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.

Staff Salaries and Payroll
Unallowable

Updated May 2022

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

See also: COVID

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.

Transferring Unused SHIP Funds to Another Participating Hospital
Unallowable

Updated May 2022

Unused SHIP funds cannot be transferred to another participating hospital.

Indirect Costs
Allowable

Updated May 2022

Indirect costs are deducted from the total award amount per state.

Indirect Cost Calculation - Grantee may request the lesser of 15 percent of the award total or their current federally negotiated indirect cost rate agreement. 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.

Remote/Telepharmacy Services
Allowable
Accountable Care Organization (ACO)

Updated May 2022: See definitions "Telehealth," "Training," "Hardware," and "Software." 

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: 

Telepharmacy software, telepharmacy software/apps to support after-hours pharmacy services, telepharmacy machines, telepharmacy machines that can dispense pre-packaged medication, printer and printing supplies used for telepharmacy operations (i.e., printing instructions with pre-packed medication), computers, and accompanying hardware to support telepharmacy operations. 

See also: telehealth, hardware, software, office supplies, training.

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

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.

ACO Fees
Allowable
Accountable Care Organization (ACO)

Updated May 2022

ACO fees 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.

Patient-Centered Medical Home (PCMH) Status Application Fee
Allowable
Value-Based Purchasing (VBP) Investment

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.

Swing Bed Software and Web Applications
Allowable
Accountable Care Organization (ACO)

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

Wellness Streaming Services
Allowable
Accountable Care Organization (ACO)

Updated May 2022

Software and hardware SHIP infrastructure for wellness streaming services as a population health project is an allowable use of SHIP funds.

Mobile Language Line Workstation for Interpretation Services
PO Pre-Approval
Accountable Care Organization (ACO)

Updated May 2022

Mobile language line workstations can potentially 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.

Messaging, Marketing, Community Outreach
Unallowable

Updated May 2022

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

Unallowable expenses may include but are not limited to: 

Signage, directional signage, message boards, books, pamphlets, one-sheets, push cards, information cards, video production, social media advertising, marketing, and community marketing.

See also: Supplies (Office)

Voice Recognition System for Dictation
Allowable
Payment Bundling (PB)

Voice recognition system for dictation to support increased quality, efficiency, and/or coding is an allowable use of SHIP funds.

Training Travel and Lodging Expenses (Vendor)
Allowable
Accountable Care Organization (ACO)

Updated May 2022, See definitions: "Training," "Contract," and "Consulting/Reviews"  

Travel and lodging costs for vendors, contractors, or a subject matter expert (SME) to travel to and from SHIP-approved training are allowable. The hospital or network should request an invoice with all related training costs (including time, travel, and lodging) bundled as one single deliverable.

NOTE: SHIP Guidance doesn't approve travel for hospitals and state offices.

See also: Training

HCAHPS Surveys
Allowable
Value-Based Purchasing (VBP) Investment

Updated May 2022 - Only HCAHPS Surveys are allowable. 

Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys completed for inpatient services are an allowable use of SHIP funds.

NOTE: Currently, this is the only allowable SHIP survey. Costs associated with conducting 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. 

See also: Surveys and Assessments

Event Reporting
Unallowable

Updated May 2022:

Reporting (prior, ongoing, or post-event) managing attendees, staff, or volunteers and event operations is not an allowable use of SHIP funds.

 

COVID-19 Testing
COVID Allowable
SHIP ARP COVID-19 Testing & Mitigation

Costs for testing, including procuring, providing, or processing COVID-19 tests (including at-home testing kits).

COVID-19 Simultaneous Multi-Disease Test
COVID Allowable
SHIP ARP COVID-19 Testing & Mitigation

Costs for testing using a simultaneous multi-disease test that must include COVID-19

COVID-19 Mitigation Activities
Allowable
SHIP ARP COVID-19 Testing & Mitigation

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.

COVID-19 Community Testing and Mitigation
COVID Allowable
SHIP ARP COVID-19 Testing & Mitigation

The cost associated with COVID-19 testing education at hospitals and community locations including home health, hospice, and long-term care.

COVID-19 EMS Support
COVID Allowable
SHIP ARP COVID-19 Testing & Mitigation

Supporting EMS as it relates to COVID-19 testing and mitigation efforts, and as part of a system improvement process

COVID-19 Isolation Areas
Allowable
SHIP ARP COVID-19 Testing & Mitigation

Alterations and renovations that do not qualify as construction to create isolation areas for potential COVID-19 patients

COVID-19 Surface Renovations
Allowable
SHIP ARP COVID-19 Testing & Mitigation

Alterations and renovations that do not qualify as construction to update surfaces to more sanitary materials to mitigate COVID-19

COVID-19 Safe and Efficient Laboratories
Allowable
SHIP ARP COVID-19 Testing & Mitigation

Alterations and renovations that do not qualify as construction to update laboratories or other key spaces for safer and more efficient COVID-19 testing.

COVID-19 Automation
COVID Allowable
SHIP ARP COVID-19 Testing & Mitigation

Addition of automated doors, sinks, toilets, soap dispensers, etc. for the purpose of COVID-19 mitigation.

COVID-19 Negative Pressure Spaces
Allowable
SHIP ARP COVID-19 Testing & Mitigation

Creating negative pressure spaces within common spaces (such as waiting rooms and bathrooms), or in rooms to treat COVID-19 positive patients.

COVID-19 Temporary Structures
COVID Allowable
SHIP ARP COVID-19 Testing & Mitigation

Installing tents, sheds, or other temporary structures to use for COVID-19 testing or mitigation activities.

COVID-19 HVAC
COVID Allowable
SHIP ARP COVID-19 Testing & Mitigation

Purchasing and installing HVAC and associated expenses to improve COVID-19 mitigation efforts.

COVID-19 Ionized Filtration
Allowable
SHIP ARP COVID-19 Testing & Mitigation

Purchasing and installing ionized filtration systems for HVAC units to improve COVID-19 mitigation efforts.

COVID-19 Personal Protective Equipment (PPE)
COVID Allowable
SHIP ARP COVID-19 Testing & Mitigation

Devices for masks, fit testing masks, respirators, or other personal protective equipment used to mitigate the spread of COVID-19.

COVID-19 Education Materials
COVID Allowable
SHIP ARP COVID-19 Testing & Mitigation

Covid-19 related education materials (including vaccination education materials) for dissemination to the public. 

COVID-19 Laboratory Supplies
COVID Allowable
SHIP ARP COVID-19 Testing & Mitigation

Laboratory supplies and equipment for COVID-19 testing. 

COVID-19 Portable Equipment
COVID Allowable
SHIP ARP COVID-19 Testing & Mitigation

Portable equipment (such as a portable x-ray machine) used to prevent patients from being moved throughout a facility. To be allowable, all portable equipment must be part of a hospital's larger COVID-19 mitigation plan.

COVID-19 Sanitation and Cleaning
COVID Allowable
SHIP ARP COVID-19 Testing & Mitigation

Sanitation and cleaning equipment (including disinfectant robots) to be used to mitigate the spread of COVID-19. Also includes ultraviolet sanitation devices.

COVID-19 Temperature Screening
COVID Allowable
SHIP ARP COVID-19 Testing & Mitigation

Temperature screening systems to be used to mitigate the spread of COVID-19. See COVID-19 Screen Staff as well.

COVID-19 Telemetry
Allowable
SHIP ARP COVID-19 Testing & Mitigation

Upgrading or expanding for telemetry equipment as part of a larger COVID-19 mitigation strategy.

COVID-19 Screening Staff
COVID Allowable
SHIP ARP COVID-19 Testing & Mitigation

Cost of paying screeners placed at facility entrance doors to protect patients and employees and mitigate the spread of COVID-19.

COVID-19 Courier Staff
COVID Allowable
SHIP ARP COVID-19 Testing & Mitigation

Costs associated with staff couriering COVID-19 tests to a laboratory. 

COVID-19 Digital Meeting Technology (Software)
COVID Allowable
SHIP ARP COVID-19 Testing & Mitigation

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. 

COVID-19 Electronic Health Records (EHR)
Allowable
SHIP ARP COVID-19 Testing & Mitigation

Electronic health record (EHR) costs supportive of COVID-19 testing and mitigation. 

COVID-19 Direct Patient Care
COVID Unallowable
SHIP ARP COVID-19 Testing & Mitigation

Costs related to treatment or direct patient care.

COVID-19 Vaccinations
COVID Unallowable
SHIP ARP COVID-19 Testing & Mitigation

Vaccine purchases, dissemination (including boosters) of vaccinations, or supplies associated with COVID-19 vaccination (considered direct patient care). 

COVID-19 Construction
COVID Unallowable
SHIP ARP COVID-19 Testing & Mitigation

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.  

COVID-19 GlideScope
COVID Unallowable
SHIP ARP COVID-19 Testing & Mitigation

Costs associated with purchasing, maintaining, or operating a GlideScope™ or other similar equipment which allows for video laryngoscope (considered direct patient care).

COVID-19 Ventilators
COVID Unallowable
SHIP ARP COVID-19 Testing & Mitigation

Costs associated with purchasing, maintaining, or operating ventilators or other similar equipment which allows for respiratory assistance.

COVID-19 Staff Salary & Benefits
COVID Unallowable
SHIP ARP COVID-19 Testing & Mitigation

Costs associated with increasing staff salaries, recruitment, retention, bonuses, incentives, or benefits such as hazard pay, employee childcare, housing allowances, travel allowances (not associated with COVID-19 courier services), meals, snacks, or other incentive benefits. See Screening Staff, Testing Staff, Courier Staff, or Travel Nurse for more information.

COVID-19 Testing Staff
COVID Allowable
SHIP ARP COVID-19 Testing & Mitigation

Costs associated with staff time spent on COVID-19 testing. 

COVID-19 Travel Nurse
COVID PO Pre-Approval
SHIP ARP COVID-19 Testing & Mitigation

Costs associated with hiring, retaining, or relocating travel nurses or travel nurse services require pre-approval.

COVID-19 Minor Alterations or Renovations (A/R)
COVID PO Pre-Approval
SHIP ARP COVID-19 Testing & Mitigation

Minor alterations or renovations that exceed 50% of the hospital's total American Rescue Plan (ARP) award.

COVID-19 Communication Equipment
COVID PO Pre-Approval
SHIP ARP COVID-19 Testing & 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, and video streaming equipment. 

Pages

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, $1,560,000 (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.