The short answer Hawaii requires TB clearance (initial and annual evaluation) for people working in licensed home health agencies under DOH TB clearance rule HAR Chapter 11-164.2, which sits alongside the home health agency licensing chapter. Workers' comp is mandatory from the first employee.
What Hawaii requires
Hawaii
TB clearance rule. HAR ch. 11-164.2 requires TB clearance for persons living or working in designated health care or residential care facilities, with initial and annual evaluation; the DOH TB Branch lists home health agencies (HAR ch. 11-97) among the covered facility types.
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TB clearance manual. The Hawaii TB Clearance Manual (May 2025) sets out implementation detail for the HAR ch. 11-164.2 clearance requirement.
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Licensing chapter. Home health agencies are licensed by DOH Office of Health Care Assurance; the licensing chapter also required agency plans for pre-employment/periodic exams and TB testing.
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Workers' comp from 1st employee. DLIR Disability Compensation Division: any employer having one or more employees, full- or part-time, permanent or temporary, must provide workers' compensation coverage unless excluded under HRS 386-1.
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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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