The short answer Rhode Island's home nursing care / home care provider licensing rules require pre-employment health screening for anyone with direct patient contact, which under the cross-referenced health care worker rule includes a two-step TST (or IGRA). Workers' comp is required at one employee.
What Rhode Island requires
Rhode Island
TB screening (licensing rule). 216-RICR-40-10-17 (Licensing Home Nursing Care Providers and Home Care Providers) requires pre-employment health screening for each individual with potential direct patient contact, conducted per Part 20-15-7.
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TB test specifics. 216-RICR-20-15-7.6(A)(5) requires pre-employment evidence of freedom from active TB via a negative two-step tuberculin skin test or FDA-approved IGRA; positives require practitioner certification of freedom from active disease, with periodic follow-up per CDC guidelines and LTBI referral/reporting.
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Workers' comp from 1st employee. With limited exceptions, employers with one or more employees must carry coverage; noncompliance carries a $1,000/day penalty (RI DLT).
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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
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