Vt. Stat. tit. 18 § 9446
The terms of a certificate of need relating to the boundaries of the geographic service area of a home health agency may be modified by the Board, in consultation with the Commissioner of Disabilities, Aging, and Independent Living, after notice and opportunity for hearing, or upon written application to the Board by the affected home health agencies or consumers, demonstrating a substantial need for the modification. Service area boundaries may be modified by the Board to take account of natural or physical barriers that may make the provision of existing services uneconomical or impractical, to prevent or minimize unnecessary duplication of services or facilities, or otherwise to promote the public interest. The Board shall issue an order granting such application only upon a finding that the granting of such application is consistent with the purposes of 33 V.S.A. chapter 63, subchapter 1A and the Health Resource Allocation Plan established under section 9405 of this title and after notice and an opportunity to participate on the record by all interested persons, including affected local governments.
18 V.S.A. § 9446