Elder-Care Long-Term Care Assistance Act of 1989

Elder-Care Long-Term Care Assistance Act of 1989 - Title I: Community Care and Nursing Facility Care under the Medicare Program - Subtitle A: Benefits - Amends title XVIII (Medicare) of the Social Security Act to add a new part C entitled "Long-Term Care Program." (Redesignates the current part C as part D.) Covers the community care and nursing facility care required by individuals who are eligible for part A (Hospital Insurance) benefits and aged individuals who enroll in part C by paying a premium covering expenditures incurred on behalf of enrollees. Limits community care coverage to 20 hours per week for moderately impaired individuals and 30 hours per week for severely impaired individuals.

Authorizes an individual who is entitled to part C benefits to request a nonprofit or public community assessment, review, and evaluation agency (CARE agency) to determine, using a standard, reproducible, uniform assessment instrument and methodology to be developed by the Secretary of Health and Human Services, whether such individual is chronically dependent and, if so, whether the impairment is moderate or severe. Requires the CARE agency to develop a community care plan for such individual which is consistent with the benefit level available for his or her degree of impairment. Requires CARE agencies to determine an individual's eligibility for nursing facility care by determining whether such individual is chronically dependent, requires the level of care provided by a nursing facility, and is likely to require such care for a continuous 60-day period. Makes initial determinations valid for six months with respect to community care and one year for nursing facility care and all subsequent determinations applicable for one year. Requires subsequent determinations to include appropriate plan of care revisions. Directs the Secretary to designate a CARE agency for each State which, in addition to its other duties, shall review periodically the quality of community care and review periodically the appropriateness of nursing facility plans of care and the classification of such plans into a level of care for payment purposes. Authorizes CARE agencies to provide outreach services to chronically dependent individuals, but requires that such agencies be independent from providers of community care and nursing facility care.

Provides Medicare payments for 80 percent of amounts determined under a fee schedule for community care. Sets forth a formula for determining Medicare payments for nursing facility care which takes into account the severity of an individual's condition and limits the charge imposed on such individual after the first 60 days of care and up to two years thereafter to one-third of the national average per diem rate and ten percent of such rate thereafter.

Establishes the Federal Medicare Long-Term Care Trust Fund to which revenues raised pursuant to this Act shall be credited and from which part C payments shall be made.

Directs the Secretary to conduct a study and report to the Congress on: (1) the factors influencing nursing facility admissions of part C beneficiaries; (2) the ratio of licensed nursing facility beds to aged individuals needed to provide cost effective care for chronically dependent individuals; and (3) whether part C payment rates for nursing facility care reflect the costs that are necessary in the efficient delivery of needed nursing facility care.

Prohibits discrimination against part C beneficiaries in nursing facility admissions or the imposition of extra charges against such beneficiaries who wish to be admitted to, or remain at, such facilities.

Sets forth conforming and miscellaneous amendments.

Subtitle B: Expanding Medicaid Buy-in - Amends title XIX (Medicaid) of the Act to expand Medicaid coverage of Medicare premiums, deductibles, and coinsurance payments to require that Medicare-eligible individuals whose income does not exceed 200 percent of the Federal poverty level receive such coverage. Allows States to provide less than full coverage to individuals whose income exceeds the Federal poverty level. Includes part C copayments and CARE agency assessment and reassessment fees among the beneficiary costs that are covered. Eliminates the resource limit on eligibility for such coverage.

Subtitle C: Financing - Amends the Internal Revenue Code to eliminate the limit on wages or self-employment income which is subject to social security taxes.

Imposes a ten percent surtax on the transfer of a deceased Medicare beneficiary's estate in excess of $100,000 and on gifts made by beneficiaries in excess of their $100,000 lifetime gift limit. Eliminates the deferral of estate surtax payments. Shortens the estate surtax payment schedule from a ten-year to a five-year schedule.

Imposes a long-term care surcharge of $3.50 for each $100 of an individual's income tax liability.

Title II: Health Benefits for Under-Poverty Individuals - Amends the Medicaid program to require States to cover hospital services; rural health clinic services; physicians' services; laboratory and X-ray services; early and periodic screening, diagnosis, and treatment of children; family planning services and supplies; medical and surgical services furnished by a dentist; prescribed drugs; and nurse-midwife services provided to individuals whose family income does not exceed the Federal poverty level. Prohibits the placement of a resource limit on such coverage or the imposition of cost-sharing requirements on such beneficiaries.

Removes all amount, duration, and scope limitations on the provision of the above-listed items and services to Medicaid beneficiaries. Requires that payment rates for such items and services be comparable to Medicare payment rates for such items and services.

Title III: Community Care to Low-Income Individuals - Amends the Public Health Service Act to authorize the Secretary to make grants for up to three years to community care agencies to assist such agencies in the provision of this Act's community care services to low-income individuals. Authorizes appropriations for such grant program for FY 1992 through 1994.