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Adoption of FGI Guidelines

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The data on state adoption that FGI has as of July 14, 2025, can be summarized as follows:

  • 43 states have adopted some edition of the Guidelines (this includes Wisconsin, which has adopted only the HVAC requirements).
  • 5 states (Kansas, Maine, Mississippi, New Hampshire, New York) that adopt the Guidelines permit use of a more recent edition than that adopted in some instances.
  • 3 states do not adopt but allow use of the Guidelines as an alternate path to compliance in some instances.
  • 4 states do not use the Guidelines in any official capacity, although most of these appear to use the documents for reference.
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Note that the descriptions of state use in the pop-up boxes often end with a date; this reflects the most recent update we have received from the state agency responsible for plan review of health and/or residential care facilities. If there is no date, it means we have attempted to verify the information with the state agency but have not yet received a response. We will update the map as we receive new information.

As stated above, the information shown on the map is what FGI knows at the dates indicated in each state description. To confirm state regulations, please check with the state department of health or other responsible state agency. The information provided here should not be relied upon to make final decisions for a design/construction project.

Calling All AHJs: Please contact FGI with revisions and updates. If you are with a state agency or accrediting organization and wish to report changes in Guidelines adoption or other use or to revise information shown in FGI’s adoption map, please let us know. Contact us explaining the change and, if possible, provide a link to further information about the change.

Other Regulatory Applications of the Guidelines

Centers for Medicare and Medicaid Services. CMS has adopted by regulation the 2012 editions of the National Fire Protection Association (NFPA) 101: Life Safety Code and NFPA 99: Health Care Facilities Code. Otherwise, CMS regulation 482.41 requires hospitals to be constructed, arranged, and maintained to ensure the safety of the patient, and to provide facilities for diagnosis and treatment and for special hospital services appropriate to the needs of the community. To achieve this, CMS requires facilities to be in accordance with acceptable standards of practice, but leaves it up to the health care organization to determine which design standard to utilize.

DNV. In its hospital accreditation standards, this national health care accreditation organization states that hospitals must follow the current edition of the FGI Guidelines.

The Joint Commission. EC.02.06.05 EP 1 states when planning new, altered, or renovated space, hospitals are to use design criteria in accordance with either state rules and regulations or the most current edition of the FGI Guidelines for Design and Construction of Hospitals. When these rules, regulations, and guidelines do not meet specific design needs, use of other reputable standards and guidelines that provide equivalent design criteria may be acceptable. The Joint Commission references use of the most recent version of the FGI Outpatient (ambulatory) and Residential Guidelines for these types of facilities. Typically, the state health department licensing entity is the authority having jurisdiction (AHJ), so health care organizations should check the AHJ’s licensing rules to determine the criteria for a facility.  10/18/23

Adoption Toolkit

FGI is pleased to make available an adoption toolkit to ease the transition process when authorities having jurisdiction (AHJs) begin to apply the newest edition of the Guidelines. The information provided is intended to help adopting AHJs, architects, engineers, facility managers, and other health care stakeholders quickly and easily get up to speed on the latest edition of the Guidelines for Design and Construction documents. Included in this toolkit are the following resources:

  • Sample adoption letter that can be adapted and shared with key stakeholders
  • PowerPoint slide that can be adapted and inserted into an email or newsletter to announce adoption and direct users to FGI’s e-commerce site for purchasing options
  • Low-resolution images of the 2022 Hospital, Outpatient, and Residential Guidelines covers for the edition being adopted
  • The benefit-cost analysis report associated with the edition being adopted
  • Edition-related FGI resources, including:
    • Errata
    • Interpretations
    • Application guidance
    • Associated FGI webinars
    • White papers
    • Guidelines adoption map
    • FGI Bulletin

Adoption toolkit files for the 2018 Guidelines


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      FGI Facility Code for Hospitals Draft

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        FGI Facility Code for Outpatient Settings Draft

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          FGI Facility Code for Residential Care and Support Settings Draft

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