Complete Form 552:

  • Item 2 -Enter the current processing month and year (MM/YY).
  • Item 3 -Enter 31.
  • Item 20 -Delete the long term care facility code. Enter the unit composition code.
  • Item 33 -Enter 57.
  • Item 44 -See WAG 27-44-00.
  • Item 45 -Delete entry.
  • Item 80 -Delete 391 or 395 and, as appropriate, 392 and 396. If the case status is changed to community spenddown, enter 390. Enter 158 CI.