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SCAN Health Plan says it authorizes direct admissions from home to skilled nursing facilities for members in its Embrace institutional special needs plan, bypassing a two-day hospital stay required by some payers. The approach is intended to speed access to care, but the report does not specify eligibility criteria or outcomes.
SCAN Health Plan authorizes some members to move directly from home to a skilled nursing facility (SNF), bypassing a two-day hospital stay that some payers require before SNF admission, company executive Quingan Zhou said at a June 2026 industry summit. The policy is intended to shorten the authorization process and avoid an inpatient step SCAN considers unnecessary for those transitions.
Zhou, SCAN’s vice president of growth strategy and operations, described the approach at Home Health Care News’ PAYER Summit. She said SCAN provides direct SNF authorization for eligible admissions from home, rather than requiring members to be hospitalized first. The source report does not specify the clinical criteria used to approve an admission.
According to Zhou, removing the hospital step allows SCAN’s utilization management decisions to be made within the same business day or one business day. She said clinical operations had to adapt to the change, but SCAN’s clinical team and medical directors concluded timely care was the reasonable approach.
SCAN operates the Embrace institutional special needs plan in California and Arizona, serving more than 4,000 members across the two states, according to the report. Embrace is designed for people who are homebound or live in a nursing home or assisted living facility. SCAN Health Plan is a nonprofit Medicare Advantage organization with more than 425,000 members across Arizona, California, Nevada, New Mexico, Texas and Washington.
A Faster Route Into Skilled Nursing
For members whose care needs can be met in a SNF, direct authorization may remove a hospital admission from the path to that care. SCAN says its process can produce a decision within one business day, which could reduce delays associated with the hospital requirement used by some other payers. The report provides no comparative data on time to placement or patient outcomes, so the effect on access and health results cannot be quantified from the available information.
The policy also puts the spotlight on how payer rules shape care transitions. Zhou said SCAN discusses processes and benefit designs with providers, arguing that both sides should identify requirements that add friction without a clear purpose. Those conversations matter to providers because payment and authorization rules can affect their operations as well as the care options available to members.
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How SCAN Describes the Model
Some payers require a two-day inpatient hospital stay before authorizing a move from home to a skilled nursing facility. The source report does not identify those payers or describe the circumstances in which the requirement applies. Zhou characterized SCAN’s direct authorization as outside the industry norm and said the company believes the hospital step does not make sense for the transitions it approves.
Zhou also linked SCAN’s approach to its nonprofit structure. She said the organization can reinvest in technology and infrastructure rather than focusing on quarterly earnings reporting. She described provider partnerships as central to growth across SCAN’s special needs and general products. These are Zhou’s explanations of the organization’s model; the report does not provide financial or operational comparisons with other health plans.
“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, because that [requirement] doesn’t make any sense.”
— Quingan Zhou, SCAN Health Plan vice president of growth strategy and operations
Eligibility and Outcomes Not Reported
The source report does not detail which members qualify for direct home-to-SNF authorization, what clinical standards guide decisions, or whether the process applies beyond the Embrace plan. It also provides no data on how many members have used the pathway, whether hospital use has fallen, or how patient outcomes compare with other admission routes. The report does not describe how the policy interacts with specific Medicare Advantage coverage rules.
Provider Discussions Continue
Zhou said SCAN continues to discuss benefit design and operating processes with provider partners, including how payment structures affect care delivery. The report identifies no announced policy changes or implementation milestones ahead. Further detail on eligibility, utilization and outcomes would be needed to assess how broadly the direct admission pathway is used and what effect it has on members.
Key Questions
What pathway does SCAN Health Plan authorize?
SCAN says it can authorize eligible members to move directly from home to a skilled nursing facility, without an intervening hospital stay.
How long does SCAN say authorization takes?
Quingan Zhou said SCAN’s utilization management turnaround is within the same business day or one business day. The report does not give a measured average or range.
Does the policy apply to every SCAN member?
The report describes the Embrace institutional special needs plan in California and Arizona, but does not give full eligibility rules or confirm that the pathway applies to every SCAN member.
What remains unknown about the direct admission approach?
The report does not provide the clinical criteria, the number of admissions handled this way, or data comparing patient outcomes and hospital use with other pathways.
Source: rss
