Ryan White HIV/AIDS Program Dental Services Report.

Ryan White
HIV/AIDS Program Part F
Dental Services Report

Instruction Manual 2019
Release Date: January 2, 2020

Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to,
a collection of information unless it displays a currently valid Office of Management and Budget (OMB) control
number. The OMB control number for this project is 0915-0151, with an expiration date of 6/30/2020. Public
reporting burden for this collection of information is estimated to average 45 hours per response for RWHAP Part
F Dental Reimbursement Program (DRP) respondents and 35 hours per response for Community Based Dental
Partnership Program (CBDPP) respondents, including the time for reviewing instructions, searching existing data
sources, and completing and reviewing the collection of information. Send comments regarding this burden
estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to:
HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 14N39, Rockville, MD 20857.

HIV/AIDS Bureau
Division of Policy and Data
Health Resources and Services Administration
U.S. Department of Health and Human Services
5600 Fishers Lane, Room 9N164
Rockville, MD 20857

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Table of Contents
What’s New In 2020 ...................................................................................................... 1
DSR Report Deadline .................................................................................................................................. 1

Form Overview ............................................................................................................. 2
Public Burden Statement ........................................................................................................................... 2

Overview of the Ryan White HIV/AIDS Dental Programs ..............................................3
Introduction............................................................................................................................................... 3
Administration ........................................................................................................................................... 4
Eligibility .................................................................................................................................................... 4

Requirements and Methods for Submission .................................................................5
General Requirements ............................................................................................................................... 5
Dental Reimbursement Program Application Requirements....................................................................... 5
Community-Based Dental Partnership Program Data Reporting Requirements .......................................... 6
Submission and Due Dates ......................................................................................................................... 6
Dental Services Report Assistance .............................................................................................................. 6
Ryan White HIV/AIDS Program Data Support Help Line .............................................................................. 7

Dental Services Report Instructions ..............................................................................8
Section 1. Institution/Program and Contact Information ............................................................................ 8
Section 2. Patient Demographics and Oral Health Services .................................................................................. 9
Section 3. Funding and Payment Coverage ............................................................................................... 16
Section 4. Staffing and Training......................................................................................................................... 19
Section 5. Additional Dental Reimbursement Program Information ......................................................... 20
Section 6. Additional Community-Based Dental Partnership Program Information ................................... 22

Glossary ...................................................................................................................... 25

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What’s New In 2020
• The Dental Reimbursement Program (DRP) Notice of Funding Opportunity
(NOFO) release date is January 3, 2020.
• Item 23a. The total unreimbursed costs of oral health care provided to patients
with HIV from July 1, 2018, through June 30, 2019, entered in Item 23a must
match the unreimbursed amount entered in fields 18a and 18g of the SF-424.

DSR Report Deadline
• Community-Based Dental Partnership Programs (CBDPPs) must submit data
no later than 6 p.m. ET, April 3, 2020.
• DRPs must submit data no later than 6 p.m. ET, April 3, 2020.

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Form Overview
The Dental Services Report is used by two programs under the Ryan White HIV/
AIDS Treatment Extension Act of 2009 (Ryan White HIV/AIDS Program): the Dental
Reimbursement Program (DRP) and the Community-Based Dental Partnership
Program (CBDPP).
The report is designed to collect data from accredited pre- and postdoctoral dental
education programs and dental hygiene education programs regarding oral health
services provided to people with HIV.
Institutions applying for dental reimbursement funding must submit a completed
report annually to receive assistance with their unreimbursed costs of care incurred
in providing direct oral health services. CBDPP grant recipients use this report to
submit annual program data, which is a condition of their grant awards.

Public Burden Statement
An agency may not conduct or sponsor, and a person is not required to respond to,
a collection of information unless it displays a currently valid OMB control number.
The OMB control number for this project is 0915-0151. Public reporting burden for
this collection of information is estimated to average 45 hours per response for DRP
respondents and 35 hours per response for CBDPP respondents, including the time
for reviewing instructions, searching existing data sources, gathering and maintaining
the data needed, and completing and reviewing the collection of information. Send
comments regarding this burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to:
HRSA Reports Clearance Officer
5600 Fishers Lane, Room 14N39,
Rockville, Maryland, 20857

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Overview of the Ryan White HIV/
AIDS Dental Programs
Introduction
The Ryan White HIV/AIDS Program (RWHAP), first authorized by the U.S. Congress in
1990, is administered by the U.S. Department of Health and Human Services (HHS),
Health Resources and Services Administration’s (HRSA) HIV/AIDS Bureau (HAB). As
part of the RWHAP, Section 2692(b) of Title XXVI of the Public Health Service Act
authorizes the secretary of Health and Human Services to make grants through the DRP
to accredited predoctoral dental, postdoctoral dental, and dental hygiene education
programs to help cover the unreimbursed costs of providing oral health services to
patients with HIV. Each eligible dental education program may submit an annual
application that documents its unreimbursed costs of providing oral health care to
patients with HIV during the prior year. The secretary distributes the available funds
among all eligible applicants, taking into account the unreimbursed costs incurred by
each institution, the total of all costs incurred by all eligible applicants, and the amount
of funds available.
Section 2692(b) also authorizes the secretary to make grants to accredited
predoctoral dental, postdoctoral dental, and dental hygiene education programs
to support partnerships between dental education programs and communitybased oral health providers. The CBDPP focuses on the provision of care and the
training of additional oral health providers through collaborative community-based
partnerships to increase access to oral health care for people with HIV. The CBDPP
grants are awarded for project periods up to five years. Each recipient must collect,
manage, and report annual program data that will document key service delivery and
educational components of the funded programs.

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Administration
The HIV/AIDS DRP and CBDPP are administered by the Division of Community HIV/
AIDS Programs (DCHAP) within the HIV/AIDS Bureau (HAB) of the Health Resources
and Services Administration (HRSA).

CBDPP questions should be directed to:
Recipient’s Project Officer

DRP questions should be directed to:
Jessica Fox, PharmD, AAHIVE, RAC
Lieutenant Commander, U.S. Public Health Service Commissioned Corps
Public Health Analyst
Health Resources and Services Administration
HIV/AIDS Bureau | Division of Community HIV/AIDS Programs
Office: (301) 945-5155
Email: [email protected]

Eligibility
To be eligible for DRP and CBDPP funding, the applicant must be an institution with
a predoctoral dental, postdoctoral dental, or dental hygiene education program that
is accredited by the Commission on Dental Accreditation of the American Dental
Association. DRP applicants must have documented unreimbursed costs of oral
health care provided to persons with HIV.

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Requirements and Methods for
Submission
General Requirements
All programs must complete Sections 1 through 4 of the DSR, which include:
• Institution/program and contact information.
• Patient demographics and oral health services.
• Funding and payment coverage.
• Staffing and training.
The requested data must be submitted in the OMB-approved format.

Dental Reimbursement Program Application
Requirements
All applicants for DRP funding will use this report to submit information for the period
July 1 through June 30 of the previous year (e.g., applications due in Spring 2020
report on services and training provided from July 1, 2018, to June 30, 2019).
In addition to Sections 1 through 4, DRP applicants also must complete Section 5,
“Additional Dental Reimbursement Program Information,” which includes items
regarding funding, payment coverage sources, and narratives. The narrative
responses describe various aspects of the applicant’s program and help portray the
scope of oral health care provided to patients with HIV.
Use the Database Utility (available for download https://hab.hrsa.gov/programgrants-management/data-reporting-requirements-and-technical-assistance)
to
complete and submit your report electronically. The DRP submission has two
components:
• Submit an application package and unreimbursed cost to Grants.gov.
• Email your data file to [email protected].

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Paper submissions will generally not be accepted. In extreme cases, you may request
a formal waiver of the requirement to submit electronically.
DRP applications received after the due date, incomplete applications,
and applications from institutions that do not have an accredited
dental or dental hygiene education program will not be accepted for
consideration for dental reimbursement program funding.

Community-Based Dental Partnership
Program Data Reporting Requirements
All CBDPP recipients will use this report to submit annual program data for the period
of January 1 through December 31 of the prior year.
In addition to Sections 1 through 4, CBDPP recipients must also complete Section
6, “Additional Community-Based Dental Partnership Program Information,” which
includes items about the community-based partnership and target populations.
You are strongly encouraged to use the DSR Database Utility (available for
download from https://hab.hrsa.gov/program-grants-management/data-reportingrequirements-and-technical-assistance) to complete and submit your report
electronically.

Submission and Due Dates
Submit the DSR by 6 p.m. ET on April 3, 2020.

Dental Services Report Assistance
To obtain materials for your submissions, go to the HRSA HIV/AIDS Bureau website
at https://hab.hrsa.gov/program-grants-management/data-reporting-requirementsand-technical-assistance. You can download the DSR Database Utility and related
materials to assist you during the submission process.
If you need technical assistance, contact Ryan White Data Support via telephone and
email.

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Ryan White HIV/AIDS Program Data Support
Help Line
Days and hours of operation: Monday – Friday, 10 a.m. – 6:30 p.m. ET
Phone number: 1-888-640-9356
Email: [email protected]
Please note that Data Support is closed on all observed federal holidays.

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Dental Services Report
Instructions
All programs must complete Sections 1 through 4 (Items 1–20).

Section 1.
Institution/Program and Contact Information
Item 1. Institution/Program Information
Enter the institution or program name, address, city, state, zip code, federal tax
identification number, and Data Universal Number System (DUNS) number. If available,
enter a website address for the organization entered in the first line.

Item 2. Purpose of This Report
Indicate whether the institution identified in Item 1 is applying for DRP funding or
submitting annual CBDPP data.

Note: Institutions applying for DRP funding and have a CBDPP
grant must submit separate reports reflecting the separate patient
populations served by DRP and CBDPP.
Applicants for DRP funding will submit information from July 1 through June 30 of
the previous year (e.g., applications due in 2020 report on services and training from
July 1, 2018, to June 30, 2019). CBDPP recipients will submit annual program data
from January 1 through December 31 of the prior year.

Item 3. Type of Institution/Program
Indicate the type of education program submitting this report (select only one option).
• Accredited predoctoral dental education program – School of Dentistry.
• Accredited postdoctoral dental education program – School of Dentistry,
Hospital, Health Center or Other.
• Accredited dental hygiene education program.

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Item 4. Program Contact Person
Indicate the name and contact information for the person most closely connected to
the provision of services covered by this report, typically the dentist or dental hygienist
managing the program. This person will be notified of funding and will be considered
the primary contact for all dental program communications. Include the contact
person’s email address, as this has become a primary method of correspondence.

Item 5. Alternate Program Contact
Provide an alternate name and contact information for a person connected to the
provision of services if the person in Item 4 is unavailable.

Item 6. Data Contact Person
Provide the name and contact information for the person responsible for verifying
the data and submitting this report, if different from the person in Item 4. This person
will be contacted for questions about the data submitted in this report. If this is the
same person listed in Item 4, indicate this on the “name” line.
Reporting demographic information about patients receiving care supported by
Ryan White HIV/AIDS Program (RWHAP) funds (as requested in Items 7–16) is a
program requirement of all RWHAP recipients. Demographic information is based
on patients’ self-identification.
All references to “your program” refer to aggregate data from your institution/
program, including all partners or sites, if applicable.
Avoid reporting in the “unknown” category whenever possible.

Section 2.
Patient Demographics and Oral Health Services
Item 7a. Unduplicated Patient Count
Indicate the number of all unduplicated patients with HIV who received at least one
oral health service from your program’s students, residents, faculty, or dental staff
during the period covered by this report, regardless of where these services were
provided. This number should include all individuals with HIV seen during this period
whose services were exclusively or partially paid for by RWHAP. Include patients
who are not continuing to receive services from your clinic because they moved,
transferred to another institution, program, or provider; or died.
This must be an actual count of patients with HIV. You may not use estimates of any
kind.

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Item 7b. New Patients
Of the number of patients reported in Item 7a, indicate how many patients were
seen by your program for the first time during the period covered by this report.
Patients who were seen in a prior period, even if after an absence from your clinic,
should not be counted as new patients.
Note: The number of new patients provided in Item 7b must be less
than or equal to the total in Item 7a.

Item 8. HIV/AIDS Status
Of the number of patients reported in Item 7a, indicate the number by HIV/AIDS
status as of the first visit in the period covered by this report.
• HIV-positive, not AIDS.
• CDC-defined AIDS (HIV-positive with AIDS-defining illness).
• HIV-positive, AIDS status unknown.
Note: The sum of all HIV/AIDS status categories must equal the total
number of patients reported in Item 7a.

The 1993 AIDS Surveillance Case Definition of the U.S. Centers for
Disease Control and Prevention
A diagnosis of AIDS is made whenever a person is living with HIV and:
• S/he has a CD4+ cell count below 200 cells per microliter.
• Her/his CD4+ cells account for less than 14 percent of all lymphocytes.
OR
• S/he has been diagnosed with one or more AIDS-defining illnesses.
Go to https://www.cdc.gov/mmwr/preview/mmwrhtml/00018871.htm
for a complete list.

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Item 9a. Gender
Of the number of patients reported in Item 7a, indicate the number by gender.
•
•
•
•

Males.
Females.
Transgender.
Unknown/unreported.
Note: The sum of all gender categories must equal the total number of
patients reported in Item 7a.

Item 9b. Sex at Birth
Of the number of patients reported in Item 7a, indicate the number by the sex
assigned to the client at birth.
• Males.
• Females.
Note: The sum of all sex categories must equal the total number of
patients reported in Item 7a.

Item 10. Pregnant Patients
Of the total number of female patients with HIV reported in Item 9b, indicate their
pregnancy status during the period covered by this report. Indicate their status as
“pregnant,” when that is known, regardless of the pregnancy outcome.
Also indicate the number who were known to not be pregnant, or who were unsure
of their pregnancy status.
•
•
•
•

Pregnant.
Not pregnant.
Unsure if pregnant.
Unknown/unreported.
Note: If data are reported in the “unknown/unreported” category,
indicate why the data are not available. The sum of all pregnancy
categories must equal the total number of female patients reported in
Item 9b.

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Item 11a. Ethnicity
Of the number of patients reported in Item 7a, indicate the number by the ethnicity
categories shown.
Note: The sum of the ethnicity categories must not exceed the total
number of patients reported in Item 7a. RWHAP dental programs
are expected to make every effort to obtain and report ethnicity
information, based on each patient’s self-identification.
Hispanic, Latino/a is a person of Mexican, Puerto Rican, Cuban, Central or South
American, or other Spanish culture or origin, regardless of race.
• Hispanic or Latino/a.
• Non-Hispanic or Latino/a.

Item 11b. Hispanic Ethnicity
Of the number of Hispanic patients reported in Item 11a, indicate the number by the
ethnic subcategories shown.
•
•
•
•

Mexican, Mexican American, Chicano/a.
Puerto Rican.
Cuban.
Other Hispanic, Latino/a or Spanish origin.
Note: The sum of the Hispanic ethnicity categories must not exceed
the total number of Hispanic patients reported in Item 11a. RWHAP
dental programs are expected to make every effort to obtain and report
ethnicity information based on each patient’s self-identification.

Item 12a. Race
Of the number of patients reported in Item 7a, indicate the number by the race
categories shown. Patients who identify with more than one race or as being of
mixed race should be counted in the “More than one race” category.
Note: The sum of all race categories must not exceed the total number
of patients reported in Item 7a. RWHAP dental programs are expected
to make every effort to obtain and report race information based on
each patient’s self-identification.

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The following racial category descriptions, defined in October 1997, are required for
all federal reporting, as mandated by OMB.
For more information, see https://obamawhitehouse.archives.gov/omb/
fedreg_1997standards. HRSA mandated use of these categories as of January 2002.
• White is a person having origins in any of the original peoples of Europe, the
Middle East, or North Africa.
• Black or African American is a person having origins in any of the black racial
groups of Africa.
• Asian is a person having origins in any of the original peoples of the Far East;
Southeast Asia; or the Indian subcontinent, including Cambodia, China, India,
Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
• Native Hawaiian or Other Pacific Islander is a person having origins in any of
the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
• American Indian or Alaska Native is a person having origins in any of the
original peoples of North and South America (including Central America) and
who maintains tribal affiliation or community attachment.
• More than one race is a person who identifies with more than one racial
category.

Item 12b. Asian Race
Of the number of Asian patients reported in Item 12a, indicate the number by the
racial subcategories shown.
•
•
•
•
•
•
•

Asian Indian.
Chinese.
Filipino.
Japanese.
Korean.
Vietnamese.
Other Asian.

Note: The sum of the Asian racial categories must not exceed the
total number of Asian patients reported in Item 12a. RWHAP dental
programs are expected to make every effort to obtain and report race
information based on each patient’s self-identification.

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Item 12c. Native Hawaiian/Pacific Islander Race
Of the number of Native Hawaiian or other Pacific Islander patients reported in Item
12a, indicate the number by the racial subcategories shown.
•
•
•
•

Native Hawaiian.
Guamanian or Chamorro.
Samoan.
Other Pacific Islander.
Note: The sum of the Native Hawaiian or other Pacific Islander racial
categories must not exceed the total number of Native Hawaiian or
other Pacific Islander patients reported in Item 12a. RWHAP dental
programs are expected to make every effort to obtain and report race
information based on each patient’s self-identification.

Item 13. Age
Of the number of patients reported in Item 7a, indicate the number of patients by
their oldest ages at any time during the period covered by this report.
•
•
•
•
•
•

12 or younger.
13-24.
25-44.
45-64.
65 or older.
Unknown/unreported.
Note: The sum of all age categories must equal the total number of
patients reported in Item 7a.

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Item 14. Household Income
Of the number of patients reported in Item 7a, indicate the number of patients by
their annual household income relative to the federal poverty guidelines at any time
during the period covered by this report. (See Poverty Guidelines, Research, and
Measurement at: https://aspe.hhs.gov/poverty-research.)
• Equal to or below the federal poverty line.
• 101-200% of federal poverty line.
• 201-300% of federal poverty line.
• >300% of federal poverty line.
• Unknown/unreported.
Note: The sum of all Household Income categories must equal the total
number of patients reported in Item 7a.

Item 15. Types of Oral Health Services
Indicate the total number of visits made by patients reported in Item 7a for each
type of service provided during the period covered by this report. This question
is intended to determine the scope and relative frequency of oral health services
provided for your patients, not the number of individual treatment procedures
performed. Therefore, report numbers of visits, not patients or procedures. As far as
possible, if your program provided several services to a patient during a single clinic
visit, count each service type as a separate visit. For example, if during a patient’s
clinic visit, you took radiographs, performed two quadrants of root planning, and
provided root canal therapy for two molars, count these as three visits — one visit
each in the diagnostic, periodontic, and endodontic service categories.
If the type of service provided is not listed, specify it in the “Other” category.
•
•
•
•
•
•
•
•
•
•
•
•
•
•

Diagnostic.
Preventive.
Oral health education/health promotion.
Nutrition counseling.
Tobacco prevention/cessation.
Oral medicine/oral pathology.
Restorative.
Periodontic.
Prosthodontic.
Oral and maxillofacial surgery.
Endodontic.
Anesthesia/sedation/nitrous oxide analgesia/palliative care.
Emergency services.
Other (specify below).

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Item 16. Location of Primary Medical Care
Of the number of patients reported in Item 7a, show the number who usually received
their primary medical care in each of the locations listed.
• Provider or clinic co-located in the same physical facility or site where oral
health care is provided.
• Provider or clinic in the same institution providing oral health care, but at a
different site.
• Other medical provider or clinic not in the same institution providing oral
health care at a different site.
• Unknown/unreported.

Note: The total number of patients reported here should be equal to
the total reported in Item 7a.

Section 3.
Funding and Payment Coverage
Item 17a. Ryan White HIV/AIDS Program Funding
Indicate whether or not the parent institution of the program identified in Item 1
received any other RWHAP funding during the period covered by this report (i.e.,
monies received from RWHAP Parts A–D, including Minority AIDS Initiative funds,
Special Projects of National Significance, or AIDS Education and Training Centers)
to provide any HIV-related services, not only oral health services or training. If the
answer is “Yes,” complete Item 17b; otherwise continue with Item 18.
• Yes.
• No.

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Item 17b. Ryan White HIV/AIDS Program Funding Amounts
Indicate the total amount the parent institution of the program identified in Item 1
received from each RWHAP Part listed (rounded to the nearest dollar).
•
•
•
•
•
•

Part A.
Part B.
Part C.
Part D.
Part F Special Projects of National Significance (SPNS).
Part F AIDS Education and Training Centers (AETCs).
Note: Only report direct reimbursements from third-party payors
(public and private) as payment for services provided in Items 18 and
19. For the purposes of this report, funding from RWHAP or other
grants is considered program income or revenue and should not be
reported in Items 18 or 19.

Item 18. Third-Party Payor Coverage
Of the number of patients reported in Item 7a, indicate how many received oral
health care with no or partial third-party payor coverage and the number whose
third-party payor coverage status was unknown.
• Number of patients who received oral health care with NO third party payor
coverage.
• Number of patients who received oral health care with PARTIAL third party
payor coverage.
• Number of patients whose third party payor coverage status was UNKNOWN.
Note: The total number of patients reported here should be equal to
the total reported in Item 7a.

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Item 19. Number of Patients and Payments Received
Indicate the number of patients with HIV whose oral health care was partially covered
by each of the listed payment sources and the amount of payments received (rounded
to the nearest dollar) from those sources, including patients who self- pay. For the
purposes of this report, count a patient if at any time during the period covered by
this report payment was received for at least one visit or service.
Report patients whose oral health care was covered by more than one payment
source under all categories of payment source from which payment was received.
For example, report a patient whose care was supported by Medicare and private
insurance twice in this table. If a payment source is not included, specify it in the
“Other” category.

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Section 4.
Staffing and Training
Item 20. Staffing and Training
For the period covered by this report, indicate the total number of students,
residents, and other nonstudent dental providers who were enrolled in or rotated
through your program, and the total number of those students, residents, and other
dental providers who received training in providing services to patients with HIV. Also
indicate the total number of hours of your training curriculum dedicated to issues
related to HIV and oral health management, and the total number of hours that all
students, residents, and other dental providers spent providing direct clinical services
for patients with HIV. Attach any optional narrative description of your HIV training
program to provide further clarification.

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Section 5.
Additional Dental Reimbursement Program
Information
This section should only be completed by institutions applying for DRP funding.

Item 21. Authorized Signature
Indicate the name and contact information for the person authorized to sign for the
institution.

A. Use of Funding
Item 22. Intended Use of DRP Funds
Check each way you will use DRP funds. If a use is not listed, specify it in the “Other”
category.
•
•
•
•
•
•
•
•
•
•

Direct patient services (e.g., provider/faculty salaries).
Patient education or outreach.
Curriculum development.
Student education/training.
Staff education/training.
Clinic staff salary/support.
Equipment/instruments/supplies/materials.
Pharmaceuticals or dental medicaments.
General operations.
Other (specify).

B. Unreimbursed Costs
Item 23a. Total Unreimbursed Costs
Indicate the total unreimbursed costs (rounded to the nearest dollar) of oral health care
provided to patients with HIV during the period covered by this report. Institutions/
programs should review their charts and financial records to calculate total actual
unreimbursed costs of services provided. If you cannot calculate actual costs, use as a
surrogate your institution’s usual fees for the services provided (before any discount or
sliding-fee schedule is applied).

Note: The total unreimbursed costs of oral health care provided to
patients with HIV from July 1, 2018, through June 30, 2019, entered in
23a must match the unreimbursed amount entered in 18a and 18g of
the SF-424.

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Item 23b. Calculation Methods
Provide a concise description of the methods used to calculate the amount reported
in Item 23a.

C. Narratives
Note: A text box is available in the Database Utility for narrative
responses (Items 24-26).
Your narrative responses will inform HRSA of your program’s unique characteristics
and strengths in providing comprehensive oral health care for patients with HIV.
Your responses will also enable HRSA to more fully understand the environment in
which oral health care is provided to patients with HIV and to gauge the extent of
collaboration among the various RWHAP-supported programs.

Item 24. Site Descriptions
Concisely describe the sites where your predoctoral dental/postdoctoral dental/
dental hygiene education program provides oral health services to patients with
HIV. In identifying these sites, describe whether students and residents provide
direct patient care in community-based facilities and whether such facilities are
organizational components of your institution or separate organizations.

Item 25. Working Relationships with Ryan White HIV/AIDS
Programs
Describe working relationships that your predoctoral dental/postdoctoral dental/
dental hygiene education program has established with RWHAPs listed in Item 17b,
including RWHAP A HIV planning councils and RWHAP B HIV consortia. Describe how
your program has been working to maximize coordination, integration, and effective
linkages among local RWHAP-funded programs.

Item 26. Special Strengths or Unique Capabilities
Concisely describe any special strengths or unique capabilities of your predoctoral
dental/postdoctoral dental/dental hygiene education program with respect to
providing oral health care for patients with HIV (e.g., facilities, hours of operation,
support services, or staff skills or expertise). Include evening and weekend clinic
hours, onsite participation in clinical trials, provider or staff diversity, special patient
education programs, the availability of childcare services, language translation
services, transportation services, or other special strengths.

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Section 6.
Additional Community-Based Dental
Partnership Program Information
This section should be completed only by CBDPP recipients.

Item 27. Partnership Program Information
List your CBDPP member organizations’ names and addresses and each partner’s
primary contact person. Also indicate if each partner receives CBDPP funds, and
briefly describe each partner’s role, function, or contribution to the partnership
(e.g., special staff skills, capacity to provide services or train providers, experience
managing grants, expertise in community outreach or dental case management,
capacity to provide transportation or child care services).

Step 1:

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Step 2:

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Item 28. Target Populations
Indicate which populations of people with HIV were specially targeted to receive
outreach or services from your program during the period covered by this report.
•
•
•
•
•
•
•
•
•
•
•

Urban populations.
Suburban populations.
Rural populations other than migrant or seasonal workers.
Migrant or seasonal workers.
Runaway or street youth.
Gay, lesbian, bisexual, transgender youth.
Gay, lesbian, bisexual, transgender adult.
Homeless persons.
Incarcerated persons.
Substance addicted persons.
Other, specify.
Note: HRSA RWHAP recipients and subrecipients may provide
HRSA RWHAP core medical services and support services to PLWH
incarcerated in Federal and State prison systems on a transitional
basis only. HRSA RWHAP recipients and subrecipients may also
provide HRSA RWHAP core medical services and support services
to PLWH incarcerated in other correctional systems on a short-term
and/or transitional basis. Please see HRSA HAB Policy Clarification
Notice 18-02 The Use of Ryan White HIV/AIDS Program Funds for
Core Medical Services and Support Services for People Living with HIV
Who Are Incarcerated and Justice Involved for further clarification on
the provision of HRSA RWHAP services to people with HIV who are
justice-involved.

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Glossary
Term

Definition

Eligible Applicant

A dental school, institution with a predoctoral or postdoctoral dental education
program, or a dental hygiene education program that have provided oral health care for
patients with HIV and been accredited by the Commission on Dental Accreditation.

Household Income

The sum of money received in the previous calendar year by all household members,
ages 15 years and older, including household members not related to the householder,
people living alone, and others in nonfamily households.

Patient with HIV

A person who has the human immunodeficiency virus; a person with documented
confirmation of her/his positive serostatus (e.g., a positive HIV test result; a letter
verifying that the person is receiving HIV-related care or services from a primary medical
care provider, case manager, or AIDS service organization; a viral load test result; an
AIDS Drug Assistance Program (ADAP) enrollment card); or a person who self-identifies
as being HIV-positive.

Period Covered by
This Report

The period for which you are reporting data. If you are applying for DRP funding, this
report should present data on services provided from July 1 through June 30 of the prior
year. If you are submitting an annual CBDPP data report, this report should present data
on services provided from January 1 through December 31 of the prior year.

Ryan White HIV/
AIDS Program

The Ryan White HIV/AIDS Treatment Extension Act of 2009—The federal legislation
created to address the health care and service needs of people with HIV disease and
their families in the United States and its territories.

Statewide
Coordinated
Statement of Need
(SCSN)

A statement of significant HIV-related issues specific to each state, which is a result of
coordination, integration, and effective links across the Ryan White HIV/AIDS Programs.
The Ryan White HIV/AIDS Treatment Extension Act of 2009 requires recipients to
conduct activities to enhance coordination across all Ryan White HIV/AIDS Programs,
including collaborative development of a SCSN.

Unduplicated
Number of Patients

Patients counted using a method by which a single individual is counted only once
during the period covered by this report, regardless of how many clinic visits were made
or procedures performed. For institutions that provided care at multiple sites, a patient
is counted only once, even if he or she received services at more than one site.

Unreimbursed Oral
Health Care Costs

The balance remaining after subtracting the total payment received from patients
with HIV or Medicaid or other third-party payors, plus grants and all other sources of
revenue to support oral health care for HIV positive patients, from the total of actual
costs incurred by the applicant institution in providing oral health care to those patients.
If actual costs to provide services cannot be calculated, then the applicant institution’s
usual fees for those procedures (before any discount or sliding-fee schedule is applied)
should be used as a surrogate for actual costs.

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