Ryan White CARE Act Dental Reimbursement Program

OMB No. 0915-0151
Expires: July 31, 2011

INSTRUCTIONS FOR COMPLETING
THE RYAN WHITE HIV/AIDS PROGRAM

DENTAL SERVICES REPORT

Division of Community-Based Programs
HIV/AIDS Bureau
Health Resources and Services Administration
Parklawn Building, Room 7A-30
5600 Fishers Lane
Rockville, Maryland 20857

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TABLE OF CONTENTS
Form Overview....................................................................................................... 1
Public Burden Statement............................................................................. 1
Overview of the Ryan White HIV/AIDS Dental Programs....................................... 2
Introduction.................................................................................................. 2
Administration.............................................................................................. 2
Eligibility ...................................................................................................... 2
Requirements and Methods for Submission........................................................... 3
General Requirements ................................................................................ 3
Dental Reimbursement Program Application Requirements ....................... 3
Submission and Due Date........................................................................... 3
Community-Based Dental Partnership Program Data Reporting
3
Requirements ..............................................................................................
Dental Services Report Assistance ............................................................. 3
Dental Services Report Instructions ....................................................................... 4
Section 1. Institution/Program and Contact Information .............................. 4
Section 2. Patient Demographics and Oral Health Services........................ 4
Section 3. Funding and Payment Coverage ................................................ 6
Section 4. Staffing and Training................................................................... 7
Section 5. Additional Dental Reimbursement Program Information............. 7
Section 6. Additional Community-Based Dental Partnership Program
Information .................................................................................................. 8
Glossary of Terms .................................................................................................. 9

Instructions for Completing the Ryan White HIV/AIDS Program
2010 Dental Services Report

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FORM OVERVIEW
The Dental Services Report is used by two
different programs under the Ryan White
HIV/AIDS Treatment Modernization Act of 2006
(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 post-doctoral dental education
programs and dental hygiene education programs
regarding oral health services provided to people
who are HIV positive.
Institutions applying for Dental Reimbursement
funding may 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 the applicant for this collection of
information is estimated to average 20 hours per
response, 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 14-45
Rockville, Maryland, 20857

Instructions for Completing the Ryan White HIV/AIDS Program
2010 Dental Services Report

1

OVERVIEW OF THE RYAN WHITE HIV/AIDS DENTAL PROGRAMS
Introduction
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 Dental
Reimbursement Program (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 community-based oral
health providers. The Community-Based Dental
Partnership Program (CBDPP) focuses on the
provision of care and the training of additional oral
health providers through collaborative communitybased 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
grantee must collect, manage, and report annual
program data that will document key service delivery
and educational components of the funded programs.

Instructions for Completing the Ryan White HIV/AIDS Program
2010 Dental Services Report

Administration
The HIV/AIDS DRP and the CBDPP are
administered by the Division of Community-Based
Programs within the HIV/AIDS Bureau (HAB) of
the Health Resources and Services Administration
(HRSA). Questions regarding these programs should
be directed to:
Mahyar Mofidi, D.M.D., Ph.D.
Telephone: 301-443-2075
Division of Community-Based Programs
HIV/AIDS Bureau, HRSA
Parklawn Building, Room 7A-30
5600 Fishers Lane
Rockville, MD 20857
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 Dental Services Report, which includes:
•
•
•
•

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 Office
of Management and Budget (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/Summer 2010 report on
services and training provided from July 1, 2008 to
June 30, 2009).
In addition to Sections 1 through 4, DRP applicants
also must complete Section 5, 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.
Submission and Due Date
To be considered for DRP funding, applications
must be received no later than June 7, 2010.
Use the Database Utility (available for download
from http://hab.hrsa.gov/tools.htm) to complete
and submit your Report electronically. The DRP
submission has two components: you must upload
a PDF of your DSR to Grants.gov and you must
email your data file to WRMA/CSR Ryan White
Data Support.
Paper submissions will generally not be accepted.
In extreme cases, applicants 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
Instructions for Completing the Ryan White HIV/AIDS Program
2010 Dental Services Report

ACCEPTED FOR CONSIDERATION FOR
DENTAL REIMBURSEMENT PROGRAM
FUNDING.
Community-Based
Dental
Partnership
Program Data Reporting Requirements
All CBDPP grantees will use this Report to submit
annual program data for the period of January 1
through December 31 of the prior year. The
CBDPP Reports are typically due in March each
year.
In addition to Sections 1 through 4, CBDPP grantees
must also complete Section 6, which includes items
about the community-based partnership and target
populations.
You are strongly encouraged to use the Database
Utility
(available
for
download
from
http://hab.hrsa.gov/tools.htm) to complete and
submit your Report electronically. If you choose
to submit an annual data report on paper, you may
fax your Report to WRMA/CSR Ryan White Data
Support, or you may mail your completed Report to
the following address:
WRMA/CSR Ryan White Project
Attn: Dental Services Report
2107 Wilson Blvd, Suite 1000
Arlington, VA 22201
FAX: (703) 312-5230
Dental Services Report Assistance
To obtain copies of materials for your submissions,
go to the HIV/AIDS Bureau Web site at
http://hab.hrsa.gov/tools.htm to view and download
the Dental Services Report, Instructions for
Completing the Report, and related materials.
WRMA/CSR Ryan White Data Support offers
technical assistance via telephone and e-mail to DRP
applicants and CBDPP grantees.
Ryan White HIV/AIDS Program Data Support
Help Line
Hours of operation: 9:00 a.m. to 5:30 p.m. ET
Days of operation: Monday through Friday
Phone Number: 1-888-640-9356
(through July 2, 2010)
E-mail: RWdatasupport.wrma@csrincorporated.com

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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 and the
address. Please remember to indicate the
institution’s Federal tax identification number and
DUNS number. If available, enter a Web site
address for the organization indicated 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 that are
applying for DRP funding and have a CBDPP
grant must submit separate Reports reflecting the
separate patient populations served by the DRP
and the CDBPP.
Applicants for DRP funding will submit
information for the period July 1 through June 30
of the previous year (e.g., applications due in 2010
report on services and training from July 1, 2008 to
June 30, 2009). CBDPP grantees will submit
annual program data for the period of 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 1 option).
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 individual will be notified of funding and will
be considered the primary contact person for all
Dental Program communications. Please indicate
the contact person’s e-mail address, as this has
become a primary method of correspondence.
Item #5. Program Updates
Check the box if the person identified in item #4
would like to receive bimonthly e-mail updates
from the HIV/AIDS Bureau. If this box is checked,
an e-mail address must be provided in item #4.

Instructions for Completing the Ryan White HIV/AIDS Program
2010 Dental Services Report

Item #6. Alternate Program Contact
Provide the name and contact information for an
alternate contact person connected to the provision
of services if the person identified in item #4
cannot be reached.
Item #7. 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
listed in item #4. The individual listed in this Item
will be contacted if there are questions about the
data submitted in this Report. Please indicate
“same person as in item #4” on the “name” line, if
that is the case.
Reporting demographic information about patients
receiving care supported by Ryan White HIV/AIDS
Program funds (as requested in items #8 – #16) is
a program requirement of all Ryan White
HIV/AIDS Program grant recipients. Demographic
information is based on patients’ selfidentification.
All references to “your program” refer to
aggregate data from your institution/program,
including all partners or sites, if applicable.
Please avoid reporting in the “unknown” category
whenever possible.
SECTION 2. PATIENT DEMOGRAPHICS AND
ORAL HEALTH SERVICES

Item #8a. Unduplicated Patient Count
Indicate the number of all unduplicated patients
with HIV who received at least one oral health
service from the students, residents, faculty, or
dental staff of your program during the period
covered by this Report, regardless of where these
services were provided. This number should
include all individuals who are HIV positive seen
during this period, regardless of the funding
sources that supported their care. Include
patients who are not continuing to receive services

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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.
Item #8b. New Patients
Of the number of patients reported in item #8a,
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
#8b must be less than or equal to the total in item
#8a.
Item #9. HIV/AIDS Status
Of the number of patients reported in item #8a,
indicate the number by HIV/AIDS status as of the
first visit in the period covered by this Report.
Note: The sum of all HIV/AIDS status categories
must equal the total number of patients reported in
item #8a.
The 1993 AIDS Surveillance Case Definition of the U.S.
1

Centers for Disease Control and Prevention*

A diagnosis of AIDS is made whenever a person is HIV-positive
and:
• He or she has a CD4+ cell count below 200 cells per
microliter;
• His or her CD4+ cells account for less than 14 percent
of all lymphocytes; OR
• That person has been diagnosed with one or more
AIDS-defining illnesses.
Go to
http://www.cdc.gov/mmwr/preview/mmwrhtml/00018871.htm
for a complete list.

pregnancy. Also, indicate the number who were
known not to be pregnant, or who were unsure of
their pregnancy status. 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 #10.
Item #12a. Ethnicity
Of the number of patients reported in item #8a,
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 #8a. Ryan White HIV/AIDS
Program dental programs are expected to make
every effort to obtain and report ethnicity
information, based on each patient’s selfidentification.
Hispanic or Latino/a is a person of Mexican,
Puerto Rican, Cuban, Central or South American,
or other Spanish culture or origin, regardless of
race.
Item #12b. Race
Of the number of patients reported in item #8a,
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 #8a. Ryan White HIV/AIDS Program dental
programs are expected to make every effort to
obtain and report race information, based on each
patient’s self-identification.

Item #10. Gender
Of the number of patients reported in item #8a,
indicate the number by gender. Note: The sum of
all gender categories must equal the total number
of patients reported in item #8a.
Item #11. Pregnant Patients
Of the total number of female patients with HIV
reported in item #10, indicate their pregnancy
status during the period covered by this Report.
Indicate their status as “pregnant,” when that is
known, regardless of the outcome of the
1

Centers for Disease Control and Prevention, "1993 Revised Classification System for HIV Infection and Expanded
Surveillance Definition for AIDS Among Adolescents and Adults," Morbidity and Mortality Weekly Report 41 (December 18,
1992), pp. 1-19.
Instructions for Completing the Ryan White HIV/AIDS Program
5
2010 Dental Services Report

The following racial category descriptions, defined
in October 1997, are required for all Federal
reporting, as mandated by the Office of
Management and Budget
(For more information see
www.whitehouse.gov/omb/fedreg/ombdir15.html).
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, for
example, 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 #13. Age
Of the number of patients reported in item #8a,
indicate the number of patients by their oldest ages
at any time during the period covered by this
Report. Note: The sum of all age categories must
equal the total number of patients reported in item
#8a.
Item #14. Household Income
Of the number of patients reported in item #8a,
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:
http://aspe.hhs.gov/poverty/figures-fed-reg.shtml.)
Note: The sum of all Household Income categories
must equal the total number of patients reported in
item #8a.

Instructions for Completing the Ryan White HIV/AIDS Program
2010 Dental Services Report

Item #15. Types of Oral Health Services
Indicate the total number of visits made by patients
reported in item #8a for each type of service
provided during the period covered by this Report.
The intent of this question is to determine the
scope and relative frequency of oral health services
provided for your patients, not the number of
individual treatment procedures performed.
Therefore, for purposes of this Report, please
report numbers of visits, not patients or
procedures. As far as possible, if your program
provided several services during a single clinic
visit, count each service type as a separate visit.
For example, if during a patient’s visit to the clinic,
you took radiographs, performed two quadrants of
root planing, and provided root canal therapy for
two molars, please count these as three visits, that
is, one visit each in the diagnostic, periodontic, and
endodontic service categories.
If the type of service provided is not listed on the
form, specify it in the “Other” category.
Item #16. Location of Primary Medical Care
Of the number of patients reported in item #8a,
show the number who usually received their
primary medical care in each of the locations
shown. Note: The total number of patients
reported here should be equal to the total reported
in item #8a.
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
Ryan White HIV/AIDS Program funding during
the period covered by this Report (i.e., monies
received from 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.
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 of the Ryan White HIV/AIDS Programs listed
(rounded to the nearest dollar).
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Item #18. Third Party Payor Coverage
Note: Only direct payments from third party
payors (public and private) for services
provided should be reported in items #18 and
#19. For the purposes of this Report, funding
from the Ryan White HIV/AIDS Program or
other grants is considered program income or
revenue, and should not be reported in items
#18 or #19.
Of the number of patients reported in item #8a,
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. Note: The total number of patients
reported here should be equal to the total reported
in item #8a.
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 indicated payment sources and the amount of
payments received (rounded to the nearest dollar)
from those sources, including patients who selfpay. For the purposes of this Report, count a
patient in this table if at any time during the period
covered by this Report, payment was received for
at least one visit or service.
Patients whose oral health care was covered by
more than one payment source should be reported
under all categories of payment source from which
payment was received. For example, a patient
whose care was supported by Medicare and private
insurance should be reported twice in this table. If
a particular payment source is not included on the
form, specify it in the “Other” category.
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
Instructions for Completing the Ryan White HIV/AIDS Program
2010 Dental Services Report

spent providing direct clinical services for patients
with HIV. Please feel free to attach any optional
narrative description of your HIV training program
if you wish to provide further clarification.
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 option for the ways in which Dental
Reimbursement Program funds will be used. If a
particular use is not listed, specify it in the “Other”
category.
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
actual costs cannot be calculated, then use as a
surrogate the applicant institution’s usual fees for
the services provided (before any discount or
sliding-fee schedule is applied).
Item #23b. Calculation Methods
Please provide a concise description of the
methods used to calculate the amount reported in
item #23a.
C. NARRATIVES
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 Ryan White
HIV/AIDS Program-supported programs.

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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
Ryan White HIV/AIDS Programs listed in item
#17b, including Part A HIV planning councils and
Part B HIV consortia. Describe how your program
has been working to maximize coordination,
integration, and effective linkages among local
Ryan White HIV/AIDS Program-funded programs.
Item #26. Development of the Statewide Coordinated
Statement of Need
Describe how your predoctoral dental/ postdoctoral
dental/dental hygiene education program has been
involved in the development and updating of the
Statewide Coordinated Statement of Need (SCSN).
Include direct and indirect involvement with your
state’s SCSN.
Item #27. Outreach
Describe any additional ways your predoctoral
dental/postdoctoral dental/dental hygiene education
program conducts outreach to persons with HIV to
increase their awareness of the availability of oral
health services, or builds community links with
program managers and providers working with this
population.

translation services, transportation services, or
other special strengths.
SECTION 6. ADDITIONAL COMMUNITYBASED DENTAL PARTNERSHIP
PROGRAM INFORMATION
This section should be completed only by CBDPP
grantees.

Item #29. Partnership Program Information
In the table provided, list the names and addresses
of the member organizations of your CommunityBased Dental Partnership Program, 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, etc.).
Item #30. Target Populations
Indicate which populations were specially targeted
to receive outreach or services from your program
during the period covered by this Report.
Note: Ryan White HIV/AIDS Program funds may
only be used for limited short-term, transitional
social support and primary care services for
incarcerated persons as they prepare to exit the
correctional system as part of effective discharge
planning. Please consult “HAB Policy Notice – 0704 of September 28, 2007” for further clarification
of the limitations on the use of Ryan White
HIV/AIDS Program funds to provide services to
incarcerated persons.

Item #28. 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).
Responses might include information regarding
evening and weekend clinic hours, onsite
participation in clinical trials, provider or staff
diversity, special patient education programs, the
availability of childcare services, language
Instructions for Completing the Ryan White HIV/AIDS Program
2010 Dental Services Report

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GLOSSARY OF TERMS
Eligible Applicant

Household income

Patient with HIV

Period Covered by
this Report

Ryan White HIV/AIDS
Program

Statewide
Coordinated
Statement of Need
(SCSN)
Unduplicated
Number of Patients
Unreimbursed Oral
Health Care Costs

A dental school or other institution with a predoctoral or postdoctoral dental
education program, or a dental hygiene education program, that has provided oral
health care for patients with HIV and has been accredited by the Commission on
Dental Accreditation.
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.
A person who has the human immunodeficiency virus; a person with documented
confirmation of her/his positive serostatus [examples include 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 ADAP (AIDS Drug Assistance Program) enrollment card and
similar documents]; or a person who self-identifies as being HIV-positive.
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.
The Ryan White HIV/AIDS Treatment Modernization Act of 2006—The Federal
legislation created to address the health care and service needs of people living with
HIV/AIDS (PLWHA) disease and their families in the United States and its
Territories. The newly enacted law changes how Ryan White funds can be used, with
an emphasis on providing life-saving and life-extending services PLWHA.
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 Modernization Act of 2006
requires grantees to conduct activities to enhance coordination across all Ryan White
HIV/AIDS Programs, including collaborative development of a SCSN.
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.
The balance remaining after subtracting the total payment received from patients with
HIV or Medicaid or other third-party payers, 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.

Instructions for Completing the Ryan White HIV/AIDS Program
2010 Dental Services Report

9