Helping Expand Access to Long-Term Health Care Act of 1988

Helping Expand Access to Long-Term Health Care Act of 1988 - Amends title XVIII (Medicare) of the Social Security Act to establish a new program under part C of such title providing grants to States for the provision of home care, adult day health care, and respite care (noninstitutional long-term care) to Medicare beneficiaries. Makes a Medicare beneficiary eligible for home care and adult day health care benefits if he or she cannot perform at least two activities from a specified list of daily living activities or suffers from a similar level of disability as a result of cognitive impairment. Makes a beneficiary eligible for respite care benefits if he or she cannot perform at least one daily living activity or suffers from a similar level of disability as a result of cognitive impairment and is dependent on the uncompensated daily assistance of a primary caregiver with whom he or she resides. Requires case managers to review the eligibility of individuals for noninstitutional long-term care and conduct follow-up assessments of an individual's care to ensure that appropriate utilization levels are maintained. Provides individuals with a reconsideration of an eligibility determination and an administrative hearing in the event of an adverse reconsideration.

Authorizes States to: (1) limit payment for home care benefits to 65 percent of the average annual cost of Medicare skilled nursing facility services and charge individuals whose income exceeds 200 percent of the Federal poverty level a copayment of five dollars per home visit; (2) cover no more than 125 days of adult day health care each year, set a reasonable cost limit on payments for such care, and impose a five dollar copayment for each day of care for individual's whose income exceeds 200 percent of the Federal poverty level; and (3) set a $2,000 limit on total expenses incurred for respite care and impose a 25 percent copayment for such incurred expenses.

Imposes conditions on the participation of adult day health care centers, including the requirement that each center have a multidisciplinary team of personnel which evaluates the needs of eligible individuals and develops individualized treatment and service plans which address such needs.

Requires each State to maintain its current level of expenditures on noninstitutional long-term care for Medicare beneficiaries with the Federal Government covering the additional cost of the part C program. Prohibits any State from having to finance more than 25 percent of the costs of such program, but requires States to cover at least five percent of such costs. Requires any State which has noninstitutional long term care savings by reason of the Federal Government's coverage of 75 percent of program costs to use such savings to provide health care for medically underserved individuals in the State. Increases the State contribution percentage when States exceed projected program costs.

Establishes the Long-Term Care Estimates Board which shall rule on a State's appeal of the Secretary of Health and Human Services' estimate of the amount which will be expended by the State to provide noninstitutional long-term care benefits for a calendar year. Authorizes States to submit their own estimates of such amount to the Secretary by August 1 of the preceding calendar year.

Establishes the Federal Long-Term Care Assistance Trust Fund from which part C payments shall be made. Requires the transfer to such trust fund of amounts saved in other Federal programs by reason of part C coverage.

Amends part B (Peer Review) of title XI of the Act to require peer review organizations to periodically review the part C eligibility determinations made by case managers.

Limits total Federal part C funding for 1989 to $1,000,000,000.

Authorizes the Secretary to allow a State to temporarily conduct a modified part C program if such State does not have sufficient service networks or trained personnel to provide the benefits set forth in this Act.

Amends title XIX (Medicaid) of the Act to provide Medicaid coverage of part C premiums.

Finances this Act's expansion of Medicare benefits by eliminating the limit on wages or self-employment income subject to the Medicare hospital insurance tax and transferring resultant revenues from the Federal Hospital Insurance Trust Fund to the Federal Long-Term Care Assistance Trust Fund.

Sets forth study and reporting requirements relating to the part C program.