Republic of the Philippines
House of Representatives
Quezon City

ENTH CONGRE:
First Regular Session

House Bill No.1 382

INTRODUCED BY REPRESENTATIVE ALFRED VARGAS.

EXPLANATORY NOTE

Every hour, a Filipino dies of End Stage Renal Disease (ESRD). Diabetes and
Hypertension are the leading causes ESRD with patients aged 50 to 70 comprising 50% of the
dialysis population.

Three types of renal replacement therapy which are hemodialysis , peritoneal dialysis
and kidney transplantation. Both kidney transplantation and peritoneal dialysis provide a higher
quality of life and are most cost-etfective therapy options . Unfortunately, majority of Filipinos
are only aware of hemodialysis as a treatment option. In dialysis cases, this bill promotes
peritoneal dialysis as the first option to attain adequate dialysis, followed by dialysis,

The proposed bill seeks to establish a comprehensive renal replacement therapy

SRD. Kidney transplantation facilities will enable this life-saving

sible to Filipinos, Dialysis serves as the “bridge” while preparing for
Kidney transplantation. Peritoneal dialysis, in particular, allows the provision of adequate dialysis
therapy. that is sustainable without an exponential increase in PHILHEALTH expenditure.
Peritoneal dialysis would shifi the provision of ESRD care to a less capital-intensive therapy.

facility tor patients with L

therapy tw be more ave

Support for the enactment of this measure is earnestly requested.

‘P. ALFRED WARGAS.
Filth District, Quezon City


Republic of the Philippines
House of Representatives
Quezon City

EIGHTEENTH CONGRESS
First Regular Session

House Bill No. 1382

INTRODUCED BY REPRESENTATIVE ALFRED VARGAS

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 PHILE 1
PACKAGE RATE FOR RENAL REPLACEMENT THERAPY OF MEMBERS AND
APPROPRIATING FUNDS THEREFOR.

Be i 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 @ declared policy of the State to adopt an integrated
and comprehensive approach to health development that will provide Comprehensive
Renal Replacement ‘Therapy (RRIT) to improve the delivery of health care services to
patients diagnosed with End Stage Renal Disease (ESRD), and to encourage them to
have @ 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 tree 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 velers tw @ health facility that provides teatment 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 cefers w the tinal stage of chronic kidney
disease in which the kidneys no longer function well enough to meet the needs
of daily. ite

© Hemudialysis or HD refers to @ medical procedure to remove fluid and waste

ees. This is

also referred

products from the blood and to correct electrolyte imbal
accomplished using a synthetic membrane or dialyzer which
to as an “artificial kidney";

Indigent refers to a patient who has no source of income or whose income is
tified by the Department of Social
Wellure and Development (DSWD) through the National Household Targeting
System (NHTS) for Poverty Reduction,
are not listed in the NH’

not sufficient for family subsistence as idk

or those patients who are indigents but
I development

as assessed by the municipal soc

Kidney transplant or KT relers 10 & surgical procedure to place @ kidney from
aw live of deceased donor into person whose kidneys no longer function

sufligiently to sustain the person's life

1 National, Regional and Provinctal hospitals refer wo hospitals and: stand
alone dialysis facilities operated and maintained either partially or wholly by the
national, regional and provincial government or other political subdivisions, or
any department, division, board or other agency thereof,

No Bulance Billing relers 10 the government policy of not charging the medical
expenses incurred over and beyond the PhilHealth package rates to a
Philtiealth member who has undergone medical treatment;

h. Peritoneal dialysis or PD refers to & 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:

1 PD First Policy oe
offered as the first dialysis modality 10 RR patients:

ers 10 the policy where peritoneal dialysis, when feasible, is

| Renal replacement therapy or RRT vet

s to therapy that partially replaces
the functions of the normal kidney. ‘Thi

may be in the form of kidney

transplantation, peritoneal dialysis and hemodialysis.

SEC. 4. Establishment of Dialysis Services Wards or Unity in National, Regional,
Provincial Guvernment Hospnals, ~ Within five (S) 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,
operating room nurses in both peritoneal dialysis and

dialysis technicians. a

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 hemodialys
3 by the DOH and the Philitealth from private dialysis el

and peritoneal dialysis, as required

5 All patients diagnosed with ESRD must be referred to a DOH:

credited transplant

© facility to atend 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

10 determine compatibility and medical suitsbility. If no living donors are available then the

HL patient will be enrolled in the deceased organ donor waiting list, This will ensure that all
12 patients with ESRD are offered the option of kidney transplantation.

b
4 SEC. 5. Chronic Kidney Disease (CKD) Prevention and Health Promotion, ~ All
18 national, provincial, and regional government hospitals, and stand-alone dialysis facilities

16 should establish CKD prevention strategies and health promotion activities which include:
17 advocacy activities targeting relatives of dialysis patients who are at high risk for
Is developing CKD themselves. the provision of instructional materials and regular
1 educational activities on the common symptoms of kidney disease such as its risk factors,
- common tests to diagnose kidney disease, the most common

20 healthy diet and. lifesty
causes of kidney failure, and advisories on the appropriate protocols for the diagnostic
evaluation of possible kidney disease.

M Patients and their relatives should be informed about the availability of the proper
28 medicines from government health centers such as those for diabetes and hypertension,
2% and the importance of the regular intake of medicines and monitoring of kidney function
je follow-up with a qualified physician,

27 through regular laboratory testing and regular eli
28 All activities pertaining to the aforementioned programs should be documented
2” accord

8 SEC. 6. Quality Standards of Dialysis Services and Transplant Facilities. ~ Hospitals,
dialysis centers for both hemodialysis and peritoneal dialysis, and transplant tucilities
shall comply with the safety and quality standards of dialy
34 shall be strictly monitored by the PhilHealth and the Health Facilities and Serv

Sor transplant services whieh

35 Regulatory Bureau of the DOIL

3 SEC. 7. Philippine Renul Disease Registry. ~ Private and public hospital
38 for both hemodialysis and peritoneal dialysis. and transplant facilities shall be mandated
Renal Disease Registry of the DOH the incidence and

s, dialysis centers

39 to report to the Philipp
40 prevalence of patients receiving peritoneal dialysis or hemodialysis treatment, and who

41 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

2 all dialysis patients in the PhilHealth dialysis database will be required prior to the

8 ayailment of benefits for both peritoneal dialysis and hemodialysis.

5 SEC. 8. Philiteulth Benefit for Kidney Transplantation - ‘The PhilHealth benefit for kidney

transplantation trom living donors shall be expanded accordingly. This shall include the


cost of laboratory work-up for both recipient and donor candidate, hospitalization for the

tra

splant 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 tw | month for the revi 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 tor all organ procurement organizations.

The Philltealth benefit, package for kidney transplantation shall cover the
evaluation and sereening 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 immune suppression for the

lifetime of the transplant patient. ay long

as the transplanted organ is funetioning and the

patient remains dialy sis-independent

All renal replacement therapy facilities shall be required to engage in regular organ

donation advocacy activities that will provide education for ail Filipinos to carry the organ
donor card, Facilities will likewise establish a potential deceased organ donor referral
system that will identity all potential deceased organ donors to the Philippine Network for
Organ Sharing,

SEC. 9% PhilHeatth Benctit tur Dialysis Treatment — Lhe Philltealth shall increase the Z-

benetit package rate for the prineipal member and each of one’s qualified dependent on

maintenance dialysis per year for peritoneal dialysis cove!

wy three (3) periton

sal dialysis
exchanges per day for three hundred sixty five (365) days, while the package rate for

hemodialysis ueatment shall be increased annually to cover a span of ninety
(0)

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 Otice

For purposes of providing optimal financial risk protection to the most vulnerable

groups includin

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

minimund basic laboratory tests consisting of complete blood count, creatinine, calcium,


phosphorus. potassium, albumin hepatitis B surface antigen (HBsAg) and anti-hepatitis
12 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 vice a year for the last wo (2) tests, The

14 schedule of these tests shall be determined by the attending physician during the course
1S of the annual dialysis treaument sessions.
lo

17 SEC. 10. Periodic sessment and Benefit Package Adjustments for nd Stage Renal
18 Dieare Patients. - A periodic assessment and reasonable adjustments of the benefit
ysis and transplant patients shall be made by the PhilHealth after taking
20 into consideration its financial sustainability and changes in the socio-economic

19 package for d

conditions of the country

SEC. 1, Free Dialysis Treatment 19 Indigent Patients, - Dialysis treatment in alt national,

regional, and provincial government hospitals shall be provided free of charge to indigent
patients as identitied by the Department of Social Welfare and Development using the
ting System for Poverty Reduction, A PD First Policy shall be
27 established for all indigent patients. unless there is a contraindication to its use in a

National Household Tar

28 particular patient

30SEC. 12. Preament Options ~ The PhilHealth shall develop a package that will provide
31 the highest benefit tor

Iney transplant, followed by peritoneal dialysis, then
hemodialysis

M The benetit package shall include w sereening test for both the donor and recipient,
38 The serwening test for possible kidney uansplantation of both the donor and recipi
36 inelude the following.

38 1 For the donor, the screening testing include blood typing, complete blood count,
39 fasting blood sugar. creatinine, hepatitis B surface antigen, anti-hepatitis C

40 antibody. urinalysis, chest x-ray and ultrasound of the kidney
4 urmary bladder

ureter. and

) For the recipient, cardiac evaluation and many other tests as needed. 3
4 During the availment of the full benefits of dialysis within the first two (2) years of
S dialysis initiation, the cost of dialysis treatment shall be paid for by the PhilHealth and the

6 PCSO as described in Section 8. These options are provided to encourage more patients

to have @ kidney transplant and attain full rehabilitation

¥ If the patient passes the criteria for the PhilHealth benefit package for
1 transplantation, the expenses for lab work-up shall be reimbursed to the patient by the
Healthcare institution alter the PhilHealth pays the benefit: to the healtheare institution,

‘ The cost of the operation for transplantation shall be ineluded in the PhilHealth 7.
4 benefit packawe which includes a month of post-hospital discharge laboratory tests for
18 the recipient and a one (1) year follow up laboratory tests for the donor. ‘The Z-benetit
lo package shall be expanded accordingly



The immunosuppression medications needed by the transplant patient, if there is
Wy ho gratt rejection, shall be lifelong. For Phill lealth patients, these medicines shall be
2u provided for one (1) year by PCSO. Atter the first year. the patient may reapply with the

21 PCSO for assistance for such medications.

28 SEC. 13, Rehabilitation Program. ~ The DOL, in coordination with the Department of
24 Labor and Employment, Technical Education and Skills Development Authority, and the
25 DSWD and other pertinent agencies, shall establish a comprehensive rehabilitation
26 program for ESRD patients who have undergone kidney transplant in order to help them
2 reach their fullest physical, psychological, social, vocational, avocational, and educational
28 potential consistent with their physiologic or anatomic condition, environmental
28 imitations. life plans and desires

Si SEC. 14. Dialysis Facility. A dialysis facility shall be compliant with the licensing

32 requirements imposed under DOH Administrative Order No. 2012-0001 dated January
33 26, 2012 for hemodialysis, and PhilHealth-Accreditation for peritoneal dialysis facilities.
M_— Hospitals without dialysis facilities first put up the necessary equipment and qualified stat
38 to perform peritoneal dialysis services. For hospitals with existing hemodialysis facilities,
j 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

i SEC. 18. Pramng for Pertuncal and Hemadialvsis Treamem and Services. ~ The DOH,
National Kidney and Hranyplant Institue (NK IL) and the Philippine Society of Nephrology
(PSN) shall provide trainin,

for medical personnel such ay physicians to take charge of

44 the hemodialysis and peritoneal dialysis centers, hemodialysis and peritoneal dialysis
4s nurses, hemodialysis and peritoneal dialysis technicians, operating room nurses,
46 transplant’ ward urses, transplant. —_ coordinators, and non
medical,

7 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
2 include hands-on workshops for dialysis,

4 SEC. 16. Establishing a Chronic Kidney Disease (CKD) Counseling Clinic. ~ AW 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 contro! the progression of kidney disease, the

4 metabolic complications of ESRD. and the indications for renal replacement. These clinics
WW shall monitor the kidney funetion of patients so that a timely referral 10 a nephrologist or
1) internisvpediatrician with specialized training in CKD can be made, with the timely
12 initiation of Renal Replacement Therapy 1 prevent requiring emergency treatment,

BW

4 The NKTH shall provide education and training modules for the medical stat of

15 CKD counseling elinies.

SEC. 17. Creation of & Renal Disease Comrot Program (REDCOP). ~ AU RRT fe
Is shall ereate a Renal Disease Control Program (REDCOP), following the model of the

ilities

19 NKII that shall promote the early recognition of kidney disease. identify persons at high
20 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.



the

SEC. 18, duthoray tw Receive Dunationy and Exemptions from Dunor's Taxes, Customs

wid Turit! Duties ‘Vhe DOW shall be authorized 1 receive donations, gills and
bequests in order to augment the funding for the establishment of the dialysis
Wwards/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 trom income or
ye fees and other charges and

donor's taxes. any other direct or indirect taxes, wharfi

restrietio

SEC. 19. Penuliy - Any hospital chiet, 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 (ie. PCSO,

PHIC) who are found selling these medications or services instead of using them for

ent. shall be penalized with the suspension of their Phill lealth
membership and shall be ineligible for assistance trom PC

D 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 alloted for their care for the second

me, they shall be
permanently ineligible to receive government assistance.

SEC. 20. Appropriations. - The initial amount necessary to implement the provisis

ns of
this Act shall be charged aguinst the current year’s appropriation of the DOH. Thereafier,
such SuM as May be necessary for the continued implementation of this Act shall be

included in the annual General Appropriations Act

SE

21. Implementing Rules and Regulations — Within sixty (60) days from

effectivity of this Act, the Secretary of Health, in coordination with the President of
PhilHicalth, the Executive Director of the NK'TI, and other relevant stakeholders, shall

issue the implementing rules and regulations 1 implement the provisions of this Act

22. Separability Clause. If any provision or part hereot is held inval
constitutional, the +

or

u

mainder of the law or the provision not otherwise affected shall

remain valid and subsisting
SEC. 23, Repeuling Clause. Any law, presidential deeree or issuance, executive order,
letter of Instruction, administrative order, rule or regulation contrary to oF inconsistent with

the provisions of this Act are hereby repealed, modified or amended accordingly

si

24. Effectivity.-This Act shall take effect fifteen (15) days after its publication in the
Official G

je oF in a newspaper of general circulation.

Ipproved.