Allowable Investments Search Tool

In general, SHIP allowable investments include activities to assist small rural hospitals with their quality improvement efforts and with their adaptation to changing payment systems through investments in hardware, software and related trainings. This includes aiding with value and quality improvement.

Unallowable investments include, but are not limited to, travel costs, hospital services, hospital staff salaries, or general supplies. Hospitals should contact their State Office of Rural Health (SORH) with questions regarding the appropriateness or fit of a certain activity or hardware/software purchase. For additional clarifications, refer to Frequently Asked Questions (FAQs).

This tool classifies a number of example investment activities as Allowable, Unallowable, or PO Pre-Approval. This is not a comprehensive list. It is only intended to provide examples of allowable SHIP activities.

Community Health Needs Assessment (CHNA)
Unallowable

Costs or fees associated with completing a Community Health Needs Assessment (CHNA) do not qualify as a SHIP Allowable Investment.

CHNAs are a fundamental part of health care operations.

Architecture Design or Drafting Consulting Fees
Unallowable

Architecture design and/or drafting consulting costs or fees do not qualify as a SHIP Allowable Investment. Consulting fees of any kind are not allowable unless they are part of education and training.

Bank Service Fees
Unallowable

Costs or fees related to bank services that create efficiency, but are not presented as training, do not qualify as a SHIP Allowable Investment.

If training is provided to staff to increase efficiency or quality improvement in support of ACO or shared savings related initiatives, for example, revenue cycle management, this type of fee would qualify as a SHIP Allowable Investment.

Manuals
Unallowable

Manuals alone, general in topic (i.e. Nursing or Clinical Policies and Procedures), or without training are considered supplies and do not qualify as a SHIP allowable investment.

Manuals that support a training investment such as efficiency or quality improvement, for example, would be allowable.

Hospital Staff Salaries
Unallowable

Hospital staff salary, of any kind, does not qualify as a SHIP allowable investment.

Outpatient Surveys
Unallowable

Costs associated with completing outpatient (i.e. ambulatory surgery, emergency department, medical practice, outpatient services) surveys do not qualify as a SHIP allowable investment.

Furniture
Unallowable

The purchase of furniture for patient rooms (i.e. reclining sleeper chair) is considered a supply and not equipment, therefore does not qualify as a SHIP allowable investment.

NRHA CAH CEO Certification
PO Pre-Approval

Costs or fees associated with the National Rural Health Association (NRHA) CAH CEO Certification may be allowable with PO Pre-Approval. 

SORH or hospital would need to define how each session relates to the SHIP funding categories. 

Fetal Monitoring Machine or Novii Monitor
Unallowable

Fetal monitoring machines or Novii monitors do not qualify as a SHIP allowable investment.

Neither piece of equipment fits under the ACO activity Mobile Health for Telehealth or Telemedicine as both are considered telecommunications, not telehealth or telemedicine. Although both pieces of equipment would increase patient safety under Value-Based Purchasing, patient safety activities are related to patient safety training.

Active Shooter Training
Unallowable

Active shooter training does not qualify as a SHIP Allowable Investment.  Active shooter training is required under the CMS Emergency Preparedness Rule.

Patient Lift Equipment
Unallowable

The purchase of patient lift equipment does not qualify as a SHIP allowable investment.

Physician Waiver to Prescribe and Dispense Buprenorphine
Unallowable

Costs or fees associated with a physician-waiver to prescribe and dispense Buprenorphine do not qualify as a SHIP allowable investment.

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.

Academic Mentorship Program
Unallowable

Costs or fees used to coordinate a mentorship program, training or educational event do not qualify as a SHIP Allowable Investment.

Telehealth Network Fees
Unallowable

State Offices of Rural Health (SORHs) need to provide justification of how telehealth network fits or aligns with SHIP purpose and intent. Telemedicine provider salaries, such as a telepsychiatry consult, do not qualify as a SHIP allowable investment.

Behavioral Risk Factor Surveillance System (BRFSS)
Unallowable

Conducting a Behavioral Risk Factor Surveillance System (BRFSS) survey for population health analysis does not qualify as an allowable investment as it isn’t training, equipment, or software in the ACO category, which covers population health. A population health analysis would however be allowable a Program activity.

Landscaping, Renovations, Alterations
Unallowable

Hospital landscaping, renovations, or alterations, both internal and external (i.e. gardens, fountains, healing gardens, alteration or renovation of waiting room), do not qualify as a SHIP allowable investment.

Handwashing Sinks
Unallowable

Hand sinks and hand wash stations, equipment, or installation of sinks do not qualify as a SHIP allowable investment.

These items are part of a hospital’s operational costs and are not clearly linked with the purpose and intent of the SHIP Program.

EMS Crew Equipment
Unallowable

Supplies and equipment used by emergency medical services (EMS) staff or EMS volunteers such as a stethoscope, watch, blood pressure cuff, and pulse oximeter do not qualify as SHIP allowable investment.

If the hospital and/or hospital-owned ambulance unit has a formal community paramedics program (CPP), hardware/software can be purchased to support the CPP to reduce EMS and emergency department misuse and readmissions. However, the use of SHIP funding for general EMS equipment is not allowable.

Patient Room Supplies
Unallowable

Supplies and equipment for patient rooms such as telephone, TV, and speakers, to improve satisfaction (HCAHPS) scores, do not qualify as a SHIP allowable investment.

Travel Expenses for Hospitals
Unallowable

Expenses incurred by hospital staff to travel to meetings or training such as mileage, food, per diem, lodging, and airfare do not qualify as a SHIP allowable investment.

Special Innovation Project (SIP) Funding
Unallowable

There is no additional SHIP grant funding for participating in a SIP, as all SHIP hospitals receive equal funding, therefore this is not allowable.

Transferring Unused SHIP Funds to Another Participating Hospital
Unallowable

Unused SHIP funds cannot be transferred to another participating hospital.

Penalty Fees
Unallowable

SHIP funds cannot be used to pay for penalties of any kind including failure to comply with Price Transparency.

Mock Audit
Unallowable

RHC or hospital mock audits do not qualify as a SHIP allowable investment.

EDCAHPS
Unallowable

Costs associated with implementing or data collection for Emergency Department Consumer Assessment Healthcare Providers and Systems (EDCAHPS) do not qualify as a SHIP allowable investment.

Price Transparency Contractors
Unallowable

Payment to contractors for Price Transparency compliance in review and/or update of charges does not qualify as a SHIP allowable investment.

Contractors
Unallowable

Payment to contractors without training or software does generally not qualify as a SHIP allowable investment.

Indirect Costs in Addition to Allocated Amount per Hospital
Unallowable

Indirect costs in addition to the allocated amount per hospital are allowable.

Indirect Cost Calculation - Grantee may request the lesser of 15 percent of the award total or their current HHS Cost Rate Allocation. 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.

Patient iPad/Tablet
Unallowable

iPads, tablets, and other technology/hardware investments are not allowable for patient purposes.

Hospital Staff iPad/Tablet
PO Pre-Approval

iPads, tablets, and other technology/hardware investments may be allowable if they will be used by staff to support efficiencies.

Financial Hospital Assessments
Unallowable

SHIP funds cannot be used for financial assessments, therefore would not be allowable. See language under Use of Funds.

Quality Reporting Data Collection-Related Training or Software
Allowable
Value-Based Purchasing (VBP) Investment

CAHs should participate in Medicare Beneficiary Quality Improvement Project (MBQIP). Any activity to support process improvements that result in improved quality reporting or improved inpatient and outpatient measures for PPS acute care hospitals is allowable.

HCAHPS Data Collection Process-Related Training
Allowable
Value-Based Purchasing (VBP) Investment

Activities to improve HCAHPS data collection, reporting, provider communications, and patient and family engagement that directly impact patient satisfaction scores are allowable. Hospitals may use funds to support an HCAHPS vendor to assist them in fully implementing HCAHPS and improve reporting.

Efficiency or Quality Improvement Training in Support of VBP Related Initiatives
Allowable
Value-Based Purchasing (VBP) Investment

Efficiency and quality improvement processes including: Six Sigma, Lean, Plan-Do-Study-Act, and others that address the following VBP initiatives patient experience of care, clinical care processes and outcomes, patient safety, care management and discharge planning, reducing readmissions, antibiotic stewardship, and emergency preparedness are allowable.

Provider-Based Clinic Quality Measures Education/Training
Allowable
Value-Based Purchasing (VBP) Investment

Education/training for provider-based rural health clinic quality improvement reporting, including patient satisfaction survey scores, is allowable.

Alternative Payment Model and Quality Payment Program Training/Education
Allowable
Value-Based Purchasing (VBP) Investment

Software or training to prepare staff and physicians for Quality Payment Program (QPP), which determines payment based on quality, resources use, clinical practice improvement, and meaningful use of certified electronic health record (EHR) technology is allowable.

Computerized Provider Order Entry Implementation and/or Training
Allowable
Accountable Care Organization (ACO)

Any educational trainings that support provider use and implementation are allowable.

Pharmacy Services
Allowable
Accountable Care Organization (ACO)

Training, hardware, and software that supports remote pharmacy services are allowable.

Disease Registry Training and/or Software/Hardware
Allowable
Accountable Care Organization (ACO)

Educational training hardware and software to support the development and implementation of a disease registry for care coordination is allowable.

Population Health and Social Determinants of Health Screening Software/Training
Allowable
Accountable Care Organization (ACO)

Software and training for analysis of population health needs by chronic disease, geographic location, or analysis of social determinants of health in improving health outcomes and care management programs are allowable.

Efficiency or Quality Improvement Training in Support of ACO or Shared Savings Related Initiatives
Allowable
Accountable Care Organization (ACO)

Quality improvement training such as the IHI Plan-Do-Study-Act (PDSA), Root Cause Analysis (RCA), TeamSTEPPS, Lean Process planning, Community Care Coordination and Chronic Care Management, CMS Abstraction & Reporting Tool, and other efficiency and quality improvement trainings are allowable investments.

Systems Performance Training in Support of ACO or Shared Savings Related Initiatives
Allowable
Accountable Care Organization (ACO)

Systems performance training, including adopting a framework approach to transition to value-based system planning, is an allowable investment.

Mobile Health and Telehealth Hardware/Software
Allowable
Accountable Care Organization (ACO)

Training hardware or software that supports the application and implementation of telehealth and/or telemedicine is an allowable investment.

Community Paramedicine Hardware/Software
Allowable
Accountable Care Organization (ACO)

If the hospital and/or hospital-owned ambulance unit has a formal Community Paramedic Program (CPP), hardware and software to support the CPP to reduce emergency medical services (EMS) and emergency department misuse and readmissions are allowable investments. However, the use of SHIP funding for general EMS equipment is not an allowable investment.

Project ECHO (Extension for Community Healthcare Outcomes)
Allowable
Accountable Care Organization (ACO)

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.

Health Information Technology (HIT) Training for Value and ACOs
Allowable
Accountable Care Organization (ACO)

Health Information Technology (HIT) Training for Value and ACOs is an allowable investment.  SHIP covers hardware, software, and training; therefore, it would be beneficial to include risk assessments and/or training associated with cybersecurity. These are allowable investments.

ICD-10 Software
Allowable
Payment Bundling (PB)

Any training that updates and computerizes hospital policies and procedures, assessment and maintenance of ICD-10, and hardware/software investments that improve quality, efficiencies, and coding are allowable investments.

ICD-10 Training
Allowable
Payment Bundling (PB)

Any training to support coding and reimbursement, documentation, or documentation improvements that result in increased coding compliance are allowable.

Efficiency or Quality Improvement Training in Support of PB or PPS Related Initiatives
Allowable
Payment Bundling (PB)

Trainings that improve processes through adoption of best practices and transition to value-based payment strategies such as financial and operational improvements are allowable investments.

S-10 Cost Reporting Training
Allowable
Payment Bundling (PB)

Training for debt and charity, and training to improve charity care processes and develop policy guidelines for S-10 Cost Reporting are allowable investments.

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This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UB1RH24206, Information Services to Rural Hospital Flexibility Program Grantees, $1,009,121 (0% financed with nongovernmental sources). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.