TL;DR
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SCAN Health Plan authorizes skilled nursing facility admissions directly from home for members in its Embrace institutional special needs plan, according to Vice President Quingan Zhou. The approach avoids a two-day hospital stay that some payers require and, Zhou said, lets the plan make authorization decisions within the same or next business day. The report does not detail eligibility criteria or outcomes.
SCAN Health Plan authorizes skilled nursing facility (SNF) admissions directly from home for members in its Embrace institutional special needs plan, skipping a hospital stay that some payers require before such an admission. Quingan Zhou, SCAN’s vice president of growth strategy and operations, described the practice at Home Health Care News’ PAYER Summit in June, saying it allows the plan to make authorization decisions within the same or next business day.
Zhou said that some payers require a two-day hospital stay before authorizing a move from home to an SNF. SCAN instead makes direct SNF authorizations, she said. Her comments describe the plan’s process; the report does not specify which members qualify, how clinicians assess each request or whether every direct admission is approved.
According to Zhou, SCAN’s utilization management turnaround time is generally the same business day or one business day. She said the plan’s clinical team and medical directors concluded that timely care was the right course. Zhou also said removing the hospital step was difficult for clinical operations, while arguing that it made more sense for patients.
SCAN, a nonprofit based in Long Beach, California, provides Medicare Advantage plans to more than 425,000 members in Arizona, California, Nevada, New Mexico, Texas and Washington. Its Embrace I-SNP operates in California and Arizona and serves more than 4,000 members, according to the source report. The plan focuses on people who are homebound or live in nursing homes or assisted living facilities.
A Hospital Stay May Not Be Required
For eligible members, direct authorization could remove an administrative step between care at home and a skilled nursing facility. Zhou’s account suggests SCAN aims to make authorization decisions quickly, which may matter when a care team believes a patient needs a higher level of support. The available reporting does not establish how often the pathway is used or measure its effect on health outcomes, costs or hospital use.
The approach also puts attention on how payer rules shape where patients receive care. A required hospital stay can affect the timing and location of an SNF admission, while direct authorization gives the payer and care team a different route to consider. SCAN’s description shows that at least one plan says it does not apply the two-day requirement in this pathway; it does not establish that the requirement is universal across insurers or circumstances.
Providers may also have a practical stake in authorization speed and benefit design. Zhou said SCAN discusses with providers how benefit structures can affect them, including in ways they may not see because payment arrangements are complicated. Those conversations, she said, can help identify processes that neither side considers useful. The report does not name specific provider partners or describe changes to a particular contract.
SCAN’s Embrace Plan in Two States
The direct-to-SNF pathway was described as part of SCAN’s Embrace institutional special needs plan, or I-SNP. The plan serves members in California and Arizona who are homebound or live in institutional care settings, including nursing homes and assisted living facilities. SCAN also offers Medicare Advantage plans across six states, but the report does not say that this direct authorization practice applies to all of its products or members.
Zhou framed the policy as part of a broader approach to payer-provider relationships. She said SCAN is willing to question processes that have become routine if they appear inefficient. She also described the organization’s nonprofit status as a factor in its ability to reinvest in technology and infrastructure rather than report earnings quarterly. These are her explanations of SCAN’s operating choices; the report provides no financial comparison with for-profit plans.
The account appeared in Home Health Care News’ coverage of its June PAYER Summit. The source presents Zhou’s description and rationale, but does not include independent data comparing SCAN’s pathway with plans that require a hospital stay. It also does not report patient or provider interviews about how the process works in practice.
““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 Remain Unreported
The source report does not state which patients meet the criteria for direct home-to-SNF authorization, what clinical documentation is required, or who initiates a request. It also does not clarify whether SCAN’s process applies to every Embrace member or only certain cases, or how often requests are denied or redirected to a hospital.
No patient outcome, cost, readmission or hospital-use data are provided to show what effect the practice has. The report also does not identify the payers that require a two-day hospital stay or specify the circumstances in which they apply that rule. Zhou’s account is a description by a SCAN executive, rather than a comparative evaluation of different payer policies.
Provider Discussions May Shape Practice
Zhou said SCAN continues to discuss benefit design and operating processes with provider partners. Those discussions may help the plan and providers identify where authorization rules or payment arrangements create friction, though the report names no specific next policy change, rollout date or public evaluation.
Further details that would clarify the pathway include its eligibility rules, the number of direct admissions, decision times across different cases and patient outcomes. SCAN has not, in the source report, announced a new milestone or published those figures. For now, the confirmed development is Zhou’s account of an existing authorization practice within the Embrace plan.
Key Questions
What does SCAN Health Plan authorize directly from home?
According to Quingan Zhou, SCAN authorizes some skilled nursing facility admissions directly from home through its Embrace institutional special needs plan, without requiring a preceding two-day hospital stay.
How quickly does SCAN make authorization decisions?
Zhou said SCAN’s utilization management turnaround time is generally the same business day or one business day. The report does not provide case-level timing data.
Who is covered by the Embrace plan?
SCAN’s Embrace I-SNP operates in California and Arizona and serves more than 4,000 members, according to the report. It focuses on people who are homebound or live in nursing homes or assisted living facilities.
Does SCAN publish results from this pathway?
The source report does not include data on the pathway’s use, patient outcomes, costs or hospital admissions. It also does not state the detailed clinical criteria for direct authorization.
Source: rss
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