The short answer Michigan does not license home health agencies at all (LARA only surveys them for Medicare certification under contract with CMS), so there is no state licensing TB requirement. Workers' comp is required at 3 employees at one time, or 1 employee working 35+ hours/week for 13+ weeks.
What Michigan requires
Michigan
No state license. Home health agencies are not state licensed as a health facility or agency in Michigan; agencies providing skilled nursing may seek Medicare certification, surveyed by LARA's Bureau of Survey and Certification for CMS.
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TB screening: no rule. With no home health licensing chapter, there is no home-health-specific TB rule; Michigan TB screening rules exist for other licensed settings such as adult foster care and homes for the aged, but not home health.
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Workers' comp threshold. Coverage is required for private employers with 3 or more employees at one time, or 1 or more employee working 35+ hours per week for 13 or more weeks in the preceding 52 weeks (MCL 418.115).
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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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