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SCAN Health Plan says it authorizes direct admissions from home to a skilled nursing facility for eligible members, bypassing a hospital stay that some payers require. Executive Quingan Zhou said the approach can keep authorization decisions within the same or next business day; the report does not provide outcome or cost data.
SCAN Health Plan authorizes some members to move directly from home to a skilled nursing facility (SNF), without first spending two days in a hospital, Vice President of Growth Strategy and Operations Quingan Zhou said at a June summit. The approach challenges a pathway Zhou described as common among some payers and is intended to speed access to post-acute care when a hospital admission is not needed.
Speaking at Home Health Care News’ PAYER Summit, Zhou said SCAN provides direct SNF authorization for admissions from home. She said the plan does not require the two-day hospital stay that some payers require before approving that transition. The report does not specify which members or clinical situations qualify, or whether the policy applies across all of SCAN’s plans.
Zhou said bypassing the hospital step allows SCAN’s utilization management turnaround to remain within the same business day or the next business day. She described the policy as a decision by the plan’s clinical team and medical directors to provide timely care. The report offers no figures on authorization volumes, hospital stays avoided, patient outcomes or costs.
The Long Beach, California-based nonprofit provides Medicare Advantage coverage to more than 425,000 members in Arizona, California, Nevada, New Mexico, Texas and Washington, according to the report. Its Embrace institutional special needs plan operates in California and Arizona and serves more than 4,000 members. Embrace focuses on people who are homebound or live in nursing homes or assisted living facilities.
A Direct Route to Skilled Nursing
For patients who need skilled nursing care but do not need inpatient hospital treatment, a hospital-first authorization rule can add a care transition before the move to a facility. SCAN’s policy removes that required stop for the admissions it approves, potentially reducing delays and avoiding a hospital stay used to meet a payer condition rather than to provide inpatient treatment. Those are implications of the model; the source report does not document how often this occurs or measure its effects.
The policy also gives home-based care providers a role in decisions about where a patient receives the next stage of care. Zhou said the transition involves coordination between payers and providers, including discussion of benefit design and its operational effects. For providers, the authorization process can affect staffing, timing and care planning. The report does not describe specific provider contracts or say how widely the direct-admission policy is used.
SCAN’s example may be relevant to other Medicare Advantage organizations considering how to manage transitions from home. But the available account describes one plan’s approach and rationale, not evidence that direct authorization produces better clinical or financial results across the sector.
How SCAN Describes Its Model
Some payers require a two-day hospital stay before approving an admission from home to a skilled nursing facility, according to the Home Health Care News report. Zhou characterized that requirement as an industry practice SCAN chose not to follow. The report does not identify the payers that use the requirement, its formal policy basis or whether it applies to every type of plan or admission.
Zhou said the change was difficult for SCAN’s clinical operations, while arguing that it made more sense for patients. She also linked the company’s operating model to its nonprofit status, saying SCAN can reinvest in technology and infrastructure rather than reporting earnings quarterly. The report presents this as Zhou’s explanation; it does not compare SCAN’s resources or operations with those of for-profit plans.
SCAN has described provider partnerships as part of its growth strategy across both special needs and general products. Zhou said discussions with providers can surface the effects of benefit designs that may not be obvious within a complicated payment system. In her account, such conversations can help the parties identify inefficient processes and develop arrangements that work for both sides.
“We do direct SNF authorization. SNF admissions from the home require a two-day stay in the hospital. We don’t do that; we go direct from the home to the SNF and skip the hospital altogether.”
— Quingan Zhou, SCAN Health Plan vice president of growth strategy and operations, speaking at Home Health Care News’ PAYER Summit
Eligibility and Results Remain Unreported
The report does not spell out the clinical criteria for direct home-to-SNF authorization, how members or providers request it, or whether the policy is available throughout SCAN’s service area. It also does not say how many admissions use the pathway, how often requests are approved, or whether other plans have adopted similar policies.
SCAN’s stated turnaround time is within the same or next business day, but no comparison with other authorization timelines is provided. The report contains no data on patient outcomes, readmissions, costs or hospital use. Those measures would be needed to assess the effects of the policy beyond its stated purpose of avoiding an additional hospital step.
Further Policy Details Would Clarify Reach
The next useful details would be SCAN’s eligibility criteria, the number of members using direct authorization and any evidence on care outcomes, timing and costs. The report does not announce a rollout date, expansion or evaluation, and it does not identify a specific next milestone. Providers and members seeking to understand whether the pathway applies to a particular case would need plan-specific information from SCAN.
Key Questions
What is SCAN Health Plan changing?
SCAN says it authorizes some admissions from home directly to a skilled nursing facility, without requiring a prior two-day hospital stay.
Does every SCAN member qualify?
The report does not provide the eligibility rules or confirm that the policy applies to every SCAN plan or member. It describes the approach in general terms.
How quickly does SCAN make authorization decisions?
Quingan Zhou said utilization management turnaround remains within the same business day or the next business day. The report does not provide a comparison with other plans.
Has SCAN shown that the policy improves outcomes or reduces costs?
The report includes no outcome or cost data. Zhou described the policy’s purpose and operating rationale, but the evidence presented does not establish its effects.
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