The short answer Massachusetts currently has no state licensure for home health or home care agencies (Medicare certification and MassHealth rules only); a home care licensure bill was in a House-Senate conference committee as of July 23, 2026 but is not yet law, so there is no licensing TB rule. Workers' comp is mandatory from the first employee.
What Massachusetts requires
Massachusetts
No home care/home health license yet. As of July 23, 2026, the home care licensure bill (H.4706) is in a House-Senate conference committee; EOHHS would run licensure once enacted, but it is not yet law.
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TB screening: no licensing rule. Because home health/home care agencies are not among DPH-licensed facility types, there is no state licensing TB screening requirement for home care workers; DPH publishes TB screening guidance for health care personnel based on CDC/NTCA 2019 recommendations.
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Workers' comp from 1st employee. All Massachusetts employers must carry workers' compensation for all employees regardless of hours or headcount; the only exception is domestic employees working under 16 hours per week (Mass. DIA).
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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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