Republic of the Philippines 
HOUSE OF REPRESENTATIVES 
Quezon City, Metro Manila 
19th Congress 
First Regular Session 
House Bill No. 
Introduced by REPRESENTATIVE EMIGDIO P. TANJUATCO III 
EXPLANATORY NOTE 
During the last two Congresses, the 17th and the 18th Congress, knowing full well the 
difficulties that many Filipinos with Chronic Kidney Disease (CKD) go through, the 
House of Representatives has passed on third reading and transmitted to its Senate 
counterpart a proposed bill providing for a Comprehensive Renal Replacement 
Therapy for Filipinos. It is fervently hoped that with this bill, the 19th Congress will see 
the passage of the “Comprehensive Renal Replacement Therapy Act.” 
According to World Health Organization data published in 2020, kidney disease deaths 
in the Philippines total 39,380, accounting for 5.84% of total deaths. Administrative 
Order No. 2021-0010 of the Department of Health acknowledges that CKD is the 4th 
leading cause of death in the country. 
Given these alarming statistics, this bill is another attempt to pursue the state’s 
mandate of: 
1. Adopting 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 by establishing facilities that would
provide quality renal health services;
2. Prioritizing the needs of the underprivileged and the sick by developing
PhilHealth packages that are tailored to cover the expenses related to renal
replacement therapy; and
3. Providing free medical care to paupers by establishing health facilities in the
national, regional and provincial levels that offer free dialysis treatments for
indigent Filipinos.
In view of the foregoing, approval of this bill is earnestly sought. 
EMIGDIO P. TANJUATCO III 
July 1, 2022
8:01 am
709


Republic of the Philippines 
HOUSE OF REPRESENTATIVES 
Quezon City, Metro Manila 
19th Congress 
First Regular Session 
House Bill No. _ 
Introduced by REPRESENTATIVE EMIGDIO P. TANJUATCO III 
AN ACT PROVIDING A COMPREHENSIVE RENAL REPLACEMENT THERAPY 
(RRT) FOR PATIENTS WITH END STAGE RENAL DISEASE IN NATIONAL, 
REGIONAL, AND PROVINCIAL GOVERNMENT HOSPITALS, INCREASING THE 
PHILHEALTH PACKAGE RATE FOR RENAL REPLACEMENT THERAPY OF 
MEMBERS AND APPROPRIATING FUNDS THEREFOR. 
Be it enacted by the Senate and the House of Representatives of the 
Philippines in Congress assembled: 
SECTION 1. Short Title. -  This Act shall be known as the “Comprehensive 
Renal Replacement Therapy Act.”  
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 (ESRD), and to 
encourage them to have a kidney transplant, primarily within the first two (2) years of 
starting 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 priority for the 
needs of the underprivileged sick, elderly, disabled, women and children. The state 
shall endeavor to provide free medical care to paupers. 
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 of Terms. – As used in this Act: 
a. Dialysis facility refers to a health facility that provides treatment for ESRD
to indigent patients and disseminates information on the various forms of
RRT such as kidney transplantation, peritoneal dialysis and hemodialysis;
b. End Stage Renal Disease or ESRD refers to the final stage of chronic
kidney disease in which the kidneys no longer function well enough to meet
the needs of daily life;
709


c. Hemodialysis or HD refers to a medical procedure to remove fluid and 
waste products from the blood and to correct electrolyte imbalances. This is 
accomplished using a synthetic membrane or dialyzer which is also referred 
to as an “artificial kidney”; 
d. Indigent refers to a patient who has no source of income or whose income 
is   not sufficient for family subsistence as identified by the Department of 
Social Welfare and Development (DSWD) through the National Household 
Targeting System (NHTS) for Poverty Reduction, or those patients who are 
indigents but are not listed in the NHTS as assessed by the municipal social 
development officer;   
e. Kidney transplant or KT refers to a surgical procedure to place a 
kidney from a live or deceased donor into a person whose kidneys no longer 
function sufficiently to sustain the person’s life; 
f. National, Regional and Provincial hospitals refer to hospitals and stand 
alone dialysis facilities operated and maintained either partially or wholly by 
the national, regional and provincial government or other political 
subdivisions, or any department, division, board or other agency thereof; 
g. No Balance Billing refers to the government policy of not charging the 
medical expenses incurred over and beyond the PhilHealth package rates 
to a PhilHealth member who has undergone medical treatment; 
h. Peritoneal dialysis or PD refers to a treatment for kidney failure and a type 
of dialysis that uses the person’s peritoneum (lining of abdominal cavity) as 
the membrane through which fluid and toxic substances are exchanged 
with blood;  
i. PD First Policy refers to the policy where peritoneal dialysis, when feasible, 
is offered as the first dialysis modality to RRT patients; 
j. Renal replacement therapy or RRT refers to 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 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 equipped with 
complete dialysis equipment and supplies for both hemodialysis and peritoneal 
dialysis, as required by the DOH and the PhilHealth from private dialysis clinics.  
 
All patients diagnosed with ESRD must be referred to a DOH-accredited 
transplant facility to attend a pre-transplant orientation and to be counseled on the 
advantages of undergoing transplantation as the best treatment for kidney failure. 
They will undergo medical evaluation for 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, provincial, and regional government hospitals, and stand-alone dialysis 
facilities should establish CKD prevention strategies and health promotion activities 
which include:  advocacy activities targeting relatives of dialysis patients who are at 
high risk for developing CKD themselves, the provision of instructional materials and 
regular educational activities on the common symptoms of kidney disease 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 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 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 
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 covering 
three (3) peritoneal dialysis exchanges per day for three hundred sixty five (365) days, 
while the package rate for hemodialysis treatment shall be increased annually to cover 
a span of ninety (90) hemodialysis sessions per year. The professional fee of the 
attending physician and hospital charges shall be included in the PhilHealth benefits 
for dialysis treatment. The remaining sessions for both peritoneal dialysis and 
hemodialysis shall be paid for by the Philippine Charity Sweepstakes Office.  
 
For purposes of providing optimal financial risk protection to the most 
vulnerable groups including the poorest of the poor, the “No Balance Billing Policy” of 
the government is hereby provided for indigents.  
 
The breakdown of the PHIC hemodialysis benefit package shall include 
standard HD treatment inclusive of the dialyzer and all other supplies needed as well 
as the minimum basic laboratory tests consisting of complete blood count, creatinine, 
calcium, phosphorus, potassium, albumin, hepatitis B surface antigen (HBsAg) and 
anti-hepatitis C virus (Anti-HCV).  The laboratory tests shall be done at a frequency of 
at least four (4) tests per year for the first six (6) tests, and twice a year for the last two 
(2) tests. The schedule of these tests shall be determined by the attending physician 
during the course of the annual dialysis treatment sessions. 
 
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 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, 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 testing include blood typing, complete blood count, 
fasting blood sugar, creatinine, hepatitis B surface antigen, anti-hepatitis C 
antibody, urinalysis, chest x-ray and ultrasound of the kidneys, ureter, and 
urinary bladder. 
 
2) For the recipient, cardiac evaluation and many other tests as needed. 
During the availment of the full benefits of dialysis within the first two (2) years 
of dialysis initiation, the cost of dialysis treatment shall be paid for by the PhilHealth 
and the PCSO as described in Section 8. These options are provided to encourage 
more patients to have a kidney transplant and attain full rehabilitation. 
 
If the patient passes the criteria for the PhilHealth benefit package for 
transplantation, the expenses for lab work-up shall be reimbursed to the patient by the 
healthcare institution after the PhilHealth pays the benefit to the healthcare institution. 
 
The cost of the operation for transplantation shall be included in the PhilHealth 
Z-benefit package which includes a month of post-hospital discharge laboratory tests 
for the recipient and a 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 DOH Administrative Order No. 2012-0001 dated January 
26, 2012 for hemodialysis, and PhilHealth-Accreditation for peritoneal dialysis 
facilities. Hospitals without dialysis facilities first put up the necessary equipment and 
qualified staff to perform peritoneal dialysis services. For hospitals with existing 
hemodialysis facilities, a peritoneal dialysis unit shall be established immediately so 
that this more cost-effective dialysis option can be made available to patients. 
Hospitals shall preferentially be provided with the necessary personnel, equipment 
and supplies as required by PhilHealth for accredited facilities. 
 
SEC. 15. Training for Peritoneal and Hemodialysis Treatment and Services. - 
The DOH, National Kidney and Transplant Institute (NKTI) and the Philippine Society 
of Nephrology (PSN) shall provide training for medical personnel such as physicians 
to take charge of the hemodialysis and peritoneal dialysis centers, hemodialysis and 
peritoneal dialysis nurses, hemodialysis and peritoneal dialysis technicians, operating 
room nurses, transplant ward nurses, transplant coordinators, and non-medical 
barangay health workers to support home based peritoneal dialysis. The NKTI shall 


accredit the centers that can provide training for the above personnel and training 
should include hands-on workshops for dialysis. 
 
SEC. 16. Establishing a Chronic Kidney Disease (CKD) Counseling Clinic. - All 
RRT facilities shall establish a chronic kidney disease (CKD) counseling clinic with 
separate personnel trained to engage patients and explain to them the normal 
functions of the kidney, the stages of CKD, the laboratories routinely performed for 
CKD patients, the common medications required that can control the progression of 
kidney disease, the metabolic complications of ESRD, and the indications for renal 
replacement. These clinics shall monitor 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 of 
CKD counseling clinics. 
 
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 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. 
 
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  
and bequests  in  order  to  augment  the  funding  for  the  establishment  of  the 
dialysis  wards/units  created  in  accordance  with  this  Act.  All  donations,  
contributions  or endowments  which  may  be  made  by  persons  or  entities  to  the  
dialysis  wards/units  in national,  regional  and  provincial  hospitals  and  the  
importation  of medical  equipment and   machineries,   spare   parts  and   other  
medical   equipment  used   solely  and exclusively  by the  dialysis  wards or units  
shall  be  exempt from  income  or donor’s  taxes,  any other direct or indirect taxes, 
wharfage fees and other charges and  restrictions.  
 
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 End Stage Renal 
Disease or PD or HD services from government hospitals and its agencies (i.e. PCSO, 
PHIC) who are found selling these medications or services instead of using them for 
their own treatment, shall be penalized with the suspension of their PhilHealth 
membership and shall be ineligible for assistance from PCSO and other government 
agencies for a period of one (1) year. If these persons are found to be engaged in the 
selling of medications or services allotted for their care for the second time, they shall 
be permanently ineligible to receive government assistance.  
 
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 PhilHealth, the Executive Director of the NKTI, and other  relevant stakeholders,  
shall  issue  the  implementing  rules  and  regulations  to  carry out  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,