NINETEENTH CONGRESS OF THE 
)
REPUBLIC OF THE PHILIPPINES 
)
Second Regular Session 
)
SENATE
S. No. 2500
of t!)f fei'f 1 f -I
23 NOV 29 All :26
RECEIVED Vf:
Introduced by Senator Joseph Victor 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
Section 11, Article XIII of the 1987 Constitution provides that the State 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. There shall be priority for the needs of the underprivileged 
sick, elderly, disabled, women, and children. This is accomplished by building healthy 
public policies, creating supportive environment, and strengthening community action 
and personal skills.
According the Philippine Statistics Authority (PSA) data, 10,000 to 20,000 
Filipinos died of disease of the genitourinary system which include renal failure and 
disorders of the kidney and ureter. Majority of the increase in total morbidity and 
mortality in the Philippine comes from Non-Communicable Diseases (NCDs), especially 
Chronic Kidney Disease (CKD). If left untreated, CKD can progress to more severe 
complications such as End-Stage Kidney Disease (ESKD) that requires more immediate 
and regular interventions. The increasing number of CKDs have become an urgent 
national concern due to the burden of the disease and high costs of care. The cost of


medical treatment for kidney disease is really exorbitant and renal transplantation is 
limited due to the expense and the shortage of donors.
It is with high hopes that this bill will make comprehensive renal replacement 
therapy services 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. Another key provision in this bill is the PhilHealth benefit package for 
kidney transplantation that will 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 addition, there is also a provision 
for free dialysis treatment to indigent patients. Lastly, 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.
In view of the foregoing, the swift passage of this bill is earnestly sought.
t3
JOSEPH VICTOR G. EJERCITO


NINETEENTH CONGRESS OF THE 
)
REPUBLIC OF THE PHILIPPINES 
)
Second Regular Session 
)
SENATE 
S. No. 2500
l^cuate
o( tl)» i
23 NOV 29 All :26
RECEIVED flV:
Introduced by Senator Joseph Victor 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:
1 
Section 1. Short Title. - This Act shall be known as the "Comprehensive Rena!
2 
Replacement Therapy Act".
3 
Sec. 2. Declaration of Policy. - It is declared policy of the State to make
4 
available essential goods, health and other social services to all citizens at affordable
5 
cost and to deliver medical care to indigents free of charge. Pursuant to this, the State
6 
shall continually improve the delivery of health services and hospital facilities to make
7 
those accessible to all.
8 
In line with this policy, the State shall adopt an integrated and comprehensive
9 
approach to health service delivery that shall include comprehensive renal
10 
replacement therapy for patients who are diagnosed with End Stage Renal Disease
11 
(ESRD).
12 
Sec. 3. Definition of Terms. - As used in this Act:
13 
a. Dialysis facility- a health facility that provide treatment for ESRD to indigent
14 
patients and disseminates information on the various forms of RRT such as
15 
kidney transplantation, peritoneal dialysis and hemodialysis;


1
2
3
4
5
6
7
8 
9
10
11
12
13
14
15
16
17
18
19
20 
21 
22
23
24
25
26
27
28
29
30
31
b. End Stage Rena! Disease (ESRD) - the final state 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 (HD) - 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 - 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 (KT) - 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. National, Regional, and Provincial Hospitals - 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 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 (PD) -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;
i. 
PD first policy - policy where peritoneal dialysis, when feasible, is offered as 
the first dialysis modality to RRT patients;
j. 
Rena! replacement therapy (RRT) - a therapy that partially replaces the 
functions of the normal kidney. This may be in the form of kidney 
transplantation, peritoneal dialysis, and hemodialysis.


1 
Sec. 4. Establishment of Dialysis Services Wards or Units in National, Regional,
2 
Provincial Government Hospitals. - Within five (5) years from effectivity of this Act, aii
3 
national, regional, and provincial government hospitals, including all stand-alone
4 
dialysis facilities shall establish, operate and maintain a dialysis services facility in their
5 
hospitals. These dialysis facilities shall have all the necessary dialysis machines,
6 
equipment and supplies. The same hospitals and dialysis facilities are mandated to
7 
train nephrologists, dialysis nurses, dialysis technicians, and operating room nurses in
8 
both peritoneal dialysis and hemodialysis.
9 
All national, regional, and provincial government hospitals, including stand-
10 
alone dialysis facilities shall have a dialysis service area that is compliant with the
11 
licensing and accreditation requirements imposed by the Department of Health (DOH)
12 
and Philippine Health Insurance Corporation (PhilHeaith). The diaiysis service area
13 
shail have the necessary personnei, dialysis equipment and supplies for both
14 
hemodialysis and peritoneal dialysis, as required by DOH and the PhilHeaith of private
15 
dialysis clinics.
16 
The dialysis facilities shall further have a non-treatment place, which shall serve
17 
as a waiting are for chronic kidney disease (CKD) patients and a business area
18 
dedicated to the provision, display, and dissemination of information on the prevention
19 
of CKD.
20 
AN patients diagnosed with ESRD shaii be referred to a DOH-accredited
21 
transpiant facility to receive orientation and counseling on the advantages of
22 
undergoing transpiantation as the best treatment for kidney failure. All potential organ
23 
donors of the patient shall be evaluated to determine compatibility. If no living donors
24 
are avaiiable, the patient shaii be enrolled in the deceased organ donor waiting iist to
25 
ensure that all patients with ESRD have the option to avail of kidney transplantation.
26 
Sec. 5. Chronic Kidney Disease (CKD) Prevention and Health Promotion. - All
27 
national, regional, and provincial government hospitals, and stand-alone dialysis
28 
facilities shaii estabiish CKD prevention strategies and health promotion activities
29 
which shaii inciude advocacy activities targeting relatives of dialysis patients who are
30 
at high risk in developing CKD themselves, the provision of instructionai materiai on
31 
the common symptoms of kidney disease and reguiar conduct of educationai activities
32 
such as heaithy diet and lifestyle, availment of regular tests to diagnose kidney


1 
disease, information on the most common causes of kidney failure, and advisories on
2 
the appropriate protocols for the diagnostic evaluation of possible kidney disease.
3 
Patients and their relatives shall be informed on the availability of the proper
4 
medicines from government health centers such as those for diabetes and
5 
hypertension, and the importance of the regular intake of medicines and monitoring
6 
of kidney function through regular laboratory testing and check-up by a qualified
7 
physician. All activities pertaining to the aforementioned programs shall be
8 
documented accordingly.
9 
Sec. 6. Quality Standards of Dialysis Services and Transplant Facilities. -
10 
Hospitals and dialysis centers for both hemodialysis and peritoneal dialysis, and
11 
transplant facilities shall comply with safety and quality standards of dialysis or
12 
transplant services, which shall be strictly monitored by the PhilHealth and the Health
13 
Facilities and Services Regulatory Bureau of the DOH.
14 
Sec. 7. Philippine Rena!Disease Registry. - Private and public hospitals, dialysis
15 
centers for both hemodialysis and peritoneal dialysis, and transplant facilities shall be
16 
mandated to report to the Philippine Renal Disease Registry of the DOH the incidence
17 
and prevalence of patients receiving peritoneal dialysis or hemodiaiysis treatments,
18 
and who have received a kidney transplant as a requirement for the renewal of their
19 
respective DOH licenses to operate a dialysis center or transplant facility. Registration
20 
of all dialysis patients in the PhilHealth dialysis database shall be required prior to the
21 
availment of both peritoneal dialysis and hemodialysis.
22 
Sec. 8. PhilHealth Benefit for Kidney Transplantation. - TTie PhilHealth benefit
23 
for kidney transplantation from living donors shall be expanded accordingly. This shall
24 
include cost of laboratory work-up for both receipt and donor candidate,
25 
hospitalization for the transplant operation, including induction immunosuppression
26 
and maintenance oral immunosuppression, machine perfusion of procured organs, the
27 
cost for organ retrieval, all medications required during hospitalization, and post
28 
discharge laboratory examinations up to once (1) month for the recipient, and up to
29 
one (1) year for the donor.
30 
The cost of organ retrieval and machine perfusion shall be established by the
31 
DOH-Philippine Organ Donation and Transplant Program for all organ procurement
32 
organizations or organ and tissue retrieval units.


1 
The PhilHealth benefit package for kidney transplantation as the best treatment
2 
option that provided the highest quality of life for ESRD patients and ensure the return
3 
of the patient to full rehabilitation, the PhilHealth shall provide lifetime support for all
4 
maintenance immunosuppression of the transplant patient, as long as the transplanted
5 
organ is functioning and the patient remains dialysis-independent.
6 
All renal replacement therapy facilities shall be required to engage in regular
7 
organ donation advocacy activities. All donor- Filipino citizens shall carry the organ
8 
donor card to be prescribed by the DOH. Health RRT facilities will likewise establish
9 
an organ and tissue donor referral system, that will identify all potential organ and
10 
tissue donors to the Philippine Network for Organ Sharing (PhilNOS).
11 
Sec. 9. PhilHealth Benefit for Dialysis Treatment. -The PhilHealth shall increase
12 
the benefit package rate for the principal member and the members' qualified
13 
dependents for maintenance peritoneal dialysis covering three (3) peritoneal dialysis
14 
exchanges per day for three hundred sixty-five (365) days, while the package rate for
15 
hemodialysis treatment shall be increased annually to cover a minimum three (3)
16 
hemodialysis sessions frequency a week, four (4) hours per session, or as may be
17 
necessary. The professional fee of the attending physician and hospital charges shall
18 
be included in the PhilHealth benefits for dialysis treatment.
19 
For purposes of providing optimal financial risk protection to the most
20 
vulnerable groups including the poorest of the poor, the "no balance billing policy" of
21 
the government is hereby provided for indigents.
22 
The breakdown of the PHIC hemodialysis benefit package shall include
23 
standard HD treatment, dialyzer and epoetin injection, and all other supplies needed
24 
as well as the minimum basic laboratory tests consisting of complete blood count,
25 
creatinine, calcium, phosphorus, potassium, albumin, hepatitis B surface antigen
26 
(HBsAg) and anti-hepatitis C virus (Antis-HCV). The laboratory tests shall be done at
27 
a frequency of at least four (4) tests per year for the first six (6) tests, and twice a
28 
year for the last two (2) tests. The schedule of these tests shall be determined by the
29 
attending physician during the course of the annual dialysis treatment sessions.
30 
Sec. 10. Periodic Assessment and Benefit Package Adjustments for End Stage
31 
Rena! Disease Patients. - A periodic assessment and reasonable adjustments of the
32 
benefit package for dialysis and transplant patients shall be made by the PhilHealth


1 
after taking into consideration its financial sustainability and changes in the socio-
2 
economic conditions of the country.
3 
Sec. 11. Free Dialysis Treatment to Indigent Patients. - Dialysis treatment in
4 
all national, regional, and provincial government hospitals shall be provided free of
5 
charge to indigent patients. A PD First Policy shall be observed for all indigent patients,
6 
under there is a contraindication for its use in a particular patient.
7 
Sec. 12. Treatment Options. -The PhilHealth shall develop a case rate package
8 
that shall provide the highest benefit for a kidney transplant procedure, peritoneal
9 
dialysis, and hemodialysis procedures.
10 
The benefit package shall include a screening test for both the kidney
11 
transplantation donor and recipient. The screening test for possible kidney
12 
transplantation of both the donor and recipient shall include:
13 
1) For the donor, screening test shall include blood typing, complete blood
14 
count, fasting blood sugar, creatinine, hepatitis C antibody, urinalysis, chest
15 
x-ray and ultrasound of the kidneys, ureter, and urinary bladder
16 
2) For the recipient, cardiac evaluation and other tests as may be needed.
17 
During the availment of the full benefits of dialysis within the first two (2) years
18 
of dialysis initiation, the cost of dialysis treatment shall be paid for by the PhilHealth
19 
as described in Section 8. These options are provided to encourage more patients to
20 
have a kidney transplant and attain full rehabilitation.
21 
If the patient passes the criteria for the PhiHealth Z-benefit package for
22 
transplantation, the expenses for selected laboratory tests may be reimbursed to the
23 
patient by the healthcare institution after the PhilHealth pays the benefit to the
24 
healthcare institution.
25 
Sec. 13. Rehabilitation Program. - The DOH, in coordination with the
26 
Department of Labor and Employment (DOLE), the Technical Education and Skills
27 
Development Authority (TESDA), the DSWD, and other pertinent agencies, shall
28 
establish a comprehensive rehabilitation program for both kidney donors and dialysis
29 
patients who have undergone kidney transplant procedure in order to help them reach
30 
their fullest physical, psychological, social, vocational, and educational potential
31 
consistent with their physiologic or anatomic condition, environmental limitations, life
32 
plans and desires.


1 
Sec. 14. Dialysis Facility. -A dialysis facility shall be compliant with the licensing
2 
requirements imposed by DOH for hemodialysis. Hospitals without dialysis facilities
3 
shall provide the necessary equipment and qualified staff to perform peritoneal dialysis
4 
services. Hospitals with existing hemodialysis facilities only, shall immediately establish
5 
a peritoneal dialysis unit to provide cost-effective dialysis option to patients. Hospitals
6 
shall equip itself with the necessary personnel, equipment and supplies as required by
7 
PhilHealth.
8 
Sec. 15. Training for Peritoneal and Hemodialysis and Transplant Treatment
9 
and Services. -The DOH, National Kidney and Transplant Institute (NKTl), Philippine
10 
Society for Transplant Surgeons (PSTS), and the Philippine Society of Nephrology
11 
(PSN) shall provide training for medical personnel such as physicians, surgeons,
12 
nurses, technicians and coordinators who shall take charge of the hemodialysis and
13 
peritoneal dialysis centers, operating rooms, transplant wards, and for non-medical
14 
barangay health workers who shall assist home based peritoneal dialysis. The NKTl
15 
shall accredit the centers that can provide training for these personnel and the training
16 
shall include hands-on workshops for dialysis.
17 
Sec. 16. Establishing a Chronic Kidney Disease (CKD) Counseling Clinic. - All
18 
RRT facilities shall establish a CKD counseling clinic and shall separately provide
19 
personnel trained to engage patients and explain to them the normal functions of the
20 
kidney, the stages of CKD, the laboratory examinations routinely performed for CKD
21 
patients, the common medications required that can control the progression of kidney
22 
disease, the metabolic complications of ESRD, and the indications for renal
23 
replacement. These clinics shall monitor the kidney function of patients so that a timely
24 
referral to a nephrologist or internist/pediatrician with specialized training in CKD can
25 
be made.
26 
The NKTl shall provide education and training modules for the medical staff of
27 
CKD counseling clinics.
28 
Sec. 17. Avaiiment of Persons with Disability (PWD) Benefits by CKD Patients.
29 
- CKD patients shall be classified as PWD, who shall be entitled to PWD benefits, in
30 
accordance with Republic Act No. 7277, otherwise known as the Magna Carta for
31 
Disabled Persons. The PhilHealth and DOH Health Technology Assessment Council


1 
shall conduct an in-depth study on both the direct and indirect cost of being affected
2 
with kidney disease and to undergo treatment for it.
3 
Sec. 18. Creation of Rena! Disease Controi Program (REDCOP). - All RRT
4 
facilities shall create a Renal Disease Control Program (REDCOP) that shall promote
5 
the early recognition of kidney disease, identify persons at high risk of developing
6 
kidney disease and initiate preventive strategies to either prevent the development of
7 
kidney disease from diabetes and hypertension, or to delay its progression to end
8 
stage renal disease. The DOH will establish a database of these patients to ensure
9 
that they are regularly monitored for disease progression and that they are receiving
10 
appropriate treatment for CKD.
11 
Sec. 19. Penaity. - Any hospital chief, administrator or officer-in-charge of
12 
hospitals, dialysis centers, and health facilities who fails to comply with Sections 5 and
13 
6 of this Act shall be meted with a fine of Fifty thousand pesos (P50,000.00) but not
14 
more than One hundred thousand pesos (P100,000.00).
15 
Likewise, persons receiving free treatment of medicines for ESRD, PD or HD
16 
services from government hospitals, such as the PHIC, who are found selling these
17 
medications or services instead of using them for their own treatment, shall be
18 
penalized with the suspension of their PhilHealth membership and other government
19 
agencies for a period of six (6) months, upon due process and hearing. If these
20 
persons are found to be engaged in the selling of medications or services allotted for
21 
their care for the second time, they shall be permanently ineligible to receive
22 
government assistance.
23 
Sec. 20. Appropriations. - The initial amount necessary to implement the
24 
provisions of this Act shall be charged against the current year's appropriations of the
25 
DOH. Thereafter, such sum as may be necessary for the continued implementation of
26 
this Act shall be included in the annual General Appropriations Act.
27 
Sec. 21. Impiementing Ruies and Regulations. - Within ninety (90) days from
28 
the effectivity of this Act, the DOH shall, in coordination with the PhilHealth, the NKTl,
29 
and other relevant stakeholders, issue the implement rules and regulations to
30 
implement the provisions of this Act.


1 
Sec. 22. Separability Clause. -If any provision of this Act is declared invalid or
2 
unconstitutional, the provisions not affected thereby shall continue to be in full force
3 
and effect.
4 
Sec. 23. Repealing Clause. - All laws, decrees, orders, rules and regulations or
5 
parts thereof which are contrary to or inconsistent with the provisions of this Act are
6 
hereby amended, repealed or modified accordingly.
7 
Sec. 24. Effectivity. - This Act shall take effect immediately after fifteen (15)
8 
days from its publication in the Official Gazette or in a newspaper of general
9 
circulation.
Approved,