HB 904: Health; certificate of need requirements concerning life plan communities; revise an exemption

Georgia's certificate of need law (O.C.G.A. § 31-6-47) normally requires health facilities to get state approval before adding services like nursing beds, but life plan communities (retirement communities offering a continuum of care) get an exemption for skilled nursing facilities that mainly serve their own residents. This bill rewrites that exemption. Currently the law allows a five-year phase-in during which a portion of beds can go to non-residents, stepping down from 50 percent to 10 percent, with an overall cap of 50 percent non-resident use during that period. The bill shortens this to a three-year phase-in (50 percent, 40 percent, then 30 percent) and removes the fourth and fifth year steps. After the three years, it sets permanent caps: no more than 25 percent of beds for non-resident long-term care patients, and the greater of five beds or 10 percent for non-resident short-term rehabilitation patients, defined as care covered by Medicare Part A or paid privately for up to 100 days per benefit period. It also renames 'sheltered nursing facility' to 'skilled nursing facility' throughout and removes the Department of Community Health's authority to define that former term.

• Shortens the exemption's phase-in period for outside (non-resident) patients from five years to three years before permanent limits kick in.
• Sets new permanent caps after the phase-in: no more than 25 percent of beds for non-resident long-term care patients and the greater of five beds or 10 percent for non-resident short-term rehabilitation patients.
• Adds a definition of 'short-term rehabilitation' as skilled nursing facility care covered by Medicare Part A or paid privately, capped at 100 days per benefit period.
• Replaces the term 'sheltered nursing facility' with 'skilled nursing facility' throughout the exemption and removes state rulemaking authority over the old term.
• Changes the requirement that the facility be used exclusively by life plan community residents after the phase-in to 'primarily' used by them, a looser standard.
• Removes the prior fourth and fifth year percentage limits (20 percent and 10 percent) since the phase-in is now only three years.

Life plan communities (retirement communities that offer housing plus a continuum of care) and their skilled nursing facilities, current and prospective residents of those communities, outside patients seeking short-term rehabilitation or long-term nursing care, and the Georgia Department of Community Health, which administers the certificate of need program.

The change affects how many beds in life plan community nursing facilities can be filled by people who are not community residents, both during a new facility's early years and permanently afterward, which could shape access to skilled nursing and rehabilitation beds for both residents and the broader public in areas served by these communities.

• Section 1 amends paragraph (17) of subsection (a) of O.C.G.A. § 31-6-47 to shorten the phase-in period for non-resident bed use from five years to three years.
• During the phase-in, non-resident new-patient limits are set at 50 percent in year one, 40 percent in year two, and 30 percent in year three, with an overall 50 percent cap on non-resident occupancy at any time.
• After the three-year period, the facility must be 'primarily' (rather than 'exclusively') used by life plan community residents.
• New permanent caps apply after the phase-in: 25 percent of beds for non-resident patients needing long-term care, and the greater of five beds or 10 percent of beds for non-resident short-term rehabilitation patients.
• Adds a definition of 'short-term rehabilitation' as skilled nursing facility beds occupied for up to 100 days per benefit period, covered by Medicare Part A or paid privately.
• Removes the Department of Community Health's authority to make rules defining 'sheltered nursing facility' and eliminates that term in favor of 'skilled nursing facility.'
• Section 2 repeals conflicting laws, a standard closing provision.

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
• skilled nursing facilities
• senior care
• Medicaid and Medicare rules