CMS issues WCMSA Reference Guide v4.5, refreshing the CDC life-table link that drives set-aside funding
The April 13, 2026 release makes two narrow changes — an updated CDC life-expectancy table link and added ZIP codes for major medical centers — but the life-table refresh resets the actuarial input behind every federal Medicare Set-Aside projection.
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The Centers for Medicare & Medicaid Services (CMS) has published Version 4.5 of its Workers' Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide, dated April 13, 2026 and carrying the document control number COBR-Q2-2026-v4.5, according to the guide itself. The Reference Guide is CMS's consolidated statement of how it reviews and approves the projected future-medical funding amounts — the WCMSA — that parties carve out of workers' compensation settlements involving Medicare beneficiaries.
Per the "Changes in This Version" section, Version 4.5 makes two changes. First, the guide states that "Additional ZIP codes have been added to the table listing major medical centers (Appendix 7)" — the table CMS uses to apply major-medical-center pricing geography in its calculations. Second, it states that "The CDC Life Table link has been updated (Section 10.3)," the section that governs how CMS projects a claimant's remaining life expectancy. This is a maintenance release rather than a policy rewrite: it does not, on its face, change the criteria for submitting a proposal, the amended-review rules, or the account-administration requirements.
The life-table link is the substantive item. CMS projects the cost of a claimant's future treatment over that claimant's life expectancy, and the guide directs reviewers to the current Centers for Disease Control and Prevention (CDC) life-expectancy table, specifying that "Table 1 for total population is used" per a CMS memorandum the guide dates to May 20, 2008. In Version 4.5 the embedded CDC source link resolves to the National Vital Statistics Report at nvsr74-06.pdf. Because the survival figure is multiplied against annualized future drug and treatment costs, the table CMS points to is one of the core actuarial inputs in every set-aside it reviews. The guide notes elsewhere that the CDC "provides annual life expectancy tables used in the calculations for the WCMSA funding amount," and the "List of Previous Version Changes" (Appendix 8) shows the immediately prior release, Version 4.4 of July 2025, made the same single substantive move: "The CDC Life Table link was updated (Section 10.3)."
CMS's submission instructions also reinforce that the agency, not the submitter, controls this input. The guide tells parties to support life-expectancy claims with documentation but "Do not include … Actuarial charts or life expectancy charts from the CDC or elsewhere," because CMS applies its own current table. The Reference Guide is the operative source; the figures and effective date above are taken from Version 4.5 as published by CMS.
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