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1. Types of extraordinary circumstances – Such a situation, factor or set of factors may include the existence of a chronic, severe medical condition for which the member has a longstanding treatment relationship with a licensed health care practitioner who does not participate in any of the Medicaid MCOs in the delivery system designated to provide care to the member. 2. Limits – A Medicaid member's preference to continue a treatment relationship with a particular physician or other health care practitioner who does not participate with an MCO in the member’s designated delivery system does not constitute an "extraordinary circumstance" in and of itself. 3. Exemption requests – Requests for exemption to mandatory enrollment in managed care due to extraordinary circumstances must be made in writing, include appropriate documentation (letter from physician, medical records, or other as indicated), and signed. Exemption requests should be routed to EOHHS. 4. Agency actions and duration of exemption – EOHHS makes enrollment exemption determinations based on a consideration of the circumstances of each member’s individual request. Once exempted, an individual can be exempt for as long as the extraordinary circumstance exists. Non- exempt Medicaid members in a household must follow the regular Medicaid MCO enrollment process. 2.39 MCO Lock-In A. Following initial enrollment into an MCO, Medicaid members are restricted to that MCO until the next open enrollment period. During this health plan lock-in, a Medicaid member may request to be reassigned to another MCO only under one of a set of specific allowed conditions. 1. Allowed conditions for reassignment requests – Members may request to be reassigned to another MCO for any of the following reasons: a. Substandard or poor quality care; b. Inadequate access to necessary specialty services; c. Lack of access to services covered under the contract, or lack of access to providers experienced in dealing with the enrollee's care needs; d. The MCO does not, because of moral or religious objections, cover the services the enrollee seeks;