TB Testing & Occupational Health Rules for Home Care Workers in Pennsylvania

TB rule (before consumer contact). 28 Pa. Code 611.56(a) requires home care agencies and registries to ensure each direct care worker and other office staff or contractors with direct consumer contact document, prior to consumer contact, screening for and freedom from active tuberculosis in accordance with CDC guidelines; the screening date may not be more than 1 year before the start date. Source ↗

12-month updates. 28 Pa. Code 611.56(b) requires the documentation to be updated at least every 12 months from the date of last evaluation and kept in the individual's file. Source ↗

Hiring gate. TB screening is a precondition of hire/roster, cross-referenced in 28 Pa. Code 611.51 (hiring and rostering of direct care workers). Source ↗

Scope note. Chapter 611 covers home care agencies and registries; Medicare-style home health agencies are separately licensed under 28 Pa. Code Ch. 601. Source ↗

Workers' comp from 1st employee. PA L&I: coverage is mandatory for any employer with at least one employee; the only exclusions are all-casual, home-based, or certain low-wage agricultural workforces; insure via carrier, SWIF, or approved self-insurance. Source ↗

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. Source ↗

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. Source ↗

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. Source ↗

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. Source ↗