The short answer Montana licenses home health agencies as health care facilities, and the minimum standards applicable to all licensed facilities require TB screening of all staff based on an annual TB risk assessment under the state TB program. Workers' comp is required from the first employee.
What Montana requires
Montana
TB screening required. ARM 37.106.313 (Minimum Standards for All Health Care Facilities: Communicable Disease Control) requires facilities to implement TB screening for all staff and clients based on an annual TB risk assessment set by the Montana Tuberculosis Prevention and Control Program; home health agencies are DPHHS-licensed facilities subject to this rule.
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Home health licensing. Home health agency-specific rules sit in ARM 37.106 (2025 reorganization); DPHHS administers home health agency licensure.
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Workers' comp from 1st employee. Coverage is required as soon as the first employee is hired; full-time, part-time, and seasonal workers are all covered (MT DLI / Montana State Fund).
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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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