Out of District School Medicaid Forms and Service Delivery Forms

Out of district placements can be quite costly.  School Medicaid reimbursement can help to make those costs more manageable.  The key lies in pursuing compliant service delivery records in addition to ensuring your district has a signed IEP, Order, Recommendation, Referral Form (ORRF) and parental consent.  Here are some tools to help you recover every possible dollar.  If you have any questions, please don’t hesitate to call or send us an email — that is what we are here for.

Out of District (OOD) Forms & Guidance

• Frequently Asked Questions for Billing Medicaid Services Delivered in OOD Placements
• OOD Facility Contract Addendum
• OOD Intake Form
• OOD Expectations Letter
• OOD Unexpected School Closing Form

Please note: Single student, monthly transaction logs appear below. For many out-of-district providers, the standard biweekly log is easier to work with than the single-student log.  If you prefer to use the biweekly logs, please click here.