HHSC is requesting contact information for people receiving Deaf Blind with Multiple Disabilities (DBMD) services in an assisted living facility (ALF) or a 1-3 person home. HHSC will use this information to identify and verify individual’s information for our upcoming DBMD onsite survey related to Home and Community-Based Services (HCBS) regulations. Please submit the following information for each person your agency serves who resides in one of these settings:

  • Provider name
  • Contact name, email/phone number
  • Individual’s name
  • Physical address of residence
  • Home phone
  • Medicaid ID
  • Medical history/diagnosis
  • Primary communication method
  • Guardian? (Y/N)
  • If individual has guardian, guardian's name and phone number
  • Intervener? (Y/N)

Please submit the requested information via fax or mail by close of business Oct. 4, 2017. For any related questions please call Desireé Martinez at 512-438-4855.

By fax: 512-438-5532

By mail:
Texas Health and Human Services
Long-Term Services and Supports
Mail Code: W-580
P.O. Box 149030
Austin, TX 78714-9030