Updated January 2023
ACO costs 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.
Updated January 2023
Changes, additions, or demolition to hospital facilities (internal and external) are an unallowable expense. This includes alterations and renovations that may improve a SHIP category area such as patient safety.
Some unallowable expenses include but are not limited to:
| Removing Walls | Adding Walls | Doorway additions/removals |
| Firebreaks | Carpet Replacement | Counter Replacement |
| Tile Replacement | Window Additions/Replacement | Restroom Upgrades/Fixes |
| Fixture Installation | Hardwired Internet Installation | Footage Increases/Decreases |
| Sidewalk Installation/Repair | Sidewalk Upgrades | Parking Lot Maintenance |
| Landscaping | Accessibility Additions/Changes | Drainage |
| Covered Walkways | Directional Signage | Roofing Upgrades/Fixes |
| HVAC Upgrades/Fixes | Sprinkler Systems |
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.
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.
Updated September 2023
Conferences may be allowable for hospital staff if most of the training sessions are within SHIP allowable investment categories. Costs for CMEs or CEUs or travel associated with the conference are unallowable. Project Officer approval is required for attendance. Please email the conference agenda along with session titles and corresponding SHIP categories to your Project Officer and ship-ta@ruralcenter.org.
Consulting is defined as the hiring or contracting of a vendor or person to provide non-guaranteed guidance on a specific subject, area, program, or activity and is an unallowable expense. SHIP-approved training given by a person or business going by the title of "consultant" is an allowable expense.
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.
Application: Contract is defined here for reference to contracting services (i.e. building, employment, alterations and renovations, etc.).
A contract is defined as a legally binding document guaranteeing reciprocal services by a vendor or person in exchange for a pre-determined payment.
Note: Some allowable training consultants, programs, and services require an agreement or contract execution.
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.
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.
Credentialing is defined as proving a skill or level of operation to provide evidence of authority, status, rights, entitlement or privileges, or the like. Credentialing and associated costs, such as renewing physician credentials for patient admittance, is an unallowable expense.
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.
Updated October 2024
SHIP supports HIT hardware/software and training, including risk assessments for cybersecurity.
Cybersecurity refers to any technology, measure, or practice for preventing cyberattacks or mitigating their impact. A strong cybersecurity strategy protects all relevant IT infrastructure layers or domains against cyberthreats and cybercrime. Examples of allowable expenses include but are not limited to:
|
Critical Infrastructure Security |
Subscriptions for Cybersecurity Software |
| Endpoint Security | Application Security |
| Cloud Security | Information Security |
| Mobile Security |
Network Security |
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.
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 on the patient is unallowable.
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.
Equipment is defined as a one-time purchase product used to perform or support a task.
Patient Equipment: Fixed or mobile product to be used directly by a patient (for treatment or comfort) such as a whiteboard, Wi-Fi router, wheelchairs, or beds. This is an unallowable expense.
Medical Equipment: Fixed or mobile product to be used to diagnose, treat, and maintain a patient's health and wellbeing, whether in person or remotely via computer software. This is an unallowable expense.
Telehealth Equipment (Computer Hardware): Fixed or mobile products to support the integration and adoption of telehealth services within a facility. This is an allowable expense. See also: Hardware.
Training Equipment: Fixed or mobile products that will be used solely to support SHIP-approved training, such as a training crash cart. This is an allowable expense.
Office equipment: Fixed, mobile, or electronic equipment used solely to support day-to-day office operations. This is an unallowable expense.
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.
Updated January 2023
Event management software, hardware, or reporting that is completed to manage attendees, staff, or volunteers and event operations is not an allowable use of SHIP funds.
Updated January 2023
Fees and fines accrued in association with a service provided to the hospital, regardless of the SHIP-approval status, are not to be paid with SHIP funds.
Examples of unallowable fees include but are not limited to:
| Bank Service Fees | Library Fees | Penalty Fees |
| Insurance Fees | Building Fines | Violation Fines |
Note that some costs are referred to as "fees" and may be allowable (like ACO Fees), fees in this context are subsidiary costs, the recurring cost for use of services, or lack thereof.
Furniture is defined as a one-time purchase product that is either fixed or moveable and required for the operation of an office, clinic, patient room, patient waiting room, or other facility space such as tables, chairs, stands, decorations, pictures, rugs, or curtains. Furniture expenses are unallowable.
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.
Hardware is defined as technology-based durable equipment as a one-time purchase to support a SHIP-approved category and is an allowable expense.
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.
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.
Updated June 2025
Activities that support ICD-11 readiness and/or implementation are allowable. This includes, but is not limited to:
| Computer software upgrades to support a future transition to ICD-11 | Computer hardware that improves quality, efficiencies, and/or coding | Social Drivers of Health and Population Health training to use Z-Codes |
| Efficiency or QI training to minimize ICD-11 transition impacts on patients and staff | Revenue Cycle Management training | Updating ICD-10 software or hardware |
| ICD-11 system and/or coding training (individual hospitals or state-wide) | ICD-11 Implementation | ICD-10 billing & coding trainings to reduce errors and improve reimbursements |
Transition to an online coding system that automatically makes ICD-11 available when appropriate | Upgrading or implementing telehealth software and hardware to take advantage of new/updated ICD codes for telehealth/telemedical services. | Trainings that update and computerize hospital policies and procedures to prepare for ICD-11 |
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.
See also: Subscription, Recurring Payment, Training (Hardware/Software/Services)
Updated September 2023
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.
Infrastructure is defined as physical support, addition, enhancement, or upgrade to ensure the operational continuance of a facility or program and is an unallowable expense. Infrastructure is often unseen and generally requires contractor and building services. An example of an infrastructure expenditure may be installing fiber optic cable for high-speed internet access, which is an unallowable expense.
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.
Updated January 2023
In general, costs associated with purchasing iPads, tablets, and mobile devices are unallowable. For purchases related to telehealth, please contact SHIP-TA@ruralcenter.org and copy your PO.
Some specific unallowable examples include but are not limited to:
| iPads | Kindle | Surface |
| iPhones | Wearable Tech | Tracking Devices |
| Survey Tools | Tablet Chargers |
See also: Patient use supplies and equipment, office supplies.
Updated January 2023
Leadership training refers to general training on leadership best practices, leadership skill building, management, etc. Expenses related to leadership training (contracts, trainers, material, speakers) are unallowable expenses. Any training that includes certification, accreditation, or license is unallowable.
Examples of unallowable costs include, but are not limited to:
| NRHA Certification | Critical Access Hospital Certification | CEO Certification |
| Fundraising Training | Academic or Professional Mentorships | Accreditations |
| Licensing | Privileging | Leadership Fundamentals |
The National Rural Health Resource Center has a collection of Leadership Videos that are available at no cost to hospitals. Compiled through various programs The Center supports, these videos can be found under the "Show more" button.
Updated January 2023
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 of unallowable costs include but are not limited to:
| Patient Lifts | Patient Beds/Bed Lifts | Blood Pressure Cuffs/Equipment |
| Oxygen Monitors | Hand Washing Sinks | Respirators |
| Purifiers | Crash Carts | Percussion Beds |
| Medical Books/Manuals | Medical Pamphlets | Stethoscopes |
| Refrigerators | Medications | Medication Dispensers |
| Sanitizers (UV Lights) | Label Printing | Thermometers |
Note: Telehealth implementation is an allowable expense, however, purchases of Bluetooth or internet enabled medical devices is unallowable.
Updated January 2023
Medical training is unallowable. Training for direct patient care, treatment, or response is unallowable.
Examples of unallowable costs include but are not limited to:
| CPR | Wound Care | Medical Credentialing |
| CNA | Vein Location Training | Medical Supplies Training |
| Medical Treatment Training | Medical Tool Training | Accident Intervention |
| Emergency Intervention | Pharmaceutical Training | Language Interpretation Training |
Note: For SHIP spending purposes, there are significant differences between medical training to treat and training to identify and prevent. Training on how to respond to a patient who has fallen is unallowable, but training on how to recognize fall risks or identify hazards is allowable.
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
Membership is defined as an arrangement between a business and the facility whereas the facility has access to associated benefits. Memberships and associated fees such as American Hospital Association are unallowable.
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.