JE SEF
/” RECEIVED

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Republic of the Philippines
HOUSE OF REPRESENTATIV
Quezon City

IGHTEENTH CONGRESS
First Regular Session

218

oduced by Honorable Roberto “Robbie” V. Puno

ANA TORY NC

The Department of Health reported that one person dies every hour from
Kidney failure, which puts it as the ninth-leading cause of death among Filipinos
today

A person whose kidneys are failing need to undergo treatment, usually
dialysis, in order to cleanse their blood of excess fluid, minerals, and waste:
According to the National Kidney and ‘Transplant Institute, more than 5,000

Filipinos are presently undergoing dialysis and approximately 1.1. million
worldwide are on renal replacement therapy and each year, and around 10,000
people need to have their kidney function replaced.

In light of the available treatment methods, kidney dis
considered a death s

is no longer
ntence. However, due to lack of access and high cost of
treatment, most of thos

afflicted with the disease remains to be untreated.

Pursuant to the constitutional mandate of the State to protect and promote
the right to health of the people and instill health consciousne:
mea

ss among them, this
ure intends to aid Filipinos suffering from renal failure by expanding the
benelits for Renal Replacement Theraphy: kidney transplantation, peritoneal
dialysis, and hemodialysis,

this proposed legislation shall provide the highest benefit to kidney
transplantation as the primary treatment for kidney disease. Philhealth benefit for
kidney transplantation shall include evaluation and screening of kidney donors
and recipients, transplant procedure, and post-transplant procedures and
remedies. Patients shall also be encouraged to consider undergoing a kidney
transplant during the first two (2) years of starting dialysis.



lo improve access to treatment, all national, provincial and regional
ilies are hereby
intain a service dialysis facility in their
hospital, including both peritoneal dialysis and hemodialysis

government hospitals, including all stand-alone dialysis fac
required 10 establish, operate and

The bill
hemodialysis, which shall also include the professional fee and hospital charges.

» increased the Philhealth package for peritoneal dialysis and

Further, this measure directs the Philippine Charity Sweepstakes Office to
provide for the remaining required sessions for dialysis after a patient consumes
his Philhealth benefit package. To ensure treatment for all, dialysis treatment in
all national, regional, and provincial government hospitals shall be provided free
of charge to indigent patients.

Iraining of nephrologists, nurses, technicians, and other persons involved
in treatment of renal diseases and education on prevention and health promotion
to patients and their families are also mandated under this measure.

Through the passage of this bill, the financial burden of Filipinos suffering
trom renal diseases will be alleviated and the necessary treatment will be provided
to them, thereby addressing the problem of renal diseases in the country.

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

i) )
A 4 0N \; (a
Ba} BR TO “ROBBIE” V. PUNO


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Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City

NTH CONG
Regular Session

HOUSE BILL.NO. 218

Be it enacted by the Senate and House of Representatives of the Philippines in
Congress assembled.

AL, PROVISIONS.

SECTION I Short Title. — This Act shall be known as the
“Comprehensive Renal Replacement Therapy Act.”

SEC. 2. Declaration of Policy. It is a declared 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 (SRD), and to encourage them to have a kidney transplant, primarily
within the first two (2) years starting of dialysis.

the State shall endeavor to make essential goods, health and other social
services available to all the people at affordable cost. There shall be a priority for
the needs of the underprivileged sick, elderly, disabled, women and children. The
State shall endeavor to [provide fr » medical care to paupers.



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It is also hereby declared as a policy to improve the delivery of health care

services to the people and to ensure hospital facilities are available, affordable, and
accessible to the people.

SEC.
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3. Definition of Terms, — As used in this Act:

Dialysis facility refers to a health facility that provides treatment for ESRD
to indigent patients and disseminates information on the various forms of
RR such as kidney transplantation, peritoneal dialysis, and hemodialysis;
End Stage Renal Disease or ESRD veters to the final stage of chronic
Kidney disease in which the kidneys no longer function well enough to meet
the needs of daily li
Hemodialysis or HD relers to a medical procedure to remove fluid and
waste products from the blood and to correct electrolyte imbalances. This i
accomplished using a synthetic membrane or dialyzer which is also referred
to as an “artificial kidney”;

Indigent refers to a patient who has no source of income or whose income
not sufficient for family subsistence as identified by the Department of
Social Welfare and Development (DSWD) through the National Household
Fargeting System (NHTS) for Poverty Reduction, or those patients who are
indigents but are not listed in the NIITS as assessed by the municipal social
development offcer;

Kidney Transplant or KT reters to a medical 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;

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;

No Balance Billing refers io the government policy of not charging the
medical expenses incurred over and beyond the PhilHealth package rates to
a Phillfealth member who has undergone medical treatment,

Peritoneal Dialysis or PD refers to a teatment of kidney failure and a type
of dialysis that uses the person’s peritoneum (lining of abdominal cavity) as
the membrane through which the fluid and toxic substances are exchanged
with blood;

PD First Policy refers to the policy where peritoneal dialysis, when feasible,
is offered as the first dialysis modality to RRT patients;



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j. Renal replacement therapy or RRT refers to therapy that partially replaces
the functions of the normal kidney. This may be in the form of the kidney
transplantation, peritoneal dialysis and hemodialysis;

SEC. 4. Establishment of Dialys Services 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 service dialysis facility in their hospital, including
both peritoneal dialysis and hemodialysis. The same hospitals and dialysis facilities
should also be mandated to train hephrologists, 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 further 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 DOL I-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 suitability 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 dec ased organ
donor waiting list. This will ensure that all patients with ESRD are offered the
option of kidney transplantation,

iS) EIG Ps) Chronic Kidney Disease (CKD) Prevention and Health
Promotion. — All national, provincial, and regional government hospitals and
stand-alone dialysis facilities to 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 education activities on the common

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symptoms of kidney disease such as its risk factors, healthy diet and lifestyle,
common tests to diagnose 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 the 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

SEC. 6. Quality Standards of Dialysis Services 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 and the
Health Facilities and Services Regulatory Bureau of the DOH

SEC. 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 DOI 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 of transplant facility. Registration of all dialysis patients in the PhilHealth
dialysis database will be required prior to the availment of benefits for both
peritoneal dialysis and hemodialysis.

SUC. 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, machine perfusion of procured organs, the cost for
organ retrieval, all medication required during the hospital stay, as well as post

discharge laboratories up to | month for the recipient, and up to 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.


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The Philllealth 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 ps dney 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 Philippine Network for Organ Sharing

SEC. 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 dependent on maintenance dialysis per year for peritoneal dialysis for
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
for the attending physician and hospital charges shall be included in the PhilHealth
benefits for dialysis treatment.

the remaining sessions for both peritoneal dialy:
be paid for by the Philippine Charity Sweepstakes Office

and hemodialysis shall

Kor 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 HD
standard treatment inclusive of the‘dialyzer and all other supplies needed as well as
the minimum basic laboratory tests consisting of complete blood count, creatinine,

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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 least two (2) tests. The schedule of these tests shall be determined by
the attending physician during the course of the annual dialysis treatment sessions.

SEC. 10. Periodic Assessment and Benefit Package Adjustments for End
Stage Renal Disease Patients— A periodic ment and reasonable adjustments
of the benefit package for dialysis and transplants patients shall be made by the
PhilHealth afier taking into consideration its financial sustainability and changes in
the socio-economic conditions of the country.

SEC. 11. Free Dialysis Treatment to Indigent Patients, — Dialys
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 to all indigent
patients, unless there is a contraindication to its use in a particular patient,

SEC. 12. Treatment Options. — The Philllealth 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. The screening test for possible kidney transplantation of both the donor
and recipient shall include the following:

1) For the donor, the 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.

2) For the recipient,

diac evaluation and many other tests as needed

During the availment of full benefits of dialysis within the first two (2) years
of dialysis initiation, the cost of dialysis treatment shall be paid for by the
Philllealth and the PCSO as described in Section 8

If the patient passes the criteria for the PhilHealth benefit package for
transplantation, the expenses for the lab work-up shall be reimbursed to the patient

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by the healthcare institution after the Philllealth pays the benefit to the healthcare
institution.

The cost of the operation for transplantation shall be included in the
Philllealth Z-benefit package which includes a month of post-hospital discharge
laboratory tests for the recipient and one (1) year follow up of laboratory tests for
the donor. The Z-benefit shall be expanded accordingly.

The immunosuppression medication 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.

SEC. 13, Rehabilitation Program. — Vhe 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 ESRDtr patients who have
undergone kidney transplant in order to help them reach their fullest physical,
psychological, social, vocational, avocational, and educational potential consistent
with their physiologic or anatomic condition, environmental limitations, life plans
and desires

SEC. 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-A 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
hecessary personnel, equipment and supplies as required by PhilHealth for
dited facilities.

SEC. 15. Training for Peritoneal and Hemodialysis Treatment and
Services. — Vhe DOU, 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,

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transplant coordinators, and non-medical barangay health workers to support home
«| peritoneal dialysis. The NKTI shall accredit the centers that can provide the
training for the above personnel and training should include hands-on workshops
for dialysis

SEC. 16. Establishing a Chronic Kidney Disease (CKD) Counseling Clinic. —
AIL RR 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 the kidney function
of patients so that a timely referral to a nephrologist or internist/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 module:
of CKD counseling clinies

for the medical staff

SEC. 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 the kidney disease and initiate
preventive strategies to either prevent the development of kidney disease (i.e. from
diabetes to 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.

SEC. 18. Authority to Receive Donations and Exemptions from Donor’s
Taxes, Customs and Tariff Dutie 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 the 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 direct or indirect taxes, wharfage
fees and other charges and restrictions.



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SEC. 19. Penalty, ~ Any hospital chief, administrator, or officer-in-charge
of hospitals, dialysis centers and health facilities who fails to comply with this Act
shall be meted with a fine of Fifty thousand pesos (P50,000.00) but not more than
One hundred thousand pesos (P 100,000.00).

Likewise, persons receiving free treatment of medicines for End Stage Renal
ase or PD or HD services from government hospitals and its agencies (ie
PCSO, PIIIC) who are found selling these medications instead of selling 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.

SEC. 20 Appropriations. — The initial amount necessary to implement the
provisions this Act shall be charged against the current year’s appropriation of the
DOIL Thereatier, such sum as may be necessary for the continued implementation
of this Act shall be included in the annual General Appropriations Act.

SEC. 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 the 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.

SEC. 22. Separability Clause. \f 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,

SEC. 23. Repeating Clause. Any law, presidential decree or issuance,
executive order, letter of instruction, administrative order, rule or regulatory
contrary to or inconsistent with the provisions of this Act are hereby repealed,
moditied, or amended accordingly

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

Approved,

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