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Therefore, in an effort to address these concerns and in light of our continuing experience in applying these policies, we are proposing to revise 412.92(b)(2) so that for SCH applications received on or after October 1, 2023, where (1) a hospital's SCH approval is dependent on its merger with another nearby hospital, and (2) the hospital meets the other SCH classification requirements, the SCH classification and payment adjustment would be effective as of the effective date of the approved merger if the MAC receives the complete application within 90 days of CMS' written notification to the hospital of the approval of the merger

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If symptoms return, you can consider a second round with medical guidance

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This gives your microbial population time to adjust and shift without causing excessive gas