Petition of Mason

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THE SUPREME COURT OF NEW HAMPSHIRE

___________________________

Department of Health and Human Services
Case No. 2023-0488
Citation: Petition of Mason, 2024 N.H. 67

PETITION OF JACOB SOLOMON MASON & a.
(New Hampshire Department of Health and Human Services)

Argued: June 27, 2024
Opinion Issued: December 19 , 2024

Wadleigh, Starr & Peters, PLLC, of Manchester (Dean B. Eggert and
Elizabeth E. Ewing on the briefs, and Dean B. Eggert orally), Eckert Seamans
Cherin & Mellott, LLC, of Boston, Massachusetts (Michael P. Flammia and
Christian B.W. Stephens on the briefs), and Nicholson Law Firm, of Concord
(Tracy M. Culberson on the briefs), for the petitioners.

McLane Middleton, Professional Association, of Manchester (Michael A.
Delaney and Rebecca S. Walkley on the briefs), for The Moore Center, Inc., and
Lakes Region Community Services.

John M. Formella, attorney general, and Anthony J. Galdieri, solicitor
general (Laura E. B. Lombardi, senior assistant attorney general, on the initial
brief and orally, and Mary A. Triick, senior assistant attorney general, on the
supplemental brief), for the New Hampshire Department of Health and Human
Services, Bureau of Developmental Services.

DONOVAN, J.

¶1 The petitioners, Jacob Solomon Mason, Matthew Halle, Tyler
Jerome, Daevon Soto, and Timothy Douglas McDonald, and their guardians,
Kayode Mason, Cheryl Hoitt, Tammy Jerome, Richard Jerome, Venus Barreto,
and the Office of Public Guardian, both in their individual capacities and as
guardians, who are joined by Lakes Region Community Services and The Moore
Center, Inc. (area agencies), seek review by way of a petition for a writ of
certiorari of a decision of the Commissioner of the New Hampshire Department
of Health and Human Services (Commissioner).1 The Commissioner granted
summary judgment to respondent Department of Health and Human Services,
Bureau of Developmental Services (BDS), ruling that BDS did not terminate the
petitioners’ services provided under RSA chapter 171-A (2022 & Supp. 2023)
and that all petitioners were therefore not entitled to an administrative appeal.
All petitioners argue that the Commissioner erred in ruling that: (1) BDS
cannot use state funds to pay for services that do not comport with the federal
Settings Rule, 42 C.F.R. § 441.301 (2023); and (2) services were not terminated
and, therefore, they were not entitled to an appeal. All petitioners also argue
that the Commissioner violated their due process rights throughout the course
of the administrative proceedings. We conclude that all petitioners had a right
to appeal pursuant to New Hampshire Administrative Rule, He-M 503.07
(effective July 25, 2015; amended December 29, 2023) (Rule 503.07), but that
RSA chapter 171-A prohibits BDS from using state funds to pay for services
that do not comport with the federal Settings Rule. Accordingly, we affirm.

I. Facts

¶2 The following facts are agreed upon by the parties or are otherwise
supported by the record. The petitioners are five severely developmentally
disabled men with behavioral disorders who require intensive care in a
residential treatment setting and receive services through New Hampshire’s
developmental services system. See RSA 171-A:1 (2022), :4 (2022). The two
area agencies administer services for each petitioner. See RSA 171-A:2, I-b
(2022) (defining “area agency”), :18 (2022) (setting forth responsibilities and
operations of area agencies). As of 2019, the petitioners were receiving services
from the Judge Rotenberg Educational Center, Inc. (JRC), a residential
1 There are eleven petitioners, including five men with developmental disabilities and their six

guardians. We refer to the five individuals as “the petitioners” and to their guardians as “guardian
petitioners.” We refer to the collective group of eleven petitioners as “all petitioners.” The area
agencies, Lakes Region Community Services and The Moore Center, Inc., are co-respondents and
were named as parties in the underlying administrative appeal. The area agencies, however, agree
with all petitioners and join their petition for a writ of certiorari.

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treatment and education program in Massachusetts that specializes in
providing intensive treatment and ancillary services for people with severe
behavioral disorders. The petitioners received federal Medicaid home and
community-based services (HCBS) waiver funding, also referred to as section
1915(c) waiver funding, for services provided by JRC. See Social Security Act §
1915(c), 42 U.S.C. § 1396n(c) (2024).

¶3 The HCBS waiver program “enables States to receive Federal funding
for community-based services provided to individuals who would otherwise be
institutionalized.” Judge Rotenberg Educ v. Dept. of Dev. Serv., 215 N.E.3d
1119, 1148 n.29 (Mass. 2023); see also 42 U.S.C. § 1396n(c)(1). In New
Hampshire, the Department of Health and Human Services (DHHS)
administers HCBS waiver funding, which includes the developmental
disabilities waiver that it administers through BDS. In 2014, the federal
Centers for Medicare and Medicaid Services (CMS) promulgated the Settings
Rule, codified in 42 C.F.R. § 441.301. See 42 C.F.R. § 441.301(c). As relevant
to this case, the Settings Rule mandates that HCBS be provided in home and
community-based settings, and it enumerates the qualities required of those
settings. See 42 C.F.R. § 441.301(c)(4)-(5). CMS gave New Hampshire and
other states until March 17, 2023, to comply with the new Settings Rule
requirements.

¶4 In early 2022, CMS informed BDS that JRC is not an approved
HCBS provider and that effective January 12, 2022, BDS could no longer use
federal HCBS waiver funding to pay for the petitioners’ services at JRC. BDS
informed the area agencies of CMS’s determination and committed to funding
the petitioners’ services at JRC using state general funds through June 30,
2022, which BDS later extended to September 2, 2022. BDS informed the area
agencies that prior to September 2, they must have either “identified a model of
service delivery with an approved 1915 (c) waiver provider” or “identified and
committed to an alternative funding source.” BDS further advised that if an
individual “remains at the JRC after September 2, 2022, your agency will be
responsible for funding the placement.” The area agencies informed JRC in
March 2022 that, because federal funding could no longer be used to pay for
services at JRC, they would terminate their contract with JRC effective June
30. It appears, however, that JRC continued to provide services without a
contract as of July 1.

¶5 In July 2022, the area agencies sent letters to the guardian
petitioners informing them that BDS would cease funding the petitioners’
services at JRC after September 2. The area agencies explained that they had
neither identified an appropriate provider that was ready, willing, and able to
provide services to the petitioners, nor identified an alternative funding source
for services at JRC that would replace the federal funds that became
unavailable in January 2022 and the state funds that would be unavailable
after September 2. Without funding to pay for services at JRC, and with no

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alternative service provider identified, the area agencies explained that “there
could be a termination of [the petitioners’] specialized services.”

¶6 The letters also notified the guardian petitioners of their right to
appeal pursuant to New Hampshire Administrative Rules, He-M 310.07
(effective April 25, 2015; amended June 24, 2023) and He-M 503.17 (effective
July 25, 2015; amended December 29, 2023) (respectively, Rule 310.07 and
Rule 503.17).2 The letters explained that the guardian petitioners were
“entitled to notice of your right to appeal a decision, determination, or action
that could terminate [the petitioners’] specialized services or adversely impact
your ability to protect [the petitioners’] right to appropriate, needed services
under RSA chapter 171-A and the administrative rules enacted pursuant to the
statute.” The agencies also suggested that pursuant to Rules 310.07 and
503.17(g), the petitioners “may have a continuing right to services, and
payment for those services, pending a decision on your appeal.”

¶7 In response to these communications, all petitioners appealed BDS’s
decision to terminate state funding to the DHHS Administrative Appeals Unit
(AAU), claiming that termination of funding without an alternative, appropriate
placement amounted to a termination of their RSA chapter 171-A
developmental disability services. All petitioners also requested that the area
agencies and BDS be compelled to continue to fund the petitioners’ placement
at JRC during the appeal. In August 2022, the area agencies filed emergency
motions, which all petitioners subsequently joined, requesting that the AAU, on
or before September 2, issue a protective order requiring BDS to continue to
fund the petitioners’ services at JRC during the pendency of the appeals.

¶8 On October 5, following a pre-hearing conference, the Commissioner
issued a decision on the emergency motions.3 The Commissioner began by

2 The parties agree that the administrative rules in effect in 2022 apply to the case at hand.

Accordingly, we apply the administrative rules as they existed in 2022.

3 The Department of Health and Human Services (DHHS) is under the direction of a commissioner

of health and human services (Commissioner). RSA 126-A:5, I (2021). The Commissioner
establishes the appeals process for matters within the jurisdiction of DHHS. RSA 126-A:5, VIII
(2021). The Administrative Appeals Unit (AAU) is the unit within DHHS “that receives appeal
requests, schedules proceedings, conducts prehearing conferences and hearings and issues
decisions for [DHHS].” N.H. Admin. R., He-C 201.02(a) (effective April 13, 2007). For most
appeals, “the commissioner, or a hearings examiner designated by the commissioner, shall
conduct an administrative hearing in accordance with the rules established by the commissioner.”
RSA 126-A:5, VIII(b); see also N.H. Admin. R., He-C 201.05(a) (effective April 13, 2007) (“All
hearings and independent reviews shall be conducted by a presiding officer appointed by the
commissioner to implement the appeals process under RSA 126-A:5, VIII.”). “Unless the
commissioner has delegated to the hearings examiner authority to issue a decision on behalf of
[DHHS], following the hearing, the hearings examiner shall submit to the commissioner a
proposed decision . . . .” RSA 126-A:5, VIII(c); see also N.H. Admin. R., He-C 201.05(b) (“Presiding
officers shall make final decisions on behalf of the commissioner in any administrative appeal

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observing that the parties agreed that JRC is ineligible to receive HCBS waiver
funding, that the petitioners are severely developmentally disabled and eligible
for waiver services, and that DHHS has a statutory obligation to provide
services to the petitioners. The Commissioner noted that the parties disagreed,
however, as to whether a termination of funding and/or services occurred and
whether BDS was obligated to continue to provide funding during the pendency
of the appeals.

¶9 BDS argued that its decision to cease using state general funds to
pay for the petitioners’ services at JRC was not a termination, and, therefore, it
did not have an obligation to continue funding during the pendency of the
appeals. All petitioners countered that BDS has a statutory obligation to
provide the petitioners with services and that Rules 310.07 and 503.17
authorized the continuation of services and payments during the appeals. The
Commissioner found that BDS’s arguments were “less persuasive” and ruled
that “[a]lthough it is premature at this point to make a decision as to whether a
termination has occurred, there is nonetheless support for [all petitioners’ and
area agencies’] position that benefits must continue pending appeal.”
Accordingly, the Commissioner granted the area agencies’ emergency motions
and ordered BDS to continue to fund the petitioners’ services at JRC during
the administrative appeals.

¶10 In February 2023, BDS filed a motion seeking: (1) an order
dismissing each appeal as of March 17, 2023; and (2) an order in each appeal
declaring that “if the Area Agency continues to administer programs and
services through contract with the [JRC to the petitioners] as of or after March
17, 2023, this will be a violation of RSA 171-A and BDS cannot be compelled to
fund the cost of such services.” BDS argued that RSA chapter 171-A,
specifically RSA 171-A:1-a, II (2022) and RSA 171-A:18, II, requires any
program or service that BDS and the area agencies provide — whether state or
federally funded — to comply with the federal Settings Rule. Given CMS’s
mandate that New Hampshire and other states must comply with the Settings
Rule as of March 17, 2023, BDS argued that all programs and services
provided pursuant to RSA chapter 171-A must also comply by that date.
Because JRC would not be in compliance with the Settings Rule by March 17,
BDS argued that it could not be compelled to fund the services and programs
that JRC provided to the petitioners — regardless of the source of funding — as
doing so would violate RSA chapter 171-A. All petitioners and the area
agencies objected.

¶11 The AAU held a status conference on March 8, during which the
two presiding hearing officers heard arguments on BDS’s motion. The hearing

under RSA 126-A:5, VIII, unless the commissioner orders otherwise in a particular matter.”). The
Commissioner ultimately issues a final decision on the appeal. RSA 126-A:5, VIII(e); see also N.H.
Admin. R., He-C 201.05(b); N.H. Admin. R., He-C 203.22(f) (effective April 13, 2007).

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officers provided the Commissioner with a written proposed order on March 10,
although this proposed order was not shared with all petitioners. On March
17, BDS ceased funding the petitioners’ services at JRC, explaining that
continuing to fund an unqualified provider after March 17, 2023, would violate
RSA 171-A:18.

¶12 On March 28, the Commissioner issued a proposed decision on
BDS’s motion. The Commissioner construed BDS’s motion for declaratory
order and dismissal as a motion for summary judgment. The Commissioner
identified the two issues that the motion presented: (1) “whether the act of not
funding services to an unqualified institution is considered a termination of
services”; and (2) “whether BDS can be compelled to fund the cost of services to
an unqualified institution.”

¶13 The Commissioner began by addressing the second issue, finding
that the deadline for compliance with the federal Settings Rule was March 17,
2023, and that CMS had deemed JRC to be an unqualified institution. The
Commissioner adopted BDS’s interpretation of RSA chapter 171-A, ruling that
“Federal law placed limits on available Medicaid funding for services and the
[New Hampshire] legislature agreed by incorporating 42 C.F.R. § 441.301 into
State law.” As a result, the Commissioner determined that “BDS cannot be
compelled to pay for services that do not comply with the settings rule.”

¶14 Regarding the first issue, the Commissioner ruled that “CMS,
through BDS, is not reducing or terminating the [petitioners’] financial
assistance but merely requiring the [petitioners] to use the assistance for care
in a qualified facility.” The Commissioner concluded that there was no
termination of benefits and, accordingly, that all petitioners were not entitled to
an appeal. Ultimately, the Commissioner granted summary judgment to BDS.

¶15 All petitioners and the area agencies filed a request for briefing and
oral argument regarding the March 28 proposed decision, and requested access
to the hearing officers’ proposed written decision following the March 8
hearing. The Commissioner granted the request for briefing and oral argument
but denied the request for the hearing officers’ proposed decision. After
considering the parties’ written and oral arguments, the Commissioner issued
a final decision on July 26, 2023 adopting the March 28 proposed decision. All
petitioners moved for reconsideration, to which BDS objected.

¶16 In August 2023, all petitioners filed in this court a petition for a
writ of certiorari and a motion requesting that this court stay the July 2023
final decision, order BDS to fund the petitioners’ services at JRC during the
pendency of this petition in accordance with the October 5, 2022 funding
order, and order BDS to reimburse JRC and the area agencies for payments
withheld in violation of the October 5 order. We accepted the petition, granted
the motion to stay, and ordered DHHS to continue funding the petitioners’

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services at JRC pending the outcome of this proceeding and to reimburse JRC
and the area agencies for payments withheld during the administrative
proceedings. By this time, only two petitioners, Jacob Solomon Mason and
Tyler Jerome, remained at JRC, as the other three petitioners had transitioned
to other qualified providers. Following oral argument, the parties filed
supplemental briefs addressing: (1) whether the State, for purposes of using
state funding, is bound by the CMS finding that JRC is not a qualified HCBS
provider pursuant to the Settings Rule; and (2) whether the Settings Rule
prohibits use of state funds to pay for services provided by JRC.

II. Analysis

¶17 A petition for a writ of certiorari is the only mechanism for review
of a fair hearings decision issued by the AAU. Petition of Guillemette, 171 N.H.
565, 568 (2018). Review on certiorari is an extraordinary remedy, usually
available only in the absence of a right to appeal, and only at the discretion of
the court. Id. Our review of an AAU decision on a petition for a writ of
certiorari entails an examination of whether the AAU acted illegally with
respect to jurisdiction, authority, or observance of the law or has
unsustainably exercised its discretion or acted arbitrarily, unreasonably, or
capriciously. Id. We exercise our power to grant such writs sparingly and only
when to do otherwise would result in substantial injustice. Id.

¶18 Because this proceeding arises from a motion deemed to be for
summary judgment, we consider the evidence, and inferences properly drawn
therefrom, in the light most favorable to the non-moving parties, here all
petitioners. See Sabinson v. Trustees of Dartmouth College, 160 N.H. 452, 455
(2010). If this review does not reveal any genuine issues of material fact, and if
the moving party is entitled to judgment as a matter of law, we will affirm. Id.
We review the fact finder’s application of the law to the facts de novo. Id.

¶19 As a threshold matter, we must first determine whether all
petitioners had a right to appeal to the AAU. See RSA 171-A:8 (2022); N.H.
Admin. R., He-M 310.07; N.H. Admin. R., He-M 503.07. All petitioners argue
that “[a]ppealable terminations occurred when JRC’s service contract was
terminated and when funding for [the] Petitioners’ services at JRC ceased”
because “[e]ach time, no alternative appropriate provider was ready or able to
assume [the] Petitioners’ care.” All petitioners contend that Rules 310.07 and
503.07 “support these conclusions.” BDS disagrees, arguing that there has
been no termination of services pursuant to RSA 171-A:8 and that Rules
310.07 and 503.07 are inapplicable to the facts of this case.

¶20 To resolve this issue, we must interpret the statutes and
regulations governing services to individuals with developmental disabilities.
We review the AAU’s statutory and regulatory interpretation de novo. Petition
of Guillemette, 171 N.H. at 568. We use the same principles of construction

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when interpreting both statutes and regulations. Id. Thus, in construing
rules, as in construing statutes, when possible, we ascribe the plain and
ordinary meaning to the words used. Id. We interpret the statute or rule as
written and will not consider what the legislature or administrative agency
might have said or add language that the legislature or administrative agency
did not see fit to include. See id. We construe all parts of a statute or
regulation together to effectuate their overall purposes and avoid absurd or
unjust results. Id. at 568-69. Thus, we assess the regulatory or statutory
scheme as a whole, and we do not consider words and phrases in isolation, but
rather within the context of the statute or regulation as a whole. Id. at 569.
When the language of a statute or regulation is plain and unambiguous, we
need not look beyond the statute or regulation itself. Id.

¶21 We begin by reviewing the statutory and regulatory framework
governing the provision of services to individuals with developmental
disabilities, such as the petitioners. See RSA ch. 171-A. DHHS is responsible
for maintaining, coordinating, and supervising the state’s developmental
disabilities services delivery system pursuant to RSA chapter 171-A. Petition of
Guillemette, 171 N.H. at 569; RSA 171-A:1, :4. The Commissioner of DHHS is
tasked with adopting rules to implement RSA chapter 171-A. RSA 171-A:3
(2022).

¶22 The state service delivery system comprises “a comprehensive
array of services for the diagnosis, evaluation, habilitation and rehabilitation of
developmentally disabled persons, including but not limited to, service
coordination, community living arrangements, employment and day services,”
and family supports. RSA 171-A:2, XVI (2022). Area agencies may use funds
dispensed by DHHS to establish, operate, or administer programs and services
for persons with developmental disabilities and may enter into contracts with
individuals or organizations to provide those programs or services. Petition of
Guillemette, 171 N.H. at 570; see RSA 171-A:19, I, II (2022). Thus, “in addition
to the basic developmental services provided by regional area agencies,
individuals may also receive developmental services through a variety of other
programs or institutions.” Petition of Guillemette, 171 N.H. at 570 (quotation
and brackets omitted).

¶23 “An individual, guardian, or representative may select any person,
any provider agency, or another area agency as a provider to deliver one or
more of the services identified in the individual’s service agreement.” N.H.
Admin. R., He-M 503.07(d). The providers must “comply with the rules
pertaining to the service(s) offered and meet the provisions specified within the
individual’s service agreement.” Id. They must also “enter into a contractual
agreement with the area agency and operate within the limits of funding
authorized by it.” Id.

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 [¶24] In certain circumstances, an area agency is obligated to refuse to
enter into a service contract with a provider or must terminate a service
contract with a provider that was chosen by the individual, guardian, or
representative. N.H. Admin. R., He-M 503.07(e), (f). An area agency must
refuse to enter into a service contract with a provider chosen by the individual,
guardian, or representative if the provider “proposes a service arrangement
which is not in accordance with department rules, or is a provider that has not
been in compliance with department rules in the past.” N.H. Admin. R., He-M
503.07(e) (emphasis added). Similarly, an area agency must terminate an
existing contract with a provider chosen by the individual, guardian, or
representative if the area agency determines that the provider is “not
implementing the service agreement, providing for the health and safety of the
individual, or in compliance with applicable rules while providing services.”
N.H. Admin. R., He-M 503.07(f) (emphasis added). The individual, guardian, or
representative may appeal the area agency’s decision under Rule 503.07(e) or
(f). N.H. Admin R., He-M 503.07(h).

¶25 Here, the area agencies terminated and did not renew their
contracts with JRC after BDS announced that it would discontinue funding the
petitioners’ services at JRC given CMS’s decision that JRC did not comply with
the federal Settings Rule. Consequently, JRC’s provider contracts expired on
June 30, 2022. At the time, BDS did not further explain its discontinuance of
funding for the petitioners’ services at JRC beyond stating that it could no
longer use federal funding and that there was neither unlimited state funding
nor an affirmative obligation to pay for services at JRC. BDS later asserted,
however, that it could not use state funds for the petitioners’ services at JRC
because RSA 171-A:2, I-b and RSA 171-A:18, II prohibit DHHS from using
either state or federal funds for providers that are not in compliance with the
Settings Rule.

¶26 It is well established that “administrative officials do not possess
the power to contravene a statute.” Petition of Strandell, 132 N.H. 110, 119
(1989) (quotation omitted). “Administrative rules may not add to, detract from,
or modify the statute which they are intended to implement.” Id. BDS’s
allegation that its use of state or federal funds for services at JRC would violate
RSA 171-A:2, I-b and RSA 171-A:18, II because JRC is not in compliance with
the Settings Rule is, essentially, an allegation that JRC is not “in compliance
with applicable rules while providing services.” N.H. Admin. R., He-M
503.07(f); see RSA 171-A:3 (directing the Commissioner to adopt rules to
implement RSA chapter 171-A); RSA 171-A:18, IV (directing the Commissioner
to “adopt rules establishing standards for the provision of services by area
agencies and authorized agencies to developmentally disabled persons”).
Accordingly, given BDS’s subsequent explanation for why it could not use state
or federal funds for JRC’s services, we construe the area agencies’ decision to
terminate and not renew their contracts with JRC, which was predicated upon
BDS’s decision to cease funding, as a decision grounded in JRC’s alleged

9
failure to be “in compliance with applicable rules while providing services.”
N.H. Admin. R., He-M 503.07(f). As a result, all petitioners were entitled to
appeal the area agencies’ termination and non-renewal of their contracts with
JRC pursuant to Rule 503.07(h).

¶27 Given this conclusion, we next consider whether the termination
and non-renewal was lawful. See N.H. Admin. R., He-M 503.07(f) (setting forth
the reasons that an area agency may terminate a contract with an existing
provider). To resolve this issue, we must determine whether RSA chapter 171-
A, specifically RSA 171-A:2, I-b and RSA 171-A:18, II, prohibits DHHS from
allocating state funds for services provided by a provider that does not comply
with the Settings Rule. See id. (termination of a contract is lawful if the
provider is not “in compliance with applicable rules while providing services”).

¶28 BDS argued during the administrative proceedings and maintains
here that RSA 171-A:2, I-b and RSA 171-A:18, II preclude DHHS from using
state funds to pay for services from a provider that does not conform with the
federal Settings Rule. BDS relies upon language in both provisions stating that
RSA chapter 171-A services for persons with developmental disabilities must
be provided or administered “in accordance with 42 C.F.R. section 441.301.”
RSA 171-A:2, I-b, :18, II. In its supplemental brief, BDS asserts that “[t]he New
Hampshire legislature [chose] to bind BDS to the [Settings Rule] requirements”
by incorporating 42 C.F.R. § 441.301 into RSA 171-A:18, II.

¶29 In contrast, all petitioners and the area agencies contend that
CMS’s “determination that JRC is not a qualified HCBS setting . . . does not
bind the State from using state funds to ensure the health, safety, and welfare
of its citizens.” They argue that RSA 171-A:2, I-b and RSA 171-A:18, II do not
prohibit DHHS from using state funds to pay for the petitioners’ services, even
if JRC is not compliant with the Settings Rule. All petitioners and the area
agencies assert that “the State may plainly still fund services using state funds
even if federal Medicaid funding is unavailable.” We disagree.

¶30 RSA 171-A:18, II provides, in relevant part, that “[a]rea agencies,
authorized agencies, and other organizations under contract to provide services
in accordance with this chapter shall administer programs and services in
accordance with 42 C.F.R. section 441.301, and any subsequent amendments
thereto.” (Emphasis added.) RSA 171-A:2, I-b defines “Area agency” as “an
entity established as a nonprofit corporation in the state of New Hampshire
which is established by rules adopted by the commissioner to provide or
coordinate services to developmentally disabled persons in the area in
accordance with 42 C.F.R. section 441.301.” (Emphasis added.) The Settings
Rule enumerates the qualities that a home and community-based setting must
possess in order for a state to use federal funding to cover the cost of services
at this setting. See 42 C.F.R. § 441.301(c)(4).

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 [¶31] As we have previously explained, the plain meaning of “in
accordance with” is “in agreement or harmony with; in conformity to.”
Krainewood Shores Ass’n v. Town of Moultonborough, 174 N.H. 103, 108
(2021) (interpreting language of RSA 677:15, I (2016)); see also Oxford English
Dictionary,
https://www.oed.com/dictionary/accordance_n?tab=meaning_and_use#37376
661 (last visited Dec. 9, 2024) (defining “in accordance with” as “in agreement
or harmony with; in conformity to; according to”). Thus, RSA 171-A:2, I-b and
RSA 171-A:18, II instruct area agencies and other entities to provide,
coordinate, or administer RSA chapter 171-A services “in agreement or
harmony with” or “in conformity” with the Settings Rule. See Krainewood
Shores Ass’n, 174 N.H. at 107-08. While the use of state funds for services
that are not in harmony or conformity with the Settings Rule would not violate
the Settings Rule itself, such use of state funds would violate RSA chapter 171-
A. The legislature’s explicit incorporation of the requirements set forth in 42
C.F.R. § 441.301 into RSA chapter 171-A prohibits DHHS from using state
funds for services that do not comply with the federal regulation.

¶32 Other principles of statutory construction support our conclusion.
For example, we have relied on legislative preambles and purpose clauses as
indicators of the meaning of a statute. See, e.g., In re Guardianship of C.R.,
174 N.H. 804, 811 (2012). Here, the language in RSA 171-A:2, I-b and RSA
171-A:18, II requiring compliance with the Settings Rule was added to RSA
chapter 171-A in 2019. See Laws 2019, ch. 287. One of the stated purposes
for adding this language was to require “services provided to individuals with
disabilities by area agencies and authorized agencies to comply with RSA 171-A
and the federal requirements for home and community based care waiver.” Id.
(Emphasis added.) Furthermore, the 2019 amendment added the same
requirement of compliance with 42 C.F.R. § 441.301 to RSA chapter 151-E,
which pertains to care for Medicaid-eligible elderly and chronically ill adults.
Id.; see also RSA 151-E:1, :4, II (2021) (“All individuals, entities, or
organizations under contract to provide services in accordance with this
chapter shall administer programs and services in accordance with 42 C.F.R.
section 441.301, and any subsequent amendments thereto.”).

¶33 Nonetheless, all petitioners and the area agencies claim that
interpreting RSA chapter 171-A as prohibiting the use of state funds for
services provided by JRC is “at odds with not only the best interests of New
Hampshire’s citizens but also the fundamental federalism principles . . . by
which the federal government cannot limit a state’s ability to use state funds to
pay for an individual’s services at a legally operated facility such as JRC.”
(Quotation omitted.) However, there is no dispute that the Settings Rule
applies only to federal funding and does not, by its own terms, preclude states
from using state funding for services that do not comply with the federal rule.
See 42 C.F.R. § 441.300 (2023); 42 C.F.R. § 441.301(c)(4); 42 U.S.C. §
1396n(c). Thus, federalism concerns are not relevant here, and our

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interpretation relies upon the language used in RSA chapter 171-A. It is the
legislature’s explicit incorporation of the Settings Rule into New Hampshire law
that prohibits “[a]rea agencies, authorized agencies, and other organizations
under contract to provide services in accordance with” RSA chapter 171-A from
administering programs and services that are not “in accordance with 42
C.F.R. section 441.301.” RSA 171-A:18, II.

¶34 As BDS observes, New Hampshire is “free to set its own standards
for purposes of expending its own funds.” Nevertheless, it chose to incorporate
the federal standard into state law, which “maximize[s] the use of federal
funding for the benefit of New Hampshire’s citizens.” Therefore, RSA chapter
171-A’s mandate that services be administered “in accordance with 42 C.F.R.
section 441.301” prohibits BDS from using state funds for services provided by
JRC. See RSA 171-A:2, I-b, :18, II. Of course, if the legislature disagrees with
our interpretation, it is free to amend the statutory scheme as it sees fit within
constitutional bounds. Doe v. Comm’r, N.H. Dep’t of Health & Human Servs.,
174 N.H. 239, 261 (2021).

¶35 Finally, all petitioners assert that “New Hampshire law precludes
DHHS from abandoning [the petitioners] and requires their humane
treatment.” We recognize that DHHS is responsible for providing appropriate
services to individuals with developmental disabilities. See RSA 171-A:1
(enabling DHHS to “establish, maintain, implement, and coordinate a
comprehensive service delivery system for developmentally disabled persons”);
RSA 171-A:4 (“[DHHS] shall maintain a state service delivery system for the
care, habilitation, rehabilitation, treatment and training of developmentally
disabled persons.”); see also RSA 171-A:13 (2022) (“Every developmentally
disabled client has a right to adequate and humane habilitation and treatment
. . . .”). The broad statutory purpose of RSA chapter 171-A, however, does not
override the specific language chosen by the legislature that prohibits the use
of state funds for services that do not comply with the Settings Rule. See
Appeal of Town of Lincoln, 172 N.H. 244, 251 (2019).

III. Conclusion

¶36 In sum, we conclude that all petitioners had a right to appeal the
area agencies’ decisions to terminate and not renew their service contracts with
JRC. See N.H. Admin. R., He-M 503.07(f), (h). However, RSA chapter 171-A
prohibits DHHS from using state funds for providers that are not in compliance
with the Settings Rule. Therefore, we affirm the Commissioner’s decision
granting summary judgment to BDS. Given this conclusion, we need not
address all petitioners’ remaining arguments.

Affirmed.

MACDONALD, C.J., and BASSETT and COUNTWAY, JJ., concurred.

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