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.

Patient-Centered Medical Home (PCMH) Status Application Fee
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.

Training Travel and Lodging Expenses (Vendor)
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

Patient Safety (Training)
Value-Based Purchasing (VBP) Investment

Updated May 2022

Patient safety training is allowable to address performance issues related to Value-Based Program initiatives. 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. See also: Patient Safety (Security), Patient Safety (Equipment), Emergency Preparedness.

Notable 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, Provider-Based Clinic Quality Measures Training.

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.

Leadership Training

Updated May 2022

Leadership Training: General training on leadership best practices, how to lead, management, etc.

Leadership training and expenses related to leadership training (contracts, trainers, material, speakers) are unallowable expenses. Note that training staff in a specific SHIP category such as Value-Based Care or Population Health is allowable. Any training that includes certification, accreditation, or license is unallowable. 

Examples of unallowable costs include, but are not limited to:

NRHA CAH CEO Certification, Academic Mentorship Programs,Certifications, Accreditations, Licensing, or Privileging

Training (Hardware/Software/Services)
Accountable Care Organization (ACO)

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: 

Provider-Based Clinic Quality Measure Training, Computerized Provider Order Entry Implementation Training, Alternative Payment Model and Quality Payment Program Training, Disease Registry Training and Software, Population Health and Social Determinants of Health Screening Training and Software, Efficiency or Quality Improvement Training in Support of ACO or Shared Savings Initiatives, Systems Performace Training in Support of ACO or Shared Savings Initiatives, Mobile Health and Telehealth Training (use, not treatment), Hardware, and Software, Community Paramedicine Hardware and Software, Health Information Technology (HIT) Training for VBP and ACO, ICD-10 Software and Training, Efficiency or Quality Improvement Training in Support of PB or PPS Initiatives, S-10 Cost Reporting Training, Price Transparency Training, 340B Drug Pricing Program Training, Billing and Coding Training, Hospital Pricing Transparency Training,Strategic Planning Development and Implementation, Health Information Technology (HIT), Mid-Level Manager Training, Value-Based Care, and Population Health Training

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. 

IMPORTANT: 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.

Medical Training

Updated May 2022

Medical training is unallowable. 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 (patient safety) is still unallowable. See also: Training (Hardware/Software), Leadership Training, Patient Safety (Training).

Notable examples of unallowable medical training include, but are not limited to: 

CPR, wound care, medical credentialing (training, testing, review, and approval) for individual or facility, nursing certifications (including CNA, CPR, ER, etc.), privilege certification or approval, medical device training (prescription dispenser, ultrasound, etc.), Bluetooth or telehealth medical device training, training to support a patient to prevent accidents (different than training to recognize risks and aversion), language interpretation training.

Training (Definition)

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. 

Subscription (Definition)

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.

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. 

Note: The SHIP allowable investment definitions do not replace the Code of Federal Regulation definition for a term. The terms in the search tool help nuance your understanding of how expenses are determined. 

Certification (Definition)

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.

Credentialing (Definition)

Credentialling is defined as proving a skill or level of operation to provide evidence of authority, status, rights, entitlement or privileges, or the like. Credentialling and associated costs, such as renewing physician credentials for patient admittance, is an unallowable expense.

Direct Patient Care (Definition)

Direct patient care occurs when a facility, its providers, or staff, provide services (directly or indirectly) to diagnose, stabilize, treat, repair, maintain, or improve the health of a patient regardless of patient status (inpatient, outpatient, swing bed, SNF, etc.) or location (med/surgical, emergency room, waiting room, ambulatory, etc.,), and is an unallowable expense.

When using SHIP funds, the expenditure must not go towards training, objects, supplies, or materials that will directly treat a patient.

Example: Telehealth implementation is an approved SHIP expenditure. Purchasing software and training that will enable staff to receive readings from a Bluetooth-enabled blood pressure cuff is allowable under telehealth implementation, but the blood pressure cuff itself is unallowable. Training on how to use the blood pressure cuff is unallowable. 

Remote/Telepharmacy Services
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. 

Medical Equipment and Supplies (Including EMS)

Updated May 2022 - See definition: "Supplies, Medical" and "Equipment, Medical" 

All medical equipment used for the treatment or diagnosis of a patient's illness or injury is unallowable. Medical equipment that serves as day-to-day operational equipment is unallowable.

Examples include but are not limited to: patient lifts, bed lifts, blood pressure cuffs, oxygen monitors, hand washing sinks, ventilation hoods, respirators, purifiers, crash carts, percussion beds, medical books or manuals (excluding books or manuals provided explicitly for training on an approved SHIP category), medical pamphlets, stethoscopes, refrigerators, medicine, dispensers, sanitizers, label printing, UV lights.

Note about Bluetooth equipment: Purchasing Bluetooth-enabled medical devices are unallowable (Blood pressure cuffs, stethoscopes, oxygen monitors, etc.).

Telehealth Application and Implementation
Accountable Care Organization (ACO)

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

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, laptops, and tablets* that are used to allow patients to access a telehealth service; Telehealth software purchases (that connect the patient to the provider) including standard subscription services; Carts that allow for the free movement of telehealth hardware; Cameras, and microphones to support application and implementation of telehealth services; Wires, connections, and cables to support telehealth implementation. 

*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.

See also: Medical Equipment and Supplies and Patient Use Equipment

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.


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.