In response to concerns about access to medical care at many Department of Veterans Affairs (VA) hospitals and clinics across the country in spring 2014, Congress passed the Veterans Access, Choice, and Accountability Act of 2014 (VACAA, P.L. 113-146 , as amended). On August 7, 2014, President Obama signed the bill into law. Since the VACAA was enacted, Congress has amended the act several times: P.L. 113-175 , P.L. 113-235 , P.L. 114-19 , P.L. 114-41 , P.L. 115-26 , P.L. 115-46 , P.L. 115-96 , and P.L. 115-182 . In addition, the VA has issued implementation regulations and guidance on several occasions in response to the changes to VACAA and challenges encountered during implementation of the law. Table 1 provides major highlights pertaining to the Veterans Choice Program (VCP)―a new, temporary program authorized by Section 101 of the VACAA that allows eligible veterans to receive medical care in the community. On June 6, 2018, President Donald Trump signed the John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal Systems and Strengthening Integrated Networks Act of 2018 (the VA MISSION Act of 2018) into law ( P.L. 115-182 ). Section 101 of this act established a new permanent Veterans Community Care Program (VCCP) that would replace VCP. This new program is expected to be operational around June 6, 2019. (The MISSION Act of 2018 stipulates that VCCP must be effective when the VA determines that 75% of the amounts deposited in the Veterans Choice Fund [VCF] have been exhausted, or when regulations are published by the VA, which is no later than one year after the date of enactment of the VA MISSION Act—June 6, 2019.) This report provides details on how the VCP is being implemented. It is meant to provide insight into the execution of the current VCP program that is still functioning until the new VCCP program becomes operational sometime in June 2019. Information contained in this report is drawn from regulations published in the Federal Register , conference calls, numerous meetings with VHA staff, and briefing materials and other information provided by the VA Office of Congressional and Legislative Affairs (which may not be publicly available). This report does not discuss the new VCCP program established by Section 101 of the VA MISSION Act of 2018. Once an eligible veteran is authorized to receive necessary treatment, including follow-up appointments and ancillary and specialty medical services, under the VCP, a veteran may receive similar services that are offered through their personalized standard medical benefits package at a VA facility. VA's standard medical benefits package includes (but is not limited to) inpatient and outpatient medical, surgical, and mental health care; pharmaceuticals; pregnancy and delivery services; dental care; and durable medical equipment, and prosthetic devices, among other things. Currently, 81 categories of medical services and procedures are authorized to be provided under VCP. However, institutional long-term care and emergency care in non-VA facilities are excluded from the VCP. "It is important to note that the VCP does not provide guaranteed health care coverage or an unlimited medical benefit." These services are authorized and provided under separate statutory authorities outside the scope of VCP. Generally, all veterans have to be enrolled in the VA health care system to receive care under the VCP. Once this initial criterion is met, a qualified veteran may choose to receive care through VCP. Veterans may become eligible for care under the VCP through one of four different pathways: 30-d ay w ait l ist (Wait-Time Eligible) : A veteran is eligible for care through the VCP when he or she is informed, by a local VA medical facility, that an appointment cannot be scheduled within 30 days of the clinically determined date of when the veteran's provider determines that he or she needs to be seen (this category also includes care not offered at the veteran's primary VA medical facility and a referral cannot be made to another VA medical facility or federal facility), or within 30 days of the date of when the veteran wishes to be seen. 40 miles or m ore d i stance (Mileage Eligible) : A veteran is eligible for care through the VCP when he or she lives 40 miles or more from a VA medical facility that has a full-time primary care physician. 40 m iles or l ess d istance (Mileage Eligible) : A veteran is eligible for care through the VCP when he or she resides in a location, other than one in Guam, American Samoa, or the Republic of the Philippines, and travels by air, boat, or ferry in order to seek care from his or her local VA facility; or incurs a traveling burden based on environmental factors, geographic challenges, or a medical condition. State or t erritory without a f ull- s ervice VA medical f acility: A veteran is eligible for care through the VCP when his or her residence is more than 20 miles from a VA medical facility and located in either Alaska, Hawaii, New Hampshire (excluding veterans who live 20 miles from the White River Junction VAMC), or U.S. territory (excluding Puerto Rico). Table 2 provides a breakdown of the unique number of veterans utilizing the VCP, by eligibility category, from November 2014 through August 28, 2018, unless otherwise noted. A veteran who believes that he or she meets one of the eligibility criteria to receive care through the VCP is to have his or her eligibility status confirmed by local VA staff. A high-level overview of the eligibility process to access care through the VCP is illustrated in Figure 1 . Local VA facility staff members are to review clinical and administrative records of the veteran to determine the appropriate medical benefits package and clinical criterion. Confirmation of the veteran's eligibility status is generally determined within 10 business days from when the request for confirmation was submitted. Veterans who are found ineligible to participate in the VCP are to be given instructions, in their notification letters, on how to appeal the VA's decision. Also see Appendix A for a detailed high-level workflow of how care is obtained through VCP. Eligible veterans have two options for receiving health care services under the Veterans Choice Program (VCP). First, veterans may choose to receive their medical care from a VA provider. A veteran who chooses this option is to receive an appointment with a VA provider. The veteran may be offered a VA appointment that is more than 30 days out or at a facility that is more than 40 miles from the veteran's residence. If an offered appointment does not accommodate the veteran's clinical needs, the local VA staff may place the veteran on an electronic waiting list until an alternate appointment becomes available. At any time , the veteran (based on the availability of clinical appointments) may choose to receive his or her medical services from a VA community care provider. The second option allows veterans to receive health care services from a VA community care provider (VCP provider) who accepts eligible VCP veterans. Veterans who choose this option are to have their names and medical authorization information sent to a VCP provider of their choice. At any time , veterans (based on the availability of clinical appointments) may choose to receive their medical services from a VA provider. Under the VCP, several entities and providers are eligible to provide care and services. These include, among others, federally qualified health centers, Department of Defense (DOD) medical facilities, Indian Health Service outpatient health facilities or facilities operated by a tribe or tribal organization, hospitals, physicians, and nonphysician practitioners or entities participating in the Medicare or Medicaid program, an Aging and Disability Resource Center, an area agency on aging, or a state agency or a center for independent living. VA employees are excluded from providing care or services under VCP, unless the provider is an employee of VA, and is not acting within the scope of such employment while providing hospital care or medical services through the VCP. Generally, VCP providers "must maintain at least the same or similar credentials and licenses as those required of VA's health care providers." The Veterans Choice Program (VCP) is not a health insurance plan for veterans. Under the VCP, veterans are given the option of receiving care in their local communities instead of waiting for a VA appointment and/or enduring traveling burdens to reach a VA facility. All veterans who are enrolled in the VA health care system are to be mailed a VCP card. The card lists relevant information about the VCP. Many veterans have attempted to use the VCP card as an insurance card. The VCP card may not be used to pay for medical services performed outside of or within the VA. Specifically, the VCP card does not replace veterans' identification cards, guarantee eligibility under the VCP, or provide health insurance-like benefits (i.e., the VCP, like all VA health care, is not health insurance). In September 2013, the VA awarded contracts to Health Net and TriWest to expand veterans' access to non-VA health care in the communities, under the Patient-Centered Community Care (PC3) initiative. Later, in November 2014, the VA modified those contracts to include support services under the Veterans Access, Choice, and Accountability Act of 2014 (VACAA, or the Choice Act). Under the Veterans Choice Program (VCP), Health Net and TriWest manage the appointments, counseling services, card distributions, and a call center. They also oversee VCP providers, medical services reporting and billing processes, and the coordination of care with private health insurers.