2026 N.H. 20, Petition of Metro Treatment of N.H.

NOTICE: This opinion is subject to motions for rehearing under Rule 22 as well as formal revision before publication in the New Hampshire Reports. Readers are requested to notify the Reporter, Supreme Court of New Hampshire, One Charles Doe Drive, Concord, New Hampshire 03301, of any editorial errors in order that corrections may be made before the opinion goes to press. Errors may be reported by email at the following address: reporter@courts.state.nh.us. Opinions are available on the Internet by 9:00 a.m. on the morning of their release. The direct address of the court’s home page is: https://www.courts.nh.gov/our-courts/supreme-court. 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 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), 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 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 …