Georgia Certificate of Need Application Readiness

Last updated: November 2026

A Georgia certificate of need (CON) is the state approval a person must obtain before developing or offering a new institutional health service or health care facility, unless the activity is excluded from the chapter. Integral Healthcare Solutions (IHS) prepares providers to file: we draft the letter of intent, the application narrative and the evidence set that the Department of Community Health (DCH) checks for completeness, and we build the filing calendar. The applicant files and attends the review. This page reads the state's own texts, opened 2026-11-06. It is not legal advice, and IHS is a consulting firm, not a law firm.

What is a Georgia certificate of need?

It is an approval under O.C.G.A. Title 31, Chapter 6. The DCH Certificate of Need page (page opened 2026-11-06) says the program is intended to measure and define need, control costs and guarantee access to healthcare services, and that the General Assembly established it in 1979. The rules are Chapter 111-2-2 of the Rules of the Georgia Department of Community Health; DCH reports updates effective January 13, 2025, and its rules page lists the adopted rules as currently effective. HB 1339, which revises the CON process and adds exemptions, was signed April 19, 2024 (Georgia General Assembly record).

What is the letter of intent period, 25 days or 30?

It is 25 days. HB 1339 as passed amended O.C.G.A. 31-6-43(a), striking 30 and inserting 25 days before an application for clinical health services, and Rule 111-2-2-.06(1) (DCH adopted rule text, page opened 2026-11-06) requires the letter of intent at least 25 days before the application for a new institutional health service or health care facility. The DCH filing requirements page still carries the 2008 wording of 30 days.

The rule also sets an outer limit: the application must be submitted no later than 25 calendar days after the Department receives the letter. If the 25th calendar day is a weekend or legal holiday, it moves to the next business day that is neither. A later application needs a new letter of intent. IHS's reading as of 2026-11-06: the two limits together leave one filing day, the 25th calendar day after receipt, moved only for a weekend or holiday. That is an IHS reading of the rule's text, not DCH's statement; confirm it with counsel before building a calendar on it.

Who needs a CON and what triggers it?

The DCH CON fact sheet (updated 2025; page opened 2026-11-06) says that, unless exempt, a CON is required for new hospitals including freestanding emergency departments; new or expanding nursing homes and home health agencies; all multi-specialty and certain single-specialty ambulatory surgery centers; Medicaid-certified personal care homes with 25 or more beds; radiation therapy, positron emission tomography, open heart surgery and neonatal services; and facilities offering a service not provided on a regular basis during the previous 12 months or adding beds. It says the list is not limited to those and is no substitute for the statutes and rules.

For ambulatory surgery, DCH's 2026 memo (effective July 1, 2026) sets CON thresholds at 4,583,458 dollars for single-specialty physician-owned centers under O.C.G.A. 31-6-47(a)(18) and 9,166,917 dollars for joint venture centers under 31-6-47(a)(19). DCH posts a new threshold memo each year effective July 1.

How does a Georgia CON filing run?

1. Decide whether a CON applies. A letter of determination request covers one matter, costs 500 dollars, and the Department has 60 days to respond if no objection is filed within 30 days of receipt, extendable by 30 days, on notice to the requester, where 60 is impractical (Rule 111-2-2-.10).
2. Send the letter of intent through the portal with the seven required items.
3. File the application through the portal with the fee. Applications received after 3:00 p.m. on a business day count as received the next business day (Rule 111-2-2-.06(3)(b)); other documents received after 5:00 p.m. count the next business day (.06(6)).
4. Completeness. The Department notifies the applicant within seven calendar days of receipt whether the application is complete or what is missing. It is deemed withdrawn if the missing information is not supplied by the 15th calendar day of the review cycle.
5. Review. Up to 120 days from receipt, unless joined with another application, with a possible 30-day extension on notice; absent good cause the Department generally does not decide before day 60. If it sees factors creating a potential for denial, it must offer a meeting on or before day 30.
6. Decision, appeal and post-approval. The CON Appeal Panel reviews the initial decision. The post-approval requirements begin the day the certificate issues.

Batched services run on a different calendar. For listed services such as skilled nursing, home health, perinatal, ambulatory surgery, positron emission tomography and radiation therapy, the Department publishes an unmet-need determination. The notice of intent is due by close of business on the 25th calendar day after publication, the application by noon on the 60th, and a missed notice disqualifies the applicant for that cycle (Rule 111-2-2-.08(1)). Each date moves to the next business day if it falls on a weekend or legal holiday.

How does IHS help?

1. Gap assessment against the rule's completeness list.
2. Evidence map of each document, its owner and its date; the architect or engineer cost estimate must be prepared within 60 days before submission.
3. Drafting of the letter of intent, any letter of determination request, the narrative and the need and utilization worksheets, for the applicant's team to review, change and approve.
4. Calendar built from the letter of intent receipt date or the batching notice.
5. Mock review with questions and drafted answers.

The client supplies the project description, financial and utilization data, property and entity documents, signing authority and the people who attend the review. CON work sits in IHS program development and compliance services, led by Thomas G. Goddard, JD, PhD. The real limit: DCH decides. IHS does not file with DCH, contact it or act as the applicant's liaison, and gives no legal conclusion on whether a project is excluded or exempt.

What to have ready

Rule 111-2-2-.06(5)(e) lists what makes an application incomplete if missing and not submitted earlier.

• A project description and need justification built on the Department's data and methodology.
• Evidence of financing, a financial pro forma, and the most recent audited statements (personal statements if audited ones are unavailable).
• For construction, renovation or expansion, certified schematic plans and cost estimates; for equipment, purchase orders or invoices.
• Written verification of entitlement to the property, with a letter documenting lessor and lessee commitment if a lease is unsigned.
• Proof of authority to do business, as applicable: Secretary of State records, bylaws or articles, and any license or permit.
• Three years of required surveys, complete and accurate.
• Post-approval reports and indigent and charity care commitments current for prior projects, and no unpaid fines.
• A copy of the application filed with the county commission of the project county, with the cover letter.
• The vendor lobbyist certification, the applicant's signature and the filing fee.

An applicant that is a component of a larger owner or operator needs the surveys, post-approval reports and charity care commitments current for every facility under the same ownership or operation.

With most of these in hand, the next step is a free introductory call to scope the work.

How do the filing routes compare?

Georgia counsel and planning firms also do this work; this page does not tell you which to choose. Other states: the CON state tracker, CON application and state licensing and CON overview.

What does it cost?

State fees come first: the filing fee is 1,000 dollars up to 1,000,000 dollars of total project cost, then one-tenth of one percent of the total cost, capped at 50,000 dollars; a determination request is 500 dollars (Rule 111-2-2-.06(4) and .10(1)(f); DCH forms page). The fee must reach the Department before the application is accepted for review. State-owned institutions are exempt from both fees, and the Department may waive them for certain hospital authority facilities and certain public non-profit providers when financial circumstances justify it, on a request made with the filing. Verify current fees with DCH. IHS scopes each engagement after a free introductory call and states no consulting fee here. The third cost is your own staff time.

What this is not

• It is not legal advice; exclusion and exemption questions belong to your counsel.
• It does not predict the decision; DCH decides.
• It is not a filing service: the applicant files.

Frequently asked questions

What is the letter of intent period for a Georgia CON application?

Twenty-five days. HB 1339 as passed changed O.C.G.A. 31-6-43(a) from 30 days to 25, and Rule 111-2-2-.06(1) requires the letter at least 25 days before the application and the application no later than 25 calendar days after the Department receives the letter. The DCH filing page still shows the older 30-day wording.

Does my project need a Georgia certificate of need?

A person proposing a new institutional health service or health care facility needs one before starting, unless the activity is excluded from the chapter. Whether your project falls inside is a question for counsel or a letter of determination.

How do I find out whether an activity is exempt?

Ask the Department in writing. A letter of determination request is required for any activity believed to be excluded from review, before it is implemented, and an activity believed to fall within a statutory exemption may not begin until the Department approves in writing.

What must a Georgia letter of intent contain?

It must be in writing, submitted through the portal, and state the legal applicant's name and address, a contact for inquiries, the facility name and address if different, the proposed site with specificity, a brief summary, the proposed service area and the cost of the project. Telephone, facsimile and e-mail notices are not accepted.

Can I file a CON application at any time?

Only for services with no batching cycle. DCH says non-batched applications are accepted throughout the year and batched ones during designated times, generally fall and spring or winter and summer depending on the service. Both need a letter of intent first.

How long does the Department take to review an application?

A review runs no longer than 120 days from receipt to the electronic decision, unless the application is joined with another. The Department may extend by 30 days on notice if conditions make 120 impractical (not in a batched cycle).

What are the state fees?

The filing fee is 1,000 dollars up to 1,000,000 dollars of total project cost, then one-tenth of one percent of the total cost, capped at 50,000 dollars. A determination request is 500 dollars. Verify current fees with DCH.

What happens after a CON is approved?

The certificate is valid only for the scope, location, costs, service area and person named on it. A project without construction is valid for 12 months from issue. A construction project that does not meet the post-approval documentation requirements in the first 12 months is deemed expired, and DCH may grant an extension on a written request that reaches it 30 days before the period ends.

Can IHS file my application or deal with the Department for me?

No. Integral Healthcare Solutions (IHS) drafts and prepares; you file through the portal and handle any contact with the state. IHS is a consulting firm, not a law firm, so exclusion and exemption questions go to your counsel.