Republic of the Philippines 
HOUSE OF REPRESENTATIVES 
Quezon City 
NINETEENTH (19th) CONGRESS 
First Regular Session 
HOUSE BILL NO._______ 
_____________________________________________________________________ 
Introduced by REP. JOSEPH STEPHEN S. PADUANO 
_____________________________________________________________________ 
EXPLANATORY NOTE 
The Philippines is one of the countries with a high risk population when it comes to 
renal disease because of numerous cases of diabetes, high blood pressure, and other hereditary 
diseases, all of which can lead to kidney malfunction.  According to the National Kidney 
Transplant Institute (NKTI), kidney diseases are already the 7th leading cause of death among 
Filipinos with one Filipino developing chronic renal failure every hour or about 120 Filipinos 
per million population per year.  In 2013, Dr. Antonio Paraiso of the Department of Health 
(DOH)’s Philippine Network for Organ Sharing (PhilNOS) reported that close to 23,000 
patients in 2004 undergoing dialysis treatment compared to the 4,000 patients in 2004.  He also 
noted that glomerulonephritis used to be the primary cause of kidney failure until it was 
overtaken by diabetes and hypertension. 
The cost of medical treatment for kidney disease is really very expensive, beyond the 
reach of ordinary patients.  It was reported that in 2007, only 73% of Filipino patients with 
kidney failure were able to afford necessary treatment.  A 2013 research by Dr. Romina 
Danguilan placed the average monthly income of chronic kidney disease (CKD) patients at 
P4,838.16 compared to the cost of treatment of P2,250 to be paid to the health care institution 
and P350.00 for the professional fee which has risen to P700.00 in January 2016.  A study by 
the Philippine Society of Nephrology (PSN) showed that 60 percent of CKD patients are the 
so-called service patients who badly needed state subsidy to get the life-saving treatment.  Most 
of them usually reach out to politicians, foundations, state agencies, the Philippine Charity 
Sweepstakes Office (PCSO), among others. 
Article XIII, Section 11 of the 1987 Philippine 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.  The State 
shall endeavor to provide free medical care to paupers. 
July 14, 2022
1:24 pm
1991


Despite the efforts of the government – through the DOH, together with its specialty 
and regional hospitals and accredited dialysis clinics, PCSO and PhilHealth – in addressing the 
problem, still the occurrence of renal diseases in the country is on the rise.  More and more 
CKD patients facing economic difficulties who cannot afford the cost of the necessary 
hospital/clinic tend to forego the treatment. 
Hence, providing a dialysis machine to national, regional, and provincial government 
hospitals will help CKD patients, especially from rural areas, to get the necessary treatment 
near their places of abode.  A dialysis machine cost around P400,000.00 and this will not 
burden the government if the provision of the machine to DOH hospitals is done on a staggered 
basis.  What is important is CKD patients from the rural areas can avail of the treatment near 
their homes. 
In consonance with the constitutional mandate to make health services available to all 
the people at affordable cost, this bill requires all national, regional, and provincial government 
hospitals to establish, operate, and maintain a dialysis service facility in their respective 
hospital in order that dialysis treatment will be available and accessible to the people especially 
those in the rural areas in a cost-effective manner.  This bill further requires that dialysis 
treatment should be provided to indigent patients, free of charge.  Moreover, this measure also 
requires that the dialysis service facility to disseminate the necessary information to prevent 
the occurrence of kidney malfunction, and CKD. 
This bill entitled House Bill No. 532 or “An Act Requiring All National, Regional, and 
Provincial Government Hospitals to Establish, Operate, and Maintain a Dialysis Service 
Facility in their Respective Hospital and Providing Free Dialysis Treatment to Indigent 
Patients” was filed in the 18th Congress, wherein it was lengthily deliberated in the Committee 
and was included in the consolidation to other similar proposed measures, and House Bill No. 
6803 or “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 of the PhilHealth Package Rate for 
Members and Appropriating Funds Therefor.” with Hon. Angelina Tan, MD, Hon Jose 
Christopher Belmonte, Hon. Estrellita Suansing, and other members of the House, including 
this Representation as proponents, was passed on Third Reading and transmitted to the Senate 
for appropriate action/s.  
For more efficient delivery of health care services to the Filipino people, the immediate 
approval of this proposed measure is earnestly sought. 
  JOSEPH STEPHEN S. PADUANO 


Republic of the Philippines 
HOUSE OF REPRESENTATIVES 
Quezon City 
NINETEENTH (19th) CONGRESS 
First Regular Session 
HOUSE BILL NO._______ 
_____________________________________________________________________ 
Introduced by REP. JOSEPH STEPHEN S. PADUANO 
_____________________________________________________________________ 
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 House of Representatives of the Philippines in Congress 
assembled: 
SECTION 1.  Short Title. – This Act shall be known as the “Comprehensive Renal 
1 
Replacement Therapy Act”. 
2 
3 
SEC. 2.  Declaration of Policy. – It is the declared policy of the State to make available 
4 
essential goods, health and other social services to all citizens at affordable cost and to deliver 
5 
medical care to indigents free of charge.  Pursuant to this, the State shall continually improve 
6 
the delivery of health services and hospital facilities to make those accessible to all. 
7 
8 
In line with this policy, the State shall adopt an integrated and comprehensive approach 
9 
to health service delivery that shall include comprehensive renal replacement therapy for 
10 
patients who are diagnosed with End Stage Renal Disease (ESRD). 
11 
12 
13 
1991


SEC. 3.  Definition of Terms.  – As used in this Act: 
1 
 
2 
a) Dialysis Facility shall refer to a facility that provides treatment for ESRD to indigent 
3 
patients and disseminates information on the various forms of renal replacement 
4 
therapy such as kidney transplantation, peritoneal dialysis and hemodialysis; 
5 
b) End Stage Renal Disease or ESRD refers to the final stage of chronic kidney 
6 
disease in which the kidneys no longer function well enough to support the needs of 
7 
a patient’s daily life; 
8 
c) Hemodialysis or HD refers to a medical procedure to remove fluid and waste 
9 
products from the blood and to correct electrolyte imbalances using a synthetic 
10 
membrane or dialyzer which is also referred to as an “artificial kidney”; 
11 
d) Indigent refers to a patient who has no source of income or whose income is not 
12 
sufficient for family subsistence as identified and assessed by the social worker of 
13 
the Department of Social Welfare and Development (DSWD) or the social worker 
14 
of the concerned local government unit; 
15 
e) Kidney Transplant or KT refers to a surgical procedure to place a healthy kidney 
16 
from a living or deceased donor into a person whose kidneys no longer function 
17 
sufficiently to sustain the person’s life; 
18 
f) National, regional, and provincial hospitals refer to hospitals and stand-alone 
19 
dialysis facilities operated and maintained either partially or wholly by the national, 
20 
regional and provincial government or other political subdivisions, or any 
21 
department, division, board or agency thereof; 
22 
g) No balance billing refers to the government policy of not charging the medical 
23 
expenses incurred over and beyond the PhilHealth package rates to a PhilHealth 
24 
member who has undergone medical treatment; 
25 
h) Peritoneal dialysis or PD  refers to a treatment for kidney failure and a type of 
26 
dialysis that uses the person’s peritoneum or the lining of the abdominal cavity, as 
27 
the membrane through which fluid and toxic substances are exchanged with blood; 
28 
i) PD First Policy  refers to the policy where peritoneal dialysis, when feasible, is 
29 
offered as the first dialysis modality to RRT patients; 
30 
j) Renal replacement therapy or RRT refers to a therapy that partially replaces the 
31 
functions of the normal kidney.  This may be in the form of kidney transplantation, 
32 
peritoneal dialysis, and hemodialysis. 
33 
 
34 
 
35 


SEC. 4. Establishment of Dialysis Services Wards or Units in National, Regional, 
1 
Provincial Government Hospitals. – Within five (5) years from the effectivity of this Act, all 
2 
national, provincial, and regional government hospitals, including all stand-alone dialysis 
3 
facilities shall establish, operate, and maintain a dialysis service facility in their hospital.  These 
4 
dialysis facilities shall have all the necessary dialysis machines, equipment and supplies.  The 
5 
same hospitals and dialysis facilities are mandated to train nephrologists, dialysis nurses, 
6 
dialysis technicians, and operating room nurses in both peritoneal dialysis and hemodialysis. 
7 
 
8 
All national, regional, and provincial government hospitals, including all stand-alone 
9 
dialysis facilities shall have a dialysis service area that is compliant with the licensing and 
10 
accreditation requirements imposed by the Department of Health (DOH) and Philippine Health 
11 
Insurance Corporation (PhilHealth).  The dialysis service area shall have the necessary 
12 
personnel, dialysis equipment and supplies for both hemodialysis and peritoneal dialysis, as 
13 
required by the DOH and the PhilHealth of private dialysis clinics. 
14 
 
15 
The dialysis facilities shall further have a non-treatment place, which shall serve as a 
16 
waiting area for chronic kidney disease (CKD) patients and a business area dedicated to the 
17 
provision, display, and dissemination of information on the prevention of CKD. 
18 
 
19 
All patients diagnosed with ESRD shall be referred to a DOH-accredited transplant 
20 
facility to receive orientation and counseling on the advantages of undergoing transplantation 
21 
as the best treatment for kidney failure.  They shall likewise undergo medical evaluation for 
22 
suitability of transplantation.  All potential organ donors of the patient shall be evaluated to 
23 
determine compatibility.  If no living donors are available, the patient shall be enrolled in the 
24 
deceased organ donor waiting list to ensure that the patients with ESRD have the option to avail 
25 
of kidney transplantation. 
26 
 
27 
SEC. 5.  Chronic Kidney Disease (CKD) Prevention and Health Promotion. – All 
28 
national, regional, provincial government hospitals and stand-alone dialysis facilities shall 
29 
establish CKD prevention strategies and health promotion activities which shall include 
30 
advocacy activities targeting relatives of dialysis patients who are at high risk in developing 
31 
CKD themselves, the provision of instructional materials on the common symptoms of kidney 
32 
disease and regular conduct of educational activities such as health diet and lifestyle, availment  
33 
of regular test to diagnose kidney disease, information on the most common causes of kidney  
34 
 
35 


failure, and advisories on the appropriate protocols for the diagnostic evaluation of possible 
1 
kidney disease. 
2 
 
3 
Patients and their relatives shall be informed on the availability of the proper medicines 
4 
from government health centers such as those for diabetes and hypertension, and the importance 
5 
of the regular intake of medicines and monitoring of kidney function through regular laboratory 
6 
testing and check-up by a qualified physician.  All activities pertaining to the aforementioned 
7 
programs shall be documented accordingly. 
8 
 
9 
SEC. 6.  Quality Standards of Dialysis Services and Transplant Facilities. – Hospitals 
10 
and dialysis centers for both hemodialysis and peritoneal dialysis, and transplant facilities shall 
11 
comply with the safety and quality standards of dialysis or transplant services, which shall be 
12 
strictly monitored by the PhilHealth and the Health Facilities and Services Regulatory Bureau 
13 
of the DOH. 
14 
 
15 
SEC. 7.  Philippine Renal Disease Registry. – Private and public hospitals, dialysis 
16 
centers for both hemodialysis and peritoneal dialysis, and transplant facilities shall be mandated 
17 
to report to the Philippine Renal Disease Registry of the DOH, the incidence and prevalence of 
18 
patients receiving peritoneal dialysis or hemodialysis treatment, and who have received a 
19 
kidney transplant as a requirement for the renewal of their respective DOH licenses to operate 
20 
a dialysis center or transplant facility.  Registration of all dialysis patients in the PhilHealth 
21 
dialysis database shall be required prior to the availment of both peritoneal dialysis and 
22 
hemodialysis. 
23 
 
24 
SEC. 8.  PhilHealth Benefit for Kidney Transplantation. – The PhilHealth Z-benefit 
25 
for kidney transplantation from living donors shall be expanded accordingly.  This shall include 
26 
the cost of laboratory work-up for both recipient and donor candidate, hospitalization for the 
27 
transplant operation, including induction immunosuppression and maintenance oral 
28 
immunosuppression, machine perfusion of procured organs, the cost for organ retrieval, all 
29 
medications required during hospitalization, and post discharge laboratory examinations up to 
30 
one (1) month for the recipient, and up to one (1) year for the donor. 
31 
 
32 
The cost of organ retrieval and machine perfusion shall be established by the DOH-
33 
Philippine Organ Donation and Transplantation Program to be observed by all organ 
34 
procurement organizations or organ and tissue retrieval units. 
35 


The PhilHealth benefit package for kidney transplantation shall cover the evaluation and 
1 
screening of the kidney donor and recipient up to the transplant and post-transplantation 
2 
procedures and remedies and shall include cases involving ESRD patients. 
3 
 
4 
In order to support kidney transplantation as the best treatment option that provides the 
5 
highest quality of life for ESRD patients and ensures the return of the patient to full 
6 
rehabilitation, the PhilHealth shall provide lifetime support for all maintenance 
7 
immunosuppression of the transplant patient, as long as the transplanted organ is functioning 
8 
and the patient remains dialysis-independent. 
9 
 
10 
All renal replacement therapy facilities shall be required to engage in regular organ 
11 
donation advocacy activities.  All donor- Filipino citizens shall carry the organ card to be 
12 
prescribed by the DOH.  Health RRT facilities will likewise establish an organ and tissue donor 
13 
referral system that will identify all potential organ and tissue donors to the Philippine Network 
14 
for Organ Sharing (PhilNOS). 
15 
 
16 
Sec. 9 PhilHealth Benefit for Dialysis Treatment. – The PhilHealth shall increase the 
17 
Z-benefit package rate for the principal member and the members’ qualified dependents for 
18 
maintenance peritoneal dialysis covering three (3) peritoneal dialysis exchanges per day for 
19 
three hundred sixty five (365) days, while the package rate for hemodialysis treatment shall be 
20 
increased annually to cover a minimum of three (3) hemodialysis sessions frequency a week, 
21 
four (4) hours per session, or as may be necessary.  The professional fee of the attending 
22 
physician and hospital charges shall be incorporated in the PhilHealth benefit package for 
23 
dialysis treatment. 
24 
 
25 
For purposes of providing optimal financial risk protection to the most vulnerable 
26 
groups including the poorest of the poor, the “no balance billing policy” of the government shall 
27 
be strictly observed in the case of indigent patients. 
28 
 
29 
The breakdown of the PHIC hemodialysis benefit package shall include standard HD 
30 
treatment, dialyzer and epoetin injection, and all other supplies needed as well as the minimum 
31 
basic laboratory test consisting of complete blood count, creatinine, calcium, phosphorus, 
32 
potassium, albumin, hepatitis B surface antigen (HBsAg) and anti-hepatitis C virus (Anti-
33 
HCV).  The laboratory test shall be done at a frequency of at least four (4) tests per year for the 
34 
first six (6) tests, and twice a year for the last two (2) tests.  The schedule of these tests shall be 
35 


determined by the attending physician during the course of the annual dialysis treatment 
1 
sessions. 
2 
 
3 
SEC. 10.  Periodic Assessment and Benefit Package Adjustment for End Stage Renal 
4 
Disease Patients. – A periodic assessment and reasonable adjustments of the benefit package 
5 
for dialysis and transplant patients shall be made by the PhilHealth after taking into 
6 
consideration its financial sustainability and changes in the socio-economic conditions of the 
7 
country. 
8 
 
9 
SEC. 11.  Free Dialysis Treatment to Indigent Patients. – Dialysis treatment in all 
10 
national, regional, and provincial hospitals shall be provided free of charge to indigent patients.  
11 
A PD First Policy shall be observed for all indigent patients, unless there is a contraindication 
12 
for its use in a particular patient. 
13 
 
14 
SEC. 12.  Treatment Options. – The PhilHealth shall develop a care rate package that 
15 
shall provide the highest benefit for a kidney transplant procedure, peritoneal dialysis and 
16 
hemodialysis procedures. 
17 
 
18 
The benefit package shall include a screening test for both the kidney transplantation 
19 
donor and recipient.  The screening test for possible kidney transplantation of both the donor 
20 
and recipient shall include: 
21 
 
22 
1) For donor, screening test shall include blood typing, complete blood count, fasting 
23 
blood sugar, creatinine, hepatitis B surface antigen, anti-hepatitis C antibody, 
24 
urinalysis, chest x-ray and ultrasound of the kidneys, ureter, and urinary bladder. 
25 
2) For the recipient, cardiac evaluation and other tests as may be needed. 
26 
 
27 
During the availment of the full benefits of dialysis within the first two (2) years of 
28 
dialysis initiation, the cost of dialysis treatment shall be paid for by the PhilHealth as described 
29 
in Section 8.  These options are provided to encourage more patients to undergo kidney 
30 
transplantation and attain full rehabilitation. 
31 
 
32 
If the patient passes the criteria for the PhilHealth Z-benefit package for transplantation, 
33 
the expenses for selected laboratory test may be reimbursed to the patient by the healthcare  
34 
 
35 


institution after the PhilHealth pays the benefit to the healthcare institution for such laboratory 
1 
expenses. 
2 
 
3 
SEC. 13.  Rehabilitation Program. – The DOH, in coordination with the Department 
4 
of Labor and Employment, the Technical Education and Skills Development Authority, the 
5 
DSWD, and other pertinent agencies, shall establish a comprehensive rehabilitation program 
6 
for both kidney donors and dialysis patients who have undergone kidney transplant procedure 
7 
in order to help them reach their fullest physical, psychological, social, vocational, and 
8 
education potential consistent with their physiologic or anatomic condition, environmental 
9 
limitations, life plans and desires. 
10 
 
11 
SEC. 14.  Dialysis Facility. – A dialysis facility shall comply with the licensing 
12 
requirements imposed by the DOH for hemodialysis services before it operates as such.  
13 
Hospitals desiring to provide peritoneal dialysis treatment services shall provide the necessary 
14 
equipment and qualified treatment services as prescribed by the PhilHealth.  Hospitals with 
15 
existing hemodialysis facilities only shall immediately establish a peritoneal dialysis unit to 
16 
provide a cost-effective dialysis option to patients. 
17 
 
18 
SEC. 15.  Training for Peritoneal and Hemodialysis, and Transplant Treatment and 
19 
Services. – The DOH, National Kidney and Transplant Institute (NKTI), Philippine Society for 
20 
Transplant Surgeons (PSTS), and the Philippine Society of Nephrology (PSN) shall provide 
21 
training for medical personnel such as physicians, surgeons, nurses, technicians and 
22 
coordinators who shall work in hemodialysis and peritoneal dialysis facilities, operating rooms, 
23 
transplant wards, and for non-medical barangay health workers who shall assist home-based 
24 
peritoneal dialysis treatment.  The NKTI shall accredit the facilities that may provide training 
25 
for these personnel, which training shall include hands-on workshops for dialysis. 
26 
 
27 
SEC. 16.  Establishing a Chronic Kidney Disease (CKD) Counseling Clinic. – All 
28 
RRT facilities shall establish a CKD counseling clinic and shall separately provide personnel 
29 
trained to engage patients and explain to them the normal functions of the kidney, the stages of 
30 
CKD, the laboratory examinations routinely performed for CKD patients, the common 
31 
medications required that can control the progression of kidney disease, the metabolic 
32 
complications of ESRD, and the indications for renal replacement.  The clinics shall monitor 
33 
the kidney function of patients so that a timely referral to a nephrologist or internist/pediatrician 
34 
with specialized training in CKD can be made. 
35 


The NKTI shall provide education and training modules for the medical staff of CKD 
1 
counseling clinics. 
2 
 
3 
SEC. 17.  Availment of Persons with Disability (PWD) Benefits by CKD Patients. – 
4 
CKD Patients shall be classified as PWD.  They shall be entitled to PWD benefits in accordance 
5 
with Republic Act No. 7277, otherwise known as the Magna Carta for Disabled Persons.  The 
6 
PhilHealth and DOH Health Technology Assessment Council shall conduct an in-depth study 
7 
on both the direct and indirect cost of being afflicted with kidney disease and undergoing 
8 
treatment for it. 
9 
 
10 
SEC. 18.  Creation of a Renal Disease Control Program. – All RRT facilities shall 
11 
create a Renal Disease Control Program that shall promote the early recognition of kidney 
12 
disease, identify persons at high risk of developing kidney disease and initiate preventive 
13 
strategies to either prevent the development of kidney disease from diabetes to hypertension, or 
14 
to delay its progression to end stage renal disease.  The DOH will establish a database of these 
15 
patients to ensure that they are regularly monitored for disease progression and that they are 
16 
receiving appropriate treatment for CKD. 
17 
 
18 
SEC. 19.  Penalty. – Any head or chief of hospital, administrator or officer-in-charge 
19 
of a hospital, dialysis center, and health facility who fails to comply with Sections 5 and 6 of 
20 
this Act shall be meted with a fine of Fifty thousand pesos (Php 50,000.00) up to a maximum 
21 
of One hundred thousand pesos (Php 100,000.00). 
22 
 
23 
Likewise, persons receiving free treatment of medicines for ESRD, PD, or HD services 
24 
from government hospitals, such as the PHIC, who are found selling these medicines or services 
25 
instead of using them for their own treatment, shall be penalized with the suspension of their 
26 
PhilHealth membership and other government assistance for a period of six (6) months, upon 
27 
due process and hearing.  If these persons are found to have committed the same violation for 
28 
the second time, they shall be permanently ineligible to receive government assistance. 
29 
 
30 
SEC. 20.  Appropriations. – The initial amount necessary to implement the provisions 
31 
of this Act for national and regional hospitals shall be charged against the current year’s 
32 
Appropriation of the DOH.  Thereafter, such sum as may be necessary for its continued 
33 
implementation shall be included in the General Appropriations Act. 
34 
 
35 


For provincial hospitals, the local government concerned shall provide the necessary 
1 
funds for the establishment and operationalization of its dialysis service units. 
2 
 
3 
SEC. 21.  Implementing Rules and Regulations. – Within ninety (90) days from the 
4 
effectivity of this Act, the DOH shall, in coordination with the PhilHealth, the NKTI, and other 
5 
relevant stakeholders, issue the implementing rules and regulations to implement the provisions 
6 
of this Act.  
7 
 
8 
SEC. 22.  Separability Clause. – If any provision or part hereof is held invalid or 
9 
unconstitutional, the remainder of the law or the provision not otherwise affected shall remain 
10 
valid and subsisting. 
11 
 
12 
SEC. 23. Repealing Clause. – All laws, presidential decree or issuance, executive 
13 
orders, letter of instruction, administrative order, rule or regulation contrary to or inconsistent 
14 
with the provisions of this Act are hereby repealed, modified or amended accordingly. 
15 
 
16 
           SEC. 24. Effectivity. – This Act shall take effect fifteen (15) days after its publication in 
17 
the Official Gazette or in at least two (2) newspapers of national circulation. 
18 
 
19 
Approved,  
20