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.
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 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.
Added May 2022: Training hardware and software for an approved SHIP investment category/subcategory is an allowable expense. Please see "Unallowable Training Hardware and Software."
Examples of allowable investments:
Devices that staff can only use for training under an approved category.
Computer training programs specific to an approved category (including training programs through modules).
Computer training that occurs virtually.
Supplies associated with training hardware and software.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. Hardware is defined as technology-based durable equipment as a one-time purchase to support a SHIP-approved category and is an allowable expense.
Architecture design and/or drafting consulting costs or fees do not qualify as a SHIP Allowable Investment. Consulting fees of any kind are not allowable unless they are part of education and training.
Hospital pricing transparency training, software, and hardware are allowable uses of SHIP funds.
Please note: Pricing transparency subscription fees can be covered under SHIP for the first year, but SHIP funds should not be used to cover a hospital’s operational cost year after year. Regarding using funds to pay for consultant or vendor to build a price transparency software, this is NOT allowable. SHIP funds can cover for price transparency training of staff for any software or website done by a consultant, but they cannot cover website development time.
Mobile language line workstations, iPads, and tablets 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 justification of how these services will support operational efficiency and increase equitable patient satisfaction.