Updated January 2023
ACO costs are an allowable investment under the ACO category. The hospital should identify how they will define progress to align with the state office’s SHIP goals.
Updated October 2024
SHIP supports HIT hardware/software and training, including risk assessments for cybersecurity.
Cybersecurity refers to any technology, measure, or practice for preventing cyberattacks or mitigating their impact. A strong cybersecurity strategy protects all relevant IT infrastructure layers or domains against cyberthreats and cybercrime. Examples of allowable expenses include but are not limited to:
|
Critical Infrastructure Security |
Subscriptions for Cybersecurity Software |
| Endpoint Security | Application Security |
| Cloud Security | Information Security |
| Mobile Security |
Network Security |
Updated October 2024
Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys completed for inpatient services are an allowable use of SHIP funds. Beginning in January 2025, collections of HCAHPS will be allowed via web-based platforms.
NOTE: Currently, HCAHPS is the only allowable SHIP survey. Costs associated with conducting other types of CAHPS or non-HCAHPS surveys and assessments (including overhead, fees, payments, contractors, etc.) are unallowable. This category is consistently under review, and we encourage SHIP Coordinators to email SHIP-TA@ruralcenter.org and copy your PO with questions or concerns.
Updated September 2023
Activities that support ICD-11 readiness and/or implementation are allowable. This includes, but is not limited to:
| Computer software upgrades to support a future transition to ICD-11 | Computer hardware that improves quality, efficiencies, and/or coding | Social Drivers of Health and Population Health training to use Z-Codes |
| Efficiency or QI training to minimize ICD-11 transition impacts on patients and staff | Revenue Cycle Management training | Updating ICD-10 software or hardware |
| ICD-11 system and/or coding training (individual hospitals or state-wide) | ICD-11 Implementation |
Note: This category is consistently under review, and we encourage SHIP Coordinators to email SHIP-TA@ruralcenter.org and copy your PO with questions or concerns.
See also: Subscription, Recurring Payment, Training (Hardware/Software/Services)
Updated September 2023
Indirect Cost Calculation - Grantee may request the lesser of 15 percent of the award total or their current federally negotiated indirect cost rate agreement. Indirect costs are deducted from the total award amount, not in addition to the total award amount. Grantees are not required to take indirect costs.
Updated January 2023
Costs for patient safety training to address performance issues related to Value-Based Program initiatives are allowable.
Examples may be training on recommendations, protocols, or information regarding best practices for patient safety and the quality of health care delivery or training on preserving confidentiality. According to the Agency of Healthcare Research and Quality (AHRQ), "safety" reduces the risk of harm and injury. Additionally, "quality" suggests striving for excellence and value.
Examples of allowable costs include but are not limited to:
| Quality Reporting Data Collection Related Training or Software | HCAHPS Data Collection Process Related Training | Efficiency or Quality Improvement Training in Support of VBP Related Initiatives |
| Provider-Based Clinic Quality Measures Training | Active Shooter Training (Non-medical Response) |
Note: Patient healthcare safety, security, and equipment that aids in treating a patient may also increase patient safety. The three are not the same, and direct patient care and hospital security measures are unallowable even if those measures increase patient safety measurements.
Updated May 2022, See definition: "Recurring Payment."
The Patient-Centered Medical Home (PCMH) process requires an initial fee at enrollment. Then the rural health clinic implements changes by going through training that provides quality or efficiency improvement in support of Value-Based Purchasing initiatives. This is an allowable investment.
Note: The application renewal fee after the initial enrollment is unallowable.
Updated January 2023
Project ECHO educates health care professionals in rural communities to treat chronic complex diseases in value-based care and payment models. This videoconferencing technology is used to create learning networks and may be a disease registry and population health training activity, and is an allowable SHIP investment.
Updated February 2025
Training, hardware, and software that support the application and implementation of remote pharmacy (telepharmacy) services are allowable.
Some examples of allowable expenses include but are not limited to:
| Telepharmacy Software | Telepharmacy Apps in Support of After-Hours Pharmacy Services | Telepharmacy Machines/Hardware |
| Telepharmacy Machines that can also dispense pre-packaged medication (automated medication dispensing systems) | Printer and Printer Supplied Used Exclusively with Telepharmacy Operations | Computer |
Both the purchasing of a remote prescription dispensing machine and the subscription for software to run a remote dispensing machine may be allowable if a grantee can confirm:
NOTE: The cost of personnel, medications, medication delivery, refilling pre-packaged medication, assistants, or hardware for direct patient care are unallowable.
Allowable
Accountable Care Organization (ACO)
Payment Bundling (PB)/Prospective Payment System (PPS)
Value-Based Purchasing (VBP) Investment
Updated February 2025
Subscriptions for products that provide critical services are becoming more prevalent in rural hospitals.
Generally, subscriptions for software are allowable. Please see the table below or email SHIP-TA@ruralcenter.org and copy your PO with questions or concerns.
Examples of allowable expenses include but are not limited to:
| SHIP Quality Reporting (inc. MBQIP core measures) | HCAHPS | Quality Improvement Training |
| Telehealth Platforms (Excluding Provider Fees) | Disease Registries | Population Health Databases |
| ACO Subscriptions or Fees | ICD-10/11 Software Subscriptions | Cybersecurity and/or IT security software |
| HIPAA Compliance | Interoperability software | Provider Databases for Care Coordination |
| Data Collection (e.g. intake software or SDOH screening for Quality Improvement and/or Care Coordination) | EMR/EHR | Price Transparency software |
| S-10 Cost Reporting software | HIPAA-compliant web and video conferencing platforms exclusively for telehealth |
Note: A common example is ICD Software. Whereas a hospital purchased one program that could be downloaded to multiple computers (or server accessed), many ICD companies have now moved to cloud-based subscription services where the hospital pays a "per user" license. This specific example would be allowable under "Payment Bundling, A: ICD-10 Software."
Updated January 2023
Software and web applications that facilitate swing bed services are allowable uses of SHIP Funds.
Updated February 2025
Training, hardware, and software supporting the application and implementation of telehealth services (telemedicine, remote healthcare, telepharmacy, etc.) are generally allowable expenses under ACO (G). For further questions and clarification, please email your FORHP Project Officer and SHIP-TA
Examples of allowable expenses may include but are not limited to:
| Computers | Telehealth Software | Carts (For Free Movement of Telehealth Hardware) |
| Cameras | Microphones | Wires, Connections, and Cables |
| HIPAA-compliant web and video conferencing platforms exclusively for telehealth |
*Computers, iPads, and Tablets used for other purposes are unallowable. Hospitals must use them for telehealth applications and implementation.
Costs associated with diagnosis, treating, and stabilizing a patient through telehealth options are unallowable expenses. Example: The hospital can purchase a camera, but is not allowed to pay the tele-physician's fees for treatment.
Note: Telecommunication training, hardware, and software are unallowable. This is defined as supplies or equipment that provide communication aid but not patient care/efficiency. An unallowable example would be a conferencing subscription for staff meetings. Allowable web and video conferencing platforms must be exclusively used for telehealth implementation and be HIPAA-compliant.
See also: CAH Telehealth Guide
Updated February 2025
Training concerning an approved SHIP category/sub-category is allowable. This includes costs associated with hardware, software, trainer (SME), and supplies (such as training manuals).
Training should not include tests, testing, certification, accreditation, credentialing, or any associated costs. Some training will conclude with a knowledge test for "training completion." This is allowable so long as it is not for certification, accreditation, or credentialing.
Conference fees need to be pre-approved by your FORHP Project Officer. Please send the request with a copy (or link) of the conference agenda to your PO and SHIP-TA.
Examples of allowable training expenses include but are not limited to:
| Provider-Based Clinic Quality Measure Training | CPOE Implementation Training | Alternative Payment Model Training |
| Quality Payment Program Training | Disease Registry Training | Population Health Training |
| Social Determinants of Health Screening Training | Systems Performance Training in Support of ACO or Shared Savings Initiatives | Mobile Health and Telehealth Software Training |
| Community Paramedicine Hardware and Software | Health Information Technology Training for VBP and ACO | ICD-10/11 Software and Training |
| S-10 Cost Report Training | Price Transparency Training | 340B Drug Pricing program Training |
| Billing and Coding Training | Strategic Planning Development and Implementation | Mid-Level Manager Training |
| Value Based Care | HIT training associated with cybersecurity, hospital pricing, transparency | Training related to Telepharmacy Machines that can also dispense pre-packaged medication (automated medication dispensing systems) |
| Culturally and Linguistically Appropriate Services (CLAS) |
Supplies associated with training(s) are allowable. Such supplies may include, but are not limited to, staff-use training whiteboards, training manuals, training books, training modules, and other necessary-to-the-efficiency supplies.
Note: Training for direct-patient care is unallowable. Examples of unallowable training would be CPR training, wound care, medical treatments, and training on medical equipment. It is important to note that medical or direct-patient care training that benefits a SHIP category (such as patient safety) is still unallowable.
Voice recognition system for dictation to support increased quality, efficiency, and/or coding is an allowable use of SHIP funds.