Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City
NINETEENTH CONGRESS
First Regular Session
HOUSE BILL NO. _________
Introduced by 4Ps Partylist Representative
JONATHAN CLEMENT M. ABALOS II
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
In the previous Congresses of the House of Representatives, healthcare has
been a key sector wherein legislation is always passed. One avenue in which
legislators believe there could still be an improvement is the improvement of Renal
Disease care.
As early as the 16th Congress, bills were already filed to increase PhilHealth
coverage for dialysis patients. Authored by Rep. Francis Calalay and Rep. Leopoldo
Bataoil, House Bill No. 5956 was passed in the Third Reading by the House of
Representatives.
Legislation on providing a Comprehensive Renal Replacement Therapy was
first seen in the 17th Congress when it was filed by Rep. Joseph Stephen S. Paduano.
House Bill No. 9156 eventually passed on Third Reading in the House of
Representatives but it failed to reach deliberation in the Senate.
Subsequently, it was again refiled in the 18th Congress as House Bill No. 6803
by Representatives Angelina Tan, Jose Christopher Belmonte, Estrellita Suansing,
July 28, 2022
5:17 pm
2738


among others, which was again passed on Third Reading by the House of
Representatives, yet, it failed to be passed on the Senate of the Philippines.
Chronic Kidney Disease is one of the leading causes of death in the
Philippines. There has been an approximately 400% increase in patients needing to
undergo dialysis in the past ten years. Kidney-related diseases, especially End Stage
Renal Disease, rank as the seventh leading cause of death for Filipinos. It is for this
reason that in 2021, in an attempt to alleviate the expenses of Filipinos undergoing
treatment, PhilHealth increased the dialysis coverage from 90 sessions per year to
144 sessions for the year 2021.
This measure aims to make treatment for Renal Diseases more accessible and
affordable. Often, dialysis for these patients is required three times a week. Due to
the high cost it takes, patients opt to skip sessions. As such, this measure aims to
increase PhilHealth coverage for indigent patients to ensure quality care is given to
these patients. Moreover, this measure aligns with the Constitutional Mandate to
make health services readily available and affordable to Filipinos.
In view of the foregoing, immediate approval of this bill is earnestly sought.
JONATHAN CLEMENT M. ABALOS II
Representative, 4Ps Partylist
Republic of the Philippines


HOUSE OF REPRESENTATIVES
Quezon City
NINETEENTH CONGRESS
First Regular Session
HOUSE BILL NO. _________
Introduced by 4Ps Partylist Representative
JONATHAN CLEMENT M. ABALOS II
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;
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;
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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,