Allowable Investments Search Tool

Identifying allowable investments for a SHIP-eligible hospital does not have to be a daunting task! This search tool created by SHIP-TA through the Federal Office of Rural Health Policy helps state coordinators and hospitals navigate the possibilities.
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18 results found

Alterations and Renovations (A&R)

Unallowable

Updated January 2023

Changes, additions, or demolition to hospital facilities (internal and external) are an unallowable expense. This includes alterations and renovations that may improve a SHIP category area such as patient safety. 

Some unallowable expenses include but are not limited to: 

Removing Walls Adding Walls Doorway additions/removals
Firebreaks Carpet Replacement Counter Replacement
Tile Replacement Window Additions/Replacement Restroom Upgrades/Fixes
Fixture Installation Hardwired Internet Installation Footage Increases/Decreases
Sidewalk Installation/Repair Sidewalk Upgrades Parking Lot Maintenance
Landscaping Accessibility Additions/Changes Drainage
Covered Walkways Directional Signage Roofing Upgrades/Fixes
HVAC Upgrades/Fixes Sprinkler Systems  

 

Unallowable investment

Contractors, Consulting, and Reviews

Unallowable

Updated January 2023

(Excluding HCAHPS and Chargemaster Review)

Contractor and consulting fees, services, and payments (recurring or one-time) are unallowable. This includes contracting for a consultant to review current operations under an approved SHIP category. 

Some unallowable expenses include but are not limited to: 

Architecture Designs Outside Employee Contracts Retainer Fees
Program Evaluation/Consulting Vendor Consultation Alterations and Renovations

Note: It is understood that some companies providing "training" in an approved SHIP category may refer to themselves as a consultant or contractor. Please e-mail SHIP-TA@ruralcenter.org if clarification is needed.

Unallowable investment

Event Management

Unallowable

Updated January 2023

Event management software, hardware, or reporting that is completed to manage attendees, staff, or volunteers and event operations is not an allowable use of SHIP funds.

Unallowable investment

Fees and Fines

Unallowable

Updated September 2026

Fees and fines accrued in association with a service provided to the hospital, regardless of the SHIP-approval status, are not to be paid with SHIP funds.

Examples of unallowable fees include but are not limited to: 

Bank Service FeesLibrary FeesPenalty Fees
Insurance FeesBuilding FinesViolation Fines
Provider-Related Service Fees  

Note that some costs are referred to as "fees" and may be allowable (like ACO Fees), fees in this context are subsidiary costs, the recurring cost for use of services, or lack thereof. 

Unallowable investment

Leadership Training

Unallowable

Updated September 2026

Leadership training refers to general training on leadership best practices, leadership skill building, management, etc. Expenses related to leadership training (contracts, trainers, material, speakers) are unallowable expenses. Any training that includes certification, accreditation, or license is unallowable. 

Examples of unallowable costs include, but are not limited to:

NRHA CertificationCritical Access Hospital CertificationCEO Certification
Fundraising TrainingAcademic or Professional MentorshipsAccreditations
LicensingPrivilegingLeadership Fundamentals
Unallowable investment

Medical Equipment and Supplies (Including EMS)

Unallowable

Updated January 2023

All medical equipment used for the treatment or diagnosis of a patient's illness or injury is unallowable. Medical equipment that serves as day-to-day operational equipment is unallowable.

Examples of unallowable costs include but are not limited to:

Patient Lifts Patient Beds/Bed Lifts Blood Pressure Cuffs/Equipment
Oxygen Monitors Hand Washing Sinks Respirators
Purifiers Crash Carts Percussion Beds
Medical Books/Manuals Medical Pamphlets Stethoscopes
Refrigerators Medications Medication Dispensers
Sanitizers (UV Lights) Label Printing Thermometers

Note: Telehealth implementation is an allowable expense, however, purchases of Bluetooth or internet enabled medical devices is unallowable. 

Unallowable investment

Medical Training

Unallowable

Updated September 2026

Medical training is unallowable. Training for direct patient care, treatment, or response is unallowable.

Examples of unallowable costs include but are not limited to:

CPRWound Care Medical Credentialing
CNAVein Location TrainingMedical Supplies Training
Medical Treatment TrainingMedical Tool TrainingAccident Intervention
Emergency InterventionPharmaceutical TrainingLanguage Interpretation Training
AI Clinical Training  

Note: For SHIP spending purposes, there are significant differences between medical training to treat and training to identify and prevent. Training on how to respond to a patient who has fallen is unallowable, but training on how to recognize fall risks or identify hazards is allowable. 

Unallowable investment

Membership(s) (including EMS)

Unallowable

Updated September 2026

The cost associated with memberships in associations, professional societies, or other organizations that are in addition to and not required of a SHIP-qualifying training course is unallowable.

Examples of unallowable costs include but are not limited to:

Telehealth Network FeesHospital Association MembershipsChamber Associations
Business AssociationsCredentialing AssociationsNetworking 
Social Media ExpensesCivic OrganizationsSponsorships
Joint Commission FeesHigh-Value NetworksClinically Integrated Networks

Note: Some SHIP-qualifying training courses may require membership for staff to utilize approved training resources. If you find a trainer, or training company, that requires a membership it is best to e-mail ship-ta@ruralcenter.org and copy your PO for clarification.

Unallowable investment

Messaging, Marketing, Community Outreach

Unallowable

Updated September 2023

Public messaging, marketing, and community outreach campaign costs are unallowable.

Examples of unallowable costs include but are not limited to: 

Signage Directional Signage Safety Signage
Message Boards One-Sheets Push Cards
Posters Information Cards Video Production
Social Media Expenses Marketing Expenses Community Outreach Expenses
Flyers/Brochures Signage  
Unallowable investment

Office Supplies

Unallowable

Updated September 2026

Costs associated with purchasing office supplies are unallowable.

Examples of unallowable costs include but are not limited to: 

Pens and PencilsE-readersElectronic Tablets
PaperBindersPrinters and Printer Ink/Toner
WhiteboardsOffice FurniturePurifiers
HumidifiersComputers (office use)Storage
Computer AccessoriesRefrigeratorsStylus
Telephones (Land or Wireless)Two-way RadiosOffice Software
Flyers/BrochuresSignage 
Unallowable investment

Patient Safety (Equipment)

Unallowable

Updated April 2026

Purchases that support the physical treatment of the patient are unallowable expenses. This includes physical equipment. An example may be the purchase of a bed that aids in preventing falls. Fall prevention is a "patient safety" activity, but SHIP funds can't be spent on beds that directly aid in treating a patient. Therefore, it would be an unallowable expense.

Examples of unallowable costs include but are not limited to:

StretchersMattressesGuard Rails
WalkersWheelchairsRamps
LiftsHand RailsCanes
PurifiersNoise MachinesIV Locators/Guides
Automated Video Monitoring Systems  

Note: This card pertains to equipment only. Please see the card for Patient Safety (Training) for more information.

Unallowable investment

Patient Safety (Security)

Unallowable

Updated May 2022

Purchases for hospital facility security, facility security assessments, and crisis management, including, but not limited to:

Security Cameras/Monitors Incident Response Training Behavioral Risk Factor Surveillance System (BRFSS)
Security/Alarm Systems Security Guards Security/Safety Monitoring

Note: Value Based Programs/Purchasing (VBP) section C: "patient safety" is about the quality of care given to patients. Please click "See more" for additional information. See also: Patient Safety (Equipment), Emergency Preparedness, Patient Safety.

Unallowable investment

Patient Use Supplies and Equipment (Including EMS)

Unallowable

Updated September 2026

Costs associated with purchasing patient-use supplies, equipment, and furniture are unallowable expenses.

Examples of unallowable cost include but are not limited to:

Tablets/E-readersPatient Room FurnitureWhiteboards
Communication BoardsHardwired InternetPatient Use Wi-Fi
Wireless RoutersChargersDividers
Patient Assistance EquipmentStoolsChairs
TelevisionsCartsTrays
Flyers/BrochuresSignage 
Unallowable investment

Physician Waiver to Prescribe and Dispense Buprenorphine

Unallowable

Updated January 2023

Costs or fees associated with a physician-waiver to prescribe and dispense Buprenorphine are an unallowable expense.

Providers may apply for a waiver with the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Become a Buprenorphine Waivered Practitioner since this has an opioid component. This process is free of charge; therefore, SHIP funds should be applied to other activities.

Unallowable investment

Staff Salaries and Payroll

Unallowable

Updated May 2022

Hospital staff salary, benefits, incentives, and bonuses, of any kind, are unallowable.  

Unallowable investment

Surveys and Assessments (Excluding HCAHPS)

Unallowable

Updated January 2023

Costs associated with conducting surveys and assessments (including overhead, fees, payments, contractors, etc.) are unallowable.

Some unallowable examples include but are not limited to:

Community Health Needs Assessment(s) (CHNA) Outpatient Surveys EDCAHPS
Hospital Finance Assessments Mock Audits (Including RHCs)  

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. 

 

Unallowable investment

Tablets and Mobile Devices

Unallowable

Updated September 2026

In general, costs associated with purchasing E-readers, tablets, and mobile devices are unallowable. For purchases related to telehealth or interpretation/translation services (including laptops, tablets, hotspots, etc.), please contact SHIP-TA@ruralcenter.org and copy your PO.

Some specific unallowable examples include but are not limited to: 

TabletsE-readersMobile/Cellular Devices
Wearable TechTracking DevicesSurvey Tools
Tablet Chargers  

See also: Patient use supplies and equipment, office supplies.

Unallowable investment

Transferring Unused SHIP Funds to Another Participating Hospital

Unallowable

Updated May 2022

Unused SHIP funds cannot be transferred to another participating hospital.

Unallowable investment

The Health Resources and Services Administration (HRSA), Department of Health and Human Services (HHS) provided financial support for this Information Services to Rural Hospital Flexibility Project. The award provided 100% of total costs and totaled $1,100,000. The contents are those of the author. They may not reflect the policies of HRSA, HHS, or the U.S. Government.

As a technical assistance provider to rural health care organizations, the National Rural Health Resource Center provides access to a wide range of resources on relevant topics. Inclusion on the National Rural Health Resource Center’s webpage or presentations does not imply endorsement of, or agreement with, the contents by the National Rural Health Resource Center or the Health Resources and Services Administration.