The short answer Maryland has a detailed TB rule: home health agency personnel must be certified TB-free within 10 days of starting service under COMAR 10.07.10.15, and Residential Service Agencies (non-medical home care) must include TB screening in pre-hire health screening. Workers' comp is mandatory from the first employee.
What Maryland requires
Maryland
TB rule (home health agencies). COMAR 10.07.10.15 requires certification of paid and unpaid personnel no later than 10 days after beginning service, via a documented negative Mantoux test within 24 months, new Mantoux testing, or chest X-ray protocol for positive reactors, plus staff training on TB signs and symptoms.
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TB rule (Residential Service Agencies). COMAR 10.07.05.10(B)(1)(c) requires pre-hire screening of every employee, independent contractor, or contractual employee of a non-medical residential service agency to include a basic health screening, including tuberculosis screening.
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Workers' comp from 1st employee. Maryland Workers' Compensation Commission: with few exceptions, every Maryland employer with one or more employees must provide coverage.
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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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