The short answer North Carolina's home care agency licensing rules explicitly require baseline TB skin testing for hands-on care employees before assignment to a client's home. Workers' comp is mandatory at 3 or more employees.
What North Carolina requires
North Carolina
TB screening (licensing rule). 10A NCAC 13J .1003 requires hands-on care employees to have a baseline TB skin test; positives must demonstrate noninfectious status before assignment, prior positives need baseline and annual verification they are free of TB symptoms, and at-risk employees are retested at OSHA-prescribed intervals per agency risk assessment.
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Licensing program. NC DHSR administers home care licensure under 10A NCAC 13J.
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Workers' comp at 3+ employees. Required for businesses with 3 or more employees under the NC Workers' Compensation Act.
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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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