The short answer Missouri licenses home health agencies (19 CSR 30-26), but the licensing rule works by requiring compliance with the federal Medicare Conditions of Participation and contains no state TB testing requirement; Missouri's TB testing mandate covers long-term care facilities, not home health. Workers' comp is required at 5 or more employees (1+ for construction).
What Missouri requires
Missouri
TB: no specific rule in licensing chapter. 19 CSR 30-26.010 requires licensed home health agencies to strictly meet the applicable Medicare Conditions of Participation (42 CFR 484), which require infection-prevention programs but not TB testing; no TB screening provision appears in Chapter 26.
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TB rule exists only for LTC. Missouri's TB testing regulation (19 CSR 20-20.100) applies to residents and workers of long-term care facilities, not home health agencies.
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Workers' comp at 5+ employees. Missouri Department of Labor & Industrial Relations: coverage is required at 5 or more employees; construction-industry employers need coverage with 1 or more.
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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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