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.
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 does not qualify as a SHIP Allowable Investment. Active shooter training is required under the CMS Emergency Preparedness Rule.
Costs or fees used to coordinate a mentorship program, training or educational event do not qualify as a SHIP Allowable 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.
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 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.
Education/training for provider-based rural health clinic quality improvement reporting, including patient satisfaction survey scores, is allowable.
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.
Any educational trainings that support provider use and implementation are allowable.
Training, hardware, and software that supports remote pharmacy services are allowable.
Last Updated 12/10/2021
Educational training hardware and software to support the development and implementation of a disease registry for care coordination is allowable.
Many programs that were previously single purchase software are now cloud-based computer programs and the fee allows sharing with other providers. Language supporting this can be found at the Agency for Healthcare Research and Quality.
Please see ACO section C for additional resources.
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.
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, including adopting a framework approach to transition to value-based system planning, is an allowable investment.
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 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.
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.
Any training to support coding and reimbursement, documentation, or documentation improvements that result in increased coding compliance are allowable.
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.
Training for debt and charity, and training to improve charity care processes and develop policy guidelines for S-10 Cost Reporting are allowable investments.
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.
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.
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 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 (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.
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 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.
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 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.
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 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.
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.
The purchase of patient lift equipment does not qualify as a SHIP allowable investment.
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.
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.
iPads, tablets, and other technology/hardware investments are not allowable for patient purposes.
iPads, tablets, and other technology/hardware investments may be allowable if they will be used by staff to support efficiencies.
Stethoscopes that are manual, Bluetooth enabled, or telehealth purposed are not an allowable use of SHIP funds.
Medical ventilation hoods that provide for the dissipation of fumes, gases, smoke, or other harmful materials from a designated area are not an allowable use of SHIP funds.
Addition of automated doors, sinks, toilets, soap dispensers, etc. for the purpose of COVID-19 mitigation.
Laboratory supplies and equipment for COVID-19 testing.
Portable equipment (such as a portable x-ray machine) that is used to prevent patients from being moved throughout a facility and to mitigate the spread of COVID-19.
Sanitation and cleaning equipment (including disinfectant robots) to be used to mitigate the spread of COVID-19. Also includes ultraviolet sanitation devices.
Upgrading or expanding for telemetry equipment as part of a larger COVID-19 mitigation strategy.
Costs associated with purchasing, maintaining, or operating a GlideScope™ or other similar equipment which allows for video laryngoscope (considered direct patient care).
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.
Costs associated with the permanent installation of internet hardware are not an allowable use of SHIP funds.
Alterations and renovations that do not qualify as construction to create isolation areas for potential COVID-19 patients
Alterations and renovations that do not qualify as construction to update surfaces to more sanitary materials to mitigate COVID-19
Alterations and renovations that do not qualify as construction to update laboratories or other key spaces for safer and more efficient COVID-19 testing.