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

PL 2024-20 rescinded. HHSC rescinded Provider Letter PL 2024-20 (TB screening/testing requirements) on Nov. 1, 2024; interim direction is for agencies to follow program regulations and internal communicable-disease/infection-control policies. Source ↗

PL 2026-02 (recommendations for other settings). HHSC's Long-Term Care Regulation Provider Letter PL 2026-02 (Jan. 20, 2026) sets out CDC/DSHS-based TB screening recommendations, but it is addressed to assisted living facilities and day activity and health services (DAHS) providers, not HCSSAs; for HCSSAs the operative posture after the PL 2024-20 rescission remains recommendation-only, with agencies directed to follow their own communicable-disease and infection-control policies informed by CDC and DSHS resources. Source ↗

HCSSA licensing regs. 26 TAC Ch. 558 (HCSSA rules) require infection-control policies but no prescriptive worker TB test. Source ↗

Workplace violence (H&S Code Ch. 331). Tex. Health & Safety Code Ch. 331 (SB 240, 2023) applies to a home and community support services agency licensed under Chapter 142 to provide home health services that employs at least two registered nurses, requiring a workplace violence prevention committee and a written prevention plan; the compliance deadline was Sept. 1, 2024. Source ↗

Workers' comp optional. TDI: Texas is the only state where most private employers may opt out (nonsubscribers); nonsubscribers must file an annual DWC notice, post/give written no-coverage notices, and lose common-law defenses in injury suits. 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 ↗