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At a June PAYER Summit, SCAN Health Plan executive Quingan Zhou said the insurer authorizes skilled nursing facility admissions directly from home, without requiring a prior two-day hospital stay. Zhou said the approach aims to speed decisions, with authorization turnaround kept within the same business day or one business day.
SCAN Health Plan authorizes some admissions to a skilled nursing facility (SNF) directly from a member’s home, bypassing a two-day hospital stay that some payers require, executive Quingan Zhou said at a June 2026 industry summit. Zhou said the pathway is intended to avoid an unnecessary hospital step and keep authorization decisions within the same business day or one business day.
Zhou, SCAN’s vice president of growth strategy and operations, described the approach at Home Health Care News’ PAYER Summit. “We do direct SNF authorization,” she said. “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.” Her comments describe SCAN’s process; the report does not detail which members or clinical circumstances qualify.
According to Zhou, the process allows SCAN’s utilization management turnaround to remain within the same business day or one business day. She said SCAN’s clinical team and medical directors view timely care as the reasonable course. Zhou also said changing the operational process was difficult for the clinical operations team, though she considered the direct pathway better for patients.
SCAN is a Long Beach, California-based nonprofit that provides Medicare Advantage plans to more than 425,000 members in Arizona, California, Nevada, New Mexico, Texas and Washington, according to the source report. Its Embrace institutional special needs plan, or I-SNP, operates in California and Arizona and serves more than 4,000 members. The plan focuses on people who live at home, in nursing homes or in assisted living facilities.
Fewer Hospital Steps Before SNF Care
For a person who needs skilled nursing care while living at home, avoiding a required hospital admission could change the route into a facility. SCAN says direct authorization removes the hospital stay from that pathway and can keep review decisions within one business day. The report does not quantify how many members use this route or whether it changes health outcomes, costs or hospital use.
The policy also places more weight on coordination between the health plan, clinicians and SNF providers. A hospital stay may be used by some payers as part of the process before a facility admission. SCAN’s model, as Zhou described it, allows the plan to authorize admission from home instead. Whether that is appropriate depends on a member’s circumstances and the plan’s authorization process; the source report does not set out clinical criteria.
For providers, the speed and design of authorization can affect how they arrange care. Zhou said SCAN discusses benefit design and payment structures with provider partners, which can have direct or indirect effects on providers. Those discussions matter because, she said, the implications of complex payment arrangements may not always be apparent to providers.
SCAN’s Provider Partnership Approach
Zhou acknowledged that direct home-to-SNF authorization differs from the practice of payers that require a two-day hospital stay before authorizing this type of admission. She framed SCAN’s choice as part of a broader effort to question processes that have become routine. “We all collectively have a responsibility of holding each other accountable for not normalizing the abnormal,” Zhou said.
The report places the policy within SCAN’s relationship with providers and its care model for people who may be living at home or in a residential care setting. Zhou said SCAN aims for payer and provider discussions to leave both sides in a better position, and described fair contracts and partnerships as important to the organization’s work.
Zhou also linked SCAN’s operating choices to its nonprofit status. She said the organization can reinvest in technology and infrastructure rather than reporting earnings quarterly. The source does not provide financial figures or establish how nonprofit status affects the direct authorization policy. Zhou described provider partnerships as central to SCAN’s growth across its special needs and general products.
““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 Still Unreported
The source report does not specify which members qualify for direct home-to-SNF authorization, what clinical standards SCAN applies, or how often the pathway is used. It also does not say whether every SCAN product follows the same process or whether the approach is limited to particular plans, regions or provider arrangements.
No comparative data are provided on patient outcomes, readmissions, costs, time to placement or the number of hospital stays avoided. Zhou described the turnaround time as remaining within the same business day or one business day, but the report gives no underlying data or comparison with the process before the policy. The comments establish SCAN’s stated approach, not its measured effect across members.
The article also does not identify the other payers that require a two-day hospital stay, or explain how that requirement varies by plan or case. Further details would be needed to compare authorization policies across insurers or assess how the direct pathway works in individual cases.
More Detail Needed on Implementation
The next useful information would be SCAN’s eligibility criteria, the clinical review steps used for direct admissions, and data showing how quickly authorizations are completed. Reporting on the volume of members served through this pathway and outcomes compared with hospital-first admissions could help clarify its reach and effects.
Provider discussions may also shape how the process works in practice. Zhou said SCAN talks with partners about benefit design and contracts, but the report does not describe any upcoming policy changes or a specific implementation milestone. For now, the available account is a description of SCAN’s current approach as presented at the June summit.
Key Questions
What does SCAN mean by direct home-to-SNF authorization?
SCAN says it can authorize an eligible member to enter a skilled nursing facility from home without first completing a two-day hospital stay. The source report does not provide the plan’s eligibility rules.
How quickly does SCAN say it makes authorization decisions?
Quingan Zhou said utilization management turnaround remains within the same business day or one business day. The report does not provide data comparing that timing with other plans.
Does the source say every SCAN member can use this pathway?
No. The report describes SCAN’s direct authorization approach but does not explain which members, plans or clinical situations qualify.
Has SCAN reported outcomes from skipping the hospital step?
The report includes no comparative figures on outcomes, costs, hospital use or the number of members admitted directly from home.
Source: rss
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