The short answer California's home health agency licensing regs (22 CCR 74723) require a TB test for all new patient-contact employees and annually thereafter. California is also the flagship workplace-violence state: Labor Code 6401.9 (SB 553) requires a written prevention plan from nearly every employer, while licensed home health care falls under Cal/OSHA's health-care WPV standard (8 CCR 3342). Workers' comp from the first employee.
What California requires
California
TB screening required. 22 CCR 74723 (Home Health Agencies - Employee Health Examinations and Health Records) requires a CDC-recommended, FDA-licensed TB test for all new employees with direct patient contact and annually thereafter; documented prior positives are excluded from retesting.
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CDPH Title 22 TB testing overview. CDPH's California TB testing regulations page explains the Title 22 TB testing requirements applicable to licensed health facilities including home health agencies.
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Workplace violence prevention (SB 553 / LC 6401.9). Since July 1, 2024, virtually all California employers, including non-medical home care agencies, must establish and maintain a written Workplace Violence Prevention Plan, train employees, and keep a violent-incident log. Health care operations covered by the Cal/OSHA health-care WPV standard (8 CCR 3342, which includes home health care and home-based hospice) follow that standard instead.
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Workers' comp from 1st employee. All California employers must carry workers' compensation even with only one employee (including part-time); operating without it is a criminal offense.
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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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Primary sources for this page
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