The short answer Oklahoma's home care agency licensing rules explicitly require TB testing for staff with direct client contact, following NTCA/CDC 2019 guidelines. Workers' comp is required from the first employee, with a narrow family-business exemption.
What Oklahoma requires
Oklahoma
TB screening (licensing rule). OAC 310:662-3-4(e)(6) requires personnel policies to include health screening for staff with direct client contact, including tuberculosis testing/tuberculin skin tests, conforming to NTCA/CDC 2019 guidelines; documented prior positives with a negative chest X-ray and no symptoms are excluded.
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Workers' comp from 1st employee. Coverage is required as soon as the first employee is hired; a statutory exemption applies for a natural-person employer with 5 or fewer total employees all related by blood or marriage.
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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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