The short answer New York's home care personnel rule (10 NYCRR 766.11) requires a pre-employment individual TB risk assessment, symptom evaluation, and baseline TB test, then an annual RN-conducted risk assessment (test only if new risk/symptoms) per DAL 21-03, plus an annual health assessment, measles/rubella immunity, and a flu vaccinate-or-mask rule under 10 NYCRR 2.59. Workers' comp from the first employee.
What New York requires
New York
766.11 personnel/TB. 10 NYCRR 766.11 requires all personnel (except those with no clinical/patient contact), prior to employment, to have an initial individual TB risk assessment, symptom evaluation, and TB test, and an annual TB assessment thereafter, as part of required health assessments including measles/rubella immunity.
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DAL 21-03 shift from annual testing. DOH DAL DHCBS 21-03 (2021) ended routine annual TST/IGRA for active employees, replacing it with an annual individual risk assessment by an RN, with testing only for new risk factors or symptoms; it applies to CHHAs, LTHHCPs, AIDS home care, hospice, and LHCSAs.
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DAL 21-05 clarification. DAL 21-05 provides further clarification of the risk-assessment-based TB approach for home care agencies.
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Flu vaccinate-or-mask. 10 NYCRR 2.59 requires unvaccinated personnel of home care agencies to wear masks during declared flu season when patients may be present.
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Workers' comp from 1st employee. NY WCB: virtually all for-profit NY employers must cover employees (WCL sections 2, 3) including part-time, leased workers, and family members; one employee triggers the same duty.
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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
- https://regs.health.ny.gov/content/section-76611-personnel
- https://www.health.ny.gov/facilities/home_care/dal/
- https://www.health.ny.gov/facilities/home_care/dal/docs/21-05.pdf
- https://regs.health.ny.gov/content/section-259-prevention-influenza-transmission-healthcare-and-residential-facilities-and
- https://www.wcb.ny.gov/content/main/coverage-requirements-wc/wc-coverage-required.jsp
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