Review Requirements Checklist

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Page 1 of 17Review Requirements ChecklistMedical Malpractice Liability Rate/RuleContact Person: Keith Fanning (217) 782-1792Line(s) of Insurance/Business:TOI Claims Made and Occurrence; filing code(s) 11.0000Claims Made; filing code(s) 11.2000Occurrence; filing code(s) 11.1000Sub — TOI Acupuncture; filing code 11.0001Ambulance Services; filing code 11.0002Anesthetist; filing code 11.0031Assisted Living Facility; filing code 11.0033Chiropractic; filing code 11.0003Community Health Center; filing code 11.0004Dental Hygienists; filing code 11.0005Dentists; filing code 11.0030Dentists – General Practice; filing code 11.0006Dentists – Oral Surgeon; filing code 11.0007Home Care Service Agencies; filing code 11.0008Hospitals; filing code 11.0009Professional Nurses; filing code 11.0032Nurse – Anesthetists; filing code 11.0010Nurse – Lic. Practical; filing code 11.0011Nurse – Midwife; filing code 11.0012Nurse – Practitioners; filing code 11.0013Nurse – Private Duty; filing code 11.0014Nurse – Registered; filing code 11.0015Nursing Homes; filing code 11.0016Occupational Therapy; filing code 11.0017Ophthalmic Dispensing; filing code 11.00181

Page 2 of 17 Optometry; filing code 11.0019Osteopathy; filing code 11.0020Pharmacy; filing code 11.0021Physical Therapy; filing code 11.0022Physicians & Surgeons; filing code 11.0023Physicians Assistants; filing code 11.0024Podiatry; filing code 11.0025Psychiatry; filing code 11.0026Psychology; filing code 11.0027Speech Pathology; filing code 11.0028Other; filing code 11.0029Links: Illinois Compiled Statutes OnlineAdministrative Regulations OnlineProduct Coding MatrixTo assist insurers in submitting compliant medical liability rate/rule filings, the Department has created thisseparate, comprehensive rate/rule filing checklist for medical liability filings.*Please see the separate form filing checklist for requirements related to medical liability forms.All filings are public record in accordance with 215 ILCS 5/404 except where another provision of theInsurance Code says otherwise. The only code section that allows for a filing to be a trade secret or confidentialis 215 ILCS 157/40 Use of Credit Information in Personal Insurance Act.The Department’s checklists include summaries that do not provide detailed information about all laws,regulations and bulletins. Therefore, the insurers should review the actual laws, regulations and bulletins toensure forms are fully compliant before filing with the Department.A form filing fee is required pursuant to 215 ILCS 5/408 (1)(jj).LINE OF AUTHORITY REFERENCEMust have proper Classand Clause authority to215 ILCS 5/4DESCRIPTION OF REVIEW STANDARDSREQUIREMENTSTo write Medical Malpractice coverage in Illinoiscompanies must be licensed to write:2

Page 3 of 17conduct this line ofbusiness in IllinoisRATES AND RULESREQUIRED TO BEFILEDList ofClasses/ClausesREFERENCEInsurers shall makeseparate filings forrate/rules and forforms/endorsements, etc.INSURER FILINGREQUIREMENTSInsurers must file theirrates, rules, plans forgathering statistics, etc.upon commencement ofbusiness.1. Class 2, Clause (c)DESCRIPTION OF REVIEW STANDARDSREQUIREMENTSThe laws and regulations for medical liabilityforms/endorsements and the laws for medicalliability rates/rules are different and each must bereviewed according to its own set oflaws/regulations/procedures. Therefore, insurersare required to file forms and rates/rulesseparately. For requirements regarding formfilings, see separate form filing checklist.REFERENCEDESCRIPTION OF REVIEW STANDARDSREQUIREMENTS215 ILCS5/155.18Insurers must file the following:a) Medical liability insurance rate manual,including all rates.50 IL Adm. Code b) Rules, including underwriting rule manuals929which contain rules for applying rates or ratingplansc) Classifications and other such schedules used inwriting medical liability insurance.d) Statement regarding whether the insurer: Has its own plan for the gathering of medicalliability statistics; or Reports its medical liability statistics to astatistical agent (and if so, which agent).The Director, at any time, may request a copy ofthe insurer’s statistical plan or request the insurerto provide written verification of membership andreporting status from the insurer’s reportedstatistical agency.Insurers are instructed to review all requirementsin this checklist, including the requirements for3

Page 4 of 17applicable actuarial documentation, as well as allmedical liability laws and regulations, to ensurethat the filing contains all essential elementsbefore submitting the filing to the Department.AMENDMENTS TOINITIAL RATE/RULEFILINGSREFERENCEAfter a new insurer has215 ILCSfiled the5/155.18rates/rules/informationdescribed above, insurers 50 IL Adm. Code929must file rates/rules, oradvise of changes tostatistical plans, as often asthey are amended.DESCRIPTION OF REVIEW STANDARDSREQUIREMENTSAfter a new insurer has filed therates/rules/information described above, insurersmust file rates/rules/rating schedules (as describedabove for new business) as often as such filingsare changed or amended, or when any new rates orrules are added.Any change in premium to the company's insuredsas a result of a change in the company's base ratesor a change in its increased limits factors shallconstitute a change in rates and shall require afiling with the Director.Insurers shall also advise the Director if its plansfor the gathering of statistics has changed, or if theinsurer has changed statistical agents.The Director, at any time, may request a copy ofthe insurer’s statistical plan or request the insurerto provide written verification of membership andreporting status from the insurer’s reportedstatistical agency.Insurers are instructed to review all requirementsin this checklist, including the requirements forapplicable actuarial documentation, as well as allmedical liability laws and regulations, to ensurethat the filing contains all essential elementsbefore submitting the filing to the Department.4

Page 5 of 17EFFECTIVE DATESOF RATE/RULEFILINGSREFERENCEIllinois is “use and file” 215 ILCSfor medical liability rates 5/155.18and rules.50 IL Adm. Code929ADOPTIONS OFADVISORYORGANIZATIONFILINGSREFERENCEDESCRIPTION OF REVIEW STANDARDSREQUIREMENTSMedical liability insurance rates and ratingschedule must be received at least annually andno later than 30 days after the effective date of anyrate change or amendment.DESCRIPTION OF REVIEW STANDARDSREQUIREMENTSInsurer must file all rates 50 IL Adm. Code Although Rule 929 allows for insurers to adoptand rules on its own929advisory organization rule filings, advisorybehalf.organizations no longer file rules in Illinois.COPIES, RETURNENVELOPES, ETC.REFERENCEDESCRIPTION OF REVIEW STANDARDSREQUIREMENTSRequirement for duplicate 50 IL Adm. Code Insurers that desire a stamped returned copy of thecopies and return envelope 929filing or submission letter must submit a duplicatewith adequate postage.copy of the filing/letter, along with a returnenvelope large enough and containing enoughpostage to accommodate the return filing.SERFF FILING"Me too" filings are notallowed.REFERENCE215 ILCS5/155.18DESCRIPTION OF REVIEW STANDARDSREQUIREMENTSA company filing directly must file using SERFF.The filings must include:50 IL Adm. Code929 ActuarialCertification Form 5The name of the company making thefiling:The FEIN of the company making thefiling:Identification of the classes of the medicalliability insurance to which the filingsapplies;Notification as to whether the filing is newor supersedes a present filing.

Page 6 of 17 Identification of all changes in allsuperseding filings is required. Thepreferred format for identifying changes isto underline the new wording andoverstrike the deleted or changed languageand give an explanation for the changesbeing made;The effective date of use: andCertification by an officer of the companyand a qualified actuary that the company’sexperience.A company must file on its own behalf all ratesfor medical liability insurance, and: 6File copies of a Rate Submission Letterusing System for Electronic Rate and FormFiling (SERFF) or in another electronicformat approved by the Director. Thisfiling must include:o The name of the company makingthe filing;o FEIN of the company making thefiling;o Identification of the classes ofmedical liability insurance to whichthe filing applies;o Notification of whether the filing isnew or supersedes a present filing.Identification of all changes insuperseding filings, as well asidentification of all supersededfilings is required;o The effective date of use; ando Certification by an officer of thecompany and a qualified actuarythat the company s rates are basedon sound actuarial principles and

Page 7 of 17are not inconsistent with thecompany‚s experience.Companies under the same ownership or generalmanagement are required to make separate,individual company filings. Company Group("Me too") filings are unacceptable.COMPANY RATEINFORMATION ONSERFFREFERENCEDESCRIPTION OF REVIEW STANDARDSREQUIREMENTSFor any rate change, the 50 IL Adm. Code Company Rate Information shall be completed forcompany rate information 929each company when a filing is being submittedmust be completed.that includes:50 IL Adm. Code754 Overall % Indicated Change Overall % Rate Impact — This is thestatewide average percentage change to theaccepted rates for the coverages includedfor each company Written premium change for this program— This is the statewide change in writtenpremium based on the proposed overallpercentage rate impact for each company Number of policyholders affected for thisprogram — This is a statewide writtenpremium for each company Maximum % Change Minimum % ChangeCLAIMS MADEREQUIREMENTSREFERENCEExtended reporting period 215 ILCS(tail coverage)5/143(2)requirements.DESCRIPTION OF REVIEW STANDARDSREQUIREMENTSWhen issuing claims-made medical liabilityinsurance policies, insurers must include thefollowing specific information in their rate/rulemanuals: Offer of an extended reporting period (tailcoverage) of at least 12 months. The rate/rulemanual must specify whether the extended7

Page 8 of 17reporting period is unlimited or indicate its term(i.e. number of years).*** Cost of the extended reporting period, whichmust be priced as a factor of one of thefollowing:***ο The last 12 months' premium.ο The premium in effect at policy issuance.ο The expiring annual premium. List of any credits, discounts, etc. that will beadded or removed when determining the finalextended reporting period premium.Insurer will inform the insured of the extendedreporting period premium at the time the lastpolicy is purchased. The insurer may not wait untilthe insured requests to purchase the extendedreporting period coverage to tell the insured whatthe premium will be or how the premium wouldbe calculated. Insurer will offer the extended reporting periodwhen the policy is terminated for any reason,including non-payment of premium, and whetherthe policy is terminated at the company's orinsured's request. Insurer will allow the insured 30 days after thepolicy is terminated to purchase the extendedreporting period coverage.******If the medical liability coverage is combinedwith other professional or general liabilitycoverages, the medical liability insurer must meetall of the above requirements, except thoseindicated with ***, in which case, the insurermust:8

Page 9 of 17 Offer free 5-year extended reporting period (tailcoverage) or Offer an unlimited extended reporting periodwith the limits reinstated (100% of aggregateexpiring limits for the duration) Cap the premium at 200% of the annualpremium of the expiring policy; and Give the insured a free-60 day period after theend of the policy to request the coverage.GROUP MEDICALLIABILITYGroup medical liabilityinsurance is notspecifically allowed underthe Illinois InsuranceCode.CANCELLATION &NONRENEWALPROVISIONREQUIREMENTSIf rate/rule manualscontain languagepertaining to cancellationor nonrenewal, mustcomply with N OF REVIEW STANDARDSREQUIREMENTS215 ILCS 5/388a- There are no enabling statutes in Illinois that388gauthorize the writing of group fire, casualty,inland marine, or surety insurance. The effect is to215 ILCS 5/393a- require that all fire, casualty, inland marine, or393gsurety insureds of the same class be treated alike.These provisions are not applicable where the215 ILCS 5/400.1 Illinois Insurance Code specifically authorizes thegrouping of risks. The only coverages that areIL Adm. Codecurrently authorized on a group basis are: a) group2302vehicle; b) group professional liability; c) groupinland marine; d) group legal.215 ILCS 5/900906REFERENCEDESCRIPTION OF REVIEW STANDARDSREQUIREMENTSSee MedicalLiability FormsChecklist forSpecificInformation aboutIllinoisCancellation &Nonrenewal Lawsand RegulationsIf a rate or rule manual contains languagepertaining to cancellation or nonrenewal of anymedical liability insurance coverage, suchprovisions must comply with all cancellation andnonrenewal provisions of the Illinois InsuranceCode, including but not limited to the following:143.10, 143.16, 143.16a, 143.17a. See MedicalLiability Forms Checklist for Specific Informationabout Illinois Cancellation & Nonrenewal Lawsand Regulations,9

Page 10 of 17ACTUARIAL REVIEW REFERENCEREQUIREMENTSRates shall not be215 ILCSexcessive, inadequate, or 5/155.18unfairly discriminatory.DESCRIPTION OF REVIEW STANDARDSREQUIREMENTSIn the making or use of rates pertaining to allclasses of medical liability insurance, rates shallnot be excessive, or inadequate, nor shall they beunfairly discriminatory.Rate and rule manual provisions should be definedand explained in a manner that allows theDepartment to ascertain whether the provisioncould be applied in an unfairly discriminatorymanner. For example, if a rate/rule manualcontains ranges of premiums or discounts, theprovision must specify the criteria to determinethe specific premium/discount an insured orapplicant would receive.The Director may, by order, adjust a rate or takeany other appropriate action at the conclusion of ahearing.PRICINGREFERENCEInsurers shall consider215 ILCScertain information when 5/155.18developing medicalliability rates.DESCRIPTION OF REVIEW STANDARDSREQUIREMENTSConsideration shall be given, to the extentapplicable, to past and prospective loss experiencewithin and outside this State, to a reasonablemargin for underwriting profit and contingencies,to past and prospective expenses both countrywideand those especially applicable to Illinois, and toall other factors, including judgment factors,deemed relevant within and outside Illinois.Consideration may also be given in the makingand use of rates to dividends, savings orunabsorbed premium deposits allowed or returnedby companies to their policyholders, members orsubscribers.The systems of expense provisions included in the10

Page 11 of 17rates for use by any company or group ofcompanies may differ from those of othercompanies or groups of companies to reflect theoperating methods of any such company or groupwith respect to any kind of insurance, or withrespect to any subDepartment or combinationthereof.MINIMUM PREMIUMRULESInsurers may group orclassify risks forestablishing rates andminimum premiums.INDIVIDUAL RISKRATINGREFERENCE215 ILCS5/155.18REFERENCERisks may be rated on an 215 ILCSindividual basis as long as 5/155.18all provisions required inSection 155.18 are met.DISCRIMINATIONREFERENCECivil Union Partnerships- 750 ILCS 75/1effective June 1, 2011DESCRIPTION OF REVIEW STANDARDSREQUIREMENTSRisks may be grouped by classifications for theestablishment of rates and minimum premiums.DESCRIPTION OF REVIEW STANDARDSREQUIREMENTSClassification rates may be modified to producerates for individual risks in accordance with ratingplans which establish standards for measuringvariations in hazards or expense provisions, orboth. Such standards may measure any differenceamong risks that have a probable effect uponlosses or expenses. Such classifications ormodifications of classifications of risks may beestablished based upon size, expense,management, individual experience, location ordispersion of hazard, or any other reasonableconsiderations, and shall apply to all risks underthe same or substantially the same circumstancesor conditions. The rate for an establishedclassification should be related generally to theanticipated loss and expense factors or the class.DESCRIPTION OF REVIEW STANDARDSREQUIREMENTSThe Religious Freedom Protection and CivilUnion Act (Public Act 96-1513) will allow bothsame-sex and different-sex couples to enter into acivil union with all of the obligations, protections,11

Page 12 of 17Civil Union Fact and legal rights that Illinois provides to marriedSheetheterosexual couples.Please note that whenever a policy form,application, or rating rule includes the terms"spouse," "married," or "immediate familymember" it is required that parties to a civil unionbe included in these definitions.RISKCLASSIFICATIONREFERENCEDESCRIPTION OF REVIEW STANDARDSREQUIREMENTSRisks may be grouped by 215 ILCSclassifications.5/155.18Risks may be grouped by classifications for theestablishment of rates and minimum premiums.Rating decisions basedsolely on domesticviolence.215 ILCS5/155.22bNo insurer may that issues a property and casualtypolicy may use the fact that an applicant orinsured incurred bodily injury as a result of abattery committed against him/her by a spouse orperson in the same household as a sole reason fora rating decision.Unfair methods of215 ILCScompetition or unfair or 5/424(3)deceptive acts or practicesdefined.It is an unfair method of competition or unfair anddeceptive act or practice if a company makes orpermits any unfair discrimination betweenindividuals or risks of the same class or ofessentially the same hazard and expense elementbecause of the race, color, religion, or nationalorigin of such insurance risks or applicants.Procedure as to unfair215 ILCS 5/429methods of competition orunfair or deceptive acts orpractices not defined.Outlines the procedures the Director follows whenhe has reason to believe that a company isengaging in unfair methods of competition orunfair or deceptive acts or practices.TERRITORIALDEFINITIONSRate/rule manuals mustcontain correct andadequate definitions ofIllinois territories.REFERENCE215 ILCS5/155.18DESCRIPTION OF REVIEW STANDARDSREQUIREMENTSWhen an insurer’s rate/rule program includesdiffering territories within the State of Illinois,rate/rule manuals must contain correct andadequate definitions of those territories, and thatall references to the territories or definitions are12

Page 13 of 17accurate, so the Department does not need torequest additional TION OF REVIEW STANDARDSREQUIREMENTSActuarial certification215 ILCSmust accompany all rate 5/155.18filings and all rule filingsthat affect rates.50 IL Adm. Code929Every rate and/or rating rule filing must include acertification by an officer of the company and aqualified actuary that the company’s rates and/orrules are based on sound actuarial principles andare not inconsistent with the company’sexperience.ActuarialCertification Form Insurers may use their own form or may use thesample form created by the Department.ACTUARIAL ORSTATISTICALINFORMATIONDirector may requestactuarial and statisticalinformation.REFERENCEDESCRIPTION OF REVIEW STANDARDSREQUIREMENTS215 ILCS5/155.18The Director may require the filing of statisticaldata and any other pertinent information necessaryto determine the manner of promulgation and the50 IL Adm. Code acceptability or unacceptability of a filing for929rules, minimum premiums, rates, forms or anycombination thereof.If the Director requests information or statisticaldata to determine the manner the insurer used toset the filed rates and/or to determine thereasonableness of those rates, as well as themanner of promulgation and the acceptability orunacceptability of a filing for rules, minimumpremiums, or any combination thereof, the insurershall provide such data or information within 14calendar days of the Director’s request.EXPLANATORYMEMORANDUMInsurers shall includeactuarial explanatorymemorandum with anyREFERENCE215 ILCS5/155.18DESCRIPTION OF REVIEW STANDARDSREQUIREMENTSInsurers shall include actuarial explanatorymemorandum with any rate filing, as well as anyrule filing that affects the ultimate premium. The13

Page 14 of 17rate filing, as well as any 50 IL Adm. Code explanatory memorandum shall contain, atrule filing that affects the 929minimum, the following information:ultimate premium. Explanation of ratemaking methodologies. Explanations of specific changes included in thefiling. Narrative that will assist in understanding thefiling.SUMMARY OFEFFECTS EXHIBITInsurers shall include anexhibit illustrating theeffect of each change andcalculation indicating howthe final effect wasderived.ACTUARIALINDICATIONREFERENCEDESCRIPTION OF REVIEW STANDARDSREQUIREMENTS215 ILCS5/155.18Insurers shall include an exhibit illustrating theeffect of each individual change being made in thefiling (e.g. territorial base rates, classification50 IL Adm. Code factor changes, number of exposures affected by929each change being made, etc.), and include asupporting calculation indicating how the finaleffect was derived.REFERENCEDESCRIPTION OF REVIEW STANDARDSREQUIREMENTSInsurers shall include215 ILCSactuarial support justifying 5/155.18the overall changes being50 IL Adm. Codemade.929Insurers shall include actuarial support justifyingthe overall changes being made, including but notlimited to: Pure premiums (if used). Earned premiums. Incurred losses. Loss development factors. Trend factors. On-Level factors. Permissible loss ratios, etc.LOSS DEVELOPMENT REFERENCEFACTORS ANDANALYSISDESCRIPTION OF REVIEW STANDARDSREQUIREMENTSInsurers shall includesupport for lossdevelopment factors andanalysis.215 ILCS5/155.18Insurers shall include actuarial support for lossdevelopment factors and analysis, including butnot limited to loss triangles and selected factors, as50 IL Adm. Codewell as support for the selected factors.92914

Page 15 of 17ULTIMATE LOSSSELECTIONSInsurers shall includesupport for ultimate lossselections.TREND FACTORSAND ANALYSISInsurers shall includesupport for trend factorsand analysis.ON-LEVEL FACTORSAND ANALYSISInsurers shall includesupport for on-levelfactors and analysis.LOSS ADJUSTMENTEXPENSESREFERENCE215 ILCS5/155.18Insurers shall include support for ultimate lossselections, including an explanation of selectedlosses if results from various methods differ50 IL Adm. Codesignificantly.929REFERENCEInsurers shall include anexpense exhibit. Insurersmay use expenseprovisions that differ fromthose of other companiesor groups of companies.DESCRIPTION OF REVIEW STANDARDSREQUIREMENTS215 ILCS5/155.18Insurers shall include support for trend factors andanalysis, including loss and premium trendexhibits demonstrating the basis for the selections50 IL Adm. Codeused.929REFERENCEDESCRIPTION OF REVIEW STANDARDSREQUIREMENTS215 ILCS5/155.18Insurers shall include support for on-level factorsand analysis, including exhibits providing on-levelfactors and past rate changes included in50 IL Adm. Codecalculations.929REFERENCEInsurers shall include215 ILCSsupport for loss adjustment 5/155.18expenses.50 IL Adm. Code929EXPENSE EXHIBITDESCRIPTION OF REVIEW STANDARDSREQUIREMENTSREFERENCEDESCRIPTION OF REVIEW STANDARDSREQUIREMENTSInsurers shall include support for loss adjustmentexpenses, including exhibits providingdocumentation to support factors used for ALAEand ULAE. If ALAE is included in lossdevelopment analysis, no additional ALAE exhibitis required.DESCRIPTION OF REVIEW STANDARDSREQUIREMENTS215 ILCS5/155.18Insurers shall include an exhibit indicating allexpenses used in the calculation of the permissibleloss ratio, including explanations and support for50 IL Adm. Code selections.929The systems of expense provisions included in therates for use by any company or group of15

Page 16 of 17companies may differ from those of othercompanies or groups of companies to reflect theoperating methods of any such company or groupwith respect to any kind of insurance, or withrespect to any sub-Department or rers shall include anexhibit for investmentincome calculation.PROFIT ANDCONTINGENCIESCALCULATIONInsurers shall include anexhibit for profit andcontingencies load.CREDIBILITYSTANDARD USEDREFERENCE215 ILCS5/155.1850 IL Adm. Code929REFERENCE215 ILCS5/155.1850 IL Adm. Code929REFERENCEInsurers shall include the 215 ILCSnumber of claims being5/155.18used to calculate the50 IL Adm. Codecredibility factor.929OTHER ACTUARIALINFORMATIONREQUIREDREFERENCEInsurers must include the 215 ILCSinformation described in 5/155.18this section.50 IL Adm. Code929DESCRIPTION OF REVIEW STANDARDSREQUIREMENTSInsurers shall include an exhibit demonstrating thecalculation for the investment income factor usedin the indication.DESCRIPTION OF REVIEW STANDARDSREQUIREMENTSInsurers shall include an exhibit illustrating thederivation of any profit and contingencies load.DESCRIPTION OF REVIEW STANDARDSREQUIREMENTSInsurers should include the number of claimsbeing used to calculate the credibility factor. Ifanother method of calculating credibility isutilized, insurers should include a description ofthe method used.DESCRIPTION OF REVIEW STANDARDSREQUIREMENTSInsurers shall also include the followinginformation: All actuarial support/justification for all ratesbeing changed, including but not limited tochanges in:16

Page 17 of 17ο Base rates;ο Territory definitions;ο Territory factor changes;ο Classification factor changes;ο Classification definition changes;ο Changes to schedule credits/debits, etc. Exhibits containing current and proposedrates/factors for all rates and classification factors,etc. being changed. Any exhibits necessary to support the filing thatare not mentioned elsewhere in this checklist.SCHEDULE RATINGPLANREFERENCEInsurers must include the 215 ILCS5/155.18described informationdescribed at right.50 IL Adm. Code929DESCRIPTION OF REVIEW STANDARDSREQUIREMENTSInsurers should include appropriate actuarialjustification when filing and/or making changes toschedule rating plans. The schedule rating planmust allow for both scheduled debits/credits andmust be limited to a maximum level of 25%.Company BulletinCB 2011-0517

Medical Malpractice Liability Rate/Rule Contact Person: Keith Fanning (217) 782-1792 Line(s) of Insurance/Business: . filing code 11.0030 Dentists – General Practice; filing code 11.0006 Dentists – Oral Surgeon; filing code 11.0007 . filing code 11.0015 Nursing Homes; filing code 11.0016 Occupational Therapy; filing code .

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