Allowable Investments Search Tool

Updated September 2023

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

Examples of unallowable costs include but are not limited to: 

Updated January 2023

Mobile language line workstations may be allowable SHIP investments if used by hospital staff to support operational efficiency and increase equitable patient satisfaction.

Note: These investments require Project Officer pre-approval. If a hospital is interested in this investment, the State SHIP coordinator should email their project officer with the justification of how these services will support operational efficiency and increase equitable patient satisfaction.

Updated January 2023

Costs associated with purchasing office supplies are unallowable.

Examples of unallowable costs include but are not limited to: 

Updated January 2023

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:

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

Updated May 2022

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

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.

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: 

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

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

Examples of unallowable cost include but are not limited to:

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

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.

Updated January 2023

Project ECHO educates health care professionals in underserved 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 January 2023

A recurring payment is defined as a pre-determined payment given over a pre-set schedule to continue services or products previously received or continuously received. Recurring payments are unallowable. Payments that occur each SHIP fiscal year for a SHIP-approved category, such as yearly ICD training, are not considered recurring and should be recorded as individual purchases.

This card is a definition to help users understand the application of SHIP spending categories and expenses. Definitions found in the SHIP Allowable Investment Search Tool may not be the same as the Federal Government's (or departments within) definition.

Updated January 2023

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: 

NOTE: The cost of personnel, medications, medication delivery, refilling pre-packaged medication, assistants, or hardware for direct patient care are unallowable. 

Updated January 2023

Renovation and alteration provide physical enhancements, changes, or other variations to an existing facility. Sometimes referred to as "upgrades," renovations and alterations often require contracting services by a licensed professional and are an unallowable SHIP expense.

Examples of unallowable expenses include but are not limited to: 

Services are defined as an act performed for remuneration.

Training services: Hiring a company or subject matter expert (SME) to conduct education and direction on a SHIP-approved category directly to hospital staff either in person on remotely via computer software. This is an allowable expense.

Physician/Medical services: Any action performed by a physician or medical staff to diagnose, treat, and maintain a patient's health and wellbeing, whether in person or remotely via computer software. This is an unallowable expense.

Pharmacy services: Any action performed by a pharmacist, pharmacy assistant, or medical staff to fill, consult, manage, or distribute medication to a patient. This is an unallowable expense.

This card is a definition to help users understand the application of SHIP spending categories and expenses. Definitions found in the SHIP Allowable Investment Search Tool may not be the same as the Federal Government's (or departments within) definition.

Software is a technology-based program designed to provide digital operational support to a SHIP-approved category and is an allowable expense. The SHIP-approved category software can be delivered through fixed format (for example, CD), downloaded, or cloud-based.

This card is a definition to help users understand the application of SHIP spending categories and expenses. Definitions found in the SHIP Allowable Investment Search Tool may not be the same as the Federal Government's (or departments within) definition.

Updated May 2022

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

Definition

Accountable Care Organization (ACO)

Payment Bundling (PB)/Prospective Payment System (PPS)

Value-Based Purchasing (VBP) Investment

Updated June 2024

A subscription is defined as an arrangement to continually receive services for a preset price. Subscription services solely in support of SHIP-approved categories such as ICD software are allowable.

Generally, subscriptions for software are allowable. See the table below or email SHIP-TA@ruralcenter.org and copy your PO with questions or concerns.

Please note that subscriptions to ongoing or on-demand training (at-will training) are unallowable expenses. Subscriptions that "happen to include" a SHIP-approved expenditure should be avoided. Subscriptions must be purchased and used for the SHIP-approved category. 

Examples of allowable expenses include but are not limited to:

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."

This card is a definition to help users understand the application of SHIP spending categories and expenses. Definitions found in the SHIP Allowable Investment Search Tool may not be the same as the Federal Government's (or departments within) definition.

Allowable

Accountable Care Organization (ACO)

Payment Bundling (PB)/Prospective Payment System (PPS)

Value-Based Purchasing (VBP) Investment

Updated June 2024

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:

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

Supplies are defined as consumable and thus replenishable objects or materials used to perform a task.

Medical Supplies: Replenishable treatment-centric products such as band aids, gauze, medications, bedpans, sanitizer, etc., are unallowable.

Patient Supplies: Replenishable patient-use centric products such as pamphlets, fliers, blankets, pillows, etc., are unallowable.

Training Supplies: Single-purpose supplies used in direct support of a SHIP allowable training, such as training books, training videos, training manuals, training software, and training hardware are an allowable expense. See also: Equipment, Hardware, and Software. Training supplies supporting credentialing, testing, and certifications (such as CPR) are unallowable.

Office Supplies: Durable or replenishable products used by staff in the day-to-day operation of the facility such as staplers, pencils, ink, and paper are unallowable.

This card is a definition to help users understand the application of SHIP spending categories and expenses. Definitions found in the SHIP Allowable Investment Search Tool may not be the same as the Federal Government's (or departments within) definition.

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:

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. 

Updated January 2023

Software and web applications that facilitate swing bed services are allowable uses of SHIP Funds.

Updated January 2023

Training, hardware, and software supporting the application and implementation of telehealth services (telemedicine, remote healthcare, telepharmacy, etc.) are allowable expenses. 

Examples of allowable expenses may include but are not limited to: 

*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 example would be a Zoom subscription for staff meetings.

See also: CAH Telehealth Guide

Training is defined as learning a specific skill or process from a professional business or subject matter expert to improve outcomes and outputs related to a SHIP-approved category and is an allowable expense.

Training for direct patient care is unallowable. 

This card is a definition to help users understand the application of SHIP spending categories and expenses. Definitions found in the SHIP Allowable Investment Search Tool may not be the same as the Federal Government's (or departments within) definition.

Updated August 4, 2022

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 a PO. 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: 

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.