The short answer New Hampshire's home health care provider licensing rules (He-P 809) require each worker to have a pre-employment physical exam or health screening plus a two-step Mantoux TB test (or other CDC-approved method) done within 12 months before hire, documented in the personnel file, with positive results reported to the state. Workers' comp is required from the first employee.
What New Hampshire requires
New Hampshire
TB screening required. He-P 809.17(h) requires personnel to submit the results of a physical examination or health screening performed by a licensed nurse or licensed practitioner and the results of two-step tuberculosis testing by the Mantoux method (or other CDC-approved method), both conducted not more than 12 months prior to employment, retained in personnel records.
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Reporting duty. He-P 809 requires the licensee to report all positive TB test results for personnel to the office of disease control per RSA 141-C:7.
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Workers' comp from 1st employee. RSA 281-A:5: every employer with any employees, full- or part-time, including family members, must carry coverage; no minimum threshold (NH Department of Labor).
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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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