The short answer Illinois's Home Health, Home Services, and Home Nursing Agency Code requires an initial health evaluation of each new client-facing employee, with content set by the agency's governing body, but does not mandate a TB test. Workers' comp is required for essentially every employer from the first hire.
What Illinois requires
Illinois
Health evaluation rule. 77 Ill. Adm. Code 245.30(c)(1)(B) requires personnel policies to include an initial health evaluation of each new employee or placed worker who has contact with clients, as specified by the governing body; no TB test is specified anywhere in Part 245.
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Infection control. 77 Ill. Adm. Code 245.75 requires an agency-wide infection control program following CDC guidelines, but no worker TB testing.
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Workplace violence law does not reach home care. The Illinois Health Care Violence Prevention Act (210 ILCS 160) defines covered health care providers as retail health care facilities, licensed hospitals, and veterans homes; home care and home health agencies are not covered.
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Workers' comp from 1st employee. The Illinois Workers' Compensation Commission requires employers to provide workers' compensation insurance for nearly everyone hired, injured, or employed in Illinois.
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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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