December 15, 2017 Cost Estimate As ordered reported by the House Committee on Energy and Commerce on October 4, 2017 View Document112.14 KB Summary H.R. 2465 would modify Medicare coverage and payment rules for speech-generating devices. CBO estimates that enacting H.R. 2465 would increase direct spending by $12 million over the 2018-2027 period. Pay-as-you-go procedures apply because enacting the legislation would affect direct spending. The legislation would not affect revenues. CBO estimates that enacting H.R. 2465 would not increase net direct spending or on-budget deficits by more than $2.5 billion in any of the four consecutive 10-year periods beginning in 2028. H.R. 2465 contains no intergovernmental or private sector mandates as defined in the Unfunded Mandates Reform Act.