Allowable Investments Search Tool
Investment Status
Investment Categories
Contractors, Consulting, and Reviews
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.
HCAHPS Surveys
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.
Medicare Beneficiary Quality Improvement Project (MBQIP)
Updated September 2023
Allowable MBQIP activities include vendor fees for HCAHPS surveys.
Note: This category is consistently under review, and we encourage SHIP Coordinators to email SHIP-TA@ruralcenter.org and copy your SHIP Project Officer with questions or concerns.
See also: HCAHPS Surveys, Surveys and Assessments
Patient Safety (Training)
Updated December 2025
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 (for example, Six Sigma, Lean, Plan-Do-Study-Act, or Antibiotic Stewardship) |
| 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.
Subscription (Definition)
Definition
Accountable Care Organization (ACO)
Payment Bundling (PB)/Prospective Payment System (PPS)
Value-Based Purchasing (VBP) Investment
Updated February 2025
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:
| SHIP Quality Reporting (inc. MBQIP core measures) | HCAHPS | Quality Improvement Training |
| Telehealth Software/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."
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.
Subscriptions
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."
Surveys and Assessments (Excluding HCAHPS)
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.
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.