Providing constitutional health care in jails often proves challenging to jail administrators. Specific recent imperatives in jail health care—including implementation of the Affordable Care Act and safely managing the mental health crisis—provide opportunities to improve quality and efficiency. This is especially important in larger jails where the scale of operations presents unique challenges and the number of patients affected is significant. The national perspective of accrediting bodies provides unique visibility on critical linkages among important innovations, best practices, and the field. In this presentation, two important areas will be discussed: 1) The effect of the Affordable Care Act on jail health care and 2) Lessons learned from a national project assessing current practices for managing the mentally ill in jail.