The short answer DC licenses home care agencies under 22-B DCMR Chapter 39; each employee must be verified as screened for and free of communicable disease within the 6 months before hire and re-screened annually per CDC guidelines (22-B DCMR 3907.6-3907.7), and DC's Medicaid personal care aide rules separately mandate an annual physical exam with a TB test. Workers' comp from the first employee.
What District of Columbia requires
District of Columbia
Licensing chapter communicable-disease screening. 22-B DCMR 3907.6 requires each home care agency, at initial employment, to verify that the employee has been screened for and is free of communicable disease within the six months immediately preceding hire, and 3907.7 requires annual communicable-disease screening according to CDC guidelines with certification that the employee is free of communicable disease; TB is not named in the chapter but is covered through the referenced CDC screening guidelines for health care personnel.
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Medicaid PCA rule (explicit TB test). 29 DCMR 5009 (Personal Care Aide Qualifications) requires an annual physical examination including a PPD/TB test for aides serving DC Medicaid beneficiaries.
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Licensure statute. DC Code Title 44, Chapter 5 (Health-Care and Community Residence Facility, Hospice and Home Care Licensure) authorizes the home care agency licensing regime.
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Workers' comp from 1st employee. Any DC employer with one or more employees must have workers' compensation coverage (DOES Office of Workers' Compensation); failure to secure coverage carries fines of $1,000 to $10,000.
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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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