Healthcare Facility Regulation in Georgia: Licensing and Inspections

Healthcare facility regulation in Georgia is handled primarily by the Healthcare Facility Regulation Division (HFRD) of the state Department of Community Health, which licenses hospitals, nursing homes, ambulatory surgical centers, and other facility types under Chapter 111-8 of the Georgia Administrative Code. Facilities that participate in Medicare or Medicaid must also satisfy federal Conditions of Participation enforced by the Centers for Medicare & Medicaid Services (CMS), and fire safety at most certified facilities is inspected by the State Fire Marshal under a contract with DCH. The framework shifted in late 2025 with the federal repeal of nursing home staffing minimums, and it continues to shift in 2026 with new accessibility deadlines for medical equipment.

Who Regulates Healthcare Facilities in Georgia

HFRD is the state agency that licenses facilities, sends survey teams to inspect them, investigates complaints, and takes enforcement action when facilities violate state rules.¹ State-level regulations sit in Chapter 111-8 of the Georgia Administrative Code, with separate subchapters for hospitals (111-8-40), nursing homes (111-8-56), and other facility types.²

CMS sets the Conditions of Participation that any facility must meet to receive Medicare or Medicaid payments, and it contracts with HFRD to conduct the certification surveys.³ The Office of the Insurance and Safety Fire Commissioner adds a third layer: the State Fire Marshal, under contract with DCH, conducts Life Safety Code inspections at hospitals, nursing homes, ambulatory surgical centers, and other Medicare- and Medicaid-certified facilities that are not accredited by a national accreditation body.⁴ Patient privacy sits with a different regulator entirely; HIPAA is enforced by the U.S. Department of Health and Human Services Office for Civil Rights.⁵

Which Facilities Need a License

Georgia law requires any facility meeting the statutory definition of an “institution” to hold a permit from DCH before it can operate. The definition is broad. It covers any building providing two or more beds used for examination, diagnosis, treatment, surgery, nursing care, or assisted living for 24 hours or longer, plus ambulatory surgical centers, birthing centers, freestanding imaging centers, specimen collection sites, and facilities treating traumatic brain injury.⁶ Private physician and dentist offices where the provider primarily sees patients are excluded.

Applicants submit documentation covering ownership, financial capacity, building code compliance, zoning approval, and operational policies for patient care, emergency procedures, and infection control. An on-site inspection is normally required before a permit is granted. Facilities intending to accept Medicare or Medicaid must also complete federal certification. Permits remain in force until revoked or suspended; provisional permits last only for a period the department specifies.⁷ Changes in ownership, location, or scope of services can trigger the need for an amended or new permit.

Certificate of Need Before You Build or Expand

In many situations a facility must obtain a Certificate of Need (CON) from DCH’s Office of Health Planning before it can even apply for a license. Georgia’s CON program was established in 1979 under O.C.G.A. Title 31, Chapter 6, and is designed to control healthcare costs, measure community need, and guarantee access to services.⁸

A CON is required before undertaking what the statute calls a “new institutional health service.” That includes building a new facility, expanding or relocating an existing one, increasing bed capacity, purchasing major diagnostic or therapeutic equipment, and adding clinical services the facility has not offered in the prior 12 months. Radiation therapy, ambulatory surgery, cardiac catheterization, and biliary lithotripsy are singled out for CON review.⁹ Applicants submit a letter of intent and a formal application and must receive approval before the project begins.

Governor Kemp signed HB 1339 in April 2024, revising the CON process and adding several new exemptions.⁸ Check the current exemption list before assuming full CON review applies; some projects may now qualify for a letter of determination instead.

Rules That Apply to Specific Facility Types

Hospitals

Hospitals must satisfy both state licensing rules under GAC Chapter 111-8-40 and, if they participate in Medicare or Medicaid, the federal Conditions of Participation in 42 CFR Part 482. The federal conditions require an effective governing body, patient rights protections, a data-driven quality assessment and performance improvement program, and adequate medical records.¹⁰ Starting January 1, 2027, hospitals offering obstetrical services must also use their quality improvement programs to assess and reduce health outcome disparities among obstetrical patients.

Every hospital with an emergency department must comply with the federal Emergency Medical Treatment and Labor Act (EMTALA). EMTALA requires the hospital to provide an appropriate medical screening examination to anyone who comes to the emergency department requesting care, regardless of insurance status or ability to pay. If the screening reveals an emergency medical condition, the hospital must stabilize the patient or arrange a transfer to a facility that can, and it may not delay screening or stabilization to ask about payment.¹¹ A receiving hospital with the specialized capabilities and capacity to treat the patient cannot refuse the transfer.¹²

All licensed healthcare facilities in Georgia, not just hospitals, must maintain a disaster preparedness plan meeting state standards and must rehearse the plan at least twice per calendar year.¹³

Ambulatory Surgical Centers

Ambulatory surgical centers perform outpatient procedures and must hold an HFRD license. Because they do not provide overnight stays, they must have clear policies for safe patient discharge and protocols for emergency transfers to a hospital if complications arise. State rules govern safety protocols, anesthesia administration, post-operative care, equipment maintenance, and staff credentialing. Centers accepting Medicare or Medicaid patients must also meet CMS certification requirements, and violations can result in penalties up to license suspension or revocation.

Nursing Homes

Nursing homes face some of the most detailed regulation of any facility type. Georgia’s staffing floor requires a minimum of 2.0 hours of direct nursing care per resident in every 24-hour period. For every seven nursing personnel on staff, at least one must be a registered nurse or licensed practical nurse, and at least one licensed nurse must be on duty and in charge during each eight-hour shift.¹⁴

The federal picture changed late in 2025. CMS had adopted stricter minimums in 2024 requiring 3.48 hours of nursing care per resident day and a 24/7 registered nurse on site. In December 2025, CMS repealed those minimums and reinstated the earlier federal standard: facilities must provide RN services for at least eight consecutive hours per day, seven days a week, and must designate a full-time RN as director of nursing.¹⁵ Georgia’s 2.0-hour minimum and its licensed-nurse-per-shift rule remain in effect regardless of the federal change.

Federal law also establishes detailed residents’ rights for skilled nursing facilities participating in Medicare, including the right to choose a personal physician, to be fully informed about care in advance, to participate in care planning, and to be free from physical or mental abuse, corporal punishment, involuntary seclusion, and restraints used for discipline or convenience. Psychopharmacologic drugs may only be administered under a physician’s order as part of a documented care plan, and an independent external consultant must review each resident’s drug plan at least annually.¹⁶ Georgia adds its own residents’ rights statute at O.C.G.A. Chapter 31-8.¹⁷

Inspections and Plans of Correction

HFRD survey teams conduct scheduled and unannounced inspections covering patient care, infection control, staff qualifications, medical recordkeeping, and operational policies. Inspections may coincide with license renewals or feed into the federal certification process.

Fire safety is evaluated on a separate track. Medicare- and Medicaid-certified facilities must comply with the 2012 edition of the National Fire Protection Association Life Safety Code and with the NFPA Health Care Facilities Code covering installation, testing, and maintenance of equipment.¹⁸ CMS can grant waivers of specific provisions when full compliance would impose unreasonable hardship, as long as the waiver does not endanger patients.

When inspectors identify deficiencies, the facility receives a written report listing every regulation violated. The facility must submit a written Plan of Correction explaining what it will do and when to fix each problem. For at least some facility types, that plan is due within ten days of receiving the inspection report.¹⁹ A facility that submits an acceptable plan and follows through is considered back in compliance. One that does not faces escalating enforcement.

New Accessibility Deadline in 2026

Healthcare facilities in Georgia operated by state or local government must meet new federal accessibility standards for medical diagnostic equipment by August 2026. Under a Department of Justice final rule implementing the Americans with Disabilities Act, at least 10 percent of each type of diagnostic equipment (minimum one unit) must meet the Standards for Accessible MDE. Facilities that specialize in treating conditions affecting mobility, such as outpatient physical therapy centers, must meet a 20 percent threshold.²⁰ By the August 2026 deadline, every covered facility using examination tables must have at least one accessible table, and every facility using weight scales must have at least one accessible scale. Accessible equipment cannot be isolated in a single area; it must be available wherever examinations take place.

Enforcement and Appeals

When a facility fails to correct deficiencies or commits serious violations, HFRD can impose fines, mandatory corrective action plans, license suspension, or license revocation. In the most serious situations, the state may appoint an external administrator to run the facility until compliance is restored, and facilities that pose an immediate danger to patients can have their permits revoked outright.⁷

Facilities participating in Medicare or Medicaid face a separate layer of federal enforcement. CMS can impose civil money penalties, deny payment for new admissions, or terminate the facility’s participation in the program. The CMS Regional Office and the state survey agency coordinate on these actions following procedures in the State Operations Manual.³

A facility that disagrees with an HFRD enforcement action has the right to an administrative hearing under Georgia’s Administrative Procedure Act, which requires notice and an opportunity to be heard in contested cases.²¹ The facility must file its hearing request within the timeframe specified in the enforcement notice. The case goes to the Office of State Administrative Hearings, where an administrative law judge reviews evidence from both sides. A facility that loses can still seek judicial review in superior court on procedural or legal grounds.

Filing a Complaint

Anyone can file a complaint about a Georgia healthcare facility with HFRD, online or by phone at (800) 878-6442.²² Common complaints involve poor quality of care, infection control failures, unsafe conditions, and staffing concerns. HFRD prioritizes cases where there is an immediate risk to patient health or safety. Investigations typically include on-site inspection, interviews with staff and patients, and review of medical records. Substantiated complaints can lead to required corrective actions such as staff retraining, revised policies, or physical improvements. Serious findings involving abuse or neglect may be referred to law enforcement or the Georgia Attorney General’s Office, and patients and families can request public records related to inspection results and complaint investigations.

1
Georgia Department of Community Health. Healthcare Facility Regulation Division
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Georgia Department of Community Health. HFRD Laws and Regulations
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Centers for Medicare & Medicaid Services. Quality, Safety and Oversight – Enforcement
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Office of the Commissioner of Insurance and Safety Fire. Healthcare Facilities (CMS)
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U.S. Department of Health and Human Services. HIPAA Compliance and Enforcement
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Justia Law. Georgia Code Title 31 Chapter 7 Article 1 Section 31-7-1 – Definitions
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Justia Law. Georgia Code Title 31 Chapter 7 Article 1 Section 31-7-3 – Requirements for Permits to Operate
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Georgia Department of Community Health. Certificate of Need (CON)
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Justia Law. Georgia Code Title 31 Chapter 6 Article 3 Section 31-6-40 – Certificate of Need Required
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eCFR. 42 CFR Part 482 – Conditions of Participation for Hospitals
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Office of the Law Revision Counsel. 42 USC 1395dd – Examination and Treatment for Emergency Medical Conditions
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Office of Inspector General. The Emergency Medical Treatment and Labor Act (EMTALA)
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Rules and Regulations of the State of Georgia. Georgia Rules and Regulations 111-8-16 – Disaster Preparedness Plans
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Georgia Secretary of State. Georgia Rules and Regulations 111-8-56 – Nursing Homes
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Federal Register. Repeal of Minimum Staffing Standards for Long-Term Care Facilities
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Office of the Law Revision Counsel. 42 USC 1395i-3 – Requirements for and Assuring Quality of Care in Skilled Nursing Facilities
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Justia Law. Georgia Code Title 31 Chapter 8 Article 5 Section 31-8-103 – Rights of Residents Generally
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Centers for Medicare & Medicaid Services. Life Safety Code and Health Care Facilities Code Requirements
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Legal Information Institute. Georgia Compilation of Rules and Regulations R 111-8-65-.08 – Inspections and Plans of Correction
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U.S. Department of Justice. Accessibility of Medical Diagnostic Equipment of State and Local Government Entities
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Justia Law. Georgia Code Title 50 Chapter 13 Article 1 Section 50-13-13 – Contested Cases
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Georgia Department of Community Health. HFRD File a Complaint