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Lawmakers want DoD to study whether Tricare may cover horse therapy

May. 24, 2013 - 01:01PM   |  
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The family of Kaitlyn Samuels, 16, and many other family memnbers with special needs were hoping Congress would pass a law requiring Tricare to cover hippotherapy — physical therapy conducted on horseback.

In April, two House legislators introduced a bill that would bolster Tricare’s “therapeutic exercise” coverage to include physical therapy treatment on any platform deemed helpful by a therapist, including “a horse, balance board, bolster and bench,” according to the bill.

On Wednesday, a House Armed Services panel joined the discussion, directing the Pentagon in a draft of the fiscal 2014 defense authorization bill to “explore the possibility of providing” the therapy either through Tricare’s basic program or its Exceptional Care Health Option program for special needs beneficiaries.

Under the legislation, HR 1960, the Defense Department would be required to provide a report of its findings to Congress by next year.

But the proposed legislation falls short of mandating that Tricare cover the treatment, disappointing those who pushed for the original bill.

Retired Navy Lt. Cmdr. Mike Hogg, a former chaplain and board member of Kaitlyn’s Foundation, called the new version “unconscionable.”

“This is more than a blow to just us — it is a blow to those who have given up so much to serve our nation. The least they deserve is proper health care coverage,” Hogg said.

Hogg said Rep. Michael Burgess, R-Texas, the original bill sponsor, “needs to change the language back to its original form or he risks hurting military families and wounded warriors, and so many others who have disabled children and are covered by Tricare.”

Kaitlyn Samuels, of Keller, Texas, was born with cerebral palsy and has participated in counselor-led physical therapy on horseback since 2009.

Her therapist, doctors and family members say the therapy she receives keeps her muscles toned, and more importantly, keeps her scoliosis in check. That disease, which can cause progressive curvature of the spine, can cause Kaitlyn’s body to fold over onto itself, crushing her lungs, digestive organs and heart.

In mid-2010, Tricare stopped paying for the sessions after learning it was paying for hippotherapy, which the government health provider considers an experimental treatment.

Kaitlyn’s parents, Navy Capt. Mark and Jennifer Samuels, 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. But Tricare Appeals Director Mark Donahue ignored the officer’s recommendation and issued a final decision to deny the claim.

Kaitlyn’s parents have said they are not seeking to change the law simply to get their money back. Instead, they are advocating on behalf of families with special needs children whose continued health depends on the treatment.

None of the top five U.S. health insurers covers hippotherapy, which they consider an “investigational” or experimental treatment that lacks scientific evidence that it works. Some major insurers, however, reimburse for the treatment depending on the wording of a claim.

In some states, Medicaid reimburses the cost for special needs patients who qualify.

Hippotherapy differs from therapeutic riding — horseback riding for recreation that also is known to have health benefits — because it is conducted by a licensed physical therapist, according to the American Hippotherapy Association.

If prescribed, hippotherapy also is included in a patient’s medical plan, boosting the argument that it is a medical treatment, according to the American Physical Therapy Association.

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