Last full regulation-level review: October 17, 2026. This is a living page — state rows are re-verified as regulations change.
Direct answer: FGI’s own adoption map counts 42 states that have adopted an edition of the FGI Guidelines into regulation (FGI adoption map, August 31, 2026). Our regulation-level review of all 50 states and the District of Columbia confirms adoption in 40 jurisdictions, finds three partial adoptions (Illinois, Kansas, Wisconsin), one adoption that runs through certificate-of-need review (Vermont), one state with no direct adoption (Texas), one unclear case (Connecticut), and five states where no adoption was found (Arkansas, California, Hawaii, Ohio, South Dakota). The editions actually enforced run from the 2001 edition (Alaska) to states whose rules point at whatever edition is current — and the enforced edition, not the newest one, is what your project will be reviewed against.
How to read this tracker
Adopted means the state’s regulation incorporates an FGI edition by reference or names it as the design standard. Dynamic means the rule points at the current or most recent edition, so the enforced edition moves when FGI publishes — those rows name what the agency currently enforces. Partial means adoption covers only some facility types or code sections. Basis shows what each row rests on: the regulation text itself, an agency source, or secondary sources only — treat the last group as a pointer, not an answer.
One rule outranks this entire page: the authority having jurisdiction’s answer for your project beats every website, including this one and including FGI’s own map. Where the two disagreed, this tracker prints the disagreement rather than picking a winner.
On this page: The tracker · Where sources conflict · What this means for a project · Questions · Go deeper
The tracker: FGI adoption and enforced edition, all 50 states + DC
| State | Status | Edition enforced | Adopting authority + citation | Source | Basis |
|---|---|---|---|---|---|
| Alabama | Adopted | 2014 (hospital, outpatient surgery, and freestanding emergency care chapters) | Ala. State Board of Health, Ala. Admin. Code 420-5-22-.03 | Source | Regulation text |
| Alaska | Adopted | 2001 | AK Dept of Health, 7 AAC 12.900(b)(1) | Source | Regulation text |
| Arizona | Adopted | 2018 | ADHS, 9 A.A.C. 10, R9-10-104.01(B)(1); R9-10-234 | Source | Regulation text |
| Arkansas | No adoption found | Not found (2001 AIA Guidelines appear only as reference item in rules appendix; equivalency use allowed) | AR Dept of Health, Health Facility Services rules | Source | Agency source |
| California | No adoption found | Not found (no code adoption; FGI informs HCAI/OSHPD Title 24 amendments; FGI record: "Equivalency") | CA Dept of Health Care Access & Information, Building Safety | Source | Agency source |
| Colorado | Adopted | 2022 (eff. 10/1/2025) | CDPHE, 6 CCR 1011-1 Ch. 2 §3.2.3 | Source | Regulation text |
| Connecticut | Unclear | Unclear — hospice inpatient regulations cite FGI 2010 (RCSA 19a-495-6m); hospital adoption not confirmable at regulation level; FGI claims current-edition statutory adoption | CT DPH, RCSA 19a-495-6m (hospice inpatient) | Source | Secondary only — verify with the AHJ |
| Delaware | Adopted | 2022 | DHCQ / Office of Health Facilities Licensure & Certification, plan-review requirements | Source | Agency source |
| District of Columbia | Adopted | Edition not stated in the rule (22 DCMR §2034.2(d) names the Guidelines without an edition); FGI records 2018 | DC Dept of Health, 22 DCMR Ch. 20 §2034.2(d) | Source | Agency source |
| Florida | Adopted | 2022 via the Florida Building Code, 8th edition (eff. 12/31/2023); FGI records a 2026 adoption effective 12/31/2026 | FL AHCA Office of Plans and Construction / FL Building Commission | See citation | Agency source |
| Georgia | Adopted | Dynamic — "edition accepted by the Department" (2026 Codes enforced beginning 8/31/2026); nursing homes recommended only | GA Dept of Community Health, Rules 111-8-40-.40/.41 | Source | Regulation text |
| Hawaii | No adoption found | Not found (HAR §11-93-6 construction requirements contain no FGI reference) | HI DOH, HAR Title 11 Ch. 93 | Source | Secondary only — verify with the AHJ |
| Idaho | Adopted | Dynamic "most recent edition" (statute, eff. 7/1/2025; FGI record: 2022 adopted) | Idaho Code §39-1305 (Title 39, Ch. 13) | Source | Regulation text |
| Illinois | Partial | No general hospital adoption; FEC rules cite 2010 (77 IAC 518.1050(F)); FGI record says 2006 — conflict | IL DPH, 77 Ill. Adm. Code 518.1050(F) | Source | Agency source |
| Indiana | Adopted | Dynamic "most recent published version" (Ind. Code 16-21-2-12.5, eff. 7/1/2025); FGI record stale (2018) — conflict | Indiana Dept of Health / Ind. Code 16-21-2-12.5 | See citation | Regulation text |
| Iowa | Adopted | 2018 | IA Dept of Inspections & Appeals, 481 IAC 51.26(1)(a) | Source | Regulation text |
| Kansas | Partial | 1996-97 in rule; newer editions allowed via variance/guidance (FGI lists KS as permitting newer editions "in some instances") | KDHE, K.A.R. 28-34-32b | Source | Regulation text |
| Kentucky | Adopted | 2006 | KY Cabinet for Health & Family Services, 902 KAR 20:009 | Source | Regulation text |
| Louisiana | Adopted | Dynamic "most current edition" (LAC 48:I.9305(N)(2)(b), as amended by 2026 SCR No. 2, replacing 2014) | LDH Health Standards Section / State Fire Marshal plan review | Source | Regulation text |
| Massachusetts | Adopted | Dynamic; 2022 in force (DPH 2022 compliance checklists eff. 6/1/2025) | MA DPH, 105 CMR 130.107 | Source | Regulation text |
| Maryland | Adopted | 2022 Hospital + 2014 Residential (nursing homes) + 2001 Outpatient (FECs) — "…incorporated by reference…" | MD OHCQ, COMAR 10.07.01.02 | Source | Regulation text |
| Maine | Adopted | 2006 (10-144 CMR 112 §2.21); waiver practice for newer editions (FGI lists ME in "newer editions in some instances" group) | ME DHHS Division of Licensing & Regulatory Services | Source | Regulation text |
| Michigan | Adopted | 2018 (all three FGI documents + ASHRAE 170-2017) | MDHHS/LARA Bureau of Construction Codes, R 325.45263 | Source | Regulation text |
| Minnesota | Adopted | 2022 for hospitals eff. 1/1/2024 (MDH interpretation doc under Minn. Stat. 144.55); 2018 Residential for assisted living | MN Dept of Health, Engineering & Plan Review | See citation | Regulation text |
| Mississippi | Adopted | Edition not stated in the rule ("codes recognized by this agency on date of construction"); FGI claims 2006 — unconfirmed | MS State Dept of Health, 15 Miss. Code R. 16-1-41.8.2 | Source | Agency source |
| Missouri | Adopted | 2010 or 2014 ("(2010 edition) or… (2014 edition)", commissioning chapters excluded) | MO DHSS, 19 CSR 30-20.030 (2026 emergency amendment retains same text) | Source | Regulation text |
| Montana | Adopted | 2018 | MT DPHHS, ARM 37.106.302(2)(a) | Source | Regulation text |
| Nebraska | Adopted | 2018 (statutory adoption) | Neb. Rev. Stat. §71-439 | Source | Regulation text |
| Nevada | Adopted | Dynamic "most recently published" (2022 + errata adopted 2023) | NV DPBH, NAC 449.0105(1)(c) | Source | Regulation text |
| New Hampshire | Adopted | Multi-edition: 2022 hospitals; 2018 nursing homes/assisted living; 2014 other types (He-P 802.07(f) + App. A incorporation list) | NH DHHS, He-P 802.07(f) | Source | Regulation text |
| New Jersey | Adopted | Conflict — rule text codifies FGI Residential 2014 "as amended and supplemented"; FGI claims automatic adoption of the newest edition | NJ Dept of Health, N.J.A.C. 8:43G | Source | Secondary only — verify with the AHJ |
| New Mexico | Adopted | Dynamic "current edition… AIA guidelines" (FGI record: 2022 by mid-2023, current 2026) | NM DOH, NMAC 8.370.12.41 | Source | Regulation text |
| New York | Adopted | Conflict — rule text cites 1996-97/2010; DOH guidance (DAL 17-01) applies 2014; FGI lists 2014 + 2018 | NYSDOH, 10 NYCRR 711.2 + DAL 17-01 | Source | Agency source |
| North Carolina | Adopted | Dynamic "including all subsequent amendments and editions" (hospital + outpatient chs. 2.x; outpatient 3.x excluded; state-written rules for nursing homes) | N.C. DHSR Construction Section, 10A NCAC 13B .6105 | Source | Regulation text |
| North Dakota | Adopted | 2014 | ND HHS, NDAC 33-07-02.1 (agency project-review page) | Source | Agency source |
| Ohio | No adoption found | Not found (no adoption; FGI may be used as alternate if it meets/exceeds state requirements) | Ohio Dept of Health | Source | Agency source |
| Oklahoma | Adopted | 2018 (eff. 9/13/2019) | OSDH Medical Facilities Service, health facilities plan review | Source | Agency source |
| Oregon | Adopted | 2018 with OR amendments (OAR 333-535-0015(3); amendments eff. 3/1/2025; skipped 2022, targeting 2026) | OHA Health Care Regulation & Quality Improvement | Source | Regulation text |
| Pennsylvania | Adopted | 2022 (mandatory eff. 2/1/2023, 52 Pa.B. 5570); 2018 Residential for LTC nursing facilities | PA Dept of Health, 28 Pa. Code plan review | Source | Agency source |
| Rhode Island | Adopted | Conflict: reg text cites AIA 2006 (216-RICR-40-10-4 §4.2(A)(10)); RI DOH guidance and FGI say 2018 | RI DOH Health Facilities Regulation | Source | Agency source |
| South Carolina | Adopted | Edition not stated in the regulation ("most current nationally accepted standards" in the FGI Guidelines, R.61-16 §1902); FGI claims current edition — unconfirmed | SC DPH, R.61-16.1902 | Source | Agency source |
| South Dakota | No adoption found | Not found | SD Dept of Health | Source | Secondary only — verify with the AHJ |
| Tennessee | Adopted | Dynamic "current edition… as approved by the Board" (2018 in practice since 1/1/2019 per FGI) | TN Dept of Health Board for Licensing Health Care Facilities, 0720-18-.08 (hospital standards ch. 1200-08-01) | See citation | Regulation text |
| Texas | No direct adoption | No direct adoption — state-authored hospital rules (26 TAC Ch. 505) historically based on FGI 2001; a reported 2018-based rewrite is unverified | TX HHSC / DSHS, 26 TAC Ch. 505 | Source | Secondary only — verify with the AHJ |
| Utah | Adopted | 2010 (R432-4-23; companion R432-4-24 reported repealed eff. 3/14/2025 — partial now); FGI record stale | Utah Dept of Health & Human Services licensing rules R432-4 | Source | Agency source |
| Vermont | Adopted (CON review) | Current edition (2022 per GMCB CON decision) | Green Mountain Care Board, 18 V.S.A. §9434 CON review | Source | Agency source |
| Virginia | Adopted | 2022 + errata (12VAC5-410-650); FGI says 2026 — a fast-track amendment was filed April 2026, effectiveness unconfirmed | VDH Office of Licensure & Certification | Source | Regulation text |
| Washington | Adopted | 2022 with WA amendments for hospitals ("…comply with the 2022 edition…" WAC 246-320-600); 2006 for ASCs (WAC 246-330) | WA Dept of Health | Source | Regulation text |
| West Virginia | Adopted | 2022 in rule text (64 CSR 12 §5.1.2.a); FGI record says "current edition" | WV Office of Health Facility Licensure & Certification | Source | Regulation text |
| Wisconsin | Partial | Conflict: FGI says no adoption (eff. 11/1/2025) but Wis. Admin. Code SPS 364.0300/364.1500 incorporate FGI 2014 (Mechanical/HVAC; Residential) for plan review | WI Dept of Safety & Professional Services, ch. SPS 364 | Source | Agency source |
| Wyoming | Adopted | 2006 | WY Dept of Health, Wyo. Code R. 048-3 Ch. 3 §3-5(b)(i) | Source | Regulation text |
Where the sources conflict — read these rows twice
Adoption trackers usually print one clean answer per state. Several states do not have one. These are the disagreements that matter most, because a design team working from the wrong one designs to the wrong book:
- New York. The regulation text (10 NYCRR 711.2) still cites the 1996-97 and 2010 editions; Department of Health guidance (DAL 17-01) applies the 2014 edition; FGI lists 2014 + 2018. Three sources, three answers — confirm the applicable edition with the DOH for your project type before design development.
- New Jersey. The readopted rule text codifies the FGI Residential Care Guidelines 2014 “as amended and supplemented,” while FGI’s own record claims New Jersey automatically adopts the newest edition. The rule text is the safer planning basis; the claim of automatic adoption is FGI’s, not the state’s.
- Rhode Island. Regulation text cites the AIA 2006 edition; state guidance and FGI both say 2018. Guidance is what plan reviewers work from in practice, but the printed rule has not caught up.
- Indiana. A 2025 statute (Ind. Code 16-21-2-12.5) now points at the “most recent published version” — a dynamic adoption — while FGI’s record still shows 2018. The statute is newer than the map.
- Illinois. There is no general hospital adoption. Freestanding emergency center rules cite FGI 2010; FGI’s record says 2006. Illinois hospital design runs on state rules, with FGI appearing only in specific facility-type regulations.
- Wisconsin. FGI records no adoption (as of November 1, 2025), yet the state building code (SPS 364) incorporates FGI 2014 for mechanical/HVAC and residential care plan review. Both statements are true in their own lanes — which is exactly why “adopted or not” is the wrong question in Wisconsin.
- Virginia and Florida. Both are mid-transition: Virginia’s verified rule text is the 2022 edition with a 2026 fast-track amendment filed but unconfirmed as effective; Florida enforces 2022 through its building code with a 2026 adoption recorded as effective December 31, 2026. Design teams in both states should date-stamp which edition their permit falls under.
- Connecticut. FGI claims a current-edition statutory adoption. The only regulation text this review could confirm is FGI 2010, in hospice inpatient regulations. Hospital-level adoption could not be confirmed at regulation level — the row is marked Unclear rather than borrowed from FGI’s claim.
What this means for a project
Design to the enforced edition, not the published one. FGI publishes on a four-year cycle; states adopt on their own clocks, and some are a decade or more behind (Alaska enforces 2001; Kansas and Wyoming enforce 2006-era text). A detail that is compliant in the current Guidelines can be non-compliant in the edition your state reviews against — and the reverse is also true: older editions sometimes permit what newer ones prohibit.
Dynamic states move under a long project. Georgia, Idaho, Louisiana, Nevada, New Mexico, North Carolina, Tennessee, Indiana, and others point their rules at the current or most recent edition. On a multi-year design, the edition in force at permit can differ from the edition at project start. Pin the applicable edition in writing with the reviewing agency early, and re-confirm at permit milestones.
Amendments are part of the edition. Several states adopt with their own amendment packages — Oregon’s amendments to the 2018 edition run to dozens of sections, and Washington publishes its own amended “Washington hospital licensing construction standard guidelines” built on the 2022 edition. Citing the edition without the state’s amendments is only half the standard.
Questions
How many states have adopted the FGI Guidelines?
FGI’s own adoption map counts 42 states (August 31, 2026). This tracker’s regulation-level review confirms adoption in 40 of the 51 jurisdictions it covers (50 states + DC), with three partial adoptions, one CON-conditioned adoption, and the remaining states having no direct adoption, an unclear record, or no adoption found. The small gap between the two counts is mostly definitional — what counts as adoption — and the conflicts section above shows the specific states where the sources diverge.
Which FGI edition should my project be designed to?
The edition your state enforces for your facility type — find it in the tracker, then confirm it with the authority having jurisdiction before design development. In dynamic-edition states, get the confirmation in writing and re-confirm at permit submission, because the enforced edition can change between project start and permit.
What if my state has not adopted FGI?
Your state still has design and construction requirements — they live in state-authored rules instead (Texas and California are the large examples). FGI may still appear as an equivalency path or an accepted alternate where the state rules allow one; Ohio expressly permits FGI as an alternate where it meets or exceeds state requirements. Absence of adoption is not absence of standards.
How is this tracker kept current?
It is a living page: rows are re-verified against regulation text as states amend their rules, and the review date at the top of the page states when the last full pass ran. If your state’s row is wrong — or has changed — tell us. Corrections from the people who work under these rules are how this page stays worth citing, and we credit contributors by name and organization, or anonymously, as they prefer.
Go deeper
- Which FGI edition is my state on? — the edition question answered state-group by state-group.
- How states adopt the FGI Guidelines — the three adoption mechanics: by reference, with amendments, and the health-department channel.
- FGI Guidelines for healthcare facilities — the Hub’s working guide to the Guidelines themselves.
- FGI 2022 vs. 2026: what changed — the current transition, edition to edition.