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Republic of the Philippines y REC
House of Representatives
Quezon City, Motes Manila
EIGHTEENTH CONGRESS
First Regular Session

House Bill No. 6041

INTRODUCED BY
REP. ALFRED VARGAS

AN ACT
PROVIDING A COMPREHENSIVE RENAL REPLACEMENT THERAPY
(RRT) FOR PATIENTS WITH END STAGE RENAL DISEASE IN NATIONAL,
REGIONAL, AND PROVINCIAL GOVERNMENT HOSPITALS, INCREASING
THE PHILHEALTH PACKAGE RATE FOR RENAL REPLACEMENT
THERAPY OF MEMBERS AND APPROPRIATING FUNDS THEREFOR

EXPLANATORY NOTE

Kidney diseases are the seventh leading cause of death in the Philippines.
According to the Department of Health, 23,000 Filipinos underwent dialysis due to
kidney failure in 2013, nearly four times higher than the 4,000 cases recorded in
2004, or a 10 to 15 percent increase a year.

Dialysis is very costly for most Filipinos who suffer from chronic kidney
diseases. To have adequate treatment, a patient has to spend Php25,000 to
Php46,000 per month.

This bill seeks to ease the financial burden of patients suffering from renal
failure. It seeks to provide a comprehensive renal replacement therapy for patients
with end stage renal disease in national, regional, and provincial government
hospitals, increasing the PhilHealth package rate for renal replacement therapy of
PhilHealth members.

In view of the foregoing, the passage of this bill is earnestly sought.


Republic of the Philippines
House of Representatives
Quezon City, Metro Manila

EIGHTEENTH CONGRESS
First Regular Session

House Bill No. 6041

INTRODUCED BY
REP. ALFRED VARGAS

AN ACT
PROVIDING A COMPREHENSIVE RENAL REPLACEMENT THERAPY
(RRT) FOR PATIENTS WITH END STAGE RENAL DISEASE IN NATIONAL,
REGIONAL, AND PROVINCIAL GOVERNMENT HOSPITALS, INCREASING
THE PHILHEALTH PACKAGE RATE FOR RENAL REPLACEMENT
THERAPY OF 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. - The State 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. The state shall endeavor to
provide free medical care to the less fortunate.

It is hereby declared a policy of the State to adopt an integrated and
comprehensive approach to health development that will provide
Comprehensive Renal Replacement Therapy (RRT) to improve the delivery of
health care services to patients diagnosed with End Stage Renal Disease
(ESRD), and to encourage them to have a kidney transplant, primarily within
the first two (2) years of dialysis treatment.


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 RRT 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 meet the needs of daily life;

c. Hemodialysis or HD refers to a medical procedure to remove fluid
and waste products from the blood and to correct electrolyte
imbalances. This is accomplished 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 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
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 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
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 RRT patients;

j. Renal replacement therapy or RRT refers to the 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 Service Wards or Units in
National, Regional, Provincial, Government Hospitals. - Within five (5)
years from the effectivity of this Act, all national, provincial, and regional
government hospitals, including all stand alone dialysis facilities are hereby
required to establish, operate and maintain a dialysis service facility in their
hospital, including both peritoneal dialysis and hemodialysis. The same
hospitals and dialysis facilities should also be mandated to train
nephrologists, dialysis nurses, dialysis technicians, and operating room
nurses in both peritoneal dialysis and hemodialysis.

All national, provincial and regional government hospitals, including
stand alone dialysis facilities shall have a dialysis service area compliant with
the licensing and accreditation requirements imposed by the Department of
Health (DOH) and Philippine Health Insurance Corporation (PhilHealth),
respectively for private dialysis clinics. It shall be provided with the necessary
personnel and equipped with complete dialysis equipment and supplies for
both hemodialysis and peritoneal dialysis, as required by the DOH and the
PhilHealth from private dialysis clinics.

All patients diagnosed with ESRD must be referred to a DOH-
accredited transplant facility to attend a pre-transplant orientation and to be
counseled on the advantages of undergoing transplantation as the best
treatment for kidney failure. They will undergo medical evaluation for
sustainability for transplantation. For those found medically suitable for
transplantation, all potential organ donors of the patient shall be evaluated
to determine compatibility and medical suitability. If no living donors are
available then the patient will be enrolled in the deceased organ donor waiting
list. This will ensure that all patients with ESRD are offered the option of
kidney transplantation.

SECTION 5. Chronic Kidney Disease (CKD) Prevention and Health
Promotion - All national, provincial and regional government hospitals, and
stand alone dialysis facilities should establish CKD prevention strategies and
health promotion activities which include: advocacy activities targeting
relatives of dialysis patients who are at high risk for developing CKD
themselves, the provision of instructional materials and regular educational
activities on the common symptoms of kidney disease, 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 should be informed about 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 regular clinic follow-up with a qualified physician. All activities
pertaining to the aforementioned programs should be documented
accordingly.

SECTION 6. Quality Standards of Dialysis and Transplant Facilities. -
Hospitals, 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 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 license to
operate a dialysis center or transplant facility Registration of all dialysis
patients in the PhilHealth Dialysis database will be required prior to receiving
benefits for both peritoneal dialysis and hemodialysis.

SECTION 8. PhilHealth Benefit for Kidney Transplantation. - The
PhilHealth 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 the hospital stay, as well as
post discharge laboratories up to one (1) month for the recipient, and up to
one (1) year for the donor.

The cost for organ retrieval and machine perfusion will be established
by the DOH-Philippine Organ Donation Program for all organ procurement
organizations.

The PhilHealth benefit package for kidney transplantation shall cover
the evaluation and screening of the kidney donor and recipient up to the
transplant procedure and post transplantation procedures and remedies. This
is inclusive of both pre- and post-kidney transplantation measures for the
benefit of End Stage Renal Disease patients.

In order to support kidney transplantation as the best treatment option
that provides the highest quality of life for End Stage Renal Disease patients


and ensures the return of the patient to full rehabilitation, the PhilHealth and
the Philippine Charity Sweepstakes Office (PCSO) shall provide support for all
maintenance immunosuppression for the lifetime 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 that will provide education for all
Filipinos to carry the organ donor card. Facilities will likewise establish a
potential deceased organ donor referral system that will identify all potential
deceased organ donors to the Philippines Network for Organ Sharing.

SECTION 9. PhilHealth Benefit for Dialysis Treatment. - The PhilHealth
shall increase the Z-benefit package rate for the principal member and each
of one’s qualified dependents on maintenance dialysis per year for 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 span of ninety (90)
hemodialysis sessions per year. The professional fee of the attending
physician and hospital charges shall be included in the PhilHealth benefits
for dialysis treatment.

‘The remaining sessions for both peritoneal dialysis and hemodialysis
shall be paid for by the Philippine Charity Sweepstakes Office.

For the 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 inclusive of the dialyzer 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 the 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 as identified by the Department
of Social Welfare and Development using the National Household Targeting
System for Poverty Reduction. A PD First Policy shall be established for all
indigent patients, unless there is a contraindication to its use in a particular
patient.

SECTION 12. Treatment Options. - The PhilHealth shall develop a package
that will provide the highest benefit for kidney transplant, followed by
peritoneal dialysis, then hemodialysis.

‘The benefit package shall include a screening test for both the donor
and recipient shall include the following:

1) For the donor, the screening testing 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.

2) For the recipient, cardiac evaluation and many other tests as
needed.

During the availment 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 and the PCSO 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 PhilHealth benefit package for
transplantation, the expenses for lab work-up shall be reimbursed to the
patient by the healthcare institution after the PhilHealth pays the benefit to
the healthcare institution.

The cost of the operation for transplantation shall be included in the
PhilHealth Z-benefit package which includes a month of post-hospital
discharge laboratory tests for the recipient and a none (1) year follow up
laboratory tests for the donor. The Z-benefit package shall be expanded
accordingly.


The immunosuppression medications needed by the transplant patient,
if there is no graft rejection, shall be lifelong. For PhilHealth patients, these
medicines shall be provided for one (1) year by PCSO. After the first year, the
patient may reapply with the PCSO for assistance for such medications.

SECTION 13. Rehabilitation Program. - The DOH, in coordination with the
Department of Labor and Employment, Technical Education and Skills
Development Authority, and the DSWD and other pertinent agencies, shall
establish a comprehensive rehabilitation program for ESRD patients who have
undergone kidney transplant in order to help them reach their fullest
physical, psychological, social, and vocational avocational, and educational
potential consistent with their physiologic or anatomic condition,
environmental limitations, life plans and desires.

SECTION 14. Dialysis Facility. — A dialysis facility shall be compliant with
the licensing requirements imposed under DOH Administrative Order No.
2012-0001 dated January 26, 2012 for hemodialysis, and PhilHealth-
Accreditation for peritoneal dialysis facilities. Hospitals without dialysis
facilities first put up the necessary equipment and qualified staff to perform
peritoneal dialysis services. For hospitals with existing hemodialysis facilities,
a peritoneal dialysis unit shall be established immediately so that this more
cost-effective dialysis option can be made available to patients. Hospitals shall
preferentially be provided with the necessary personnel, equipment and
supplies as required by PhilHealth for accredited facilities.

SECTION 15. Training for Peritoneal and Hemodialysis Treatment and
Services. - The DOH, National Kidney and Transplant Institute (NKTI) and
the Philippine Society of Nephrology (PSN) shall provide training for medical
personnel such as physicians to take charge of the hemodialysis and
peritoneal dialysis centers, hemodialysis and peritoneal dialysis nurses,
hemodialysis and peritoneal dialysis technicians, operating room nurses,
transplant ward nurses, transplant coordinators, and non-medical barangay
health workers to support home based peritoneal dialysis. The NKTI shall
accredit the centers that can provide training for the above personnel and
training should include hands-on workshops for dialysis.

SECTION 16. Establishing a Chronic Kidney Disease (CKD) Counseling
Clinic. - All RRT facilities shall establish a chronic kidney disease (CKD)
counseling clinic with separate personnel trained to engage patients and
explain to them the normal functions of the kidney, the stages of CKD, the
laboratories 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 he kidney function of patients so that a timely referral to
a nephrologist or internists/ pediatrician with specialized training in CKD can
be made, with the timely initiation of Renal Replacement Therapy to prevent
requiring emergency treatment.

The NKTI shall provide education and training modules for the medical
staff of CKD counselling clinics.

SECTION 17. Creation of a Renal Disease Control Program (REDCOP). ~
All RRT facilities shall create a Renal Disease Control Program (REDCOP),
following the model of the NKTI, that shall promote the early recognition of
kidney disease, identify persons at high risk for the development of kidney
disease and initiate preventive strategies to either prevent the development of
kidney disease (i.e., 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 18, Authority to Receive Donations and Exemptions from
Donor’s Taxes, Customs and Tariff Duties. - The DOH shall be authorized
to receive donations, gifts and bequests in order to augment the funding for
the establishment of the dialysis wards/ units created in accordance with this
Act. All Donations, contributions or endowments which may be made by
persons or entities to the dialysis wards/units in national, regional and
provincial, hospitals and the importation of medical equipment and
machineries, spare parts and other medical equipment used solely and
exclusively by the dialysis wards or units shall be exempt from income or
donor’s taxes, any other direct or indirect taxes, wharf age fees and other
charges and restrictions.

SECTION 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
(PhPS50,000.00) but not more than One Hundred Thousand Pesos (Php
100,000.00).

Likewise, persons receiving free treatment of medicines for End Stage
Renal disease or PD or HD services from government hospitals and its
agencies (i.e. PCSO, 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 shall be ineligible for
assistance from PCSO and other government agencies for a period of one (1)
year. 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.

SECTION 20. Appropriations. — The initial amount necessary to implement
the provisions of this Act shall be charged against the current year’s
appropriation 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.

SECTION 21. Implementing Rules and Regulations. - Within sixty (60)
days from the effectivity of this Act, the Secretary of Health, in coordination
with the President of PhilHealth, the Executive Director of the NKTI, and other
relevant stakeholders, shall issue the implementing rules and regulations to
implement the provisions of this Act.

SECTION 22. Repealing Clause. ~ All laws, presidential decrees, executive
orders, letter of instruction, administrative order, rules and regulation
contrary to or inconsistent with the provisions of this Act are hereby repealed
or modified accordingly.

SECTION 23. Separability Clause. - If any provision of this act is held
invalid or unconstitutional, the other provision not affected hereby shall
remain valid and subsisting.

SECTION 24. Effectivity. - This Act shall take effect fifteen (15) days after
its publication either in the Official Gazette or in a newspaper of general

circulation.

Approved,