely
20 
referral to a nephrologist or internist/pediatrician with specialized training in CKD can
21 
be made, with the timely initiation of Renal Replacement Therapy to prevent requiring
22 
emergency treatment.
23 
The NKTl shall provide education and training modules for the medical staff or
24 
CKD counseling clinics.
25 
Sec. 17. Creation of a Rena! Disease Control Program (REDCOP). - All RRT
26 
facilities shall create a Renal Disease Control Program (REDCOP), following the model
27 
of the NKTl, that shall promote the early recognition of kidney disease, identify
28 
persons at high risk for the development of kidney disease and initiate preventive
29 
strategies to either prevent the development of kidney disease (ie. from diabetes and
30 
hypertension) or to delay its progression to end stage renal disease. The DOH will
31 
establish a database of these patients to ensure that they are regularly monitored for
32 
disease progression and that they are receiving appropriate treatment for CKD.


1 
Sec. 18. Authority to Receive Donations and Exemptions from Donor's Taxes,
2 
Customs and Tariff Duties. - The DOH shall be authorized to receive donations, gifts,
3 
or bequests in order to augment the funding for the establishment of the dialysis
4 
wards/units created in accordance with this Act. All donations, contributions or
5 
endowments which may be made by persons or entities to the dialysis wards/units in
6 
national, regional, and provincial government hospitals and the importation of medical
7 
equipment and machineries, spare parts and other medical equipment used solely and
8 
exclusively by the dialysis wards/units, shall be exempt from income or donor's taxes,
9 
any other direct or indirect taxes, wharfage fees and other charges and restrictions.
10 
Sec. 19. Penaity. - Any hospital chief, administrator or officer-in-charge of
11 
hospitals, dialysis centers, and health facilities who fails to comply with Sections 5 and
12 
6 of this Act shall be meted with a fine of Fifty Thousand Pesos (P50,000.00) but not
13 
more than One Hundred Thousand Pesos (P100,000.00).
14 
Likewise, persons receiving free treatment of medicines for End Stage Renal
15 
Disease or PD or HD services from government hospitals and its agencies (ie. PCSO,
16 
PHIC) who are found selling these medicines or services instead of using them for
17 
their own treatment, shall be penalized with the suspension of their PhilHealth
18 
membership and shall be ineligible for assistance from PCSO and other government
19 
agencies for a period of one (1) year. If these persons are found to be engaged in the
20 
selling of medications or services allotted for their care for the second time, they shall
21 
be permanently ineligible to receive government assistance.
22 
Sec. 20. Appropriations. - The initial amount necessary to implement the
23 
provisions of this Act shall be charged against the current year's appropriation of the
24 
DOH. Thereafter, such sum as may be necessary for the continued implementation of
25 
this Act shall be included under the Health Facilities Enhancement Fund in the annual
26 
General Appropriations Act.
27 
Sec. 21. Impiementing Ruies and Reguiations (IRR). - Within sixty (60) days
28 
from the effectivity of this Act, the Secretary of Health, in coordination with the
29 
President of PhilHealth, the Executive Director of the NKTl, and other relevant
30 
stakeholders, shall promulgate the IRR to implement the provisions of this Act,
31 
Provided, That the non-promulgation of the rules and regulations provided under this
32 
section shall not prevent the immediate implementation of this Act upon effectivity.


1 
Sec. 22. Separability Clause. - If for any reason any section or provision of this
2 
Act is declared unconstitutional, other provisions hereof which are not affected thereby
3 
shall continue to be in full force and effect.
4 
Sec. 23. Repealing Clause. - All laws, orders, rules and regulations or parts
5 
thereof inconsistent with this Act are hereby repealed or modified accordingly.
6 
Sec. 24. Effectivity. - This Act shall take effect fifteen (15) days after its
7 
complete publication in the Official Gazette or in two (2) newspapers of general
8 
circulation in the Philippines.
Approved,
10