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What You Should Know
- ATA Action—the advocacy arm of the American Telemedicine Association (ATA)—launched the Cross-State Care Coalition, uniting health systems, digital health platforms, and clinical innovators to advance bipartisan federal legislation modernizing clinician licensure across state lines.
- The coalition is co-chaired by Johns Hopkins Medicine and ATA Action, building upon policy foundations established under the Licensure Innovation for Telehealth Transformation (LIFTT) Initiative introduced in March 2026.
- The legislative framework focuses on targeted, narrow federal pathways designed to reconcile conflicting state licensing rules without displacing states’ constitutional authority over clinical scope of practice, medical discipline, or patient safety standards.
- The initiative targets high-friction clinical scenarios where state borders disrupt care, prioritizing established patient continuity, virtual subspecialty access, remote second opinions, rare disease management, technology-enabled care, and decentralized clinical trial protocols.
- Founding healthcare health system and industry coalition members include Johns Hopkins Medicine, Access TeleCare, AdventHealth, Clara, MedStar Health, The Ohio State University Wexner Medical Center, Sanford Health, Talkiatry, and Teladoc Health.
Preserving State Authority via Narrow Federal Exceptions
A central tenet of the coalition’s policy platform is avoiding a top-down federalization of medical licensure. Instead, the initiative seeks targeted federal carve-outs that leave states’ underlying police powers, medical board disciplinary frameworks, and clinical scopes of practice intact:
- Narrow, Targeted Pathways: Establishes statutory safe harbors specifically where state-by-state licensing conflicts disrupt established doctor-patient relationships or restrict specialized access.
- Preserving State Oversight: States retain full authority over clinical standards of care, disciplinary actions, malpractice oversight, and professional accountability.
- Non-Displacement: Rather than replacing state medical licensing compacts (such as the Interstate Medical Licensure Compact – IMLC), the federal pathways are designed to complement state reciprocity agreements.
Five Core Legislative and Clinical Priorities
The coalition’s policy framework focuses on high-friction clinical environments where physical borders impose acute administrative and clinical barriers:
- Continuity of Care for Established Patients: Enabling clinicians to provide routine follow-up, chronic condition management, and post-discharge consultations when established patients travel or temporarily cross state borders.
- Access to Rare, Complex, and Subspecialty Care: Permitting out-of-state tertiary and quaternary subspecialists to deliver virtual care, specialty second opinions, oncology reviews, and pre-transplant workups without requiring full redundant licensure in the patient’s home state.
- Federally Regulated Clinical Trials: Removing state licensing hurdles for decentralized clinical research, enabling principal investigators and sub-investigators to monitor enrolled trial participants virtually across multiple jurisdictions.
- Safeguarding Patient Protection & Accountability: Ensuring that every cross-state virtual consultation maintains clear lines of clinical liability, verifiable credentials, and patient safety reporting mechanisms back to state boards.
- Interoperable, Connected Care Infrastructure: Fostering technical and policy standards that support seamless bidirectional health information exchange between out-of-state specialists and local primary care medical homes.
Founding Coalition Members Across Health Systems and Digital Health
The coalition unites academic medical centers, non-profit integrated delivery networks, specialty behavioral health platforms, and enterprise virtual care operators:
- Academic & Health System Anchors: Johns Hopkins Medicine (Co-Chair), AdventHealth, MedStar Health, The Ohio State University Wexner Medical Center, and Sanford Health.
- Virtual Care & Digital Health Innovators: Access TeleCare, Clara, Talkiatry, and Teladoc Health.
Transitioning from Temporary Extensions to Permanent Policy
The formation of the Cross-State Care Coalition marks a critical inflection point in telehealth policy. Over the past several years, virtual care advocacy largely centered on temporary legislative vehicles—such as extending Medicare telehealth flexibilities, geographic waiver suspensions, and high-deductible health plan (HDHP) safe harbors.
By shifting focus toward interstate licensure, provider organizations and digital health vendors are tackling the underlying structural barrier that limits nationwide hybrid care delivery models. For multi-state health systems and virtual specialty providers, establishing narrow federal pathways provides regulatory clarity, lowers clinical compliance risk, and protects network integrity as care models evolve across state borders.
