The short answer Washington's in-home services licensing rules (chapter 246-335 WAC) require a TB risk assessment for every new employee at hire and annually, with testing when the assessment indicates. Workers' comp (state fund) applies from the first employee, and WA's health care workplace violence law (RCW 49.19) expressly reaches home health, hospice, and home care agencies.
What Washington requires
Washington
TB screening required. WAC 246-335-525 (home health; parallel -425 for home care and -625 for hospice) requires a TB infection-control program including a TB risk assessment for all new employees at hire using the DOH form, an annual assessment of new risk factors, TB testing when criteria are triggered, and TB education at hire.
Source ↗
Workplace violence applies to home care. Chapter 49.19 RCW requires a workplace violence prevention plan, security/safety assessment, training, and recordkeeping, and explicitly includes home health, hospice, and home care agencies under chapter 70.127 RCW, with enforcement flexibility for in-home settings.
Source ↗
WPV law strengthened for 2026. 2SHB 1162 (2025) amends RCW 49.19 effective Jan. 1, 2026: annual (not triennial) plan updates, mandatory timely investigation of every incident, and periodic reporting to safety committees.
Source ↗
Workers' comp from 1st employee (state fund). Washington is a monopolistic state: any employer with at least one employee (even part-time) must have industrial insurance through L&I; private WC policies are not valid.
Source ↗
☆ Rules change. We watch them for you.
Get one short email when Washington's home care requirements change. No spam, unsubscribe anytime.
Reviewed quarterly by Vitable Health.
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.
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 ↗
Primary sources for this page
More Washington guides