Petition of Metro Treatment of N.H.

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THE SUPREME COURT OF NEW HAMPSHIRE

___________________________

Department of Health and Human Services
Case No. 2025-0064
Citation: Petition of Metro Treatment of N.H., 2026 N.H. 20

PETITION OF METRO TREATMENT OF NEW HAMPSHIRE, L.P.
(New Hampshire Department of Health and Human Services)

Argued: February 10, 2026
Opinion Issued: April 29, 2026

Sheehan Phinney Bass & Green, PA, of Manchester (John-Mark Turner
and Cassandra O. Rodgers on the brief, and Cassandra O. Rodgers orally), for
the petitioner.

Wadleigh, Starr & Peters, PLLC, of Manchester (Michael J. Tierney and
Elizabeth E. Ewing on the brief, and Michael J. Tierney orally), for the
respondent.

John M. Formella, attorney general, and Anthony J. Galdieri, solicitor
general (Mary A. Triick, senior assistant attorney general, on the memorandum
of law and orally), for the State.

DONOVAN, J.

¶1 This case arises from a payment dispute between the petitioner,
Metro Treatment of New Hampshire, L.P. (Metro), a healthcare provider, and

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the respondent, AmeriHealth Caritas New Hampshire (AmeriHealth), a
Medicaid Managed Care Organization (MCO). Metro seeks review of a decision
in which the Administrative Appeals Unit (AAU) of the New Hampshire
Department of Health and Human Services (DHHS) determined that it has
subject matter jurisdiction over the parties’ dispute under RSA 126-A:5, VIII
(2021). We affirm the AAU’s decision and remand.

I. Facts

¶2 The AAU found, or the record supports, the following facts. Metro
operates DHHS-licensed outpatient opioid treatment clinics. AmeriHealth is an
MCO in which some of Metro’s Medicaid-eligible patients are enrolled. RSA
126-A:5, XIX(c)(3) (2021) defines an MCO as “an entity that is authorized by
law to provide covered health services on a capitated risk basis and arranges
for the provision of medical assistance services and supplies and coordinates
the care of Medicaid recipients residing in all areas of the state.” The parties’
relationship is governed by an ancillary services agreement. The agreement
provides that AmeriHealth “is responsible for providing or arranging for the
provision of health care services to its Members.” AmeriHealth makes
payments to Metro on claims for “Covered Services provided to Members.”

¶3 After conducting an audit of Metro’s patients’ records, AmeriHealth
informed Metro that it sought to recoup $36,722.27 in alleged overpayments on
Metro’s claims. AmeriHealth sought to recoup these payments as a result of
Metro’s alleged violation of New Hampshire Administrative Rules, He-A chapter
304, which governs opioid treatment programs. Metro appealed AmeriHealth’s
determination in accordance with the procedures set forth in the parties’
agreement. AmeriHealth accepted Metro’s appeal and reduced the
overpayment it sought to recoup by $556.13. AmeriHealth also informed Metro
that it had the right to dispute the overpayment determination by “pursu[ing] a
State Fair Hearing, in accordance with RSA 126-A:5, VIII.”

¶4 Metro thereafter filed an appeal with the AAU, although it
maintained that the AAU lacked jurisdiction over payment disputes between
Medicaid MCOs and healthcare providers. The AAU issued a written decision
concluding that it has jurisdiction under RSA 126-A:5, VIII “to hear appeals
arising from a determination that Medicaid payments were inappropriately
made and should be recouped.” The AAU thereafter denied Metro’s motion for
reconsideration and stayed the proceedings pending Metro’s filing of a petition
for a writ of certiorari in this court. We accepted the petition for a writ of
certiorari to determine whether the AAU has jurisdiction in this matter.

II. Analysis

¶5 A petition for a writ of certiorari is the only mechanism for review of
a decision issued by the AAU. Petition of Mason, 177 N.H. 112, 120 (2024),

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2024 N.H. 67, ¶17. 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.

¶6 The question in this case is whether the AAU has jurisdiction over a
payment dispute in which an MCO seeks to recoup alleged overpayments of
Medicaid funds that were made to a healthcare provider. Metro maintains that
RSA 126-A:5, VIII “does not grant jurisdiction to hear a dispute between an
MCO and one of its contracted providers, in the absence of any action or
decision by DHHS.” AmeriHealth counters that because the administration of
the State’s Medicaid program is within DHHS’s jurisdiction, the AAU has
jurisdiction over matters concerning the alleged overpayment of Medicaid
funds.

¶7 We review the AAU’s statutory and regulatory interpretation de novo.
Id. at 121, 2024 N.H. 67, ¶20. We use the same principles of construction
when interpreting both statutes and regulations. Id. 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. Id. We construe all parts of a
statute or regulation together to effectuate their overall purposes and avoid
absurd or unjust results. Id. 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. Id. When the language
of a statute or regulation is plain and unambiguous, we need not look beyond
the statute or regulation itself. Id.

¶8 “Administrative agencies are granted only limited and special subject
matter jurisdiction.” Appeal of Campaign for Ratepayers’ Rights, 162 N.H. 245,
250 (2011). “That jurisdiction is dependent entirely upon the statutes vesting
the agency with power and the agency cannot confer jurisdiction upon itself.”
Id. (quotation and brackets omitted). “Furthermore, a tribunal that exercises a
limited and statutory jurisdiction is without jurisdiction to act unless it does so
under the precise circumstances and in the manner particularly prescribed by
the enabling legislation.” Id. (quotation omitted).

¶9 The introductory language of RSA 126-A:5, VIII provides:

The commissioner shall establish an appeals process for any
individual applying for or receiving services from the department or

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its contract service providers, any providers, programs, services, or
facilities which are licensed or certified by the department, or with
regard to actions related to employees of the department or any
other matter within the jurisdiction of the department.

The parties construe paragraph VIII as providing for the AAU’s jurisdiction over
appeals relating to: (1) “any individual applying for or receiving services from
the department or its contract service providers”; (2) “any providers, programs,
services, or facilities which are licensed or certified by the department”; (3)
“actions related to employees of the department”; and (4) “any other matter
within the jurisdiction of the department.” Id.

¶10 We agree that paragraph VIII provides for four categories of
appeals. Although the first and second categories could be construed as
allowing for only one class of appellants — by “any individual applying for or
receiving services” from DHHS, its contract service providers, or its licensees —
it is more likely, in our view, that the legislature intended to create two classes:
one class of individuals applying for or receiving services, and the other of
DHHS licensees. Id.

¶11 The grammatical structure of paragraph VIII supports this
construction. First, paragraph VIII repeats the word “any” before both
“individual applying for or receiving services” and “providers, programs,
services, or facilities.” Id. Thus, the text itself suggests two discrete classes of
appellants — individuals and licensees — because the second “any” would be
superfluous if the legislature’s intent was to create only one class of appellants.
Second, paragraph VIII uses the disjunctive “or” between “the department” and
“contract service providers” but does not disjoin “contract service providers”
from “any providers, programs, services, or facilities which are licensed or
certified by the department.” Id. Had the legislature intended to create a
single class of appellants for both the first and second categories of appeal, it
presumably would have listed together the department, its contract service
providers, and its licensees. See id.

¶12 Because we construe all parts of a statute together to effectuate its
overall purpose, Petition of Mason, 177 N.H. at 121, 2024 N.H. 67, ¶20, we also
look to the subparagraphs of paragraph VIII to discern the legislature’s intent.
Those provisions support the conclusion that paragraph VIII provides for a
category of appeals by individuals applying for or receiving services and a
discrete category of appeals by licensees. Subparagraph (a) requires a
“jurisdictional review” to determine whether “a denial or change in services,
benefits, or a license is automatic due entirely to a change in state or federal
law.” RSA 126-A:5, VIII(a) (emphasis added). Subparagraph (d) contemplates
proposed decisions that may be “adverse to the individual applying for or
receiving services, facility or employee who made the appeal.” RSA 126-A:5,
VIII(d) (emphasis added). These subparagraphs provide additional context to

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the introductory language of paragraph VIII and indicate that the legislature
intended to create a right of appeal for “any providers, programs, services, or
facilities which are licensed or certified by the department.” RSA 126-A:5, VIII.

¶13 In its written decision, the AAU determined that it had jurisdiction
in this matter under the second and fourth categories of paragraph VIII. Id.
Regarding the second category, the AAU reasoned that “RSA 126-A:5, VIII . . .
requires [DHHS] to establish an appeal process” so that “Medicaid providers,
such as [the petitioner], have the ability to appeal an adverse determination.”
In addition, regarding the fourth category, the AAU concluded that state and
federal law “make clear that the administration of the Medicaid program, and
assurance that Medicaid funds are appropriately utilized, are matters squarely
within the jurisdiction” of DHHS. See generally RSA ch. 161 (2023 & Supp.
2025); RSA ch. 167 (2023 & Supp. 2025); 42 C.F.R. § 438 subpt. F (2016). It
further noted that “[t]his case involves the alleged violation of portions of
Administrative Rule He-A 304 and [an MCO’s] decision to recoup payments
based upon such a violation,” which constituted “an action over which [DHHS]
retains ultimate jurisdiction.”

¶14 Paragraph VIII’s second category directs DHHS to establish an
appeals process for “any providers, programs, services, or facilities which are
licensed or certified by the department.” There is no dispute in this case that
Metro’s clinics in New Hampshire are providers of “addiction treatment
services” that are licensed by DHHS. Therefore, because Metro is a provider
“which [is] licensed or certified by” DHHS, the AAU has jurisdiction to decide
the petitioner’s appeal. RSA 126-A:5, VIII.

¶15 Nevertheless, Metro argues that “the AAU’s rules limit appeals to
those involving department actions or decisions.” (Capitalization and italics
omitted.) Therefore, it asserts, “the AAU’s jurisdictional grant [is] limited to
reviewing departmental decisions, not third-party, MCO decisions” such as
AmeriHealth’s decision here. Metro also claims that the administrative rules
provide that only “members” can appeal decisions by MCOs, and providers
cannot. AmeriHealth acknowledges that this case turns on the meaning of
DHHS’s rules but counters that because this dispute “relates to a departmental
action” — specifically, “the investigation and overpayment demand for the
return of the public Medicaid funds” — the AAU has jurisdiction. We agree.

¶16 As a threshold matter, it is well established that “[r]ules adopted by
State boards and agencies may not add to, detract from, or in any way modify
statutory law.” Appeal of Campaign for Ratepayers’ Rights, 162 N.H. at 252.
The plain language of RSA 126-A:5, VIII does not restrict DHHS’s jurisdiction to
hear appeals filed by “providers . . . licensed or certified by the department”
only when decisions or actions of the department are involved. Adopting
Metro’s reasoning that the administrative rules further limit DHHS’s
jurisdiction would therefore “modify statutory law.” Id.

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[¶17] Metro is correct that many of DHHS’s administrative rules concern
appeals from “decisions made by the department” or from a “department
decision or action.” For example, the rules define “[a]ppeal” as “a request by a
person adversely affected by a department decision or action to review that
decision or action in accordance with the provisions of RSA 126-A:5, VIII.”
N.H. Admin. R., He-C 201.02(b). The rules also provide that “[w]hen a written
notice of decision or action is issued by the department, the department shall
notify any person aggrieved by the decision or action that the person is entitled
to request a hearing.” N.H. Admin. R., He-C 203.02. Another rule requires
that “[t]he department shall prove its case by a preponderance of the evidence”
in a hearing that addresses “[a]ny action taken by the department to recoup
benefits.” N.H. Admin. R., He-C 203.14(f)(3).

¶18 Moreover, the rules also provide that “[r]eferences to the
department in He-C 200 shall include the department’s contract service
providers when they are participating in appeal proceedings affecting any
individual applying for or receiving services.” N.H. Admin. R., He-C 201.13(a).
We are not persuaded by Metro’s argument that this provision applies only
when the appealing party is an “individual applying for or receiving services.”
Id. Rather, we agree with the State that the category of proceedings “affecting
any individual applying for or receiving services,” id., extends beyond
proceedings “brought directly by such individuals.”

¶19 This appeal concerns whether AmeriHealth, which contracts with
DHHS to provide Medicaid-managed-care services, is entitled to recoup
payments from Metro based upon Metro’s alleged failure to comply with
DHHS’s administrative rules relating to patient examinations, drug screening,
counseling, and treatment plans. The alleged overpayments arise directly from
Metro’s provision of services to individuals. We therefore conclude that the
AAU has jurisdiction under RSA 126-A:5, VIII. Given our conclusion, we need
not address Metro’s argument that the AAU erroneously interpreted DHHS’s
contract with AmeriHealth as “creat[ing] jurisdiction beyond the AAU’s enabling
legislation.”

III. Conclusion

¶20 In sum, because DHHS has jurisdiction over appeals filed by
“providers . . . which are licensed or certified by the department,” and because
Metro is a provider that is licensed by DHHS, we conclude that the AAU has
jurisdiction in this matter. RSA 126-A:5, VIII. We therefore need not
determine whether this case falls within the other categories contemplated by
RSA 126-A:5, VIII. Because the AAU properly determined that it has
jurisdiction in this matter, we affirm its decision and remand for further

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proceedings. We note in closing that because the issue is not before us, we
express no opinion as to whether the AAU’s jurisdiction is exclusive.

Affirmed and remanded.

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