EIGHTEENTH CONGRESS OF THE 
)
REPUBLIC OF THE PHILIPPINES 
)
First Regular Session 
)
of I’if 
r.ftrr;>
S E N A T E  
S. No. 
2 9 8
•19 
JU L-8 P3 ;41
RECEiVll)
Introduced by SENATOR RAMON BONG REVILLA, JR.
AN ACT
REQUIRING ALL NATIONAL, REGIONAL, AND PROVINCIAL GOVERNMENT 
HOSPITALS TO ESTABLISH, OPERATE AND MAINTAIN A DIALYSIS WARD 
OR UNIT IN THEIR RESPECTIVE HOSPITAL AND PROVIDING FREE 
DIALYSIS TREATMENT TO INDIGENT PATIENTS
EXPLANATORY NOTE
In 2013, the Department of Health has expressed alarm over the rising cases 
of kidney disease. Kidney diseases has consistently ranked in the 10 most deadly 
diseases both in the Philippines and worldwide.
In this light, it is imperative that the State adopts a systematic and far-reaching 
strategy to address this health issue. This bill proposes to equip local government units 
to deal with these kinds of diseases in their respective units. Instead of patients going 
to the Metro for treatment, we urge local government units to be able to treat their 
constituents in their own local hospitals.
Furthermore, this proposed measure expands the coverage of benefits for 
kidney patients. This will aid significantly in the finances of the patients. More 
importantly, this bill institutionalizes free dialysis treatment to indigent patients.
This bill is in consonance with the mandate of the Constitution to make health 
services accessible to our countrymen at affordable cost. For the efficient delivery of 
healthcare services to the Filipino people, consideration of this proposed measure is 
earnestly sought.
BONG REVILLA, JR.


EIGHTEENTH CONGRESS OF THE 
)
REPUBLIC OF THE PHILIPPINES 
)
First Regular Session 
)
S E N A T E  
S. No. 
298
, -  
m Put?
of tlif €rrtrrl<Hj’
■19 
JU L-8 P3 ’41
RECEIVED BY;
Introduced by SENATOR RAMON BONG REVILLA, 3R.
AN ACT
REQUIRING ALL NATIONAL, REGIONAL, AND PROVINCIAL GOVERNMENT 
HOSPITALS TO ESTABLISH, OPERATE AND MAINTAIN A DIALYSIS WARD 
OR UNIT IN THEIR RESPECTIVE HOSPITAL AND PROVIDING FREE 
DIALYSIS TREATMENT TO INDIGENT PATIENTS
Be it enacted by the Senate and House o f Representatives o f the Philippines in 
Congress assembled:
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Section 1. Short Title. -  This Act shall be known as the "Comprehensive Renal 
Replacement Therapy Act of 2019."
Sec. 2. Declaration o f 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 (ESRD), and to 
encourage them to have a kidney transplant, primarily within the first two (2) years 
of starting dialysis.
The State shall endeavour 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 endeavour to provide free medical care to indigents.


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It is also hereby declared as a policy of the State 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. 3. Definition o f 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 Rena! 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 the daily life;
c. Hemodialysis or HD refers to a medical procedure to remove fluid 
and waste products from the blood and correct electrolyte 
imbalances. This is accomplished using a synthetic membrane or 
dialyzer which is also referred to as "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 
standalone 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;


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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 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 RRT patients;
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Rena! Replacement Therapy or RRT refers to therapy that partially 
replaces the functions of the normal kidney. This may be in the form 
of kidney transplantation, peritoneal dialysis and hemodialysis.
Sec. 4. -  Establishment o f Dialysis Services Wards or Units in National, 
Regional, and 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 further be provided with the necessary personnel and supplies for both 
hemodialysis and peritoneal dialysis, as required by the DOH and the PhilHealth from 
private dialysis clinics.


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All patients diagnosed with ESRD must be referred to a DOH-accredited 
transplant facility to attend a pre-transplant orientation and to be counselled 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 deceased organ donor waiting list. 
This will ensure that all patients with ESRD are offered the option of kidney 
transplantation.
Sec. 5. -  Chronic Kidney Disease (CKD) Prevention and Health Promotion. -  All 
national, regional, and provincial 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 
risk for developing CKD themselves, the provision of instructional materials and regular 
educational activities on the common 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 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.
Sec. 6. -  Quality Standard o f 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.


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Sec. 7. -  Philippine Renai 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 will be 
required prior to the availment of benefits for both peritoneal dialysis and 
hemodialysis.
Sec. 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 1 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.
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


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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 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 PhilFlealth 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 covering three (3) 
peritoneal dialysis exchanges per day for three hundred sixty five days (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 PhilFlealth benefits 
for dialysis treatment. The remaining sessions for both peritoneal dialysis and 
hemodialysis shall be paid for by the Philippine Charity Sweepstakes Office.
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 id hereby provided for indigents.
The breakdown of the PFIC hemodialysis benefit package shall include standard 
FID 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 (FIBsAG) and 
anti-hepatitis C Virus (Anti-FICV). 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.


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Sec. 10. -  Periodic Assessment and Benefit Package Adjustments for End Stage 
Rena! 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.
Sec. 11. -  Free Diaiysis Treatment to Indigent Patients. -  Dialysis treatments 
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.
Sec. 12. -  Treatment Options. -  The PhilHealth shall develop a package that 
will provide the highest benefit for kidney transplant, followed by peritoneal dialysis, 
the 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 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.


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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 the 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 one (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.
Sec. 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, 
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 the 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 preferably be provided with the necessary personnel, equipment and 
supplies as required by PhilHealth for accredited facilities.
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Sec. 15. Training for Peritoneai 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 centers that can provide training for the above personnel and training should 
include hands-on workshops for dialysis.
Sec. 16. Establishing a Chronic Kidney Disease (CKD) Counselling Clinic. -  All 
RRT facilities shall establish a chronic kidney disease (CKD) counselling 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 modules for the medical staff or 
CKD counselling clinics.
Sec. 17. Creation o f a Rena! 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 (ie. 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.


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Sec. 18. Authority to Receive Donations and Exemptions from Donor's Taxes, 
Customs and Tariff Duties. -  The DOH shall be authorized to receive donations, gifts, 
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 government hospitals and the importation of medical 
equipment and machineries, spare parts and other medical equipment used solely and 
exclusively by the dialysis wards/units shall be exempt from income or donor's taxes, 
any other direct or indirect taxes, wharfage fees and other charges and restrictions.
Sec. 19. Penalty. -  Any hospital chief, administrator of 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 (P50,000.00) but not 
more than One Hundred Thousand Pesos (P100,000.00).
Likewise, persons receiving free treatment of medicines for End Stage Renal 
Disease or PD or HD services from government hospitals and its agencies (ie. PCSO, 
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 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 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.
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.
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shall issue the implementing rules and regulations to implement the provisions of this 
Act.
Sec. 22. Separability Clause. -  If for any reason any section or provision of this 
Act is declared unconstitutional, other provisions hereof which are not affected thereby 
shall continue to be in full force and effect.
Sec. 23. Repealing Clause. -  All laws, orders, rules and regulations or parts 
thereof inconsistent with this Act are hereby repealed or modified accordingly.
Sec. 24. Effectivity. -  This Act shall take effect fifteen (15) days after its 
publication in at least two (2) newspapers of general circulation.
Approved,