Republic of the Phi
HOUSE OF REPRESENTATIVES
Quezon City, Metro Manila

NINETEENTH CONGRESS
I Regular Session

House Bill No. 505

Introduced by Representatives EDVIC G. YAP, ERIC G. YAP, PAOLO Z.
DUTERTE, JOCELYN P. TULFO, RALPH TULFO, and JEFFREY SORIANO.

EXPLANATORY NOTE

Section 11, Article XIII of the 1987 Constitution provides that the State shall adopt an
integrated and comprehensive approach to health development which shall endeavor
to make essential goods, health and other social services available to all the people at

affordable cost.

According to the National Kidney and Transplant Institute (NKTI), Chronic Kidney
Disease Stage 5 (CKD 5) has been identified as the seventh leading cause of death in
the country, with 120 per million Filipinos acquiring the said disease in a year. Latest
estimates show that around 2.3 million Filipinos have chronic kidney disease.
Furthermore, in 2016, 36,000 were in a dialysis treatment, showcasing a 15% increase

in the number of patients within just a year.

Despite this alarming rate of chronic kidney disease cases, the cost of medical
treatment for kidney disease remains exorbitant—beyond the reach of ordinary
patients. CKD 5 can be treated with kidney transplantation or renal dialysis, however,
while kidney transplant is a definitive treatment, the low levels of organ donations,
lack of infrastructure, and high cost of transplantation makes dialysis as the most

viable option for renal patients in the Philippines.

Notwithstanding the recent upgrade of the PhilHealth coverage for hemodialysis

outpatient, granting a maximum of 144 sessions per calendar year still do not


surmount to the actual number of dialysis needed by the patients, given how dreadful

the chronic kidney disease is.

This bill seeks to address all these issues through the provision of a comprehensive
renal replacement therapy services available to all Filipinos who suffer End Stage
Kidney Disease by including it in the coverage of treatment services provided by the
PhilHealth, In addition, this proposed measure also supports kidney transplantation
which is the best treatment option that will provide quality of life for End Stage
Kidney Disease patients.

In view of the foregbing, approval of this bill is earnestly sought.

t

EDVIC|G. YAP PAOLO 4. DUTERTE

YAP JOCELYN P. TULFO

yuma SORIANO RALPH TULFO


Republic of the Philippines
HOUSE OF REPRESENTATIVES.
Quezon City, Metro Manila

NINETEENTH CONGRESS
1 Regular Session

505

House Bill No.

Introduced by Representatives EDVIC G. YAP, ERIC G. YAP, PAOLO Z.
DUTERTE, JOCELYN P. TULFO, RALPH TULFO, and JEFFREY SORIANO.

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
assemblei

SECTION 1. Short Title. - This Act shall be known as the “Comprehensive
Renal Replacement Therapy Act.”

SEC. 2. Declaration of Policy. ~ It is the declared policy of the State to make
available essential goods, health and other social services to all citizens at affordable
cost and to deliver medical care to indigents free of charge. Pursuant to this, the State
shall continually improve the delivery of health services and hospital facilities to make
those accessible to all.

In line with this policy, the State shall adopt an integrated and comprehensive
approach to health service delivery that shall include comprehensive renal
replacement therapy for patients who are diagnosed with End Stage Renal Disease
(ESRD).

SEC. 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
ney disease in which the kidneys no longer function well enough to
support the needs of a patient's 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 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 and assesed by the social
worker of the Department of Social Welfare and Development (DSWD) or
the social worker of the concerned local government unit;

e. Kidney Transplant or KT refers to a surgical procedure to place a healthy
kidney from a living or deceased donor into a person whose kidneys no
longer function sufficiently to sustain the person's life;

f. National, Regional, and Provincial Hospitals 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 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 or the 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;

j. Renal replacement therapy or RRT refers to a 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 of Dialysis Services Wards or Units in National,
Regional, Provincial Goverment Hospitals. - Within five (5) years from the
effectivity of this Act, all national, regional, and provincial government hospitals,
including all stand-alone dialysis facilities shall establish, operate and maintain a
dialysis service facility in their hospitals. These dialysis facilities shall have all the
necessary dialysis machines, equipment and supplies. The same hospitals and dialysis
facilities are mandated to train nephrologists, dialysis nurses, dialysis technicians, and
operating room nurses in both peritoneal dialysis and hemodialysis.

Alll national, regional, and provincial government hospitals, including all
stand-alone dialysis facilities shall have a dialysis service area that is compliant with
the licensing and accreditation requirements imposed by the Department of Health
(DOH) and’ Philippine Health Insurance Corporation (PhilHealth). The dialysis


service area shall have the necessary personnel, dialysis equipment and supplies for
both hemodialysis and peritoneal dialysis, as required by the DOH and the PhilHealth
of private dialysis clinics.

‘The dialysis facilities shall further have a non-treatment place, which shall
serve as a waiting area for chronic kidney disease (CKD) patients and a business area
dedicated to the provision, display, and dissemination of information on the
prevention of CKD.

All patients diagnosed with ESRD shall be referred to a DOH-accredited
transplant facility to receive orientation and counseling on the advantages of
undergoing transplantation as the best treatment for kidney failure. They shall
likewise undergo medical evaluation for suitability of transplantation. All potential
organ donors of the patient shall be evaluated to determine compatibility. If no living
donors are available, the patient shall be enrolled in the deceased organ donor waiting
list to ensure that all patients with ESRD have the option to avail 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 shall establish CKD prevention strategies and health promotion activities
which shall include advocacy activities targeting relatives of dialysis patients who are
at high risk in developing CKD themselves, the provision of instructional materials
on the common symptoms of kidney disease and regular conduct of educational
activities such as healthy diet and lifestyle, availment of regular tests to diagnose
kidney disease, information on 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 shall be informed on 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 check-up by a qualified
physician. All activities pertaining to the aforementioned programs shall be
documented accordingly.

SEC. 6. Quality Standards of Dialysis Services and Transplant Facilities. -
Hospitals and 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 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 shall be
required prior to the availment of both peritoneal dialysis and hemodialysis.

SEC. 8. PhilHealth Benefit for Kiduey Transplantation - The PhilHealth Z-
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
hospitalization, and post discharge laboratory examinations up to one (1) month for
the recipient, and up to one (1) year for the donor.

The cost of organ retrieval and machine perfusion shall be established by the
DOH-Philippine Organ Donation and Transplant Program for all organ procurement
organizations or organ and tissue retrieval units.

The PhilHealth benefit package for kidney transplantation shall cover the
evaluation and screening of the kidney donor and recipient up to the transplant and
post-transplantation procedures and remedies and shall include cases involving
ESRD patients.

In order to support kidney transplantation as the best treatment option that
provides the highest quality of life for ESRD patients and ensures the return of the
patient to full rehabilitation, the PhilHealth shall provide lifetime support for all
maintenance immunosuppression 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. All donor- Filipino citizens shall carry the organ donor
card to be prescribed by the DOH. Health RRT facilities will likewise establish an
organ and tissue donor referral system that will identify all potential organ and tissue
donors to the Philippine Network for Organ Sharing (PhilNOS).

SEC. 9. PhilHealth Benefit for Dialysis Treatment.-The PhilHealth shall
increase the Z-benefit package rate for the principal member and the members’
qualified dependents for maintenance 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 minimum of
three (3) hemodialysis sessions frequency a week, four (4) hours per session, or as may
be necessary. The professional fee of the attending physician and hospital charges
shall be included in the PhilHealth benefits for dialysis treatment.

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 is hereby provided for indigents.

The breakdown of the PHIC hemodialysis benefit package shall include
standard HD treatment, dialyzer and epoetin injection, 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.

SEC. 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.

SEC. 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. A PD First Policy shall be observed for all indigent
patients, unless there is a contraindication for its use in a particular patient.

SEC. 12. Treatment Options. - The PhilHealth shall develop a case rate package
that shall provide the highest benefit for a kidney transplant procedure, peritoneal
dialysis, and hemodialysis procedures.

The benefit package shall include a screening test for both the kidney
transplantation donor and recipient. The screening test for possible kidney
transplantation of both the donor and recipient shall include:

1) For the donor, 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, cardiac evaluation and other tests as may be 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
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 Z-benefit package for
transplantation, the expenses for selected laboratory tests may be reimbursed to the
patient by the healthcare institution after the PhilHealth pays the benefit to the
healthcare institution.

SEC. 13. Rehabilitation Program. - The DOH, in coordination with the
Department of Labor and Employment, the Technical Education and Skills
Development Authority, the DSWD, and other pertinent agencies, shall establish a
comprehensive rehabilitation program for both kidney donors and dialysis patients
who have undergone kidney transplant procedure in order to help them reach their


fullest physical, psychological, social, vocational, 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 by DOH for hemodialysis. Hospitals without dialysis
facilities shall provide the necessary equipment and qualified staff to perform
peritoneal dialysis services. Hospitals with existing hemodialysis facilities only, shall
immediately establish a peritoneal dialysis unit to provide cost-effective dialysis
option to patients. Hospitals shall equip itself with the necessary personnel,
equipment and supplies as required by PhilHealth.

SEC. 15. Training for Peritoneal and Hemodialysis, and Transplant Treatment
and Services. - The DOH, National Kidney and Transplant Institute (NKTD,
Philippine Society for Transplant Surgeons (PSTS), and the Philippine Society of
Nephrology (PSN) shall provide training for medical personnel such as physicians,
surgeons, nurses, technicians and coordinators who shall take charge of the
hemodialysis and peritoneal dialysis centers, operating rooms, transplant wards, and
for non-medical barangay health workers who shall assist home based peritoneal
dialysis. The NKTI shall accredit the centers that can provide training for these
personnel and the training shall include hands-on workshops for dialysis.

SEC. 16. Establishing a Chronic Kidney Disease (CKD) Counseling Clinic. - All
RRT facilities shall establish a CKD counseling clinic and shall separately provide
personnel trained to engage patients and explain to them the normal functions of the
kidney, the stages of CKD, the laboratory examinations 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.

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

SEC. 17. Availment of Persons with Disability (PWD) Benefits by CKD
Patients. - CKD patients shall be classified as PWD, who shall be entitled to PWD
benefits, in accordance with Republic Act No. 7277, otherwise known as the Magna
Carta for Disabled Persons. The PhilHealth and DOH Health Technology Assessment
Council shall conduct an in-depth study on both the direct and indirect cost of being
affected with kidney disease and to undergo treatment for it.

SEC. 18. Creation of a Renal Disease Control Program (REDCOP). - All RRT
facilities shall create a Renal Disease Control Program (REDCOP) that shall promote
the early recognition of kidney disease, identify persons at high risk of developing
kidney disease and initiate preventive strategies to either prevent the development of
kidney disease 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.

SEC, 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 (P50,000.00) but not
more than One hundred thousand pesos (P100,000.00).

Likewise, persons receiving free treatment of medicines for ESRD, PD or HD
services from government hospitals, such as the 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 other government
agencies for a period of six (6) months, upon due process and hearing. 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 appropriations 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 ninety (90) days from
the effectivity of this Act, the DOH shall, in coordination with the PhilHealth, the
NKTI, and other relevant stakeholders, issue the implementing rules and regulations
to implement the provisions of this Act.

SEC. 22. Separability Clause. - If 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. Repealing Clause. - Any law, presidential decree or issuance,
executive order, letter of instruction, administrative order, rule or regulation contrary
to or inconsistent with the provisions of this Act are hereby repealed, modified 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 circulation.

Approved,