Republic of the Philippines 
HOUSE OF REPRESENTATIVES 
Quezon City, Metro Manila 
NINETEENTH CONGRESS 
First Regular Session 
HOUSE BILL NO. ____________ 
Introduced by 
HON. CHRISTOPHERSON “COCO” M. YAP 
EXPLANATORY NOTE 
The Constitution states that the State shall protect and promote the right to health of 
the people and that it shall adopt an integrated and comprehensive approach to health 
development which shall endeavor to make essential goods, health, and other social 
services available to all the people at affordable cost. Guided by these constitutional 
provisions, this representation joins the other members of the House of Representatives 
in the push for the passage of this bill into law in this 19th Congress. 
In the Philippines, kidney illness is one of the leading causes of mortality. The lack or 
difficulty of access by rural Filipinos and the high cost of medical treatment contributes 
to this alarming number. 
This measure makes comprehensive renal replacement therapy services available for 
those suffering from end-stage chronic kidney disease. Unlike hemodialysis, kidney 
transplantation is the best treatment option, providing the highest quality of life and 
ensuring rehabilitation for these patients. 
August 2, 2022
6:00 pm
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This additional healthcare option in national, regional, and provincial government 
hospitals, made available for free to indigent Filipinos, will narrow the gap in healthcare 
opportunities between the haves and the have-nots. 
 
Hence, we are earnestly seeking the urgent approval of this bill. 
 
 
CHRISTOPHERSON “COCO” M. YAP 
Representative, Second District of Southern Leyte 
 
 


Republic of the Philippines 
HOUSE OF REPRESENTATIVES 
Quezon City, Metro Manila 
NINETEENTH CONGRESS 
First Regular Session 
HOUSE BILL NO. ____________ 
Introduced by 
HON. CHRISTOPHERSON “COCO” M. YAP 
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 
1 
Replacement Therapy Act.” 
2 
3 
SEC. 2. 
Declaration of Policy. – It is the declared policy of the State to make 
4 
available essential goods, health and other social services to all citizens at 
5 
affordable cost and to deliver medical care to indigents free of charge. 
6 
Pursuant to this, the State shall continually improve the delivery of health 
7 
services and hospital facilities to make those accessible to all.  
8 
9 
In line with this policy, the State shall adopt an integrated and 
10 
comprehensive approach to health service delivery that shall include 
11 
comprehensive renal replacement therapy for patients who are diagnosed 
12 
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with End Stage Renal Disease (ESRD). 
13 
 
14 
SEC. 3.  
Definition of Terms. – As used in this Act:   
15 
 
16 
a) Dialysis facility refers to a health facility that provides treatment for 
17 
ESRD to indigent patients and disseminates information on the various 
18 
forms of RRT such as kidney transplantation, peritoneal dialysis and 
19 
hemodialysis; 
20 
 
21 
b) End Stage Renal Disease or ESRD refers to the final stage of chronic 
22 
kidney disease in which the kidneys no longer function well enough to 
23 
support the needs of a patient’s daily life;  
24 
 
25 
c) Hemodialysis or HD refers to a medical procedure to remove fluid and 
26 
waste products from the blood and to correct electrolyte imbalances 
27 
using a synthetic membrane or dialyzer which is also referred to as an 
28 
“artificial kidney”; 
29 
 
30 
d) Indigent refers to a patient who has no source of income or whose 
31 
income is not sufficient for family subsistence as identified and assessed 
32 
by the social worker of the Department of Social Welfare and 
33 
Development (DSWD) or the social worker of the concerned local 
34 
government unit; 
35 
 
36 
e) Kidney Transplant or KT refers to a surgical procedure to place a 
37 
healthy kidney from a living or deceased donor into a person whose 
38 
kidneys no longer function sufficiently to sustain the person’s life; 
39 
 
40 
f) National, Regional, and Provincial Hospitals refer to hospitals and 
41 
stand-alone dialysis facilities operated and maintained either partially 
42 
or wholly by the national, regional and provincial government or other 
43 
political subdivisions, or any department, division, board or agency 
44 
thereof; 
45 


 
46 
g) No Balance Billing refers to the government policy of not charging the 
47 
medical expenses incurred over and beyond the PhilHealth package 
48 
rates to a PhilHealth member who has undergone medical treatment; 
49 
 
50 
h) Peritoneal dialysis or PD refers to a treatment for kidney failure and a 
51 
type of dialysis that uses the person’s peritoneum or the lining of the 
52 
abdominal cavity, as the membrane through which fluid and toxic 
53 
substances are exchanged with blood; 
54 
 
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i) PD First Policy refers to the policy where peritoneal dialysis, when 
56 
feasible, is offered as the first dialysis modality to RRT patients; 
57 
 
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j) Renal replacement therapy or RRT refers to a therapy that partially 
59 
replaces the functions of the normal kidney. This may be in the form 
60 
of kidney transplantation, peritoneal dialysis, and hemodialysis. 
61 
 
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SEC. 4.  
Establishment of Dialysis Services Wards or Units in National, Regional, 
63 
Provincial Government Hospitals. – Within five (5) years from the 
64 
effectivity of this Act, all national, regional, and provincial government 
65 
hospitals, including all stand-alone dialysis facilities shall establish, 
66 
operate and maintain a dialysis service facility in their hospitals. These 
67 
dialysis facilities shall have all the necessary dialysis machines, equipment 
68 
and supplies. The same hospitals and dialysis facilities are mandated to 
69 
train nephrologists, dialysis nurses, dialysis technicians, and operating 
70 
room nurses in both peritoneal dialysis and hemodialysis. 
71 
 
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All national, regional, and provincial government hospitals, including all 
73 
stand-alone dialysis facilities shall have a dialysis service area that is 
74 
compliant with the licensing and accreditation requirements imposed by 
75 
the Department of Health (DOH) and Philippine Health Insurance 
76 
Corporation (PhilHealth). The dialysis service area shall have the 
77 
necessary personnel, dialysis equipment and supplies for both 
78 


hemodialysis and peritoneal dialysis, as required by the DOH and the 
79 
PhilHealth of private dialysis clinics. 
80 
 
81 
The dialysis facilities shall further have a non-treatment place, which shall 
82 
serve as a waiting area for chronic kidney disease (CKD) patients and a 
83 
business area dedicated to the provision, display, and dissemination of 
84 
information on the prevention of CKD. 
85 
 
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All patients diagnosed with ESRD shall be referred to a DOH-accredited 
87 
transplant facility to receive orientation and counseling on the advantages 
88 
of undergoing transplantation as the best treatment for kidney failure. 
89 
They shall likewise undergo medical evaluation for suitability of 
90 
transplantation. All potential organ donors of the patient shall be 
91 
evaluated to determine compatibility. If no living donors are available, the 
92 
patient shall be enrolled in the deceased organ donor waiting list to ensure 
93 
that all patients with ESRD have the option to avail of kidney 
94 
transplantation. 
95 
 
96 
SEC. 5.  
Chronic Kidney Disease (CKD) Prevention and Health Promotion. - All 
97 
national, regional, and provincial government hospitals, and stand-alone 
98 
dialysis facilities shall establish CKD prevention strategies and health 
99 
promotion activities which shall include advocacy activities targeting 
100 
relatives of dialysis patients who are at high risk in developing CKD 
101 
themselves, the provision of instructional materials on the common 
102 
symptoms of kidney disease and regular conduct of educational activities 
103 
such as healthy diet and lifestyle, availment of regular tests to diagnose 
104 
kidney disease, information on the most common causes of kidney failure, 
105 
and advisories on the appropriate protocols for the diagnostic evaluation 
106 
of possible kidney disease. 
107 
 
108 
Patients and their relatives shall be informed on the availability of the 
109 
proper medicines from government health centers such as those for 
110 


diabetes and hypertension, and the importance of the regular intake of 
111 
medicines and monitoring of kidney function through regular laboratory 
112 
testing and check-up by a qualified physician. All activities pertaining to 
113 
the aforementioned programs shall be documented accordingly. 
114 
 
115 
SEC. 6.  
Quality Standards of Dialysis Services and Transplant Facilities. – 
116 
Hospitals and dialysis centers for both hemodialysis and peritoneal 
117 
dialysis, and transplant facilities shall comply with the safety and quality 
118 
standards of dialysis or transplant services, which shall be strictly 
119 
monitored by the PhilHealth and the Health Facilities and Services 
120 
Regulatory Bureau of the DOH.        
121 
 
122 
SEC. 7.  
Philippine Renal Disease Registry.- Private and public hospitals, dialysis 
123 
centers for both hemodialysis and peritoneal dialysis, and transplant 
124 
facilities shall be mandated to report to the Philippine Renal Disease 
125 
Registry of the DOH the incidence and prevalence of patients receiving 
126 
peritoneal dialysis or hemodialysis treatment, and who have received a 
127 
kidney transplant as a requirement for the renewal of their respective 
128 
DOH licenses to operate a dialysis center or transplant facility. 
129 
Registration of all dialysis patients in the PhilHealth dialysis database shall 
130 
be required prior to the availment of both peritoneal dialysis and 
131 
hemodialysis. 
132 
 
133 
SEC. 8.  
PhilHealth Benefit for Kidney Transplantation - The PhilHealth benefit 
134 
for kidney transplantation from living donors shall be expanded 
135 
accordingly. This shall include the cost of laboratory work-up for both 
136 
recipient and donor candidate, hospitalization for the transplant 
137 
operation, including induction immunosuppression and maintenance oral 
138 
immunosuppression, machine perfusion of procured organs, the cost for 
139 
organ retrieval, all medications required during hospitalization, and post 
140 
discharge laboratory examinations up to one (1) month for the recipient, 
141 
and up to one (1) year for the donor.   
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The cost of organ retrieval and machine perfusion shall be established by 
144 
the DOH-Philippine Organ Donation and Transplant Program for all 
145 
organ procurement organizations or organ and tissue retrieval units. 
146 
 
147 
The PhilHealth benefit package for kidney transplantation shall cover the 
148 
evaluation and screening of the kidney donor and recipient up to the 
149 
transplant and post-transplantation procedures and remedies and shall 
150 
include cases involving ESRD patients. 
151 
 
152 
In order to support kidney transplantation as the best treatment option 
153 
that provides the highest quality of life for ESRD patients and ensures the 
154 
return of the patient to full rehabilitation, the PhilHealth shall provide 
155 
lifetime support for all maintenance immunosuppression of the transplant 
156 
patient, as long as the transplanted organ is functioning and the patient 
157 
remains dialysis-independent. 
158 
 
159 
All renal replacement therapy facilities shall be required to engage in 
160 
regular organ donation advocacy activities. All donor- Filipino citizens 
161 
shall carry the organ donor card to be prescribed by the DOH. Health 
162 
RRT facilities will likewise establish an organ and tissue donor referral 
163 
system that will identify all potential organ and tissue donors to the 
164 
Philippine Network for Organ Sharing (PhilNOS).  
165 
 
166 
SEC. 9.  
PhilHealth Benefit for Dialysis Treatment. – The PhilHealth shall increase 
167 
the Z-benefit package rate for the principal member and the members’ 
168 
qualified dependents for maintenance peritoneal dialysis covering three (3) 
169 
peritoneal dialysis exchanges per day for three hundred sixty five (365) 
170 
days, while the package rate for hemodialysis treatment shall be increased 
171 
annually to cover a minimum of three (3) hemodialysis sessions frequency 
172 
a week, four (4) hours per session, or as may be necessary. The 
173 
professional fee of the attending physician and hospital charges shall be 
174 


included in the PhilHealth benefits for dialysis treatment. 
175 
 
176 
For purposes of providing optimal financial risk protection to the most 
177 
vulnerable groups including the poorest of the poor, the “no balance 
178 
billing policy” of the government is hereby provided for indigents.  
179 
 
180 
The breakdown of the PHIC hemodialysis benefit package shall include 
181 
standard HD treatment, dialyzer and epoetin injection, and all other 
182 
supplies needed as well as the minimum basic laboratory tests consisting 
183 
of complete blood count, creatinine, calcium, phosphorus, potassium, 
184 
albumin, hepatitis B surface antigen (HBsAg) and anti-hepatitis C virus 
185 
(Anti-HCV). The laboratory tests shall be done at a frequency of at least 
186 
four (4) tests per year for the first six (6) tests, and twice a year for the last 
187 
two (2) tests. The schedule of these tests shall be determined by the 
188 
attending physician during the course of the annual dialysis treatment 
189 
sessions. 
190 
 
191 
SEC. 10.  
Periodic Assessment and Benefit Package Adjustments for End Stage 
192 
Renal Disease Patients. - A periodic assessment and reasonable 
193 
adjustments of the benefit package for dialysis and transplant patients 
194 
shall be made by the PhilHealth after taking into consideration its 
195 
financial sustainability and changes in the socio-economic conditions of 
196 
the country. 
197 
 
198 
SEC. 11.  
Free Dialysis Treatment to Indigent Patients.  - Dialysis treatment in all 
199 
national, regional, and provincial government hospitals shall be provided 
200 
free of charge to indigent patients. A PD First Policy shall be observed for 
201 
all indigent patients, unless there is a contraindication for its use in a 
202 
particular patient. 
203 
 
204 
SEC. 12.  
Treatment Options. - The PhilHealth shall develop a case rate package 
205 
that shall provide the highest benefit for a kidney transplant procedure, 
206 


peritoneal dialysis, and hemodialysis procedures.  
207 
 
208 
 
The benefit package shall include a screening test for both the kidney 
209 
transplantation donor and recipient. The screening test for possible kidney 
210 
transplantation of both the donor and recipient shall include: 
211 
 
212 
a) For the donor, screening test shall include blood typing, complete 
213 
blood count, fasting blood sugar, creatinine, hepatitis B surface 
214 
antigen, anti-hepatitis C antibody, urinalysis, chest x-ray and 
215 
ultrasound of the kidneys, ureter, and urinary bladder 
216 
 
217 
b) For the recipient, cardiac evaluation and other tests as may be needed. 
218 
 
219 
During the availment of the full benefits of dialysis within the first two (2) 
220 
years of dialysis initiation, the cost of dialysis treatment shall be paid for 
221 
by the PhilHealth as described in Section 8. These options are provided to 
222 
encourage more patients to have a kidney transplant and attain full 
223 
rehabilitation. 
224 
 
225 
If the patient passes the criteria for the PhilHealth Z-benefit package for 
226 
transplantation, the expenses for selected laboratory tests may be 
227 
reimbursed to the patient by the healthcare institution after the PhilHealth 
228 
pays the benefit to the healthcare institution. 
229 
 
230 
SEC. 13.  
Rehabilitation Program. - The DOH, in coordination with the 
231 
Department of Labor and Employment, the Technical Education and 
232 
Skills Development Authority, the DSWD, and other pertinent agencies, 
233 
shall establish a comprehensive rehabilitation program for both kidney 
234 
donors and dialysis patients who have undergone kidney transplant 
235 
procedure in order to help them reach their fullest physical, psychological, 
236 
social, vocational, and educational potential consistent with their 
237 
physiologic or anatomic condition, environmental limitations, life plans 
238 


and desires. 
239 
 
240 
SEC. 14.  
Dialysis Facility. - A dialysis facility shall be compliant with the licensing 
241 
requirements imposed by DOH for hemodialysis. Hospitals without 
242 
dialysis facilities shall provide the necessary equipment and qualified staff 
243 
to perform peritoneal dialysis services. Hospitals with existing 
244 
hemodialysis facilities only, shall immediately establish a peritoneal 
245 
dialysis unit to provide cost-effective dialysis option to patients. Hospitals 
246 
shall equip itself with the necessary personnel, equipment and supplies as 
247 
required by PhilHealth. 
248 
 
249 
SEC. 15.  
Training for Peritoneal and Hemodialysis, and Transplant Treatment 
250 
and Services. - The DOH, National Kidney and Transplant Institute 
251 
(NKTI), Philippine Society for Transplant Surgeons (PSTS), and the 
252 
Philippine Society of Nephrology (PSN) shall provide training for medical 
253 
personnel such as physicians, surgeons, nurses, technicians and 
254 
coordinators who shall take charge of the hemodialysis and peritoneal 
255 
dialysis centers, operating rooms, transplant wards, and for non-medical 
256 
barangay health workers who shall assist home based peritoneal dialysis. 
257 
The NKTI shall accredit the centers that can provide training for these 
258 
personnel and the training shall include hands-on workshops for dialysis. 
259 
 
260 
SEC. 16.  
Establishing a Chronic Kidney Disease (CKD) Counseling Clinic. - All 
261 
RRT facilities shall establish a CKD counseling clinic and shall separately 
262 
provide personnel trained to engage patients and explain to them the 
263 
normal functions of the kidney, the stages of CKD, the laboratory 
264 
examinations routinely performed for CKD patients, the common 
265 
medications required that can control the progression of kidney disease, 
266 
the metabolic complications of ESRD, and the indications for renal 
267 
replacement. These clinics shall monitor the kidney function of patients so 
268 
that a timely referral to a nephrologist or internist/pediatrician with 
269 
specialized training in CKD can be made.  
 
270 


 
 
 
271 
The NKTI shall provide education and training modules for the medical 
272 
staff of CKD counseling clinics. 
273 
 
274 
SEC. 17.  
Availment of Persons with Disability (PWD) Benefits by CKD Patients. –
275 
CKD patients shall be classified as PWD, who shall be entitled to PWD 
276 
benefits, in accordance with Republic Act No. 7277, otherwise known as 
277 
the Magna Carta for Disabled Persons. The PhilHealth and DOH Health 
278 
Technology Assessment Council shall conduct an in-depth study on both 
279 
the direct and indirect cost of being affected with kidney disease and to 
280 
undergo treatment for it. 
281 
 
282 
SEC. 18.  
Creation of a Renal Disease Control Program (REDCOP). - All RRT 
283 
facilities shall create a Renal Disease Control Program (REDCOP) that 
284 
shall promote the early recognition of kidney disease, identify persons at 
285 
high risk of developing kidney disease and initiate preventive strategies to 
286 
either prevent the development of kidney disease from diabetes and 
287 
hypertension, or to delay its progression to end stage renal disease. The 
288 
DOH will establish a database of these patients to ensure that they are 
289 
regularly monitored for disease progression and that they are receiving 
290 
appropriate treatment for CKD. 
291 
 
292 
SEC. 19.  
Penalty. - Any hospital chief, administrator or officer-in-charge of 
293 
hospitals, dialysis centers, and health facilities who fails to comply with 
294 
Sections 5 and 6 of this Act shall be meted with a fine of Fifty thousand 
295 
pesos (P50,000.00) but not more than One hundred thousand pesos 
296 
(P100,000.00).  
 
297 
 
298 
Likewise, persons receiving free treatment of medicines for ESRD, PD or 
299 
HD services from government hospitals, such as the PHIC, who are found 
300 
selling these medications or services instead of using them for their own 
301 
treatment, shall be penalized with the suspension of their PhilHealth 
302 


membership and other government agencies for a period of six (6) months, 
303 
upon due process and hearing. If these persons are found to be engaged in 
304 
the selling of medications or services allotted for their care for the second 
305 
time, they shall be permanently ineligible to receive government assistance.  
306 
 
307 
SEC. 20.  
Appropriations. - The initial amount necessary to implement the 
308 
provisions of this Act shall be charged against the current year’s 
309 
appropriations of the DOH.  Thereafter, such sum as may be necessary 
310 
for the continued implementation of this Act shall be included in the 
311 
annual General Appropriations Act.  
312 
 
313 
SEC. 21.  
Implementing Rules and Regulations – Within ninety (90) days from the 
314 
effectivity of this Act, the DOH shall, in coordination with the PhilHealth, 
315 
the NKTI, and other relevant stakeholders, issue the implementing rules 
316 
and regulations to implement the provisions of this Act. 
317 
 
318 
SEC. 22.  
Separability Clause. - If any provision or part hereof is held invalid or 
319 
unconstitutional, the remainder of the law or the provision not otherwise 
320 
affected shall remain valid and subsisting. 
321 
 
322 
SEC. 23.  
Repealing Clause. - Any law, presidential decree or issuance, executive 
323 
order, letter of instruction, administrative order, rule or regulation 
324 
contrary to or inconsistent with the provisions of this Act are hereby 
325 
repealed, modified or amended accordingly. 
326 
 
327 
SEC. 24. 
Effectivity.-This Act shall take effect fifteen (15) days after its publication 
328 
in the Official Gazette or in a newspaper of general circulation.  
329 
 
330 
 
331 
Approved, 
332