ACO Fees
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 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 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 |
Certification is defined as achieving benchmark outcomes (such as passing a test or inspection) in support of the desired skill, upgrade, or acknowledgment and is utilized in a manner to increase the value (or perception) of a person, business, or program. Certifications and associated costs 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 September 2023
Conferences may be allowable for hospital staff if most of the training sessions are within SHIP allowable investment categories. Costs for CMEs or CEUs or travel associated with the conference are unallowable. Project Officer approval is required for attendance. Please email the conference agenda along with session titles and corresponding SHIP categories to your Project Officer and ship-ta@ruralcenter.org.
Consulting is defined as the hiring or contracting of a vendor or person to provide non-guaranteed guidance on a specific subject, area, program, or activity and is an unallowable expense. SHIP-approved training given by a person or business going by the title of "consultant" is an allowable 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.
Application: Contract is defined here for reference to contracting services (i.e. building, employment, alterations and renovations, etc.).
A contract is defined as a legally binding document guaranteeing reciprocal services by a vendor or person in exchange for a pre-determined payment.
Note: Some allowable training consultants, programs, and services require an agreement or contract execution.
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
(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.
Addition of automated doors, sinks, toilets, soap dispensers, etc. for the purpose of COVID-19 mitigation.
Costs associated with the purchase, maintenance, or usage of communication equipment including 2-way radios, electronic messaging boards for COVID-19 testing and mitigation, nurse call systems, and video streaming equipment.
The cost associated with COVID-19 testing education at hospitals and community locations including home health, hospice, and long-term care.
Construction costs, including, but are not necessarily limited to permanent building additions, new permanent buildings, permanent building expansions, modular buildings (and installations), increasing the footprint of the facility, significant new ground disturbance, and projects with a total cost of $500,000 or more.
Costs associated with staff couriering COVID-19 tests to a laboratory.
Digital meeting technology software purchases to conduct digital/virtual meetings to mitigate the spread of COVID-19 by maintaining physical distancing and reducing facility traffic.
Costs related to treatment or direct patient care.
COVID-19 related education materials (including vaccination education materials) for dissemination to the public.
Electronic health record (EHR) costs supportive of COVID-19 testing and mitigation.
Costs associated with designing and implementing employee burnout/mental health strategies require pre-approval.
Supporting EMS as it relates to COVID-19 testing and mitigation efforts, and as part of a system improvement process
Costs associated with purchasing, maintaining, or operating a GlideScope™ or other similar equipment which allows for video laryngoscope (considered direct patient care).
Purchasing and installing HVAC and associated expenses to improve COVID-19 mitigation efforts.
Purchasing and installing ionized filtration systems for HVAC units to improve COVID-19 mitigation efforts.
Alterations and renovations that do not qualify as construction to create isolation areas for potential COVID-19 patients
Laboratory supplies and equipment for COVID-19 testing.
Minor alterations or renovations that exceed 50% of the hospital's total American Rescue Plan (ARP) award.
Costs associated with mitigating the spread of COVID-19 and other related respiratory diseases. For the purpose of the SHIP Testing and Mitigation grants, activities that mitigate negative outcomes at the patient level through direct patient care are not allowable. See direct patient care.