SACRAMENTO -- In what's becoming an annual rite of spring in the state Capitol, a coalition of health-care advocates unveiled its latest ``Patient Bill of Rights'' last week in an effort to overhaul how health maintenance organizations treat their 20 million California members.

Over the past few years, similar reforms have been bottled up in the state Legislature or vetoed by former Gov. Pete Wilson. But emboldened Democrats and patient advocates are convinced Gov. Gray Davis will move to adopt at least some of the measures, based on statements by his administration.

In anticipation of the new political landscape, the HMO industry already has begun softening opposition to some less restrictive bills.

``It's just about time,'' said Bill Powers of the Congress of California Seniors. ``We're beginning to call this the `Impatient Bill of Rights.';''

But that doesn't mean HMO representatives and reform advocates won't be pitched for battle this year before the Legislature, which saw some of its toughest fights last year over health care reform.

This year's package of bills includes at least a dozen measures designed to keep money out of medical decisions, expand access to second opinions and independent reviews, and provide for redress when care is denied. It is backed by Health Access California and a coalition of consumer, labor and senior groups, and sponsored by eight Democratic state legislators.

The proposal most likely to provoke a fight between reformists and the HMO industry would overturn the law that severely restricts privately insured patients from suing their HMOs. Some consumer and attorney groups intend to make HMO liability a top priority this year, after a San Bernardino County jury handed down a record-setting $120 million verdict in January against Aetna U.S. Healthcare.<P>

Californians with private employer-paid health plans can only recover the cost of treatments denied; the Aetna case highlighted the legal inequities that allowed the wife of the dead man, who was denied cancer treatment, to collect $116 million in punitive damages because he had worked for the government.

Cognizant that increased regulation of the industry is imminent, California's health maintenance organizations are moving toward supporting measures that ease access to second opinions and prompt and impartial reviews in an effort to blunt the liability issue.

But Zelman said he fears the Legislature is not paying enough attention to all the potential costs mounting up as they consider hundreds of bills with health-care components.

``If you combine more benefits with fewer means of controlling costs, premiums are already at rock-bottom, how can managed care plans survive without significantly increasing costs?'' he said.

Health care premiums are already rising this year in California. New benefits vs. higher costs is the delicate balance Davis administration officials are facing as they finish a 60-day review of reform options honed in a series of meetings with doctors, employers, insurers and patients. In those meetings, officials stressed that Davis wants to incorporate three principles into any reforms: giving physicians more clout in medical decision-making, holding managed care executives accountable for their decisions and guaranteeing a second opinion in critical situations.

Davis has not yet backed any specific legislation. At least a few key Democratic legislators, including state Sen. Jackie Speier, D-San Mateo, don't think HMO liability is crucial for meaningful reform and prefer beefing up other kinds of redress.

The so-called Patient Bill of Rights is designed to address consumers' needs at several steps: increasing public information to aid in the choice of a health plan, setting up an independent advocate to advise in grievance situations and extending more review options to outside medical experts if care is denied.

Independent review is sought by doctors and consumers, who say health plans sometimes base the decision on whether to pay for treatment more on its cost than on the patient's need. Second opinions, they argue, also should come from outside the patient's provider group to ensure independence.

While affected Medicare enrollees can choose traditional fee-for-service Medicare programs or another HMO if one is available, in Monterey and 10 other counties there is no HMO alternative.

``It's no different than red-lining,'' charged Speier, chair of the Senate Insurance Committee. ``Is it fair to allow HMOs in California who are cherry-picking off healthy young people and not covering senior citizens?''

Speier's measure, which was passed by her committee last week, would use the state's huge clout as a major purchaser of health care coverage by banning CalPERS and MediCal from contracting with an HMO that doesn't offer Medicare coverage in the same area they wish the state contract.

At the hearing, several HMO representatives complained that a Medicare reimbursement rate increase of 2 percent granted last year by the federal government is not enough to cover escalating costs.

``We don't want to leave any county,'' said Health Net's Jeff Shelton told the committee. ``We are finding it difficult to stay in business.''