(g) Rehabilitative therapy provided pursuant to subsection (a)(17) may include additional therapeutic exercises or therapeutic activities if such exercises or activities are included in the authorized individual plan of care of the individual receiving such therapy. Such exercises 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 law has received bipartisan sponsorship from Representative Michael Burgess (R-Texas), its primary sponsor, and from cosponsors Tom Cotton (R-Arkansas) and Marc A. Veasey (D-Texas).
The bill has come to pass largely because of the efforts of the parents of a child named Kaitlyn Samuels, the 17-year-old daughter of a Navy officer.
Kaitlyn has severe scoliosis, epilepsy, cerebral palsy and some cognitive disabilities that render her unable to speak. She requires regular physical therapy sessions to help her develop and strengthen her back and abdominal muscles to help support the weight of her spine and upper body. If she does not regularly exercise these muscles, it is possible that she could slowly suffocate herself.
Her physical therapists had trouble finding a therapy that she would tolerate. She has limited insight into her condition and had not been cooperative with standard modes of therapy, such as benches and balance balls. But when therapists tried the same exercises on horseback, Kaitlin responded very well. According to the family, since she does not tolerate the other forms of therapy, her horseback therapy is the only thing preventing her scoliosis from curving her spine to the point where her internal organs are crushed.
Unfortunately, TRICARE officials didn’t care. At least for long. They covered the horseback therapy for a while, and then changed their minds about it, demanding over $1,300 in reimbursements from the family for payments already made.
While the standard therapies were readily approved under existing TRICARE guidelines, the same therapies done on horseback were deemed non-reimbursable. Horse therapy, or hippotherapy, as it’s called in the medical profession, was considered “unproven” by TRICARE, even though it was already proven in Kaitlyn’s particular case. The family appealed the decision through several reviews, but TRICARE ultimately ruled against them.
As we reported here last year, TRICARE officials overruled the recommendation of the hearing officer and denied the benefit – putting the government in the absurd position of approving therapies that are proven not to work while specifically denying the one therapy that was effective.
The Samuels family fought back – contacting their Congressional representatives, networking with the tight-knit community of parents of special needs children (who have some PR skills of their own!), starting a Facebook page and leveraging social media to get the word out about their private foundation.
Kaitlyn has been able to continue her therapy, thanks to generous private donations.
Meanwhile, the bill now goes to the House Ways and Means Committee.