The short answer Alabama does not license home health agencies at the state level (Certificate of Need review plus federal Medicare/Medicaid certification surveyed by ADPH), so no state licensing rule imposes worker TB screening. Workers' comp is unusual: mandatory only at 5 or more employees.
What Alabama requires
Alabama
No state licensure / no TB rule. Alabama's State Health Plan rule states there is no licensure requirement for home health agencies in Alabama; agencies need a Certificate of Need and, if Medicare/Medicaid, federal certification via ADPH. No state licensing regulation imposes worker TB screening, so CDC baseline screening of health care personnel is the applicable best practice.
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ADPH provider standards. ADPH's Bureau of Health Provider Standards handles certification and survey of home health agencies operating in Alabama.
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Workers' comp at 5+ employees. Alabama law requires workers' compensation coverage only for businesses with five or more employees (full- or part-time, including corporate officers and LLC members); penalties reach $1,000 per employee per day.
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The federal baseline (applies in every state)
Federal
No federal TB mandate for home care workers. There is no federal law requiring tuberculosis screening of home care or home health workers; TB screening obligations for this workforce are set by each state's facility licensing law. Federal Medicare Conditions of Participation for home health agencies (42 CFR Part 484) require an infection-prevention program but do not prescribe worker TB testing.
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2019 CDC/NTCA baseline screening standard. The 2019 CDC/National Tuberculosis Controllers Association recommendations for U.S. health care personnel call for a baseline (pre-placement) individual TB risk assessment, symptom evaluation, and a TB test (IGRA or TST) for those without documented prior positive results. Routine annual (serial) testing of health care personnel is no longer recommended absent ongoing exposure; instead facilities should provide annual TB education and symptom screening.
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Positive-result workup. Personnel with a newly positive TB test or TB symptoms should receive a chest X-ray and clinical evaluation to rule out active TB disease; those found to have latent TB infection should be offered and encouraged to complete LTBI treatment per CDC guidance.
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OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030). OSHA's Bloodborne Pathogens Standard applies to home care/home health workers with reasonably anticipated exposure to blood or other potentially infectious materials. Employers must maintain a written exposure control plan, provide annual training, and offer the hepatitis B vaccine series at no cost within 10 working days of assignment to covered workers.
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