A Georgia Certificate of Need (CON) is a state approval you must obtain from the Georgia Department of Community Health (DCH) before building a new healthcare facility, expanding an existing one, or starting certain clinical services. The program is codified at O.C.G.A. Title 31, Chapter 6, and it exists to measure community need, control costs, and protect access to care across the state.1Georgia Department of Community Health. Certificate of Need If you’re a provider, developer, or investor planning a healthcare project in Georgia, the CON decision comes before almost every other one.
Projects and Services That Require a CON
Georgia defines “new institutional health services” broadly. Under O.C.G.A. 31-6-40, you generally need a CON to:
- Build a new hospital, nursing home, or other covered facility, or relocate an existing one.
- Expand an existing facility by adding beds, wings, or new service areas.
- Convert a facility’s type, such as upgrading a general acute care hospital to a specialty hospital, or converting a non-covered facility into a covered one.
- Add clinical health services that weren’t regularly offered at a treatment or diagnostic center in the prior 12 months, including surgery performed in an operating room environment.
The program also reaches major capital expenditures above a dollar threshold that the DCH adjusts periodically. That means renovations or equipment purchases at an existing facility can require CON approval on their own if they exceed the current threshold. Check the DCH’s published threshold before assuming a project is out of scope.
How to Apply for a Georgia CON
Before filing a formal application, you must submit a letter of intent to the DCH.2Justia. Georgia Code 31-6-40 – Certificate of Need Required for New Institutional Health Services; Exemption The letter puts the department and other stakeholders on notice that a project is being proposed. The full application follows.
The application isn’t a form-fill. It has to include a detailed financial plan covering costs, funding sources, and long-term feasibility, and it has to make the substantive case that the project belongs. The DCH also gathers input from other stakeholders, which can include public hearings where community members and competing providers weigh in.
Filing Fees
Fees are tied to total project cost. Projects costing $1,000,000 or less carry a flat $1,000 fee. Above that threshold, the fee is one-tenth of one percent of the total project cost, capped at $50,000.3Georgia Secretary of State. Subject 111-2-2 Certificate of Need For projects involving leased equipment or donated facilities, the fee is calculated on the fair market value of what’s being acquired rather than the lease price. If the project cost rises during review because of amendments or supplemental information, you owe the difference, with a minimum supplemental payment of $500.
How the DCH Decides
O.C.G.A. 31-6-42 sets the criteria the DCH applies to CON applications. Three carry the most weight:
- Community need. The population in the service area must actually need the proposed services. A second cardiac surgery center in a county that barely supports one faces an uphill battle.
- Financial feasibility. The project must be adequately financed and viable both short and long term. The DCH does not want to approve a project that collapses two years in.
- Relationship to existing services. The proposed service must have a positive relationship to the existing healthcare delivery system in the area. This is where incumbent providers often push back, arguing a new entrant would destabilize services that already meet demand.
The criteria give the DCH substantial discretion. A project can be financially sound and well-designed and still get denied because community need isn’t strong enough, or because approval would undermine an existing facility serving a vulnerable population. Applications that treat the criteria as a checklist rather than a substantive argument tend to fail on their own weakness before opposition ever files a word.
Appealing a CON Decision
CON decisions routinely generate disputes. An existing hospital may oppose a new competitor’s application. A denied applicant may believe the DCH misread the evidence. Either way, Georgia law provides a structured appeals path under the Administrative Procedure Act.
The first step is requesting an administrative hearing. The case is forwarded to the Georgia Office of State Administrative Hearings, where an administrative law judge reviews the evidence from all sides. The judge issues a decision, which the relevant agency can affirm, modify, reverse, or send back for further proceedings. If either party is still dissatisfied after the agency’s final decision, they can appeal to superior court.
These challenges are neither quick nor cheap. CON disputes often involve competing healthcare systems with deep pockets and strong incentives to fight. For smaller providers, litigation cost alone can be a barrier, which is another reason the quality of the initial application matters. A well-documented application that clearly addresses each statutory criterion is far easier to defend than one that cut corners.
Reform Efforts to Watch
Georgia lawmakers have repeatedly introduced bills aimed at reshaping the CON process. House Bill 198 proposed exemptions for certain facilities and services along with a streamlined application process intended to ease burdens on rural providers. Competing proposals in the state Senate have offered their own versions. None has produced a wholesale overhaul, but the legislative interest is sustained.
Proposals to loosen CON requirements draw support from would-be market entrants and free-market advocates, while existing hospital systems and safety-net providers warn that deregulation could lead to cherry-picking of profitable services and abandonment of less profitable but essential ones. Rural hospitals, which often operate on thin margins, are particularly vocal about the protections CON provides.
If you’re planning a project in Georgia, monitor these developments. A change in the CON threshold or a new category of exemptions can alter the feasibility of a project quickly once it gains political momentum.