Texas has the dubious distinction of being ranked last among states when it comes to telemedicine implementation. 

Texas, Alabama and Arkansas all received grades of "F" from the American Telemedicine Association, as noted in a report from the National Center for Policy Analysis (NCPA). All other states but Georgia which earned a “C,” earned “As” and “Bs.”

But, Texas has "strongly resisted efforts to expand telemedicine in the state’s private health sector,” according to the report.

Texas, Alabama and Georgia are the only states that require an in-office follow-up visit after a telemedicine encounter. "This is striking considering Texas ranks 51 out of 51 (including Washington, D.C.) for access to medical care in the United States," the report says.

In January 2015, the Texas Medical Board prohibited doctors from writing prescriptions for telemedicine patients who did not have a previous relationship, including an in-person visit. Regulations also require in-office follow-up visits.

The restrictions came as nearly 13 percent of the state's population has been designated as medically underserved, meaning that an individual's circumstances make it difficult to either access or afford health care services, the report said.

The report says the holdup of telemedicine implementation is undermining healthcare accessibility goals of Texas.

"The protectionist policies of the Texas Medical Board (TMB) threaten to undermine the effort Texas has made to increase access to medical care through telemedicine," wrote Jennifer Vermeulen, an NCPS research associate. "With the population of Texas projected to double by 2050, attempting to limit telemedicine patients and providers is a dangerous bet against the future of healthcare in Texas."