GPRA Assessments

Government Performance and Results Act (GPRA) Assessments General Overview

The Government Performance and Results Act (GPRA) assessment is used to evaluate the performance of HHSC substance use programs. The programs that use this assessment include, but are not limited to, the programs which receive funding originating from the Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Treatment (CSAT).

Have the client answer all of the questions. At the beginning of each section, you should introduce the next section of questions, (e.g., “Now I’m going to ask you some questions about…”) Read each question as it is written. In certain cases, the item in parentheses may or may not be read to the client. If a client is having trouble understanding a question, you may explain it to the client to help in its understanding; however, do not change the wording of the question.

To meet the SAMHSA GPRA specifications that was published to all the state organizations in June 2022, HHSC staff have made the changes to the GPR 100 (Treatment client) and GPR 101 (client in recovery). These changes will be effective until HHSC introduces a new solution to capture GPRA assessment data.

HHSC has removed all the tabs other than ‘Record Management’ from Initial/Follow Up/Discharge GPRA Assessment. Providers will now download an Excel template that will be used to answer the assessment questions with the client.

Providers will no longer be able to ‘Close Complete’ GPRA Assessment forms in the CMBHS application. This capability will only be provided to HHSC staff.

General Information about all GPRA Assessment Types

An assessment, more comprehensive than a screening, is a health professional’s review of an individual. The review consists of an evaluation of a variety of domains including current and past functioning in the areas of behavioral health diagnoses, planned services, demographics, military family and deployment, drugs and alcohol use, family and living conditions, education employment and income, crime and criminal justice status, mental and physical health problems and treatment/recovery, and social connectedness.

From the assessment, you identify the person’s problems, goals, strengths, and limitations. The assessment is the foundation for collaboration with the client on the development of the plan for treatment and recovery. The strengths and limitations are used to individualize services in ways that increase their likelihood of being beneficial to the client.

How to conduct a GPRA Assessment

Read response categories that appear in lower-case lettering. If all response categories are in capital letters, ask the question open-ended (in other words, do not read the responses, but instead let the client answer and then mark which response the client indicates.

If the client refuses to answer a question, mark “REFUSED” on the tool. For items where response options are read to the client, do not offer “REFUSED” to answer as response options—these options should be client-generated only.

If the client does not know the answer to a question after staff explanation or refuses to answer a question where “REFUSED” is not listed as a response option, then the interviewer should leave the question blank in the Excel tool. The question will be marked as “MISSING DATA” for these items. The same process should be followed if a question within the GPRA Tool is accidentally missed or skipped and cannot be asked of the client.

Questions intended for provider staff do not have a “REFUSED” response option. Providers are expected to be able to report on these questions and should not skip or leave any of these items blank.

Before starting the assessment, consider using a calendar to mark off the last 30 days. Many questions in the tool refer to the last 30 days and having a calendar present may assist with client recall of events.

Assessments must be conducted in person unless your organization has been instructed otherwise.

Before You Start an Assessment

Your business entity must have a contract (or other approved written agreement) with HHSC to perform GPRA Opioid Assessments and document them in CMBHS.

The CMBHS user must be assigned a role that permits documentation of GPRA Opioid Assessments. You must have the proper credentials and they must be accurately entered into your CMBHS account in order to be assigned those roles. Click here for a summary of Roles in CMBHS and each role's Read-Only or Read/Write Page Rights.

Before you attempt to document an Assessment in CMBHS, make sure you are fully aware of how to use the Document Status and Save functions. For more information about Document Status, Click here .

Verify that you have the correct client record by checking the client’s name and at least one other identifier before you begin to document.

To begin a GPRA assessment, your agency and the client must meet the following pre-conditions:

Initial:

Pre-Conditions for Treatment Clients:

Clients in treatment services must have the following three documents in place:

The client must have a financial eligibility with DSHS Program Funding or BMO Authorized Funding. Financial Eligibility can be completed within the same provider or it can be consented from OSAR Provider Location.
The client must have a Service Begin, in closed complete status, with a Service Type that contains the word "Opioid".

The funding source must be DSHS Program Funding or BMO Authorized Funding.
The service begin must have been created within the same Provider/ Administrative Location, however, it is allowable for the service begin to have been created at a different Service/Clinic location. The secondary location must still meet the location-based requirements for accessing GPRA.

3. The client must have an Initial SUD Assessment in closed complete status.

The document type must be “Assessment SUD” with the description containing the phrase “Initial-Treatment Services”
Clients who begin in detoxification service types, or other mental health services may have a different initial assessment type and subsequently only had an “Update” SUD assessment when they began MAT services. In this instance you must go back and do an initial SUD Assessment.

Pre-Conditions for Recovery Support Services/ Case Management Clients:

The client must have an Open Case with the case type: “TTOR - Recovery Services – Adult”, “TTOR Recovery Services – Youth” or “TTOR Integrated Services”.

Six Month Follow-Up:

You will be able to initiate the Follow-up assessment only when an initial assessment is in "Closed Complete" status and it has been at least 5 months since the initial GPRA assessment interview date.
If the initial GPRA Assessment is in "Closed Incomplete", "Ready for Review" and/or "Draft" statuses, then the system shall display the pop-up message to inform you about the missing information.

Discharge:

You can access the discharge assessment using the menu on the left of the screen or, for treatment clients, you may access the assessment within the Discharge Client document. When accessing through the Discharge Client document type, you should fill out the required fields prior to initiating the GPRA Discharge Assessment.
You will be able to initiate the discharge assessment only when the initial assessment is in the "Closed Complete" status.
If the initial GPRA Assessment is in "Ready for Review" and/or "Draft" statuses, then the system shall display the pop-up message to inform you about the missing information.

Time Frame for GPRA Assessment Completion

CMBHS sends messages to remind staff when each assessment type is due. The messages will only be sent to the clinician/recovery coach/case manager assigned to the client. Reminder messages will not display in your clinician/recovery coach/case manager workspace for clients who are unassigned. To see if the client needs an assessment completed you may view reminders in the Client Workspace or use the “GPRA – Clients Due for Assessment” report. More details click here.

Initial	For clients in Medication Assisted Treatment (Opioid Treatment Services or Office Based Opioid Treatment) programs except services like Opioid Therapy Services (NAS) – Adult” and “Opioid Substitution Therapy (MAT Specialized Female) (PPW) – Adult, GPRA initial assessments should be completed within 4 days after the client enters the program, but no later than 4 weeks after their Service Begin date. For clients in Recovery Support Services (RSS) programs, GPRA initial assessments should be given when a client is fully engaged in RSS services. This includes when a client commits to long term recovery coaching. If a client is engaged in services 60 days after their Case Open date, the program should conduct a GPRA assessment. An initial GPRA assessment is completed when a client begins services for the first time. Each time a client leaves treatment/recovery support services and their file is closed, but they reenter treatment at a later date, an additional round of GPRA assessments must be initiated using the initial identifier assigned to the client. Changes in the federal funding may also require completing a new initial GPRA assessment. The dates for follow-up assessments will be determined by the date of the most recent initial GPRA assessment. For example: A client enters in January and completes the first GPRA intake assessment. He/she leaves treatment in March and his/her file is closed. He/she re-enters treatment in April and completes the second GPRA intake assessment. The client’s first 6-month follow-up assessment will be due in October (6 months after April).
Six Month Follow-Up	Follow-up assessments should be completed by the sixth month from the GPRA initial assessment date. The window period allowed for these GPRA follow-up assessments is one month before the 6-month anniversary date and up to two months after the 6-month anniversary date. For example, if a client receives the GPRA initial assessment on January 1st, the six-month follow-up anniversary date would be July 1st. The window period for conducting the 6-month follow-up assessment would open one month before the anniversary date on June 1st, and close two months after the anniversary date on September 1st. The target follow-up rate is 100%; meaning programs must attempt to follow-up with all clients. The minimum follow-up completion rate is 80%.
Discharge	When to conduct the GPRA discharge assessment? If the client is present on the day of discharge/closing their case, the GPRA discharge assessment should be conducted on the day of discharge. If a client has not finished treatment, drops out, or is not present the day of discharge/closing their case, the program must locate the client to conduct the in-person assessment. Your organization will have 14 days after discharge to contact the client and conduct the in-person discharge assessment. If the assessment has not been conducted by day 15, conduct an administrative discharge.

Process Flow to Document GPRA (Initial/Follow Up/Discharge) assessment in the CMBHS application.

After verifying the preconditions, the system allows the user to access the GPRA Assessment screen.
On accessing the GPRA Assessment screen theuser enters the data on the ‘Record Management’ tab.
Save the assessment in ‘Draft’ status.
Click on ‘Download Template’ available on the saved version of the form.
The file name format is

TypeOfAssessmentClient#-InterviewDate-DocumentNumber.xlxs

Example: Initial12345-12132022-1234.xlxs.

Document Number is visible when “show all columns” checkbox is selected on the Client Workspace page.

Enter the data on the downloaded spreadsheet (that contains GPRA Assessment questions).
Save the same file (in xlsx.) format on your computer.
Click on ‘Attachments’ control on the GPRA Assessment in the CMBHS application.
Upload the completed GPRA assessment attachment.
Close the ‘Attachments’ control.
Click on ‘Edit’ control on the GPRA Assessment screen.
Select the ‘Ready for Review’ value from ‘Document Status’ field (if the form is ready for submission).
System saves the form in the ‘Client Workspace’.
HHSC staff will validate that the assessment has no errors. Upon passing, the assessment will be saved in closed complete.

Record Management Information

OVERVIEW

This section pertains to client identification information. The Record management information must be filled out for each GPRA assessment. This section is filled out by you while conducting the assessment; the questions are not asked of the client.

1. CMBHS Client ID (System Generated)

Intent/Key Points

This field automatically fills in the client’s CMBHS client ID. The ID is used when reporting to federal systems.

2. Client Type (System Generated)

Intent/Key Points

This question identifies the type of services the client is receiving.

Answer Choice Definitions

There are two types of clients included in this categorization:

Treatment client—A client who is receiving substance use treatment by your agency.
Client in recovery—A client who is receiving recovery support services from your agency.

Notes

This is a system generated field.
If the patient is in SUD treatment services and has a Service Begin with a Service-Type of "Opioid" then CMBHS will display "Treatment client". You must be entering this record while under a CMBHS location that provides treatment services.
If the patient is in Recovery Support Services and has an Open Case with Case Type "TTOR - Recovery Services - Adult", then CMBHS will display "Client in recovery". You must be entering this record while under a CMBHS location that provides recovery support services. ‎

Interview Type (Required)

Initial

6-month follow-up: Did you conduct a follow-up interview? Yes OR No

If No is selected, a new field displays, ‘How many attempts were made to contact this client for the follow-up interview? (Required). A number must be entered.

Discharge: Did you conduct a discharge interview? Yes OR No

If No is selected, a new field displays, ‘How many attempts were made to contact this client for the discharge interview? (Required). A number must be entered.

Intent/Key Points

The type of GPRA assessment that is being completed. For each interview, CMBHS will automatically fill in the assessment type based on the link you used to start the assessment. For an initial assessment you will enter the interview date. For follow-up and discharge assessments, you will indicate whether the interview was conducted, and if conducted, enter the interview date.

Answer Choice Definitions

Initial

No selections are required. The system will automatically record that you are completing an initial assessment.

6-month follow-up

CLICK the radio button option that best matches the client’s answer:
- “YES” — Select this when you are able to conduct the assessment with the client.
- “NO” – Select this when you are not able to conduct the assessment with the client. In the Follow-up status tab, you will be able to select the reason why the follow-up assessment could not be conducted.

Discharge

CLICK the radio button option that best matches the client’s answer:
- “YES” — Select this when you are able to conduct the assessment with the client.
- “NO” – Select this when you are not able to conduct the assessment with the client.

Notes

When “NO” is selected, the system will automatically hide the assessment tabs that are not required.

For Follow-up GPRA Assessment Only
- An Initial GPRA Assessment must exist.
- The Initial GPRA Assessment date must be at least 5 months prior to the time a Follow-up GPRA Assessment is conducted.
For Discharge GPRA Assessment Only
- An Initial GPRA Assessment must exist.
- Discharge assessment date must be after the initial GPRA assessment date.

4. Interview Date (Required)

Intent/Key Points

The date the GPRA assessment was completed. (If an interview was not conducted for follow-up or discharge, this question will not appear.) The initial GPRA interview date will determine when subsequent follow-up interviews are due. It is also used to calculate the project’s follow-up rate based on how many of the follow-up interviews that were due that have been completed. The GPRA intake/baseline interview date combined with the discharge date is used to calculate the client’s length of stay.

Notes

The interview date is auto-populated by the system with the current/today's date. If needed, you can backdate up to 90 calendar days as long as it's not before the funding source begin date (from the Service Begin document) or case open date, whichever applies.

The interview date cannot be prior to 1/21/2023. If an interview date is entered < 1/21/2023, the system will display the error message

“Due to the change in the GPRA Assessment tool effective 1/21/2023, an interview date before 1/21/2023 is not allowed”

If the interview was conducted prior to 1/21/2023 and was not entered into CMBHS you must conduct a new GPRA assessment using the new interview tool.

For treatment clients, if Interview Date is prior to the funding source begin date upon saving the document, then the system will display the following warning message: "Interview Date cannot be before the Funding Source Begin Date".
For RSS or case management clients, if Interview Date is prior to the open case date upon saving the document, then the system will display the following warning message: "Interview Date cannot be before the Open Case Date".
You will not be allowed to continue if the backdate exceeds 90 calendar days or the backdate is prior to the funding source begin date/case open date.
You will not be allowed to continue if the date is blank. The following warning message will appear: "Interview Date is required".

Document Status (Required)

Answer Choice Definitions

SELECT the appropriate Document Status drop-down:
- Draft
- Ready for Review

Document Status Date (System Generated)

This date represents the date.

Attachments

On the Attachments screen the user can upload only xlsx files. No other extension is allowed in the Attachments control of GPRA Assessment.
Users will be able to upload the attachments only on ‘Draft’ and ‘Ready for Review’ status.
Only one attachment is allowed (on Draft and Ready for Review Document Status). If you need to upload a new version of the assessment you must first delete the old attachment. Please ensure you have the original version of the assessment downloaded if you plan to make edits. Only delete the attachment in CMBHS when you are ready to upload the new attachment.
If you want to attach other file extensions (pdf, jpg, etc,), you may use administrative notes instead.