[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[S. 1560 Introduced in Senate (IS)]

112th CONGRESS
  1st Session
                                S. 1560

      To enhance access to controlled substances for residents of 
    institutional long-term care facilities, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           September 14, 2011

   Mr. Kohl introduced the following bill; which was read twice and 
               referred to the Committee on the Judiciary

_______________________________________________________________________

                                 A BILL


 
      To enhance access to controlled substances for residents of 
    institutional long-term care facilities, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Nursing Home Resident Pain Relief 
Act of 2011''.

SEC. 2. DEFINITIONS.

    Section 102 of the Controlled Substances Act (21 U.S.C. 802) is 
amended--
            (1) in paragraph (3), by adding at the end the following: 
        ``Solely for purposes of section 309(f), the term `agent' 
        includes a facility designee.''; and
            (2) by adding at the end the following:
            ``(57) The term `institutional long-term care facility' 
        means--
                    ``(A) a facility certified to participate in the 
                Medicare or Medicaid programs as a nursing facility, as 
                defined in section 1919(a) of the Social Security Act 
                (42 U.S.C. 1396r(a));
                    ``(B) a skilled nursing facility, as defined in 
                section 1819(a) of the Social Security Act (42 U.S.C. 
                1395i-3(a)); or
                    ``(C) any other entity of a type designated by the 
                Attorney General by regulation.
            ``(58) The term `administrator of an institutional long-
        term care facility' means--
                    ``(A) a corporation, company, partnership, or other 
                entity that--
                            ``(i) owns, operates, or manages an 
                        institutional long-term care facility; and
                            ``(ii) may be held liable, by law or by 
                        consent, for the acts or omissions of the 
                        facility designees who are delegated authority 
                        by the institutional long-term care facility in 
                        connection with the dispensing of controlled 
                        substances, including liability for any civil 
                        penalties authorized under part D of this 
                        title; and
                    ``(B) an individual who--
                            ``(i) has been designated as a co-
                        administrator by an entity described in 
                        subparagraph (A);
                            ``(ii) is responsible for managing, 
                        supervising, or overseeing the care provided to 
                        residents of the institutional long-term care 
                        facility or the work of the employees of the 
                        institutional long-term care facility; and
                            ``(iii) can be held personally liable, 
                        along with the entity described in subparagraph 
                        (A), at law or by consent, for the acts or 
                        omissions of the facility designees of the 
                        institutional long-term care facility in 
                        connection with the dispensing of controlled 
                        substances, including liability for any civil 
                        penalties authorized under section 402.''.

SEC. 3. ORAL COMMUNICATION OF PRESCRIPTION INFORMATION FOR RESIDENTS OF 
              INSTITUTIONAL LONG-TERM CARE FACILITIES.

    Section 309 of the Controlled Substances Act (21 U.S.C. 829) is 
amended--
            (1) in subsection (a), in the first sentence, by inserting 
        ``except as provided in subsection (f) and'' after ``without 
        the written prescription of a practitioner''; and
            (2) by adding at the end the following:
    ``(f) Controlled Substances Dispensed to Residents of Institutional 
Long-Term Care Facilities Through the Use of Facility Designees.--
            ``(1) Definitions.--In this subsection--
                    ``(A) the term `authorizing agreement' means a 
                written agreement--
                            ``(i) between--
                                    ``(I) an individual practitioner 
                                providing medical care to, or 
                                supervising medical care being provided 
                                to, a resident of an institutional 
                                long-term care facility whose care is 
                                provided or supervised by the 
                                practitioner; and
                                    ``(II) an administrator of the 
                                institutional long-term care facility;
                            ``(ii) that authorizes the administrator to 
                        designate 1 or more qualified individuals to 
                        act as facility designees for the purpose of 
                        dispensing a controlled substance to the 
                        resident; and
                            ``(iii) that includes a written 
                        authorization from the practitioner, in a form 
                        and manner specified by the Attorney General, 
                        that specifies whether the scope of the 
                        authorization is for--
                                    ``(I) controlled substances in 
                                schedule II only; or
                                    ``(II) all controlled substances, 
                                regardless of schedule; and
                    ``(B) the term `facility designee' means an 
                individual designated by the administrator to whom the 
                authority to act as an agent of a practitioner is 
                delegated under paragraph (3)(A).
            ``(2) Authorization.--
                    ``(A) In general.--A practitioner may enter into an 
                authorizing agreement with an administrator of an 
                institutional long-term care facility if the 
                administrator has--
                            ``(i) adopted written policies and 
                        procedures that specify the duties and 
                        responsibilities of a facility designee and 
                        that require documentation of the acceptance of 
                        the duties and responsibilities by a facility 
                        designee, consistent with the authorizing 
                        agreement; and
                            ``(ii) provided copies of the policies and 
                        procedures adopted under clause (i) to the 
                        practitioner and to each facility designee.
                    ``(B) Rescission of authority.--A practitioner may 
                in writing, at any time--
                            ``(i) rescind the authorizing agreement;
                            ``(ii) rescind the authority of a facility 
                        designee; or
                            ``(iii) modify the scope of the 
                        authorization of a facility designee.
            ``(3) Delegation of authority.--
                    ``(A) In general.--Under an authorizing agreement, 
                an administrator of an institutional long-term care 
                facility may, in accordance with the policies and 
                procedures described in paragraph (2)(A)(i) delegate, 
                in writing, the authority to act as a facility designee 
                to 1 or more health care professionals who are 
                qualified under subparagraph (B).
                    ``(B) Requirements for qualification.--To qualify 
                to be a facility designee under subparagraph (A), a 
                health care professional shall be--
                            ``(i) directly employed by, and subject to 
                        the supervision and control of, the 
                        institutional long-term care facility;
                            ``(ii) lawfully acting within the scope of 
                        the employment of the individual; and
                            ``(iii) be a registered nurse, advanced 
                        practice nurse, physician's assistant, or 
                        equivalent professional who is licensed, 
                        certified, registered, or otherwise permitted 
                        to provide professional nursing or health care 
                        by the jurisdiction in which the individual is 
                        employed.
                    ``(C) Requirement.--A written delegation of 
                authority under subparagraph (A) shall specify, at the 
                option of the practitioner, and in accordance with the 
                authorizing agreement, whether the scope of the 
                authorization is for--
                            ``(i) schedule II controlled substances 
                        only; or
                            ``(ii) all controlled substances, 
                        regardless of schedule.
                    ``(D) Service as a facility designee.--A facility 
                designee shall act in accordance with the policies and 
                procedures described in paragraph (2)(A)(i).
                    ``(E) List of authorizing agreements and facility 
                designees.--
                            ``(i) In general.--An administrator of an 
                        institutional long-term care facility shall 
                        establish and maintain a current list of--
                                    ``(I) all practitioners who have 
                                entered into an authorizing agreement 
                                with the administrator; and
                                    ``(II) all facility designees of 
                                each practitioner described in 
                                subclause (I) that are employees of the 
                                institutional long-term care facility.
                            ``(ii) Requirements.--The list required 
                        under clause (i) shall--
                                    ``(I) be--
                                            ``(aa) dated upon 
                                        establishment and each time the 
                                        list is updated; and
                                            ``(bb) made readily 
                                        available in appropriate places 
                                        on the premises of the 
                                        institutional long-term care 
                                        facility to ensure proper 
                                        notice of which employees of 
                                        the institutional long-term 
                                        care facility are facility 
                                        designees for which 
                                        practitioners; and
                                    ``(II) include--
                                            ``(aa) the name and address 
                                        of the institutional long-term 
                                        care facility and the 
                                        administrator of the 
                                        institutional long-term care 
                                        facility;
                                            ``(bb) the name of each 
                                        practitioner who has entered 
                                        into an authorizing agreement 
                                        with the administrator of the 
                                        institutional long-term care 
                                        facility; and
                                            ``(cc) for each 
                                        practitioner listed under item 
                                        (bb)--

                                                    ``(AA) the name of 
                                                each facility designee; 
                                                and

                                                    ``(BB) whether 
                                                practitioner is 
                                                providing authorization 
                                                for schedule II 
                                                controlled substances 
                                                only or all controlled 
                                                substances, regardless 
                                                of schedule.

                            ``(iii) Distribution of list.--An 
                        administrator of an institutional long-term 
                        care facility shall provide the list 
                        established under clause (i) to--
                                    ``(I) all pharmacies to which the 
                                institutional long-term care facility 
                                submits prescriptions for dispensing; 
                                and
                                    ``(II) each practitioner who has 
                                entered into an authorizing agreement 
                                with the administrator of the 
                                institutional long-term care facility.
                            ``(iv) Updates.--The administrator of an 
                        institutional long-term care facility shall 
                        promptly update and redistribute a list 
                        established under clause (i) if--
                                    ``(I) there are any changes to the 
                                information required to be included in 
                                the list under clause (ii); or
                                    ``(II) the authority of any 
                                facility designee on the list is 
                                rescinded or modified under paragraph 
                                (2)(B).
                    ``(F) Prohibition of redelegation of authority.--A 
                facility designee may not redelegate any aspect of the 
                authorization of the practitioner to another 
                individual.
            ``(4) Transmission by a facility designee of a valid oral 
        prescription issued by practitioner.--
                    ``(A) In general.--Except as provided in 
                subparagraph (D), a practitioner who is providing 
                medical care to, or supervising medical care being 
                provided to, a resident of an institutional long-term 
                care facility may issue an oral prescription for the 
                resident for a controlled substance which is a 
                prescription drug as determined under the Federal Food, 
                Drug, and Cosmetic Act (21 U.S.C. 301 et seq.), and the 
                oral prescription may be communicated through a 
                facility designee acting under the authorizing 
                agreement of the practitioner.
                    ``(B) Policies.--A practitioner or a facility 
                designee acting under this subsection shall follow the 
                requirements of this subsection regardless of the 
                schedule of the controlled substance for which an oral 
                prescription is being communicated.
                    ``(C) Requirements.--
                            ``(i) Responsibilities of practitioner.--In 
                        issuing an oral prescription under subparagraph 
                        (A), a practitioner shall provide to the 
                        facility designee--
                                    ``(I) the full name of the 
                                resident;
                                    ``(II) the drug name, strength, and 
                                dosage form;
                                    ``(III) the quantity prescribed;
                                    ``(IV) the directions for use; and
                                    ``(V) the name, address, and Drug 
                                Enforcement Administration registration 
                                number of the prescribing practitioner.
                            ``(ii) Responsibilities of a facility 
                        designee.--A facility designee that receives an 
                        oral prescription issued under subparagraph (A) 
                        shall promptly--
                                    ``(I) create a document that 
                                reduces such oral prescription to 
                                writing, which shall include--
                                            ``(aa) all of the 
                                        information provided by the 
                                        practitioner under clause (i);
                                            ``(bb) the legible full 
                                        name and signature of the 
                                        facility designee;
                                            ``(cc) the name and address 
                                        of the institutional long-term 
                                        care facility;
                                            ``(dd) the date and time 
                                        the facility designee received 
                                        the oral prescription; and
                                            ``(ee) an attestation by 
                                        the covered individual, under 
                                        penalty of perjury as provided 
                                        in section 1746 of title 28, 
                                        United States Code, that--

                                                    ``(AA) the facility 
                                                designee has personally 
                                                spoken with the 
                                                prescribing 
                                                practitioner; and

                                                    ``(BB) all the 
                                                information required 
                                                under clause (i) was 
                                                provided by the 
                                                practitioner and is 
                                                accurately and 
                                                completely recorded by 
                                                the facility designee 
                                                on the document; and

                                    ``(II) transmit the written 
                                document, or a facsimile thereof, to a 
                                pharmacy for dispensing.
                            ``(iii) Prohibition.--A document described 
                        in clause (ii)(I) may not be prepared, in whole 
                        or in part, by a pharmacy.
                            ``(iv) Facsimiles.--If a facility designee 
                        transmits a written document described in 
                        clause (ii)(I) by facsimile, the facsimile 
                        shall serve as the original written 
                        prescription and shall be maintained in 
                        accordance with regulations promulgated by the 
                        Attorney General.
                    ``(D) Schedule ii controlled substances.--
                            ``(i) In general.--An oral prescription for 
                        a schedule II controlled substance shall only 
                        be issued through or transmitted by a facility 
                        designee under subparagraph (A) during an 
                        emergency situation, as described in subsection 
                        (a), and the quantity prescribed shall be 
                        limited to an amount adequate to treat the 
                        patient during the emergency situation.
                            ``(ii) Non-emergency situations.--A 
                        schedule II controlled substance may only be 
                        dispensed for treatment of a resident of an 
                        institutional long-term care facility in a non-
                        emergency situation if the prescription is in 
                        writing and signed by the prescribing 
                        individual practitioner, as described in 
                        subsection (a).
                    ``(E) Rule of construction.--Nothing in this 
                subsection shall be construed to--
                            ``(i) preclude a practitioner from 
                        issuing--
                                    ``(I) a prescription for a 
                                controlled substance and transmitting 
                                the prescription directly to the 
                                pharmacy, as otherwise authorized in 
                                subsections (a), (b), or (c) or by 
                                regulations issued by the Attorney 
                                General; or
                                    ``(II) a written prescription for a 
                                controlled substance, signed by the 
                                practitioner, and having the written 
                                prescription transmitted to the 
                                pharmacy through a duly authorized 
                                agent of the practitioner (including a 
                                facility designee), as otherwise 
                                authorized by subsections (a), (b), or 
                                (c) of this section or by regulations 
                                issued by the Attorney General; or
                            ``(ii) authorize a facility designee to 
                        make any determination that underlies any 
                        element of a prescription.
                    ``(F) Rulemaking authority.--The Attorney General 
                may, by regulation, promulgate rules specifying 
                additional requirements with respect to the formatting, 
                content, and creation of the written document described 
                in subparagraph (C)(ii).
                    ``(G) Record of oral prescriptions.--
                            ``(i) In general.--Each practitioner who 
                        issues an oral prescription to a facility 
                        designee shall--
                                    ``(I) create a contemporaneous 
                                record of the oral prescription; and
                                    ``(II) maintain the record in a 
                                written or electronic log at the 
                                registered location of the 
                                practitioner, in accordance with 
                                section 307.
                            ``(ii) Contents and retention 
                        requirements.--The Attorney General shall 
                        specify by regulation the contents and 
                        retention requirements for record required to 
                        be kept under clause (i).
                            ``(iii) Responsibility of the 
                        practitioner.--A practitioner shall be 
                        responsible for the creation of the 
                        contemporaneous record of the oral prescription 
                        required under clause (i)(I), and may not 
                        delegate or assign any responsibilities under 
                        clause (i), in whole or in part, to--
                                    ``(I) a pharmacy;
                                    ``(II) a facility designee; or
                                    ``(III) an institutional long-term 
                                care facility (including an employee of 
                                the institutional long-term care 
                                facility).
                    ``(H) Definition of oral prescription.--The 
                Attorney General may, if determined by the Attorney 
                General to be necessary, define by regulation the term 
                `oral prescription' for purposes of this subsection.
            ``(5) Pharmacy verification of oral prescriptions 
        transmitted by facility designees.--
                    ``(A) In general.--Upon receiving an oral 
                prescription from a practitioner that was reduced to 
                writing and transmitted under paragraph (4), a pharmacy 
                shall--
                            ``(i) determine whether the institutional 
                        long-term care facility employee who 
                        transmitted the prescription is a facility 
                        designee for the prescribing practitioner for 
                        the prescribed controlled substance based on 
                        the most recent list of the facility designees 
                        that the institutional long-term care facility 
                        provided to the pharmacy under paragraph 
                        (3)(E)(iii); and
                            ``(ii) document the determination under 
                        clause (i), which shall include a notation on 
                        the prescription document to memorialize that 
                        the cross-check was completed that includes--
                                    ``(I) the initials of the verifying 
                                pharmacist; and
                                    ``(II) the date and time of the 
                                verification.
                    ``(B) Transmission to prescribing practitioner.--
                Not later than 72 hours after a pharmacy dispenses a 
                controlled substance pursuant to an oral prescription 
                issued under paragraph (4), the pharmacy shall transmit 
                a copy of the prescription document that the pharmacy 
                received from the facility designee under paragraph 
                (4)(C)(ii), clearly marked as having been dispensed, to 
                the prescribing practitioner.
                    ``(C) Practitioner requirement.--A practitioner 
                shall--
                            ``(i) endorse, by physically affixing his 
                        written signature to the copy of the 
                        prescription the pharmacy transmitted to the 
                        practitioner under subparagraph (B), if the 
                        prescription was issued by the practitioner; 
                        and
                            ``(ii) not later than 5 business days after 
                        receiving the copy of the prescription from the 
                        pharmacy, return the prescription to the 
                        pharmacy in accordance with subparagraph (E).
                    ``(D) Endorsement of prescription.--By endorsing a 
                prescription under subparagraph (C), the practitioner--
                            ``(i) attests that the oral prescription 
                        memorialized and transmitted by a facility 
                        designee was authorized by the practitioner 
                        named on the prescription; and
                            ``(ii) certifies that the prescription 
                        information conveyed by the facility designee--
                                    ``(I) was accurate;
                                    ``(II) matches the information in 
                                the record kept by the practitioner 
                                under paragraph (4)(G); and
                                    ``(III) was based on determinations 
                                and instructions made by the 
                                practitioner.
                    ``(E) Return of endorsed prescription to 
                pharmacy.--The practitioner may deliver a prescription 
                endorsed under subparagraph (C)(i) to the pharmacy in 
                person, by mail, by facsimile, or by other appropriate 
                means of delivery, except that if the practitioner uses 
                the mail for delivery, the prescription shall be 
                postmarked during the 5-business-day period described 
                in subparagraph (C)(ii).
                    ``(F) Attachment of endorsement to prescription.--A 
                dispensing pharmacy shall attach a prescription 
                endorsed under subparagraph (C)(i) to the prescription 
                document that the pharmacy received from the facility 
                designee under paragraph (4)(C).
                    ``(G) Noncompliance.--
                            ``(i) In general.--If a pharmacy does not 
                        receive an endorsed prescription required under 
                        this paragraph from a practitioner within the 
                        5-business-day period described in subparagraph 
                        (C)(ii), the pharmacy--
                                    ``(I) may not dispense any 
                                subsequent prescriptions for controlled 
                                substances issued by or on behalf of 
                                the practitioner for residents at the 
                                institutional long-term care facility, 
                                unless the prescription is a written 
                                prescription issued directly by the 
                                practitioner, until the required 
                                endorsement of the oral prescription is 
                                received; and
                                    ``(II) shall note the limitation 
                                described in subclause (I) on the most 
                                recent copy of the list that the 
                                institutional long-term care facility 
                                provided to the pharmacy under 
                                paragraph (3)(E)(iii).
                            ``(ii) Notice to dea.--A pharmacy shall 
                        notify the nearest office of the Drug 
                        Enforcement Administration if the pharmacy does 
                        not receive an endorsed prescription from a 
                        practitioner by the end of the 10-business-day 
                        period beginning on the date on which the 
                        pharmacy transmitted notice to the practitioner 
                        under subparagraph (B).
            ``(6) Recordkeeping.--
                    ``(A) In general.--Each institutional long-term 
                care facility shall--
                            ``(i) maintain a readily retrievable 
                        written or electronic logbook, in which it 
                        records each instance in which a facility 
                        designee memorializes and transmits an oral 
                        prescription for a controlled substance to a 
                        pharmacy on behalf of a practitioner under 
                        paragraph (4); and
                            ``(ii) keep, on the premises of the 
                        institutional long-term care facility--
                                    ``(I) the logbook described in 
                                clause (i); and
                                    ``(II) copies of--
                                            ``(aa) any authorizing 
                                        agreements;
                                            ``(bb) any policies and 
                                        procedures issued by the 
                                        institutional long-term care 
                                        facility under paragraph 
                                        (2)(A)(i);
                                            ``(cc) any notice of 
                                        rescission or modification of 
                                        the authority of a facility 
                                        designee;
                                            ``(dd) each list prepared 
                                        by the administrator of the 
                                        institutional long-term care 
                                        facility under paragraph 
                                        (3)(E); and
                                            ``(ee) all documents 
                                        created by facility designees 
                                        to reduce oral prescriptions to 
                                        writing, under paragraph 
                                        (4)(C)(ii)(I).
                    ``(B) Retention of copies.--An institutional long-
                term care facility shall--
                            ``(i) retain a copy of any document 
                        described in subparagraph (A)(ii)(II) until the 
                        end of the 5-year period beginning on the date 
                        on which the document was created; and
                            ``(ii) whether retained in written or 
                        electronic form, make available for inspection 
                        and copying by the Attorney General under 
                        section 510--
                                    ``(I) the logbook described in 
                                subparagraph (A)(i); and
                                    ``(II) copies of the documents 
                                described in subparagraph (A)(ii)(II).
                    ``(C) Prohibition.--The logbook required under 
                subparagraph (A)(i) may not be prepared, maintained, or 
                updated, in whole or in part, by a pharmacy.
                    ``(D) Contents of logbook.--The logbook shall 
                contain, at a minimum--
                            ``(i) all of the information required under 
                        paragraph (4)(C); and
                            ``(ii) the name, address, and telephone 
                        number of the pharmacy to which each 
                        prescription was transmitted.
                    ``(E) Rulemaking authority.--The Attorney General 
                may promulgate rules relating to the formatting, 
                content, and updating of the logbook required to be 
                kept under clause (A)(i).
            ``(7) Rule of construction.--Nothing in this subsection 
        shall be construed to allow an institutional long-term care 
        facility, or an administrator, employee, or agent of an 
        institutional long-term care facility, who is not a 
        practitioner, to prescribe, administer, dispense, distribute, 
        deliver, possess, maintain, stock, or otherwise use a 
        controlled substance except as expressly provided by this 
        title.''.

SEC. 4. PRACTITIONER RECORDKEEPING.

    Section 307 of the Controlled Substances Act (21 U.S.C. 827) is 
amended--
            (1) in subsection (a)--
                    (A) in paragraph (2), by striking ``and'' at the 
                end;
                    (B) in paragraph (3), by striking ``inventory.'' 
                and inserting ``inventory; and''; and
                    (C) by adding at the end the following:
            ``(4) every registrant who prescribes a controlled 
        substance for a patient residing at an institutional long-term 
        care facility under section 309(f) shall maintain the 
        prescribing log described in subsection (f)(2)(G) of that 
        section.''; and
            (2) in subsection (c)(1)(A), by adding after ``treatment of 
        an individual'' the following: ``, or under section 309(f)''.

SEC. 5. PENALTIES.

    (a) In General.--Section 402 of the Controlled Substances Act (21 
U.S.C. 842) is amended--
            (1) by amending subsection (a)(1) to read as follows:
            ``(1) who is subject to the requirements of part C, 
        including an institutional long-term care facility and an 
        administrator or employee of an institutional long-term care 
        facility who are subject to any of the requirements under 
        section 309(f), to distribute or dispense a controlled 
        substance, or to aid in the prescribing or dispensing of a 
        controlled substance, in violation of section 309;''; and
            (2) in subsection (c)--
                    (A) in paragraph (1)--
                            (i) by amending subparagraph (B) to read as 
                        follows:
                    ``(B) In the case of a violation of paragraph (5) 
                or (10) of subsection (a) of this section, the civil 
                penalty for each violation shall not exceed $10,000, 
                except that if a person refuses or negligently fails to 
                make any record, report, notification, declaration, or 
                statement required by section 309(f), the civil penalty 
                for each violation shall be not less than $3,000 and 
                not more than $10,000.''; and
                            (ii) by adding at the end the following:
                    ``(C) In the case of a violation of subsection 
                (a)(1), the civil penalty shall be not less than $5,000 
                for each violation.''; and
                    (B) in paragraph (2)--
                            (i) in subparagraph (A), by striking 
                        ``sentenced to imprisonment of not more than 
                        one year'' and inserting ``sentenced to a term 
                        of imprisonment of not more than 3 years''; and
                            (ii) in subparagraph (B), by striking ``2 
                        years'' and inserting ``5 years''.
    (b) Directive to the United States Sentencing Commission.--
            (1) In general.--Pursuant to its authority under section 
        994 of title 28, United States Code, and in accordance with 
        this subsection, the United States Sentencing Commission shall 
        review and, if appropriate, amend the Federal Sentencing 
        Guidelines and policy statements to conform to the amendments 
        made by this Act.
            (2) Requirements.--In carrying out this subsection, the 
        Commission shall--
                    (A) establish new guidelines and policy statements, 
                as warranted, in order to implement new or revised 
                criminal offenses created under this title;
                    (B) assure reasonable consistency with other 
                relevant directives and with other sentencing 
                guidelines;
                    (C) account for any additional aggravating or 
                mitigating circumstances that might justify exceptions 
                to the generally applicable sentencing ranges;
                    (D) make any necessary conforming changes to the 
                sentencing guidelines; and
                    (E) assure that the guidelines adequately meet the 
                purposes of sentencing under section 3553(a)(2) of 
                title 18, United States Code.

SEC. 6. RULE OF CONSTRUCTION.

    Nothing in this Act or in the amendments made by this Act shall be 
construed to alter or eliminate the requirements relating to electronic 
prescriptions for controlled substances in effect on the date of 
enactment of this Act, as established by the Attorney General.
                                 <all>