TB screening for home health employees in California

California home health agencies are licensed under Title 22 of the California Code of Regulations, and section 74723 sets the employee health rules. It is short, but the dates in it are the ones surveyors check.

The initial health assessment

Section 74723 requires every agency to require health assessments and keep health records for employees with direct patient contact. The written assessment is a prerequisite of employment and must be performed within six months before employment or within 15 days of starting. It covers general health and includes tuberculosis screening.

Annual TB screening

CDPH's Title 22 TB summary applies annual TB screening to home health agency employees with direct patient contact. The test must be a CDC-recommended, FDA-licensed method (a skin test or an interferon-gamma release blood test). An employee with a documented prior positive is not retested; they need a chest X-ray on record and a symptom review instead.

There is one exception: the annual screening can be waived if the local health officer certifies in writing that less frequent testing is acceptable. Agencies that want to follow the newer CDC guidance of risk-based rather than annual testing need that written approval, or a program flexibility waiver from CDPH, before changing their schedule.

Home care organizations are different

Non-medical home care organizations are licensed by the Department of Social Services, not CDPH. For them, Health and Safety Code section 1796.45 makes a TB examination a condition of initial and continuing employment. Agencies that hold both licenses need both records.

In the file

• The initial health assessment, dated inside the six-month / 15-day window.
• Each TB screening result with its date and method.
• For prior positives: the chest X-ray and the annual symptom screen.
• Any local health officer letter or CDPH waiver that changes the interval.

Tracking the dates

The TB test is the item that expires most often in a home health file, because it renews every year for every person. In Benson HR it is a compliance item with a 12-month renewal; each person is reminded before it lapses and uploads the new result from their phone, and the grid shows who is current. The compliance tracking page has the detail.