HB904: HB904 Health; certificate of need requirements concerning life plan communities; revise an exemption

Georgia requires most new health care facilities to get a certificate of need before opening, but life plan communities (retirement communities that include on-site nursing care) have long had a special exemption for their skilled nursing facilities as long as those beds are mainly used by the community's own residents. Current law lets a life plan community's nursing facility temporarily serve non-residents on a declining percentage basis over five years before the facility must serve residents exclusively. House Bill 904 shortens that phase-in window from five years to three years. It also changes what happens afterward: instead of requiring the facility to serve residents exclusively once the window ends, the bill says the facility must be primarily, but not entirely, used by residents, and it sets permanent caps allowing up to 25 percent of long-term care beds and the greater of five beds or 10 percent of short-term rehabilitation beds to go to non-residents. The bill also adds a definition of 'short-term rehabilitation' tied to Medicare coverage rules and repeals conflicting laws.

• Shortens the period during which a life plan community's skilled nursing facility can serve non-resident patients under the certificate of need exemption from five years to three years.
• Changes the standard after the phase-in period from requiring exclusive use by residents to requiring only primarily by residents, permitting some ongoing non-resident use.
• Sets a permanent cap allowing up to 25 percent of long-term care skilled nursing beds to be occupied by non-residents not under contract with the life plan community.
• Sets a permanent cap allowing the greater of five beds or 10 percent of short-term rehabilitation beds to be occupied by non-residents.
• Adds a definition of 'short-term rehabilitation' as skilled nursing facility beds occupied for no more than 100 days per benefit period and covered under Medicare Part A or paid privately.
• Keeps in place the existing rule that no life plan community resident can be denied access to the sheltered skilled nursing facility and that no existing patient can be forced out to comply with the law.

Life plan communities (retirement communities offering on-site skilled nursing care), their residents, non-resident patients who use spare nursing beds on a short-term basis, and the Georgia Department of Community Health, which issues written exemptions and enforces the certificate of need program.

Life plan communities would have less time, three years instead of five, to fill empty nursing beds with outside patients before facing tighter restrictions, but they would also gain a permanent, though capped, ability to keep serving some non-resident long-term care and rehabilitation patients rather than being required to serve residents exclusively.

• Section 1 amends O.C.G.A. § 31-6-47(a)(17), the certificate of need exemption for life plan community nursing facilities.
• Reduces the transition period for phased non-resident bed use from five years to three years, with the existing year-by-year percentage caps (50 percent in year one down to 10 percent in year five) still referenced in the text.
• After the transition period, changes the requirement from exclusive resident use to primarily resident use, adding permanent caps of 25 percent for long-term care beds and the greater of five beds or 10 percent for short-term rehabilitation beds used by non-residents.
• Adds a definition limiting 'short-term rehabilitation' to stays of no more than 100 days per benefit period covered by Medicare Part A or paid privately.
• Retains the department's authority to issue rules defining and regulating use of the term 'sheltered nursing facility.'
• Section 2 repeals all laws and parts of laws in conflict with the Act.

1. 2026-01-12House Second Readers (House)
2. 2025-04-04House First Readers (House)
3. 2025-04-02House Hopper (House)

• Deborah Silcox (R, HD-053)Primary sponsor
• Sharon Cooper (R, HD-045)

• certificate of need
• life plan communities
• nursing home regulation
• health care licensing
• senior living