A military family’s push to convince Tricare to pay for their daughter’s equine therapy is now in the hands of Congress.
House lawmakers last week introduced a bill that would require the government health program to cover physician-recommended physical therapy regardless of the platform or tools a therapist uses for treatment.
For Kaitlyn Samuels, a 16-year-old with cerebral palsy who is physically and mentally disabled, this means a horse.
Kaitlyn, of Keller, Texas, has participated in counselor-led physical therapy on horseback since 2009, a treatment initially cost-shared by Tricare. But in mid-2010, Tricare stopped paying for the sessions.
According to Tricare, the practice, known as hippotherapy, is an experimental treatment, which Tricare does not cover.
The therapy “lacks reliable evidence establishing it as proven” for treating any medical conditions, Tricare officials told Kaitlyn’s parents, Navy Capt. Mark and Jennifer Samuels.
They appealed, arguing that using a horse to tone muscles and improve skeletal strength was similar to using a bench or stability ball in a physical rehabilitation setting.
In March 2012, a Tricare hearing officer agreed and recommended Tricare pay the cost-share, about $1,300.
“Should [Kaitlyn] fail to get proper PT, she will need surgery, a cost that would be incurred by the government. [Without surgery] the curving can continue until her organs are crushed and she dies,” wrote Claude Heiny, a Tricare administrative judge.
But Tricare Appeals Director Mark Donahue ignored Heiny’s recommendation and issued a final decision to deny the claim.
Working with an attorney at the law firm Akin Gump Strauss Hauer and Feld, the Samuelses have lobbied since early March for a change to Tricare regulations.
The bipartisan bill, H.R. 1705, co-sponsored by Reps. Michael Burgess, R-Texas, Tom Cotton, R-Ark., and Marc Veasey, D-Texas, would add therapeutic exercises or therapeutic activities to the list of rehabilitative therapies covered by Tricare.
“Such experience or activities may include, in addition to other therapeutic exercises or therapeutic activities, therapies provided on a horse, balance board ball, bolster and bench,” the proposed bill states.
The Samuelses have said their fight is not about the money; Kaitlyn’s therapy costs roughly $160 a week, which they have paid mainly out of pocket, with funds given by a donor to Kaitlyn’s therapy center.
The bill will go to the House Armed Services Committee for consideration.
“Our bill simply corrects discrimination and would ensure that beneficiaries receive rehabilitative therapies that are prescribed by a patient’s physician and included in a patient’s individualized plan of care authorized by his or her physical therapist,” Burgess wrote colleagues in a letter urging them to support the legislation.
A Tricare spokesman declined to comment on pending legislation.
Jennifer Samuels said the law would help thousands of wounded warriors and military family members with special needs who benefit from therapeutic riding or other forms of physical therapy.
“This law would put the decision of what therapy tool is proper for each patient in the hands of the doctors and therapists. For my daughter, this therapy means life, death or some horrible surgery, but she’s not alone — there are 27 other military families who use the center where Kaitlyn goes,” Jennifer Samuels said.