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.

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. 

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.

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.

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.

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.

Price Transparency Training
Allowable
Payment Bundling (PB)

Training on revenue cycle management to improve processes that provide clear information about charges and costs including topics such as Chargemasters and price transparency is an allowable investment.

340B Drug Pricing Program Training
Allowable
Payment Bundling (PB)

A 340B Drug Pricing Program training intended to increase efficiency or quality improvement in support of Prospective Bundling and Prospective Payment Systems initiatives is an allowable investment.

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

The Patient-Centered Medical Home (PCMH) process requires a fee at enrollment and then the rural health clinic implements changes by going through training that provides quality or efficiency improvement training in support of Value-Based Purchasing initiatives. This is an allowable investment. However, the application renewal fee each year would not be considered allowable.

Billing and Coding Training
Allowable
Value-Based Purchasing (VBP) Investment

Billing and Coding training for employees working in an RHC and/or provider-based primary care clinics are allowable if the practices are owned by a critical access hospital (CAH).

Mid-Level Manager Training/Education for Value-Based Care and Population Health
Allowable
Accountable Care Organization (ACO)

Mid-level manager (MLM) training/education for the “why” and “how” of Value-Based Care and Population Health, and tools and strategies to help MLMs lead others in this time of change are allowable.

Contractor Travel and Lodging Expenses
Allowable
Accountable Care Organization (ACO)

Travel and lodging fees for contractors to get to a SHIP training can be covered. The hospital or network should request an invoice with all related training fees (including time, travel, and lodging) bundled as one single deliverable.

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

Strategic Planning Development and Implementation
Allowable
Accountable Care Organization (ACO)

Strategic planning development and implementation sessions that include staff training are allowable uses of SHIP funds. This could include Systems performance training in support of ACO or shared savings-related initiatives.

Staff-Provider Communication Whiteboards
Allowable
Value-Based Purchasing (VBP) Investment

Whiteboards used in conjunction with training for quality improvement are an allowable use of SHIP funds.

NOTE: Apart from training, whiteboards are not an allowable cost.  

Example of an allowable use of funds: If hospitals are doing a training on efficient and effective rounding, and part of that training requires the use of a whiteboard for implementing the rounding process and improving the quality and efficiency of providers and staff. 

Training Crash Carts
Allowable
Value-Based Purchasing (VBP) Investment

Training crash carts that allow for continuous staff training to improve clinical care are an allowable use of SHIP funds. Examples of allowable training crash carts would be code blue simulation training carts.

Note: Real crash carts not used for simulation would not be an allowable use of SHIP Funds given those are part of the hospital’s day-to-day patient care operations.

Medical Training and Certification
Unallowable

Training and/or certification for direct patient care including behavioral health training is not allowable. Examples: SANE-A (Sexual Assault Nurse Examiner), PMHCNS-BC (Adult Psychiatric-Mental Health Clinical Nurse Specialist), CTC (Computed Tomography Certification).

Library Fees and Services
PO Pre-Approval
Value-Based Purchasing (VBP) Investment

Library fees and services that are used strictly for training access or material and not ongoing operational access can be an allowable use of SHIP funds but requires PO approval.

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.

Outpatient Surveys
Unallowable

Surveys completed for medical clinics, ambulatory services, emergency room, specialty clinics, home health,  and other outpatient services are NOT an allowable use of SHIP funds. This includes OAS-CAHPS and CG CAHPS.

HCAHPS Surveys
Allowable
Value-Based Purchasing (VBP) Investment

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

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.