The Centers for Medicare and Medicaid Services (CMS) issued an Informational Bulletin to update its Waiver Technical Guide Version 3.5 and clarify its position on employment and employment related services. In the update, CMS emphasized the importance of competitive work for people with disabilities and highlighted its goal to promote integrated employment options through the waiver program. The TA Guide added a new core service definition by splitting supported employment into two definitions – individual and small group supported employment. It clarified that volunteer work and other unpaid integrated community employment activities are pre-vocational services, not supported employment services. The TA guide also clarified that pre-vocational services are designed to help obtain competitive employment and are time-limited although no specific limit is given in the update.