Fiscal Year (FY) 2020 Coronavirus Aid, Relief, and Economic Security (CARES) Small Rural Hospital Improvement Program Examples of Allowable Uses of Funds

This is a list of CARES award activities and purchases that may support hospitals funded through the Small Rural Hospital Improvement Program (SHIP). One-time funding will provide support to hospitals to prevent, prepare for, and respond to the coronavirus-related (COVID-19) public health emergency.

This list is not exhaustive, as there may be other allowable uses of funds consistent with the terms and conditions of your award. Ensure that your activities to address COVID-19 are consistent with CDC guidance for healthcare professionals and federal, state, territorial and local public health recommendations.

Consult with your project officer as needed if you have any questions.

Safety – Hospitals are safe for staff and patients

  • Purchase supplies for respiratory hygiene and cough etiquette, including alcohol-based hand sanitizer that contains at least 60% alcohol, tissues, and no-touch receptacles for disposal.
  • Purchase PPE or supplies to fashion protection for hospital personnel and suspected or known-infected patients, including National Institute for Occupational Safety and Health (NIOSH)-approved N95 respirators for hospital personnel.
  • Review, update, and/or implement your emergency operations plan, including plans to address surge capacity and potential provider and other hospital staff absenteeism.
  • Refresh training for all staff on standard and contact precautions, respiratory hygiene, and infection control procedures, including administrative rules and engineering controls, environmental hygiene, and appropriate use of personal protective equipment (PPE). Hospitals may consider using the Centers for Disease Control and Prevention’s (CDC) pre-pandemic training for influenza, which is also recommended for COVID-19.
  • Review your infection control plan and make necessary adjustments to align with CDC Guidelines for Environmental Infection Control in Health-Care Facilities.
  • Ensure and enhance as needed to align with evolving recommendations, implementation of infection control plans and procedures, particularly regarding surface, space, clothing, and instrument cleaning/sanitization.
  • Create new and enhance existing preparedness and response workflows to embed CDC guidelines and recommendations, which may require role/task reassignment.
  • Train staff, establish workflows, and designate separate space for clinical and administrative services for persons under investigation and those testing positive for coronavirus.
  • Purchase and post visual alerts (signs, posters) at entrances and in strategic places providing instruction on hand hygiene, respiratory hygiene, and cough etiquette.
  • Embed CDC guidance into electronic health record (EHR) clinical decision support tools.
  • Purchase and install temporary barriers and/or reconfigure space through minor alteration and renovation activities to support appropriate physical distancing of patients and/or maximize isolation precautions for persons under investigation and those testing positive for coronavirus.
  • Renovate interior floor plan and/or purchase equipment to maximize the use of telehealth.
  • Enhance or install heating, ventilation, and air conditioning (HVAC) systems to promote facility air quality and hygiene

The following are ineligible costs:

  • Purchase or upgrade of an electronic health record (EHR) that is not certified by the Office of the National Coordinator for Health Information Technology;
  • New construction activities (new stand-alone structure) and/or associated work required to expand a structure to increase the total square feet of a facility;
  • Significant site work such as new parking lots or storm water structures;
  • Work outside of the building other than improvements to the building entry for handicapped accessibility, generator concrete pads, and other minor ground disturbance;
  • Installation of a permanently affixed modular or prefabricated building; and
  • Facility or land purchases.

Response – Detect, prevent, diagnose, and treat COVID-19

  • Support COVID-19 testing and laboratory costs, including purchasing COVID-19 tests, specimen handling and collection, storage, and processing equipment, as appropriate.
  • Purchase equipment (such as ventilators and respiratory equipment) to treat patients impacted by COVID-19
  • Support increased capacity for patient triage, testing (including drive- or walk-up testing) and laboratory services, and assessment of symptoms, through enhanced telephone triage capacity, digital applications, text monitoring systems, videoconference, and additional providers and other personnel.
  • Enhance telehealth infrastructure to perform triage, care, and follow-up via telehealth, including with patients in their homes, community settings, public housing, and other locations, including patients with unstable or no housing.
  • Perform outreach and provide patient and community-wide education on hand hygiene, cough etiquette, and COVID-19 transmission, using existing materials where available.
  • Disseminate educational materials on precautions to prevent, contain, or mitigate COVID-19 and other respiratory illnesses.
  • Purchase and administer COVID-19 therapeutics and vaccines when available, including other measures that may be identified to lessen severity or length of COVID-19 illness.
  • Enhance staffing and purchase equipment and supplies (e.g., triage tents) as necessary to create separate temporary testing areas and deploy drive- or walk-up testing and laboratory services locations.
  • Enhance website and social media feeds to include patient self-assessment tools and facilitate access to telemedicine visits.
  • Enhance telemedicine infrastructure to optimize virtual care, including the use of home monitoring devices and video to help triage need for emergency services.
  • Enhance workflows, health information exchange capacity, and data exchange to support communications with public health partners, centralized assessment locations, and other health care providers.
  • Provide or otherwise support enhanced medical respite/recuperative care services.
  • Purchase or lease radiological equipment to aid in testing and diagnosis, including the purchase of health information technologies to support remote reading.
  • Purchase a mobile unit to provide testing and/or to deliver care.
  • Coordinate with public health entities to help develop and enact the local and state emergency response plans.
  • Support transitions in care (e.g., to and from hospitals or other health care providers) and coordination with health care partners, including health departments and other hospitals, by enhancing workflows, health information exchange capacity, and data exchange. 
  • Increase enabling services that address social risk factors amplified by the public health emergency (e.g., transportation, community health workers, home visits).

Maintain hospital operations

  • Support personnel salaries in response to COVID-19 impacts.
  • Support transitions as necessary to increase access to care through telehealth.
  • Repurpose office space and/or reassign personnel to maintain or increase capacity to hospital services in the context of COVID-19 and ongoing needs of the patient population.
  • Develop new and/or update existing patient registries to inform workflows that will support continuity of services to patients whose access has been limited by COVID-19 response.
  • Provide paid leave to exposed or vulnerable hospital staff, including those unable to work due to the public health emergency.
  •  Hire and/or contract with new providers and/or other personnel to support increased service demand due to COVID-19.
  • Purchase equipment to enhance electronic tracking, data exchange, reporting, and billing.
  • Purchase or upgrade of an electronic health record