CMS-2V2-25-001_rev2.pdf

Notice of Funding Opportunity

Application due March 7, 2025

Nursing Home Staffing Campaign Opportunity number: CMS-2V2-25-001

Contents Before you begin 3

Step 1: Review the Opportunity 4

Basic information 5

Eligibility 7

Program description 9

Step 2: Get Ready to Apply 23

Get registered 24

Find the application package 24

Step 3: Prepare Your Application 25

Application contents and format 26

Step 4: Learn About Review and Award 33

Application review 34

Award notices 41

Step 5: Submit Your Application 42

Application submission and deadlines 43

Step 6: Learn What Happens After Award 46

Post-award requirements and administration 47

Contacts and Support 51

Appendix A 53

Contents 2

Before you begin If you believe you are a good candidate for this funding opportunity, secure your SAM.gov and Grants.gov registrations now. If you are already registered, make sure your registrations are active and up-to-date.

SAM.gov registration (this can take several weeks)

You must have an active account with SAM.gov. This includes having a Unique

Entity Identifier (UEI).

See Step 2: Get Ready to Apply

Grants.gov registration (this can take several days)

You must have an active Grants.gov registration. Doing so requires a Login.gov registration as well.

See Step 2: Get Ready to Apply

Apply by the application due date

Applications are due by 11:59 p.m. Eastern Time on March 7, 2025.

To help you find what you need, this NOFO uses internal links. In Adobe

Reader, you can go back to where you were by pressing Alt + Left Arrow

(Windows) or Command + Left Arrow (Mac) on your keyboard.

Before you begin 3 https://sam.gov/ https://grants.gov/

Jump to a step

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1:

Review the Opportunity

In this step

Basic information 5

Eligibility 7

Program description 9

Basic information Centers for Medicare & Medicaid Services (CMS)

U.S. Health and Human Services

Center for Clinical Standards and Quality (CCSQ)

Recruiting nurses to work in nursing homes through financial incentives.

Have questions?

See Contacts and

Support.

Key facts

Opportunity name:

Nursing Home Staffing

Campaign

Opportunity number:

CMS-2V2-25-001

Announcement type:

New

Assistance listing:

93.693

Key dates

Application submission deadline: March 7, 2025, 11:59 p.m. ET

Optional letter of intent deadline: January 24, 2025, 11:59 p.m. ET

Informational webinar:

January 29 at 3:00 p.m.

ET; Email

NHSC@cms.hhs.gov to register.

Expected award date:

May 9, 2025

Expected earliest start date: May 15, 2025

See other submissions for other time frames that may apply to this

NOFO.

Summary The Centers for Medicare & Medicaid Services (CMS) is committed to improving safety and quality of care in the nation’s nursing homes. Nursing home staffing is a critical factor for improving care for nursing home residents.

However, nursing homes sometimes struggle to hire enough nursing staff to meet residents’ needs. Additionally, state survey agencies, who are responsible for inspecting nursing homes for compliance with federal regulations, also struggle to hire nurses to conduct these inspections. The

Nursing Home Staffing Campaign (NHSC) is aimed at increasing the availability of nurses to work in the nursing home environment, such as in qualifying nursing homes or in an oversight capacity for a state inspection agency.

This Notice of Funding Opportunity (NOFO) is focused on helping to recruit

Registered Nurses (RNs) to work in nursing homes by offering financial incentives. Through this NOFO, CMS is accepting applications for cooperative agreements to entities who will administer financial incentives, such as tuition reimbursement and stipends, to RNs to work for three years in a qualifying nursing home or in an oversight role with a state agency.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 5 mailto:NHSC@cms.hhs.gov

Funding details Type: Cooperative agreement, which means that both you and CMS will have roles in the project. Throughout the life of your project, we will be there to help and work with you.

Expected total funding for the program: $80,000,000 subject to availability of funds.

Expected total awards: 5 to 10.

Funding range per applicant for each budget period: $5,000,000 to

$20,000,000. The project expects five (5) budget periods during the period of performance.

We will provide funding in five budget periods of 12 months each over a five-year period of performance.

Step 1: Review the Opportunity 6

Eligibility Eligible applicants

• The following types of organization may apply:

Education organizations

• Public and state-controlled institutions of higher education.

• Private institutions of higher education.

Nonprofit organizations

• Nonprofits that have a 501(c)(3) status with the IRS, other than institutions of higher education.

• Nonprofits that do not have a 501(c)(3) status with the IRS, other than institutions of higher education.

• Community and consumer-focused nonprofit groups.

Other organizations

• Small nonprofit businesses.

Faith-based organizations that meet the organizational eligibility requirements in this section are welcome to apply.

Other eligibility requirements This opportunity is only open to nonprofit nursing and educational organizations, such as national associations for nursing schools, nurses, or nursing students. Your organization must have demonstrated experience working with large numbers of nursing schools (e.g., hundreds) and large numbers of nurses (e.g., thousands) across multiple states. See the merit review criteria for more information.

You should also demonstrate experience administering (or the ability to administer) similar programs where your organization has overseen the distribution of funds to individuals and tracked the individuals’ fulfillment of the commitment to receive the funds. For example, you could demonstrate that your organization has provided funds to an individual in return for a work commitment and then confirmed that the individual is fulfilling the work commitment.

Step 1: Review the Opportunity 7

Completeness and responsiveness criteria We will review your application to make sure it meets the requirements found in eligibility, applications contents and format, and application submission and deadlines.

We may not consider an application that:

• Is from an organization that doesn’t meet all eligibility criteria.

• Requests funding above the award ceiling shown in the funding range.

• Is submitted after the deadline.

• Is not submitted through Grants.gov.

• Meets any of the eligibility limitations.

The Division of Grants Management Director or the Deputy Director may choose to continue the review process for an ineligible application if it is in the best interests of the government to meet the objectives of the program.

Eligibility limitations The following organizations are ineligible:

• Individual nursing homes, nursing home chains, or nursing home associations.

• State agencies or government-owned entities.

• CMS Quality Improvement Networks or Quality Improvement

Organizations.

◦ CMS will also review and disqualify organizations with a perceived conflict of interest that could imply the funds or actions taken would be directed to an area, nursing home, or set of nursing homes in an unfair or subjective manner, or that funds may be used in a manner that is inconsistent with the intent of this program.

Application limits You may only submit one application under this NOFO.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 8 https://word-edit.officeapps.live.com/we/wordeditorframe.aspx?ui=en%2DUS&rs=en%2DUS&wopisrc=https%3A%2F%2Fgartner365.sharepoint.com%2Fsites%2FNOFO100Workspace%2F_vti_bin%2Fwopi.ashx%2Ffiles%2Fc9adf7b3174248389fe1e0ed6c0eda17&wdenableroaming=1&mscc=1&hid=76C609A1-F0D0-4000-D371-AEFE4FBF67D1&wdorigin=ItemsView&wdhostclicktime=1707421111271&jsapi=1&jsapiver=v1&newsession=1&corrid=de92e597-126e-4505-8b92-89252560edb8&usid=de92e597-126e-4505-8b92-89252560edb8&sftc=1&cac=1&mtf=1&sfp=1&instantedit=1&wopicomplete=1&wdredirectionreason=Unified_SingleFlush&rct=Normal&ctp=LeastProtected#_Funding_Details https://word-edit.officeapps.live.com/we/wordeditorframe.aspx?ui=en%2DUS&rs=en%2DUS&wopisrc=https%3A%2F%2Fgartner365.sharepoint.com%2Fsites%2FNOFO100Workspace%2F_vti_bin%2Fwopi.ashx%2Ffiles%2Fc9adf7b3174248389fe1e0ed6c0eda17&wdenableroaming=1&mscc=1&hid=76C609A1-F0D0-4000-D371-AEFE4FBF67D1&wdorigin=ItemsView&wdhostclicktime=1707421111271&jsapi=1&jsapiver=v1&newsession=1&corrid=de92e597-126e-4505-8b92-89252560edb8&usid=de92e597-126e-4505-8b92-89252560edb8&sftc=1&cac=1&mtf=1&sfp=1&instantedit=1&wopicomplete=1&wdredirectionreason=Unified_SingleFlush&rct=Normal&ctp=LeastProtected#_Application

Program description Statutory authority This program is funded under the authority of sections 1819(h)(2)(B)(ii)(IV)(ff) and 1919(h)(3)(C)(ii)(IV)(ff) of the Social Security Act (SSA), which authorizes the Secretary of the Department of Health and Human Services to use a portion of civil money penalties (CMPs) collected to support activities that benefit residents. This authority is codified in 42 CFR 488.433, which states that these funds must be used entirely for activities that protect or improve the quality of care or quality of life for residents.

Background CMS is committed to increasing staffing in nursing homes. For example:

• In 2015, we implemented the Payroll-Based Journal (PBJ) program to collect and report staffing information for nursing homes.

• In 2018, we began using PBJ data to calculate each nursing home’s Five

Star Quality Rating, incentivizing nursing homes to increase their staffing.

This data was also used to calculate measures of staff turnover, in 2022.

• Most recently, in May 2024, we finalized a new regulation establishing minimum staffing standards for all nursing homes.

To help improve nursing home staffing and support providers’ efforts to comply with the new regulations, we are launching a nursing home staffing campaign (NHSC) to help recruit nurses to work in nursing homes or in an oversight capacity with a state survey (i.e., inspection) agency.

The NHSC will support a national effort aimed at increasing the number of nurses who work in nursing homes or as inspectors with state survey agencies. The program will also make it easier for individuals to enroll in certified nurse aide (CNA) training programs, highlight the career pathways available to nurses who work in nursing homes, and provide financial incentives to recruit more RNs.

This funding opportunity is specifically focused on recruiting RNs to work in nursing home environments by offering financial incentives.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 9 https://www.cms.gov/newsroom/fact-sheets/medicare-and-medicaid-programs-minimum-staffing-standards-long-term-care-facilities-and-medicaid-0 https://www.cms.gov/newsroom/fact-sheets/medicare-and-medicaid-programs-minimum-staffing-standards-long-term-care-facilities-and-medicaid-0

Purpose CMS, through its Center for Clinical Standards and Quality (CCSQ) is accepting applications for cooperative agreements to entities to administer financial incentives, such as tuition reimbursement and stipends, to RNs to work in a qualifying nursing home or in an oversight role with a state agency for three years. CMS will enter into cooperative agreements with organizations who will become Financial Incentive Administrators (FIAs) to provide funds to RNs that are contingent on their working in a qualifying nursing home or state survey agency for a subsequent three years (a minimum of 30 hours per week, on average). Applicants must demonstrate:

• Experience administering, or the ability to administer, similar programs where your organization has overseen the distribution of funds to individuals and tracked the individuals’ fulfillment of the commitment to receive the funds.

◦ For example, you could demonstrate that your organization has provided funds to an individual in return for a work commitment and then confirmed through paystubs or employer verification that the individual is fulfilling the work commitment.

• The ability to partner with other entities, such as state agencies, who may contribute additional funds to increase the number of financial incentives available for RNs in their state.

Regional structure CMS has aligned all states, territories, and Washington D.C. into six regions of the country for this award. This structure helps interested RNs easily identify the appropriate entity to contact for a financial incentive (see figure 1).

The regions are:

• Region 1: ME, NH, MA, RI, CT, VT, NY, NJ, DE, PA, MD, DC, VA, WV

• Region 2: NC, SC, GA, FL, KY, TN, MS, AL, PR

• Region 3: MN, WI, IL, IN, MI, OH

• Region 4: NM, TX, OK, AR, LA

• Region 5: MO, IA, NE, KS, CO, UT, WY, MT, ND, SD

• Region 6: WA, OR, ID, NV, CA, AZ, HI, AK, GU

Awards are based on these regions in the following:

Step 1: Review the Opportunity 10

• CMS will evaluate applicants’ coverage of the entire country, but will award one or two applicants to serve each of the six regions. We will not award more than two applicants for any one region.

• We may award applicants to serve more than one region.

• In regions with two awards, one cooperative agreement will be focused on administering financial incentives to RNs who obtained a four-year degree (bachelor’s degree in nursing), and the other will be focused on

RNs who obtained a two-year degree (associate’s degree in nursing).

• If we award only one cooperative agreement in a specific region, the awardee will focus on both types of degreed nurses.

For example:

• Region 1 awardees: Applicant A and Applicant B

• Region 2 awardees: Applicant C and Applicant D

• Region 3 awardees: Applicant A and Applicant E

• Region 4 awardees: Applicant C and Applicant E

• Region 5 awardees: Applicant B

• Region 6 awardees: Applicant C and Applicant F

Figure 1.

Program timeline The timeline for this program includes three distinct phases:

• Infrastructure set-up, which starts at the beginning of the cooperative agreement, and we estimate would last for six months.

• Recruitment, which starts after infrastructure set-up and lasts for approximately a year and a half.

Step 1: Review the Opportunity 11

• Work Completion Period, which starts after recruitment and lasts for three years while financial incentives are being administered. This phase includes all of Years 3, 4, and 5 of the period of performance.

See Figure 2 under Program requirements and expectations, section 3.

Program requirements and expectations

1. National coverage Even though CMS will award cooperative agreements for specific regions (as described in the regional structure above), you must demonstrate your ability to perform outreach and maintain coverage for four-year and/or two-year degree nurses in all states.

Here are some examples of how you could document this ability:

• You could provide documentation that shows hundreds of four-year and/ or two-year degree nursing schools are members of your association and include the locations of those schools.

• You could provide a letter of intent signed by many nursing schools and include their locations. This letter would indicate the schools’ willingness to partner with you on this program.

• You could provide documentation demonstrating that thousands of members of your association are nurses who recently obtained (or will soon obtain) their licenses through a four-year and/or two-year degree program.

2. Infrastructure set-up You must describe your ability to implement an infrastructure to begin distributing funds to qualified RNs quickly after receipt of the award.

Your description should include a timeline of major milestones, including:

• When you will begin recruiting nurses and when the first nurse will be recruited.

• When financial incentives will be disbursed.

We estimate that awardees will set up their infrastructure within six months after the award date. However, a faster timeline for recruitment and disbursement of funds is preferred.

Step 1: Review the Opportunity 12

3. Recruitment Activities You must describe how you will recruit nurses. Your description should include:

• Strategies you will use for recruitment, such as relationships and communication channels you will rely on.

• How you have successfully done similar programs or activities in the past.

• How you will ensure a broad-based and equitable recruitment of individuals amongst various cultures and ethnicities, including minorities and underserved populations.

• Estimates of the number of nurses you will recruit to work in qualifying nursing homes or state survey agencies. Include the methodology used to calculate the estimate.

You will only recruit nurses during the designated recruitment period, which lasts approximately a year and a half. The designated recruitment period will begin immediately after the infrastructure has been completed, although we acknowledge some recruitment activities could commence prior to completing the infrastructure set-up. The recruitment period will end three years prior to the end of the program period. This timeline will allow you to distribute funds for RNs’ entire three-year work commitment during the program period. See example in figure 2. We also note that there may be overlap between the recruitment period and when RNs begin receiving financial incentives as RNs will start to receive funds as soon as they begin their work commitment as outlined at the financial incentive administration section.

Figure 2.

Step 1: Review the Opportunity 13

Towards the end of the recruitment period (Prior to the end of Year 2), we will evaluate the results to determine if the program should be extended an additional year. If we do extend the program, the recruitment period will last for an additional year for a total of two and a half years.

4. Financial incentive administration You must administer funds to nurses according to these guidelines:

• Distribute funds to qualified RNs who work in a qualifying location for either or both of the following:

◦ RN student loan debt amounts up to $40,000 over three years.

◦ $10,000 as a stipend for living expenses over three years. The stipend will need to be adjusted for the cost of living for a particular area, based on the current wage index used in the CMS Skilled

Nursing Facility Prospective Payment System.

• If an RN is recruited during the recruitment period but starts working in a qualifying location on a date that is less than three years before the end of the program period, the RN’s work commitment will be shortened to the amount of time left in the program period. Their tuition reimbursement and/or stipend will be prorated based on the shortened work commitment (see figure 3).

Figure 3.

• You must distribute funds (loan debt reimbursement and/or stipend) to recipients every three months in equal (or relatively equal) amounts so that the final payment to an individual occurs at the end of their three-year work commitment.

• Maintain a process to qualify applicants, such as verifying their RN licensure and outstanding student loan debt.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 14 https://www.cms.gov/medicare/payment/prospective-payment-systems/skilled-nursing-facility-snf/wage-index#:~:text=The%20FY%202023%20SNF%20PPS,FY%202025%20%2D%20Proposed%20(ZIP) https://www.cms.gov/medicare/payment/prospective-payment-systems/skilled-nursing-facility-snf/wage-index#:~:text=The%20FY%202023%20SNF%20PPS,FY%202025%20%2D%20Proposed%20(ZIP)

• Maintain a process to track each RN’s fulfillment of their work commitment, such as working a minimum of 30 hours per week, on average, in the nursing home or state agency where they accepted assignment as a condition for receiving the financial incentive.

◦ For example, you could confirm that RNs are fulfilling their work commitments through paystubs with hours per week worked or employer verification at regular intervals up till the end of the work commitment.

• Your processes should make sure that RNs who do not provide evidence of fulfilling their work commitments do not continue to receive funds.

5. Stakeholder collaboration We expect you to work with individual states, who may provide additional funding directly to your program to increase the funds available for financial incentives.

You are also required to coordinate and cooperate with CMS, its contractors and partners, and other stakeholders to ensure continuity of program operations and to maximize results. For example, this may include sharing results with CMS strategic partners or collaborating with CMS contractors to raise awareness of this program through targeted marketing.

6. Vacancy and placement coordination You must do the following to coordinate placement of RNs in jobs:

• Maintain an updated list of qualifying nursing homes that are seeking to hire RNs in your region.

• Work with state agencies to understand their RN staffing needs.

• Match recruited nurses to a nursing home or state agency that most aligns with their work preferences and location.

In your application, describe how you plan to meet these requirements.

Qualifying nursing homes Qualifying nursing homes must meet our criteria for prioritizing areas with shortages of RNs. CMS will provide awarded applicants with a list of qualifying nursing homes in areas with high labor shortages of RNs.

Applicants should prioritize the nursing homes in these areas, such as based on the number of RN staffing vacancies or staffing levels. To assist applicants with their proposals, the estimated number of qualifying nursing homes in high labor shortage areas in each state is included as Appendix A. CMS is also open to suggestions on methods for identifying qualifying nursing homes in

Step 1: Review the Opportunity 15 high labor shortage areas. Applicants can submit their suggestions with their proposals.

If a qualifying nursing home loses its qualifying status after an RN has started to work there or committed to working there under this program, the RN may continue to work there for the entire three-year commitment and continue to obtain their full financial incentive.

Note: While we are currently prioritizing recruiting RNs for nursing homes in high labor shortage areas, we may expand the scope of this program based on its results. For example, we may expand the criteria for qualifying nursing homes or expand the program to also target licensed practical nurses or licensed vocational nurses (LPNs/LVNs).

RN Eligibility RNs’ must meet the following requirements to qualify for this program:

• RNs must meet all licensure requirements for the state they will be working in.

• RNs must work a minimum of 30 hours, on average, per week each quarter. We will consider limited exceptions, such as medical leave or a single extended absence. However, the expectation is that the RN is a full-time employee of the nursing home or state agency.

• RNs must be a direct employee of the nursing home or state agency. RNs working as a contractor or through a staffing agency (e.g., travel nurse agency) are not eligible for this program.

• RNs with any student loan debt for education related to the RN license are eligible for this program, regardless of when they obtained their degree or license.

◦ We are soliciting alternative options from applicants for this component. Please provide recommendations for any alternatives, such as whether there should be a time limit for when an RN obtained their degree or license to qualify for this program (e.g., within the last

12 months). Include the recommendations and rational in your application. CMS will make a final decision about these incentives before the start of the recruitment period, and all awardees will use the same criterion.

• RNs who have obtained their license in the previous 12 months but do not have student loan debt are still eligible for the stipend for the same three-year commitment.

◦ We are soliciting alternative options from applicants for this component. Please provide recommendations about incentives for

Step 1: Review the Opportunity 16

RNs who do not have student loan debt, or on the timeframe of when an RN received their license, include those recommendations and rationale in your application. CMS will make a final decision about these incentives before the start of the recruitment period, and all awardees will use the same criterion.

• RN’s must start working at a nursing home or state agency after applying for financial incentives to qualify for this program. The intent is to use this program to recruit new nurses to work in nursing homes, rather than provide incentives to nurses that have already been working in nursing homes.

◦ We are soliciting feedback on the eligibility of RNs who started working at a nursing home or state agency shortly before applying for financial incentives. We are interested in feedback about whether excluding them from eligibility may cause unintended issues.

For example, would they leave their current employer because they are disappointed that someone who started shortly after them was able to obtain a financial incentive, and they were not? This unintended consequence could lead to a vacancy at their original employers, which is not the intent of the program. Conversely, we’re concerned that allowing them to qualify is not consistent with the intent of the program, which is to recruit nurses to work in nursing homes and state agencies (i.e., nurses already working in these areas have already been recruited).

Therefore, we are seeking feedback if we should consider excluding or including RNs who already work at a nursing home or state agency prior to applying for a financial incentive. For example, if they should be included, would there be a timeframe that they must have started working (e.g., in the last three months)? Also, would they qualify for the full incentive or a portion?

We also note that should CMS make any changes to the RN eligibility qualifications; it will be implemented consistently across all awardees.

7. Administrative costs You must state what percent or amount of funds you will use for administrative activities related to administering financial incentives. We strongly prefer applications with lower administrative costs, which allow for more RNs to receive financial incentives.

Your administrative costs should also be clear in your budget and budget narrative.

Step 1: Review the Opportunity 17

8. Learning and diffusion networks You must establish and coordinate learning and diffusion networks with nursing schools and nursing homes to identify and disseminate best practices for recruiting RNs. This includes hosting webinars or conference calls and distributing materials (e.g., newsletter) to nursing schools and nursing homes.

We will participate and help coordinate these activities to support relationships between nursing schools, nursing homes, the FIAs, and CMS.

You should propose how you will structure these activities, such as how many conference calls you will hold (e.g., four per year), and how often information will be distributed (e.g., quarterly).

9. Reporting and meetings You must include the following reports and meetings in the project timeline in your project narrative:

• Within 2 weeks of award:

◦ Kick-off meeting with CMS.

• Within one month of award:

◦ Implementation plan submitted to CMS.

• Within every 30 days after submitting the implementation plan, for 120 days (4 reports total):

◦ Implementation status report.

◦ Status update call with CMS.

• Within every 30 days after implementation:

◦ Status update call with CMS.

◦ Written brief. The brief must include relevant information about your program, such as:

▪ Number of nurse applicants.

▪ Number of incentives and amount of incentives distributed.

▪ Work locations of nurses.

▪ Narrative of program operations

▪ Status of working with states, etc.

▪ Other areas identified by CMS.

• Within 120 days after implementation, and within every 90 days thereafter:

◦ Quarterly call with CMS (can be combined with a monthly call).

Step 1: Review the Opportunity 18

◦ Report. The report should be a cumulative summary of the monthly briefs and the previous quarter’s operations, including an updated budget report.

• Within 30 days after the end of the first award year:

◦ Annual report, which is a comprehensive review of each year’s results, operations, and budget.

◦ Final Report, which is a comprehensive review of all of project year results, operations, budget, lessons learned and best practices.

Cooperative agreement terms Cooperative agreements require substantial CMS project involvement after an award is made. There are specific roles for both you and CMS. We may be in contact at least once a month, and more frequently when appropriate. All awards under this NOFO will be structured as cooperative agreements.

Your responsibilities

• Comply with the terms and conditions of the award.

• Collaborate with CMS staff to implement and monitor the project.

• Submit the performance measures requested.

• Submit all required performance assessments, evaluations, and financial reports included in the terms and conditions.

• Attend monthly calls with the CMS project or grants management specialist to discuss your project’s progress and challenges. The meetings will include key personnel and the project officer.

• Participate in any virtual meetings.

Our responsibilities

• Monitor the project’s performance and progress.

• Collaborate with you and provide substantial project planning and implementation input.

• Provide substantial input in evaluation activities.

• Make recommendations for continuing the project.

• Review and approve website content before launch and updates.

• Review and approve all key personnel.

• Maintain regular communication with you through at least monthly conference calls along with technical assistance and consultation.

Step 1: Review the Opportunity 19

• Review and provide feedback on all required performance assessment reports.

• Review and approve all required submitted data.

• Provide a structured approach to sharing, integrating, and actively applying improvement concepts, tactics, and lessons learned.

Substantial involvement relates to programmatic involvement, not administrative oversight.

Funding policies and limitations Limitations We do not allow the following costs:

• Pre-award costs.

• Meeting matching requirements for any other federal funds or local entities.

• Services, equipment, or support that are the legal responsibility of another party under federal, state, or tribal law, such as vocational rehabilitation or education services.

• Services, equipment, or support that are the legal responsibility of another party under any civil rights law, such as modifying a workplace or providing accommodations that are obligations under law.

• Goods or services not allocable to the project.

• Supplanting existing state, local, tribal, or private funding of infrastructure or services, such as staff salaries.

• Construction.

• Capital expenditures for improvements to land, buildings, or equipment that materially increase their value or useful life as a direct cost, except with our prior written approval.

• The cost of independent research and development, including their proportionate share of indirect costs. See 45 CFR 75.476.

• Funds related to any activity designed to influence the enactment of legislation, appropriations, regulation, administrative action, or executive order.

• Certain telecommunications and video surveillance equipment. See 2 CFR

200.216.

◦ Meals, unless in limited circumstances such as:

◦ Subjects and patients under study.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 20 https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-E/subject-group-ECFR8a7b546124f3ead/section-75.476 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200/subpart-C/section-200.216 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200/subpart-C/section-200.216

◦ Where specifically approved as part of the project or program activity, such as in programs providing children’s services.

◦ As part of a per diem or subsistence allowance provided in conjunction with allowable travel.

• Other than for normal and recognized executive-legislative relationships or participation by an agency or officer of a state, local, or tribal government in policymaking and administrative processes within the executive branch of that government, funding awarded under this NOFO may not be used for:

◦ Paying the salary or expenses of any grant recipient, or agent acting for such recipient, related to any activity designed to influence the enactment of legislation, appropriations, regulation, administrative action, or executive order proposed or pending before the Congress or any state government, state legislature, or local legislature or legislative body.

◦ Lobbying, but awardees can lobby at their own expense if they can segregate federal funds from other financial resources used for lobbying.

For guidance on some types of costs that we restrict or do not allow, see 45

CFR part 75, General Provisions for Selected Items of Cost.

See also program-specific limitations.

Program-specific limitations CMS estimates approximately $80,000,000 total to fund an estimated 5-10 recipients over five years. The period of performance is May 15, 2025, through

May 14, 2030 (5 years). Funding beyond the first year is subject to satisfactory recipient progress, and a decision that continued funding is in the best interest of the Federal Government.

General policies

• Support beyond the first budget year will depend on:

◦ Availability of funds.

◦ Satisfactory progress in meeting your project’s objectives.

◦ A decision that continued funding is in the government’s best interest.

• If we receive more funding for this program, we will consider:

◦ Funding more applicants.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 21 https://www.ecfr.gov/current/title-45/part-75/subject-group-ECFR5d90ba314caea08

◦ Extending the period of performance.

◦ Awarding supplemental funding.

Indirect costs Indirect costs are costs you charge across more than one project that cannot be easily separated by project.

Indirect costs are costs you charge across more than one project that cannot be easily separated by project. Learn more at 2 CFR 200.414, Indirect Costs.

To charge indirect costs you can select one of two methods:

Method 1 — Approved rate. You currently have an indirect cost rate approved by your cognizant federal agency.

Method 2 — De minimis rate. Per 2 CFR 200.414(f), if you have never received a negotiated indirect cost rate, you may elect to charge a de minimis rate. If you are awaiting approval of an indirect cost proposal you may also use the de minimis rate. If you choose this method, costs included in the indirect cost pool must not be charged as direct costs.

This rate is 15% of modified total direct costs (MTDC). See 2 CFR 200.1 for the definition of MTDC. You can use this rate indefinitely.

Indirect costs for training awards cannot exceed 8% of MTDC. See 45 CFR

75.414(c)(1)(i). For modified total direct costs, we now use the definition at 2

CFR 200.1.

Salary rate limitation The salary rate limitation in the current appropriations act applies to this program. As of January 2024, the salary rate limitation is $221,900. We will update this limitation in future years.

Program income Program income is money earned as a result of your award-supported project activities. You must use any program income you generate from awarded funds for approved project-related activities. Find more about program income at 45 CFR 75.307.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 22 https://www.ecfr.gov/current/title-2/section-200.414 https://www.ecfr.gov/current/title-2/section-200.414 https://www.ecfr.gov/current/title-2/part-200#p-200.1(Modified%20Total%20Direct%20Cost%20(MTDC)) https://www.ecfr.gov/current/title-45/part-75#p-75.414(c)(1)(i) https://www.ecfr.gov/current/title-45/part-75#p-75.414(c)(1)(i) https://www.ecfr.gov/current/title-2/part-200#p-200.1(Modified%20Total%20Direct%20Cost%20(MTDC)) https://www.ecfr.gov/current/title-2/part-200#p-200.1(Modified%20Total%20Direct%20Cost%20(MTDC)) https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-D/subject-group-ECFR911e5e1a30bfbcb/section-75.307

Step 2:

Get Ready to Apply

In this step

Get registered 24

Find the application package 24

Get registered SAM.gov You must have an active account with SAM.gov. This includes having a Unique

Entity Identifier. SAM.gov registration can take several weeks. Begin that process today.

To register, go to SAM.gov Entity Registration and select Get Started. From the same page, you can also select the Entity Registration Checklist for the information you will need to register.

When you register or update your SAM.gov registration, you must agree to the financial assistance general certifications and representations. You must agree to those for grants specifically, as opposed to contracts, because the two sets of agreements are different. You will have to maintain your registration throughout the life of any award.

Grants.gov You must also have an active account with Grants.gov.

You can see step-by-step instructions at the Grants.gov Quick Start Guide for

Applicants.

Need Help? See Contacts and Support.

Find the application package The application package has all the forms you need to apply. You can find it online. Go to Grants Search at Grants.gov and search for the opportunity number CMS-2V2-25-001.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 2: Get Ready to Apply 24 https://sam.gov/content/entity-registration https://www.hhs.gov/sites/default/files/financial-assistance-general-certification-representations.pdf http://grants.gov/applicants/applicant-registration https://www.grants.gov/quick-start-guide/applicants https://www.grants.gov/quick-start-guide/applicants http://grants.gov/search-grants

Step 3:

Prepare Your Application

In this step

Application contents and format 26

Application contents and format

Component Submission format

Project abstract Use the Project Abstract Summary form.

Project narrative Use the Project Narrative Attachment form.

Budget narrative Use the Budget Narrative Attachment form.

Attachments Insert each in the Other Attachments form.

Other required forms Upload using each required form.

See requirements for other submissions.

Your organization’s authorized organizational representative (AOR) must certify and submit your application.

We will provide instructions on document formats in the following sections.

See completeness and responsiveness criteria to understand what may disqualify your application from consideration.

Project abstract Limit to one page. May be single spaced. Follow other formatting requirements for the project narrative.

Write a one-page summary of your proposed project including its purpose and outcomes. Do not include any proprietary or confidential information. We will use this document for information sharing and public information requests if you get an award. Include:

• The name of your organization.

• The names of any subrecipients or sub-awardee organizations, if applicable.

• Project goals.

• Total budget amount.

• A description of how you will use funds.

Step 3: Prepare Your Application 26

Project narrative The project narrative is the most important part of your application and should clearly describe your proposed project. You must address the proposed goals, measurable objectives, and milestones in accordance with the instructions in the following sections.

See the merit review criteria to understand how reviewers will assess and score your project narrative.

The project narrative should clearly describe how you will address all of the program requirements. Number the sections of your project narrative to match the numbers of the subsections in the program requirements. In addition to those sections, the project narrative should also include a clear timeline with specific milestones that your program will meet. Here is a full list of the sections that your project narrative should include, with links to the full requirements:

• 1. National coverage

• 2. Infrastructure set-up

• 3. Recruitment activities

• 4. Financial incentive administration

• 5. Stakeholder collaboration

• 6. Vacancy and placement coordination

• 7. Administrative costs

• 8. Learning and diffusion networks

• 9. Reporting and meetings

• 10. Project timeline and milestones

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 3: Prepare Your Application 27 https://gbc-word-edit.officeapps.live.com/we/wordeditorframe.aspx?ui=en-US&rs=en-US&IsLicensedUser=1&WOPISrc=https%3A%2F%2Fapi.box.com%2Fwopi%2Ffiles%2F1620638970206#_Merit_Review

Required format for project narrative Page limit: 15 pages, excluding attachments.

Endnotes are not included in the page limit.

File name: Project Narrative

File format: PDF

Font size: 12-point font

Footnotes and text in graphics may be 10-point.

Font color: Black or Blue

Spacing for project abstract, tables, and footnotes: Single-spaced

Spacing for main content: Double-spaced

Margins: 1-inch

Page size: 8.5 x 11

Include consecutive page numbers throughout.

Budget narrative The budget narrative supports the information you provide in Standard Form

424-A. See other required forms.

It includes added detail and justifies the costs you ask for. As you develop your budget, consider:

• If the costs are reasonable and consistent with your project’s purpose and activities.

• Restrictions on spending funds. See funding policies and limitations.

• HHS now uses the definitions for equipment and supplies in 2 CFR 200.1.

The new definitions change the threshold for equipment to the lesser of the recipient’s capitalization level or $10,000 and the threshold for supplies to below that amount.

To create your budget narrative, see detailed instructions and a template on our website.

In your budget narrative, you will:

• Identify a PI/PD who will dedicate sufficient time and effort to manage and provide oversight of the grant program.

• Provide an overall estimated budget for the entire five-year period of performance. That is, state the total costs across all five years.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 3: Prepare Your Application 28 https://www.ecfr.gov/current/title-2/part-200#p-200.1(Equipment) https://www.ecfr.gov/current/title-2/part-200#p-200.1(Supplies) https://www.cms.gov/about-cms/work-us/grants-cooperative-agreements/how-apply-cms-grants/budget-and-budget-narrative

• Provide a detailed budget for the first 12-month budget period:

◦ Include breakdown of costs for each line item in your SF-424A.

◦ Describe the proposed costs for each activity or cost within the line item.

◦ Define the proportion of the requested funding designated for each activity.

◦ Justify the costs, including how you calculated them.

• Provide a high-level summary of budget costs for Year 2 through Year 5:

◦ Estimate the amount of funds you will request from CMS each year.

• Explain how you separate costs and funding administered directly by you as the lead agency, from funding your subaward to other consortium members.

• Be clear about how costs link to each activity and the goals of this program.

The program will run for five years to allow for an infrastructure set-up period, a recruitment period, and three years of distribution of financial incentives.

See example diagram:

The infrastructure set-up period is estimated to be 6 months. Applicants must propose and describe their timeline for infrastructure set-up. Shorter timelines are highly preferred. Also, towards the end of the recruitment period, CMS will evaluate the results to determine if the program should be extended an additional year. This would enable an additional year for the recruitment period.

To create your SF-424A and budget narrative, see detailed instructions in

Guidance for Preparing a Budget Request and Narrative on our website.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 3: Prepare Your Application 29 https://www.cms.gov/about-cms/work-us/grants-cooperative-agreements/budget-and-budget-narrative

Required format for budget narrative Page limit: 10

File name: Budget Narrative

File format: PDF

Font size: 12-point font

Font color: Black or Blue

Margins: 1-inch

Page Size: 8.5 x 11

Include consecutive page numbers throughout.

Attachments You will upload attachments in Grants.gov using the Other Attachments form.

Attachments do not count against application page limits, except for the business assessment of application organization. Do not include additional attachments not requested in the NOFO. Reviewers will not review any attachments that are not listed here.

Indirect cost agreement If you include indirect costs in your budget using an approved rate, include a copy of your current agreement approved by your cognizant agency for indirect costs. If you use the de minimis rate, you do not need to submit this attachment.

Proof of nonprofit status If your organization is a nonprofit, you need to attach proof. We will accept any of the following:

• A copy of a current tax exemption certificate from the IRS.

• A letter from your state’s tax department, attorney general, or another state official saying that your group is a nonprofit and that none of your net earnings go to private shareholders or others.

• A certified copy of your certificate of incorporation. This document must show that your group is a nonprofit.

• Any of these documents for a parent organization. Also included is a statement signed by an official of the parent group stating that your organization is a nonprofit affiliate.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 3: Prepare Your Application 30 https://www.ecfr.gov/current/title-45/part-75#p-75.2(Cognizant%20agency%20for%20indirect%20costs) https://www.ecfr.gov/current/title-45/part-75#p-75.2(Cognizant%20agency%20for%20indirect%20costs)

Resumes and job descriptions For key personnel, attach resumes for positions that are filled. If a position isn’t filled, attach the job description with qualifications.

Business assessment of applicant organization Maximum 12 pages, single-spaced.

We must assess your organization’s risk before we can make an award. This analysis includes your organization’s:

• Financial stability.

• Quality of management systems.

• Internal controls.

• Ability to meet the management standards prescribed in 45 CFR Part 75.

For us to complete your assessment, you must review, answer, and attach the completed business assessment questions found on our website in Business

Assessment of Applicant Organization on our website.

Organizational chart Include an organizational chart that clearly identifies the reporting relationships of key personnel assigned to implementing the planning grant.

Other required forms You will need to complete four other required forms. Submit the following required forms through Grants.gov. You can find them in the NOFO application package or review them and their instructions at Grants.gov Forms.

Form Submission requirement

Application for Federal Assistance

(SF-424)

With the application. See extra instructions in the next section.

Budget Information for Non-

Construction Programs (SF-424A)

With the application.

Disclosure of Lobbying Activities (SF-

LLL)

With the application.

Project/Performance Site Location(s)

Form

With the application.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 3: Prepare Your Application 31 https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75 https://www.cms.gov/files/document/business-assessment-template-revised.pdf https://www.cms.gov/files/document/business-assessment-template-revised.pdf https://grants.gov/forms/forms-repository/sf-424-individual-family https://grants.gov/forms/forms-repository/sf-424-family

Extra instructions for SF-424: Application for Federal Assistance Special instructions include:

• To write your Descriptive Title of Applicant’s Project in Item 15, see

Writing a Strong Descriptive Title on our website.

• Check No to item 19c. State review under Executive Order 12372 does not apply.

• Your authorized organizational representative (AOR) must electronically sign this form. The AOR is the person who can make legally binding commitments for your organization. When the AOR authorizes an application, they agree to assume all award obligations.

Pre-award requirements There are no pre-award requirements for this notice of funding opportunity.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 3: Prepare Your Application 32 https://www.cms.gov/about-cms/work-us/grants-cooperative-agreements/how-apply-cms-grants

Step 4:

Learn About Review and Award

In this step

Application review 34

Award notices 41

Application review Initial review We review each application to make sure it meets basic requirements.

We will review your application to make sure that it meets both the completeness criteria and the responsiveness criteria. If your application does not meet these criteria, we will not move it to the merit review phase.

We will not review any pages that exceed the page limit.

Merit review A merit review panel reviews all applications that pass the initial completeness and responsiveness review. The members use the following criteria. For more information, see Merit Review and Selection Process on our website.

Criterion Total number of points = 100

Experience and competency: Your organization’s experience (the organization applying and/or the key personnel) operating programs with similar components and objectives, such as how the applicant has existing relationships with nursing schools (2-year and/or 4-year degree schools) or nursing students that will support the applicant’s ability to recruit RNs in all states (from…