Do states adopt FGI Guidelines into building code?

Q: Do states adopt FGI Guidelines into building code?

Yes — 43 states have adopted FGI into their regulatory frameworks, typically by reference in health facility licensing regulations (not the building code itself), making the adopted edition's minimum requirements enforceable for new construction and major renovations.

Q: How many states adopt the FGI Guidelines?

43 states, for new construction and major renovations.

Q: Is FGI part of the building code?

Usually adopted through health facility licensing regulations, parallel to the IBC-based building code. Both must be satisfied.

State capitol with a document being stamped into law, connecting to a hospital construction site — Forty-three states. One phone call to confirm yours.

Yes — 43 states have adopted the FGI Guidelines (now FGI Codes) into their regulatory frameworks for healthcare facility construction, typically by reference: the state’s health facility licensing regulations incorporate a specific FGI edition, making its minimum requirements enforceable as code for new construction and major renovations. This is the primary way FGI — a voluntary consensus standard — becomes law.

How adoption works

Adoption by reference. The state regulation names the FGI document and edition year (e.g., “the 2022 edition of the FGI Guidelines for Design and Construction of Hospitals”). Everything in that edition becomes enforceable.
With amendments. Some states adopt FGI with state-specific modifications — additions, deletions, or substitutions. The adopted-plus-amended version is what the plan reviewer enforces.
Through the health department, not the building code. FGI adoption usually lives in health facility licensing regulations (department of health), running parallel to the state’s building code (IBC-based). A project must satisfy both — they don’t override each other.
On the state’s timeline. States adopt new FGI editions through their own rulemaking, often years after FGI publishes. The 2026 Codes will phase into state regulations gradually.

Building code vs. health facility regulations

This distinction matters: the building code (IBC and its referenced standards) governs structural, fire, and general life safety. The health facility regulations incorporating FGI govern healthcare-specific planning and design — room sizes, clearances, clinical adjacencies, handwashing, ventilation via ASHRAE 170. Your project needs plan review clearance under both, often from different agencies.

What to verify for your project

Has the state adopted FGI? (Probably — 43 have.)
Which edition and which document? (Hospital? Outpatient? Residential?)
Any state amendments modifying FGI requirements?
Which agency does plan review — and what’s their submittal process?

Forty-three states. One phone call to confirm yours.

See which edition your state enforces and the FGI 2026 compliance guide.

FAQ

How many states adopt the FGI Guidelines?
43 states have adopted FGI documents for regulating healthcare facility new construction and major renovations.

Is FGI part of the building code?
Usually not directly — it’s typically adopted through health facility licensing regulations, running parallel to the IBC-based building code. Projects must satisfy both.

What happens when FGI publishes a new edition?
Nothing changes legally until each state adopts it through rulemaking — a process that typically takes years and varies by state.